Journal of Emergency Medicine最新文献

{"title":"Implementation and Outcome of a Protocol-Based Treatment for Diabetic Ketoacidosis in a Tertiary Care Pediatric Emergency Department","authors":"Gulser Esen Besli MD ,&nbsp;Merve Nur Hepokur MD ,&nbsp;Sibel Ergin Sahin MD ,&nbsp;Asan Onder MD ,&nbsp;Metin Yildiz MD ,&nbsp;Irem Bulut MD ,&nbsp;Hamdi Cihan Emeksiz MD","doi":"10.1016/j.jemermed.2024.10.013","DOIUrl":"10.1016/j.jemermed.2024.10.013","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objectives</h3><div>To assess the impact of the development and utilization of the standard treatment pathway for DKA on patient outcomes.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>p</em> = 0.007, <em>p</em> &lt; 0.001, respectively), higher correction rates of bicarbonate and blood ketones (<em>p</em> = 0.003, <em>p</em> &lt; 0.001, respectively), shorter duration of IV insulin treatment (<em>p</em> = 0.008), more appropriate potassium dosage administrating to IV fluids (<em>p</em> &lt; 0.001), lower incidence of hypokalemia, hypophosphatemia, and hypoglycemia (<em>p</em> = 0.008, <em>p</em> = 0.002, <em>p</em> = 0.036, respectively), and smaller number of IV bags use (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 10-22"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","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}

{"title":"Comment on “Ultrasound-Guided Erector Spinae Plane Nerve Block for Relief of Acute Cholecystitis Pain”","authors":"Amiya Kumar Barik DM ,&nbsp;Anju Gupta MD ,&nbsp;Chitta Ranjan Mohanty MD ,&nbsp;Rakesh Vadakkethil Radhakrishnan MSN","doi":"10.1016/j.jemermed.2024.10.019","DOIUrl":"10.1016/j.jemermed.2024.10.019","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 124-125"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808105","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":"Case Report of an Obstructive Endotracheal Mass from a Blood Clot: An Airway Nightmare","authors":"Sara Bradley DO,&nbsp;Verena Schandera MD,&nbsp;Mary L. Bing MD, MPH","doi":"10.1016/j.jemermed.2024.10.005","DOIUrl":"10.1016/j.jemermed.2024.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Central airway obstruction from a mass is a rare but deadly manifestation of advanced primary lung cancer that can cause considerable challenges during endotracheal intubation, including airway debris or bleeding, ventilation difficulties, and prolonged postintubation hypoxia.</div></div><div><h3>Case Report</h3><div>This case report describes a patient presenting with the chief symptom of massive hemoptysis who was difficult to ventilate and oxygenate after an easy intubation. On bedside bronchoscopy, an obstructing mass was found at the carina that was later determined to be caused by a blood clot. Patient course was complicated by tension pneumothoraces, prolonged hypoxia, and cardiopulmonary arrest.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>Early recognition of an obstructing airway mass can be achieved with bedside fiberoptic bronchoscopy and allow for prompt mobilization of specialty services with rigid bronchoscopy capabilities for mass removal.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 78-81"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425431","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":"Comment on “End-Tidal Oxygen as an Effective Noninvasive Measure of Preoxygenation during Rapid Sequence Intubation in the Emergency Department”","authors":"Arjang Khorasani MD,&nbsp;M. Ramez Salem MD","doi":"10.1016/j.jemermed.2024.10.017","DOIUrl":"10.1016/j.jemermed.2024.10.017","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 119-120"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808037","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":"Streptococcal Toxic Shock Syndrome: A Case Series Emphasizing the Urgency of Recognition and Tailored Treatment","authors":"Ehsan Yavari MD ,&nbsp;Gaurav Puri MD","doi":"10.1016/j.jemermed.2024.10.010","DOIUrl":"10.1016/j.jemermed.2024.10.010","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Case Presentations</h3><div>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.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>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.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 74-77"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","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}

