Journal of Emergency Medicine最新文献

{"title":"Managing Auricular Hematoma: An Emergency Medicine Narrative Review","authors":"Brit Long M.D ,&nbsp;Jessica Mason M.D ,&nbsp;Rachel E. Bridwell M.D ,&nbsp;Michael Gottlieb M.D","doi":"10.1016/j.jemermed.2024.08.021","DOIUrl":"10.1016/j.jemermed.2024.08.021","url":null,"abstract":"<div><h3>Background</h3><div>Auricular hematoma is a condition commonly seen in the emergency department among patients presenting with trauma to the ear. It may result in several complications such as perichondritis and cauliflower ear if not managed appropriately.</div></div><div><h3>Objective</h3><div>This narrative review provides an evidence-based summary of the evaluation and management of auricular hematoma.</div></div><div><h3>Discussion</h3><div>Auricular hematoma is most commonly associated with shearing or blunt trauma to the ear, resulting in formation of a hematoma within the subperichondrial space. This hematoma obstructs the nutrient supply from the perichondrium to the avascular cartilage. Without a nutrient supply, the ear is at risk for infection, necrosis, and fibrocartilaginous deposition causing cauliflower ear. If a fluctuant hematoma is present within the cartilaginous auricle within 7 days of injury, evacuation should be offered. Prior to the procedure, analgesia should be performed using an auricular block. The hematoma can then be evacuated via needle aspiration or incision and drainage followed by a bolster compression dressing to prevent reaccumulation of blood within this potential space. Despite limited data, 7–10 days of antibiotics are currently recommended with coverage for <em>Pseudomonas aeruginosa</em> (eg, fluoroquinolones in adults, amoxicillin-clavulanate in children). This may mitigate the risk of perichondritis. Patients should be reevaluated at 24–48 hours and abstain from contact sports for at least 2 weeks.</div></div><div><h3>Conclusion</h3><div>Emergency clinicians must be knowledgeable regarding the evaluation and management of auricular hematoma, including the various drainage techniques.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 62-75"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189547","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}

{"title":"Point-of-Care Ultrasound Diagnosis of Pyocele: A Rare Complication of Testicular Infection","authors":"Noman Ali MBBS, FCPS (EM), DRCPSC (PoCUS),&nbsp;Alan Tan MD, CCFP (EM),&nbsp;Jordan Chenkin MD MEd, FRCPC, DRCPSC (PoCUS)","doi":"10.1016/j.jemermed.2024.09.008","DOIUrl":"10.1016/j.jemermed.2024.09.008","url":null,"abstract":"<div><h3>Background</h3><div>Epididymo-orchitis is one of the common causes of acute scrotal pain that requires an accurate diagnosis as delayed management can result in complications such as pyocele, abscess, or testicular infarction. Point-of-care ultrasound (PoCUS) has emerged as a valuable diagnostic tool in the management of testicular emergencies in the emergency department (ED) including testicular infections</div></div><div><h3>Case Report</h3><div>Here we report a case of an elderly man who presented to the ED with a complaint of right-sided testicular pain and swelling. The diagnosis of pyocele was made using a PoCUS, facilitating an early referral to urology services.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>This case underscores the important role of PoCUS in the timely and accurate diagnosis of pyocele. The prompt identification of pyocele enabled early referral to urology services, highlighting the significance of integrating PoCUS into the management of testicular emergencies in the ED.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 58-61"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189549","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}

{"title":"A Prospective Crossover Study Comparing Six Current Generation Supraglottic Airway Device's Ability to Seal During CPR in Human Cadavers","authors":"Joe Holley MD ,&nbsp;Robert Dunne MD ,&nbsp;Heather Robinson MD ,&nbsp;Richard Williams RRT ,&nbsp;Andisheh Motealleh PhD","doi":"10.1016/j.jemermed.2024.08.012","DOIUrl":"10.1016/j.jemermed.2024.08.012","url":null,"abstract":"<div><h3>Background</h3><div>Supraglottic airway (SGA) devices are frequently used during cardiopulmonary respiration (CPR), but little is known about their ability to consistently seal the airway during CPR.</div></div><div><h3>Objectives</h3><div>The objective of this prospective crossover human cadaver study was a comparison of intrathoracic pressures (ITPs) generated during automated CPR (aCPR) with an Impedance Threshold Device (ZOLL Medical Corporation, Chelmsford, MA) with six currently available SGAs to a standard endotracheal tube (ETT). The hypothesis was that current SGAs would vary in their ability to develop ITPs compared with the ETT.</div></div><div><h3>Methods</h3><div>Airway pressures and negative ITP were measured in six recently deceased human cadavers of varying body habitus. After placement of an ETT and six different SGAs, we assessed airway and ITPs during aCPR and manual positive pressure ventilation using bag-valve mask. The ETT served as the control for airway seal and was placed first followed by each SGA. Primary outcome compared airway and ITP among all groups.</div></div><div><h3>Results</h3><div>SGAs varied in their ability to create negative airway pressure and negative ITP.</div></div><div><h3>Conclusion</h3><div>In this human cadaver model, the ability to generate negative ITP varied with different SGAs during aCPR with an Impedance Threshold Device.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 25-31"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074443","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}

