Journal of Emergency Medicine最新文献

{"title":"Emergency Department Patients with Para-Fluorofentanyl Overdose","authors":"Kim Aldy DO ,&nbsp;Alex Krotulski PhD ,&nbsp;Jeffrey Brent MD, PhD ,&nbsp;Sharan Campleman PhD ,&nbsp;Rachel Culbreth PhD, MPH ,&nbsp;Barry Logan PhD ,&nbsp;Paul Wax MD ,&nbsp;Alexandra Amaducci DO ,&nbsp;Bryan Judge MD ,&nbsp;Michael Levine MD ,&nbsp;Evan Schwarz MD ,&nbsp;Diane P. Calello MD ,&nbsp;Christopher W. Meaden MD ,&nbsp;Joshua Shulman MD ,&nbsp;Adrienne Hughes MD ,&nbsp;Robert Hendrickson MD ,&nbsp;Joseph Carpenter MD ,&nbsp;Jennie Buchanan MD ,&nbsp;Alex F. Manini MD, MS ,&nbsp;Toxicology Investigators Consortium (ToxIC) Fentalog Study Group","doi":"10.1016/j.jemermed.2024.11.020","DOIUrl":"10.1016/j.jemermed.2024.11.020","url":null,"abstract":"<div><h3>Background</h3><div>Fentanyl analogs, such as para-fluorofentanyl (PFF), are increasing in the illicit opioid supply.</div></div><div><h3>Objectives</h3><div>This study characterizes demographics, clinical effects, and sex differences for naloxone administration in emergency department (ED) patients with confirmed PFF overdose compared with fentanyl.</div></div><div><h3>Methods</h3><div>This prospective observational cohort is from the ToxIC Fentalog Study between 2020 and 2023 at 10 participating U.S. hospitals. Adult patients with suspected opioid overdose presenting to EDs were screened and eligible if waste serum samples were available for comprehensive toxicological analysis. Fentanyl-positive patients were included in this analysis examining associations between PFF and naloxone administration, with stratified analyses for sex differences.</div></div><div><h3>Results</h3><div>Of 4873 screened, 833 were included; 694 PFF negative (PFFN) and 139 PFF positive (PFFP). Mean age was 41 years, and men were predominant (PFFN 73.1% vs. PFFP 69.8%). More than half of PFFP patients presented at 2 of the 10 participating sites, New York (29.8%) and Pennsylvania (21.3%). The most common indication for naloxone was depressed level of consciousness (PFFN 82.1% vs. PFFP 79.8%). PFFP were less likely to receive naloxone doses &gt; 2 mg compared with PFFN (48.2% vs. 60.8%, <em>p</em> = 0.002). After controlling for covariates, PFFP were less likely to receive out-of-hospital naloxone (adjusted odds ratio 0.87; 95% confidence interval 0.81–0.94). PFFP men were less likely to receive naloxone doses ≥ 2 mg (adjusted odds ratio 0.64; 95% confidence interval 0.42–0.97), but this association was not significant for women.</div></div><div><h3>Conclusion</h3><div>PFF was present in almost 20% of ED patients with confirmed fentanyl overdose. Although naloxone administration was lower for PFF compared with fentanyl, differences were more pronounced in men. Clinicians and public health officials should be aware of the evolving illicit opioid supply. Future study is warranted to explore the PFF dose response and mechanism behind these observed sex differences due to fentanyl analogs.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 56-69"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912850","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":"Toxic Shock Syndrome due to Streptococcus Pyogenes: Case Report","authors":"A. Ganss ,&nbsp;S. Venturini ,&nbsp;I. Reffo ,&nbsp;M. Avolio ,&nbsp;M. Domini ,&nbsp;D. Rufolo ,&nbsp;L. Corich ,&nbsp;G. Del Fabro ,&nbsp;A. Callegari ,&nbsp;M. Crapis ,&nbsp;G. Basaglia ,&nbsp;G. Nadalin","doi":"10.1016/j.jemermed.2024.11.009","DOIUrl":"10.1016/j.jemermed.2024.11.009","url":null,"abstract":"<div><h3>Background</h3><div>Toxic shock syndrome (TSS) is one of the most devastating clinical manifestations of <em>Streptococcus pyogenes</em> (also known as Group A Streptococci or GAS), characterized by an overwhelming production of toxins. The incidence of TSS is increasing worldwide, and the mortality rate remains unacceptably high. Due to the rapid progression of infection, rapid diagnosis is crucial, as early initiation of aggressive supportive measures, along with antibiotics, source control, immunoglobulin, and steroids, can improve patient outcomes. IgM- and IgA-enriched immunoglobulins represents a new therapeutic option, as highlighted in the case reported here.</div></div><div><h3>Case report</h3><div>A 66-year-old man was admitted for cellulitis of the right arm with shock, disseminated intravascular coagulation (DIC), renal and hepatic compromise, suggestive of toxic shock syndrome (TSS). Blood cultures revealed <em>S. pyogenes</em>, confirming the diagnosis. The patient was treated with combination antibiotic therapy (clindamycin, piperacillin/tazobactam), steroids and enriched immunoglobulins in addition to vasopressor and high flow oxygen. He was discharged home with complete recovery after 1 month.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>In the emergency department, the primary goals of management of TSS include aggressive resuscitation, prompt administration of appropriate antibiotics, source control if feasible, and early intensive care unit admission.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 77-82"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772420","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":"Shedding Light: How One Family's Tragedy Became Another's Beacon","authors":"Alexandra Reens MD","doi":"10.1016/j.jemermed.2024.10.007","DOIUrl":"10.1016/j.jemermed.2024.10.007","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 114-115"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433047","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":"Diverse by Design: A Comprehensive Guide to Inclusive Hiring for Emergency Medicine Faculty","authors":"Cortlyn Brown MD, MCSO, FAAEM","doi":"10.1016/j.jemermed.2024.10.016","DOIUrl":"10.1016/j.jemermed.2024.10.016","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Discussion</h3><div>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.</div></div><div><h3>Conclusion</h3><div>The guide is a vital tool for creating inclusive academic EM environments, improving diversity, and enhancing patient care and educational outcomes.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 133-139"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","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}