{"title":"Out-of-Hospital Cardiac Arrest 30-Day-Outcomes: The Importance of the First Electrocardiogram After Successful Resuscitation","authors":"Eimo Martens ,&nbsp;Giulio Mastella MD ,&nbsp;Daniela Simson ,&nbsp;Petra Barthel ,&nbsp;Anna Saleki MD ,&nbsp;Franziska Hahn ,&nbsp;Michael Dommasch PD ,&nbsp;Marharyta Pavliuchenko ,&nbsp;David Federle ,&nbsp;Julia Allescher ,&nbsp;Tobias Haufe ,&nbsp;Jan Andreas Köhlen ,&nbsp;Alexander Müller ,&nbsp;Karl-Ludwig Laugwitz ,&nbsp;Christian Kupatt ,&nbsp;Alexander Steger","doi":"10.1016/j.jemermed.2024.09.010","DOIUrl":"10.1016/j.jemermed.2024.09.010","url":null,"abstract":"<div><h3>Background</h3><div>While there is substantial evidence on the impact of prehospital resuscitation efforts on survival after out-of-hospital cardiac arrest (OHCA), the importance of the first electrocardiogram after return of spontaneous circulation has been much less studied.</div></div><div><h3>Objectives</h3><div>The aim of this study was to identify prognostically relevant electrocardiographic findings in patients after OHCA due to myocardial infarction (MI).</div></div><div><h3>Methods</h3><div>A total of 119 patients admitted to hospital after suffering an OHCA due to MI were retrospectively analyzed. Patient characteristics and the first 12-lead electrocardiogram after return of spontaneous circulation were collected. The primary outcome was 30-day mortality.</div></div><div><h3>Results</h3><div>A number of electrocardiographic findings were significantly associated with 30-day mortality: atrial fibrillation/flutter (HR 2.29 [95% CI 1.17–4.49, <em>p</em> = 0.015]), right bundle branch block (HR 2.23 [95% CI 1.14–4.56, <em>p</em> = 0.020]), bifascicular block (HR 2.51 [95% CI 1.04–6.059, <em>p</em> = 0.040]), T inversion (HR 2.01 [95% CI 1.02–3.99, <em>p</em> = 0.043]), QTc duration ≥500 ms (HR 2.21 [95% CI 1.10–4.42, <em>p</em> = 0.025]) and QT dispersion ≥ 100 ms (HR 2.11 [95% CI 1.02–4.37, <em>p</em> = 0.045]).</div></div><div><h3>Conclusion</h3><div>Several different electrocardiographic findings are associated with increased mortality in patients with OHCA due to MI.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 1-9"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523405","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":"Coagulation Studies are Frequently Ordered in Emergency Department Chest Pain Patients and do not Change Emergency Department Management","authors":"Jarryd Rivera MD ,&nbsp;Samidha Dutta DO ,&nbsp;Karly Castellaw DO ,&nbsp;Priyanka Dharampuriya DO ,&nbsp;Michael Weinstock MD","doi":"10.1016/j.jemermed.2024.11.003","DOIUrl":"10.1016/j.jemermed.2024.11.003","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 23-30"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","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}

{"title":"Use of an Endotracheal Tube for a Thoracostomy in a Child in Cardiac Arrest: A Case Report","authors":"Kunj Bhatt MD,&nbsp;Jacob Ziff MD,&nbsp;Duncan Grossman DO,&nbsp;Julia Tokarski MD","doi":"10.1016/j.jemermed.2024.10.006","DOIUrl":"10.1016/j.jemermed.2024.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Traditionally, when patients arrive at an emergency department in cardiac arrest with a concern for a pneumothorax, a thoracostomy tube is placed for decompression. A literature review found no case reports of an endotracheal tube being used in lieu of a thoracostomy tube for a pneumothorax in a child in cardiac arrest.</div></div><div><h3>Case Report</h3><div>A case of a 4-week-old female infant who presented to the emergency department in cardiac arrest with a pneumothorax is discussed.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>It is important for clinicians to be aware of alternative management strategies for the management of a pneumothorax. This case suggests that an endotracheal tube being used as a thoracostomy tube in a child in cardiac arrest can help acutely treat a pneumothorax by providing immediate and continuous decompression. In a prehospital or low-resource setting, an endotracheal tube may offer benefits similar to a thoracostomy tube as an immediate treatment modality.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 71-73"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449251","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":"Reply to Comment on \"The Uncommon Encounter of a Transcranial TASER Injury\"","authors":"Barry Hahn MD","doi":"10.1016/j.jemermed.2024.11.001","DOIUrl":"10.1016/j.jemermed.2024.11.001","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Page 118"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808036","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 Case of Palpitations in Pregnancy","authors":"Mario J. Castellanos MD ,&nbsp;Hanni M. Stoklosa MD, MPH ,&nbsp;Derek L. Monette MD, MHPE ,&nbsp;Kathleen A. Wittels MD","doi":"10.1016/j.jemermed.2024.10.018","DOIUrl":"10.1016/j.jemermed.2024.10.018","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 126-132"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476695","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}