{"title":"Acute Limb Ischemia: The Role of Physical Diagnosis in the Expedient Work-Up and Management in the Emergency Department—A Consultant's Perspective","authors":"Scott S. Berman MD, MHA, FACS, DFSVS","doi":"10.1016/j.jemermed.2024.09.007","DOIUrl":"10.1016/j.jemermed.2024.09.007","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 87-90"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189535","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}

{"title":"Impact of Extreme Temperature and Particulate Matter 2.5 on Outcomes of Out-of-Hospital Cardiac Arrest","authors":"Yongyeon Choi MPH ,&nbsp;Sangshin Park MPH, PhD","doi":"10.1016/j.jemermed.2024.10.014","DOIUrl":"10.1016/j.jemermed.2024.10.014","url":null,"abstract":"<div><h3>Background</h3><div>Extreme temperature and particulate matter-2.5 (PM_2.5) are known to affect the outcomes of out-of-hospital cardiac arrest (OHCA). However, studies that examine their effects at the exact time of OHCA occurrence are limited.</div></div><div><h3>Objective</h3><div>This study aimed to investigate the impact of extreme cold, extreme heat, and PM_2.5 on OHCA outcomes at the time of occurrence.</div></div><div><h3>Methods</h3><div>We analyzed data from 82,497 OHCAs (aged &gt; 18 years) in South Korea between January 2016 and December 2021. Extreme temperatures were defined as extreme cold (≤5th percentile) and extreme heat (≥95th percentile). PM_2.5 refers to particulate matter ≤ 2.5 micrometers, with extreme PM_2.5 defined as ≥95th percentile. The outcomes were survival to discharge and good neurological outcome, defined as a cerebral performance category of 1 or 2 at hospital discharge. We performed a multivariable logistic regression analysis to assess the impact of extreme temperature and PM_2.5 on OHCA outcomes.</div></div><div><h3>Results</h3><div>Extreme cold (-4.2°C to -20.2°C) showed no association with OHCA outcomes when compared to normal conditions (-0.9°C to 26.6°C). However, OHCAs during extreme heat (28.7°C to 39.3°C) showed a 15% significantly lower probability of survival to discharge (adjusted odds ratio [aOR]: 0.85, 95% confidence interval (CI): 0.74–0.98) compared to normal conditions. OHCAs during extreme PM_2.5 (56 to 218 µg/m³) were associated with 14% lower probability of survival to discharge (aOR: 0.86, 95% CI: 0.75–0.99) compared to normal PM_2.5 (0 to 43 µg/m³).</div></div><div><h3>Conclusion</h3><div>Extreme heat and PM_2.5 were significantly associated with a decreased probability of survival to discharge in OHCA patients.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 32-42"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189543","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}

{"title":"American Academy of Emergency Medicine","authors":"","doi":"10.1016/S0736-4679(25)00043-5","DOIUrl":"10.1016/S0736-4679(25)00043-5","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 100-101"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348185","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}

{"title":"Role of Erector Spinae Plane Block in Acute Abdominal Pain","authors":"Raghuraman M. Sethuraman M.D.,&nbsp;Vinod Krishnagopal M.D.,&nbsp;Raj Murugan M.D.,&nbsp;Sudhakaran Rajendran M.D.","doi":"10.1016/j.jemermed.2024.09.003","DOIUrl":"10.1016/j.jemermed.2024.09.003","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Page 91"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348186","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}

