Journal of Emergency Medicine最新文献_第10页

Coagulation Studies are Frequently Ordered in Emergency Department Chest Pain Patients and do not Change Emergency Department Management.

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-11-12 DOI: 10.1016/j.jemermed.2024.11.003

Jarryd Rivera, Samidha Dutta, Karly Castellaw, Priyanka Dharampuriya, Michael Weinstock

{"title":"Coagulation Studies are Frequently Ordered in Emergency Department Chest Pain Patients and do not Change Emergency Department Management.","authors":"Jarryd Rivera, Samidha Dutta, Karly Castellaw, Priyanka Dharampuriya, Michael Weinstock","doi":"10.1016/j.jemermed.2024.11.003","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.11.003","url":null,"abstract":"Background: Despite research findings, implementation into clinical practice is often delayed. Coagulation panels are still ordered as part of an emergency department (ED) chest pain evaluation, despite multiple studies showing that it is unnecessary and does not change management.Objective: Our primary outcome is to determine if the practice of ordering coagulation studies (prothrombin time [PT]/international normalized ratio [INR]) is still occurring in ED chest pain patients. Our secondary outcome is to determine if abnormal results change management.Methods: We performed an institutional review board (IRB) approved retrospective chart review of patients with chest pain presenting to three rural-community EDs over 49 months. Medical students, blinded to the study intent, performed data abstraction using the approach of Gilbert and Lowenstein to determine if coagulation testing (PT/INR) was \"indicated\" based on a preexisting condition (i.e., liver disease) or medication use (warfarin). Next, the data abstractors determined if the abnormal coagulation results prompted a therapeutic intervention or change in the management in the ED.Results: We randomly identified 1,200 patients with chest pain before covid-19 and, after exclusions, analyzed 830 patient charts. 440 patients (53.0%) had coagulation panels completed, but they were only indicated in 55 of the 440 patients (12.5%). Of the 385 patients without indications, 378 (98.2%) had an INR level in the normal range and 7 patients (1.8%) had an elevated INR. None of these 7 patients had a change in ED management.Conclusions: In this multicenter study, 53% of ED patients with chest pain had coagulation studies ordered. Only 12.5% were indicated. None of the abnormal results in patients without indications resulted in a change in ED management.","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Case Report of an Obstructive Endotracheal Mass from a Blood Clot: An Airway Nightmare.

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-11-08 DOI: 10.1016/j.jemermed.2024.10.005

Sara Bradley, Verena Schandera, Mary L Bing

引用次数: 0

Shedding Light: How One Family's Tragedy Became Another's Beacon.

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-11-06 DOI: 10.1016/j.jemermed.2024.10.007

Alexandra Reens

引用次数: 0

Penile Urethral Stone.

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-11-06 DOI: 10.1016/j.jemermed.2024.10.015

Tse-Ying Lee, Wan-Ching Lien

引用次数: 0

Implementation and Outcome of a Protocol-Based Treatment for Diabetic Ketoacidosis in a Tertiary Care Pediatric Emergency Department.

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-11-06 DOI: 10.1016/j.jemermed.2024.10.013

Gulser Esen Besli, Merve Nur Hepokur, Sibel Ergin Sahin, Asan Onder, Metin Yildiz, Irem Bulut, Hamdi Cihan Emeksiz

{"title":"Implementation and Outcome of a Protocol-Based Treatment for Diabetic Ketoacidosis in a Tertiary Care Pediatric Emergency Department.","authors":"Gulser Esen Besli, Merve Nur Hepokur, Sibel Ergin Sahin, Asan Onder, Metin Yildiz, Irem Bulut, Hamdi Cihan Emeksiz","doi":"10.1016/j.jemermed.2024.10.013","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.10.013","url":null,"abstract":"Background: The standardization of clinical practice in emergency treatment of diabetic ketoacidosis (DKA) is a prerequisite for improving patient care. For this purpose, a standardized DKA protocol incorporating a two-bag system has been implemented since January 2020 in our center.Objectives: To assess the impact of the development and utilization of the standard treatment pathway for DKA on patient outcomes.Methods: This retrospective cohort study involved patients diagnosed with DKA and admitted to the pediatric emergency department (PED). The entire period of the study was from January 2017 to September 2022. Patients with DKA managed before and after implementation of the protocol were compared in terms of clinical outcomes.Results: Out of 145 patients, 77 (53%) patients were in the pre-protocol group, 68 (47%) were in the protocol group. Age, sex, and severity of DKA were similar between the groups. Implementation of the protocol resulted in shorter resolution time of acidosis and ketosis (p = 0.007, p < 0.001, respectively), higher correction rates of bicarbonate and blood ketones (p = 0.003, p < 0.001, respectively), shorter duration of IV insulin treatment (p = 0.008), more appropriate potassium dosage administrating to IV fluids (p < 0.001), lower incidence of hypokalemia, hypophosphatemia, and hypoglycemia (p = 0.008, p = 0.002, p = 0.036, respectively), and smaller number of IV bags use (p < 0.001).Conclusion: Implementation of a protocol-based pathway for DKA involving a two-bag system provided earlier correction of ketoacidosis, decreased the risk of complications, and reduced resource utilization in the PED.","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Use of an Endotracheal Tube for a Thoracostomy in a Child in Cardiac Arrest: A Case Report.