{"title":"Predictors of Hospital Admissions and Return Visits in Children with Suspected Dehydration Presenting to the Emergency Department","authors":"Rasha D. Sawaya MD ,&nbsp;Sarah S. Abdul-Nabi MD ,&nbsp;Ola El Kebbi MD ,&nbsp;Hani Tamim PHD ,&nbsp;Adonis Wazir MD ,&nbsp;Maha Makki BA ,&nbsp;Zavi Lakissian MSC, MD ,&nbsp;Suhair Sakr BS ,&nbsp;Rana Sharara-Chami MD, FAAP","doi":"10.1016/j.jemermed.2024.09.006","DOIUrl":"10.1016/j.jemermed.2024.09.006","url":null,"abstract":"<div><h3>Background</h3><div>Dehydration is a primary cause of visits to pediatric emergency departments (PED).</div></div><div><h3>Objectives</h3><div>1) To identify predictors of hospital admission and return visits (RV) in PED patients with all-cause dehydration. 2) To explore the association between dehydration and serum bicarbonate (HCO₃) levels.</div></div><div><h3>Methods</h3><div>This single-center prospective cohort study included patients under 18 years with dehydration from any cause, presenting to the PED of a tertiary center from November 2018 to March 2020. The primary outcome was hospital admission; the secondary outcome was RV to the PED. HCO₃ was measured for all visits. Bivariate and multivariate analyses were conducted.</div></div><div><h3>Results</h3><div>The study included 324 patients: most with mild dehydration (199/324, 61%). Of these, 74 (22.8%) were admitted, while 250 (77%) were discharged, 25 of which (10.8%) returned to the PED. Predictors of hospital admission included physician-estimated dehydration &gt;5% (adjusted odds ratio [aOR] = 2.9; 95% CI: 1.5–5.8), ≥1 intravenous (IV) fluid bolus (aOR = 5.4; 95% CI: 1.2–23.8), antibiotics (aOR = 11.92; 95% CI: 3.4–35.5), and HCO₃ ≤16 mmol/L (aOR = 4.4; 95% CI: 1.3–14.7). Admitted patients had lower mean HCO₃ levels (19.94 ± 3.38 mmol/L vs. 20.98 ± 2.65 mmol/L, <em>p</em> = 0.017). Dry mucous membranes at the index visit were the only significant predictor of RV (12% vs. 35.5%, <em>p</em> = 0.023). Antipyretics/analgesics were associated with RV (76% vs. 51.9%, <em>p</em> = 0.03). Gastritis was inversely associated (4.0% vs. 22.3%, <em>p</em> = 0.03) with RV, but these were nonsignificant in multivariate analysis.</div></div><div><h3>Conclusion</h3><div>In this PED cohort, we found no predictors for RV to the PED. However, HCO₃ ≤16 mmol/L, physician-estimated dehydration &gt;5%, ≥1 IV fluid bolus, and PED antibiotics were associated with increase hospital admission. If replicated, these findings can help clinicians make faster disposition decisions when caring for dehydrated pediatric patients.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 13-24"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189554","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}

{"title":"Developing and Updating Differential Diagnosis Tables in Emergency Medicine for Potentially Life-Threatening Diseases.","authors":"Ryota Inokuchi, Toshihiko Takada, Masao Iwagami, Tetsu Sasaki, Takehiro Sugiyama, Hiromu Maehara, Masataka Gunshin, Kazuaki Shinohara, Nanako Tamiya, Kent Doi","doi":"10.1016/j.jemermed.2025.01.005","DOIUrl":"https://doi.org/10.1016/j.jemermed.2025.01.005","url":null,"abstract":"<p><strong>Background: </strong>No study has verified whether the published differential diagnosis tables cover all potentially life-threatening diseases observed in real-world clinical practice and updated the tables using real-world data.</p><p><strong>Objectives: </strong>To create initial differential diagnosis tables based on published resources, and to validate and update the tables using the National Hospital and Ambulatory Medical Care Survey (NHAMCS) database as a real-world reference METHODS: We created the initial differential diagnosis tables using published textbooks, UpToDate®, BMJ Best Practice, and databases (Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar databases) without language restrictions from their inception to September 22, 2022. Then, we extracted chief complaints and diagnosis lists from the NHAMCS database of emergency patients aged ≥16 years between November 2016 and 2019. Finally, we compared the diagnosis lists from the NAMCS database and the initial tables to cover all potentially life-threatening diseases.</p><p><strong>Results: </strong>We created the initial tables for 78 chief complaints and 2054 differential diagnoses (554 and 1500 in the red and yellow categories, respectively). Additionally, we created 71 chief complaints and 1,468 differential diagnoses from the NHAMCS database. We found 114 potentially life-threatening diseases associated with 39 chief complaints not covered by the initial tables. Finally, the initial tables were updated to include 78 chief complaints and 2168 differential diagnoses.</p><p><strong>Conclusions: </strong>The updated differential diagnosis tables will help prevent missed diagnoses of potentially life-threatening diseases, improve patient outcomes, and facilitate clinical research.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014236","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}

{"title":"Association Between Emergency Medical Services Intervention Volume and Out-of-Hospital Cardiac Arrest Survival: Comment.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1016/j.jemermed.2025.01.003","DOIUrl":"https://doi.org/10.1016/j.jemermed.2025.01.003","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986413","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}