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-11-06 DOI: 10.1016/j.jemermed.2024.10.006

Kunj Bhatt, Jacob Ziff, Duncan Grossman, Julia Tokarski

引用次数: 0

Diverse by Design: A Comprehensive Guide to Inclusive Hiring for Emergency Medicine Faculty.

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-11-04 DOI: 10.1016/j.jemermed.2024.10.016

Cortlyn Brown

{"title":"Diverse by Design: A Comprehensive Guide to Inclusive Hiring for Emergency Medicine Faculty.","authors":"Cortlyn Brown","doi":"10.1016/j.jemermed.2024.10.016","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.10.016","url":null,"abstract":"Introduction: Emergency medicine (EM) lacks diversity, with only 9.9% of physicians from underrepresented backgrounds and women comprising 25% of the workforce. Diverse faculty enhance patient outcomes, innovation, and equitable education. This manuscript introduces the Brown Academic Emergency Medicine Faculty Inclusive Hiring Guide to address these disparities.Methods: Developed through literature review, stakeholder input, and pilot testing, the guide identifies best practices for equitable hiring. Key metrics such as patient outcomes and faculty retention informed the recommendations, refined through feedback from faculty and DEI experts.Results: The guide provides strategies to mitigate bias, standardize evaluations, and create inclusive job postings. It emphasizes training search committees, equitable interviews, and ongoing assessment of DEI metrics.Discussion: This resource offers practical, evidence-based solutions for advancing diversity in academic EM, addressing systemic barriers, and fostering equity. Continuous evaluation is critical for sustained progress.Conclusion: The guide is a vital tool for creating inclusive academic EM environments, improving diversity, and enhancing patient care and educational outcomes.","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Streptococcal Toxic Shock Syndrome: A Case Series Emphasizing the Urgency of Recognition and Tailored Treatment.

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-11-02 DOI: 10.1016/j.jemermed.2024.10.010

Ehsan Yavari, Gaurav Puri

{"title":"Streptococcal Toxic Shock Syndrome: A Case Series Emphasizing the Urgency of Recognition and Tailored Treatment.","authors":"Ehsan Yavari, Gaurav Puri","doi":"10.1016/j.jemermed.2024.10.010","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.10.010","url":null,"abstract":"Background: Streptococcal toxic shock syndrome (TSS) is a rare but lethal condition associated with Streptococcus Pyogenes Group A (GAS). With rising incidence and high mortality, timely recognition and management are crucial. This case series presents two adult TSS cases caused by invasive GAS, highlighting the importance of early identification and multidisciplinary management.Case presentations: The first case involves a 42-year-old male who presented with fever, dizziness, and a tender, erythematous olecranon following an elbow laceration. Despite negative imaging for necrotizing fasciitis, a positive throat swab for GAS prompted immediate broad-spectrum antibiotics and aggressive resuscitation. Clindamycin and intravenous immunoglobulin were administered. The patient developed TSS and acute kidney injury, requiring intensive care and hemodialysis. The second case features a previously healthy 43-year-old female presenting with systemic symptoms and a rash, without trauma history. Positive GAS blood cultures confirmed TSS, leading to similar management and subsequent renal complications requiring hemodialysis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: These cases highlight the evolving epidemiology of invasive GAS infections and the associated risk of TSS. Early identification and appropriate tailored treatment are essential to reduce morbidity and mortality, especially given the recent surge in invasive GAS. Clinical vigilance for skin changes and thorough laboratory investigations, including non-sterile site cultures, are critical. Early identification enables the use of adjunctive treatments like clindamycin and IVIG, and facilitates appropriate de-escalation of antibiotics. Prompt consultation with infectious disease, intensive care, and surgical teams is necessary to ensure optimal treatment.","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Reduced-Dose Tenecteplase in High-Risk Pulmonary Embolism.

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-11-02 DOI: 10.1016/j.jemermed.2024.10.011

Jennifer Hammond, Dean Cataldo, Christopher Allison, Seth Kelly

{"title":"Reduced-Dose Tenecteplase in High-Risk Pulmonary Embolism.","authors":"Jennifer Hammond, Dean Cataldo, Christopher Allison, Seth Kelly","doi":"10.1016/j.jemermed.2024.10.011","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.10.011","url":null,"abstract":"Background: Pulmonary embolism (PE) is a venous thromboembolic disease occurring when thrombi detach and embolize to pulmonary arteries, causing substantial morbidity and mortality in older adults yearly. In patients experiencing hemodynamic compromise, systemically administered thrombolytic therapy followed by anticoagulation over anticoagulation alone is recommended for initial management.Case report: This report describes successful treatment of a patient over 90 years of age presenting to the Emergency Department with an acute, high-risk PE who received low-dose, systemically administered tenecteplase followed by systemic anticoagulation with unfractionated heparin. The patient was initiated on norepinephrine 0.5 µg/kg/min for hemodynamic support. They were administered a reduced dose of tenecteplase (17.5 mg or 0.37 mg/kg) bolus followed by unfractionated heparin and subsequent transfer to the medical intensive care unit. At 1 h post-tenecteplase, norepinephrine was decreased to 0.2 µg/kg/min. At 14 h post-tenecteplase, the norepinephrine requirement was minimal at 0.02 µg/kg/min and resolved with extubation 15 h post-tenecteplase. The patient did not develop any clinically significant bleeding and was discharged to an acute rehabilitation facility on hospital day 7. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Available evidence suggests positive outcomes and dosing guidance for low-dose alteplase for PE treatment, though at the time of this report the authors identified a gap in existing literature surrounding the same concept with reduced-dose tenecteplase. Further studies are needed to investigate this intervention further.","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Change of Pace: Modifying Pacemaker Settings in the Emergency Department as Emergency Physicians, A Case Report.

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-11-02 DOI: 10.1016/j.jemermed.2024.10.012

Maritza Kelesis, Martin Huecker, Robert Whitford

{"title":"A Change of Pace: Modifying Pacemaker Settings in the Emergency Department as Emergency Physicians, A Case Report.","authors":"Maritza Kelesis, Martin Huecker, Robert Whitford","doi":"10.1016/j.jemermed.2024.10.012","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.10.012","url":null,"abstract":"Background: Pacemakers are implantable or external devices that send electrical impulses, allowing the heart to contract. Some common indications for permanent pacemaker placement include symptomatic bradycardia due to high-grade atrioventricular (AV) block, sick sinus syndrome, chronic bifascicular block, and postcardiac transplantation. Like all devices, pacemakers can malfunction or stop working entirely. We present a patient with an implantable pacemaker/cardioverter and defibrillator (ICD) displaying symptomatic failure to capture, and settings were adjusted in the emergency department (ED). Adjustment in the ED resolved the patient's symptoms and required no further interventions.Case report: An 82-year-old woman with atrial fibrillation, heart failure, and a Medtronic dual chamber pacer/ICD (Medtronic, Minneapolis, Minnesota) presented to the ED for complaints of weakness and lightheadedness. Emergency medical services noted intermittent bradycardia, hypotension, and decreased responsiveness. Electrocardiogram (ECG) revealed failure to capture. The Medtronic application was used to interrogate and reprogram the device. The settings were DDD at a rate of 60 beats/min with ventricular output of 4.5 millivolts (mV) and atrial output of 4.5 mV, which were changed to ventricular lead outputs from 4.5 mV to 8.0 mV and rate from 60 to 80 for additional cardiac output. After this adjustment, the bradycardia resolved, and ECG showed a successful AV-paced rhythm. Transcutaneous pacing was never required. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Adjustment of pacer settings in the ED to stabilize the critically ill patient is within the scope of the emergency physician. We can reduce stress to the patient and prevent hospitalizations. Pacemakers can become a tool to optimize treatment plans for an aging population in whom pacemakers are becoming more common.","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0