{"title":"The Ten Test and Sensory Evaluation of Hand and Finger Injuries in the Emergency Department","authors":"Emilie H. Lothet MD,&nbsp;Aaron J. Lacy MD,&nbsp;Elizabeth B. Odom MD","doi":"10.1016/j.jemermed.2024.10.008","DOIUrl":"10.1016/j.jemermed.2024.10.008","url":null,"abstract":"<div><h3>Background</h3><div>Hand and finger injuries are a common presenting complaint to the emergency department (ED) and are associated with significant morbidity. Neurologic evaluation of these injuries is a crucial component of the patient assessment and can be done via a variety of testing methods.</div></div><div><h3>Discussion</h3><div>Although most taught and cited in the ED literature, the two-point discrimination test for sensation has several drawbacks, including limited reproducibility and reliability. Although often utilized by hand surgical specialists, the Semmes-Weinstein monofilament test and the Weinstein Enhanced Sensory Test are not practical for the emergency physician due to the need for specialized equipment and frequent calibration. The Ten Test, a relatively new sensory evaluation method, has been shown to be reliable, reproducible, and pragmatic in varying types of clinical environments.</div></div><div><h3>Conclusion</h3><div>The Ten Test is a pragmatic alternative method of evaluation to two-point that is utilized by specialists in hand surgery and injuries. The emergency physician should consider adding the Ten Test to their evaluation and reporting of hand and finger injuries in the ED.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 54-59"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472554","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":"Controversies in the Management of Acute Pulmonary Embolism in the Emergency Department","authors":"Thomas Pederson MD ,&nbsp;Christopher “Kit” Tainter MD ,&nbsp;Michael Self MD ,&nbsp;Mina Ghobrial MD ,&nbsp;Christian Sloane MD ,&nbsp;Stephanie Mergen MD ,&nbsp;Brent Kennis MD ,&nbsp;Amir Aminlari MD ,&nbsp;William Cameron McGuire MD ,&nbsp;Gabriel Wardi MD","doi":"10.1016/j.jemermed.2024.10.003","DOIUrl":"10.1016/j.jemermed.2024.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Acute pulmonary embolism (PE) is frequently diagnosed in the Emergency Department (ED), and the management approach can be nuanced.</div></div><div><h3>Objective</h3><div>In this narrative review, we synthesize the literature in selected areas of ongoing controversy regarding the diagnostic and management approaches for acute PE in the ED, and provide evidence-based recommendations to empower emergency physicians (EPs) to provide optimal care in these situations.</div></div><div><h3>Discussion</h3><div><span>d</span>-Dimer is used to clinically exclude the diagnosis of PE patients who are stratified as low risk. However by utilizing likelihood ratio and with certain scoring tools, patient historically considered moderate or high risk for PE may safely be able to have the diagnosis excluded with a negative <span>d</span>-dimer. Traditional risk stratification and management strategies can be cautiously applied to patients with concomitant Coronavirus-19 infection while awaiting more definitive studies. There is an increasing trend in the diagnosis of isolated subsegmental PE, and many patients receiving this diagnosis may be treated without anticoagulation provided that they have no evidence of associated deep vein thrombosis (DVT) and can be closely followed as an outpatient. There is a persistent hesitancy to discharge patients with newly diagnosed acute PE, and existing well-supported risk stratification tools and clinical decision frameworks can support the EP's decision to safely discharge low-risk patients.</div></div><div><h3>Conclusion</h3><div>tThis review of the literature empowers emergency clinicians to manage challenging PE cases in the ED.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 31-43"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468309","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":"Implementation of an Emergency Department Opioid Use Disorder Initiative: Clinical Processes and Institution Specific Education Improve Care","authors":"Aaron Krumheuer MD ,&nbsp;Alexander T Janke MD, MHS ,&nbsp;Alex Nickel MD ,&nbsp;Erin Kim ,&nbsp;Carrie Bailes MD ,&nbsp;Emily E. Ager MD ,&nbsp;Ella K. Purington MD ,&nbsp;Syed Mohammad Mahmood MD ,&nbsp;Mitchell Hooyer MD ,&nbsp;Mary Loretta Ryan MD ,&nbsp;Jessica E. Baker ,&nbsp;Megan Purdy MD ,&nbsp;Colin F. Greineder MD, PhD ,&nbsp;Carolyn V. Commissaris MD ,&nbsp;Shawna N. Smith PhD ,&nbsp;Christopher M. Fung MD, MS ,&nbsp;Eve D. Losman MD, MHSA","doi":"10.1016/j.jemermed.2024.10.009","DOIUrl":"10.1016/j.jemermed.2024.10.009","url":null,"abstract":"<div><h3>Background</h3><div>Emergency department (ED) visits associated with opioid use and fatal overdoses increase annually. Emergency clinician-initiated medication for opioid use disorder (MOUD) reduces mortality and improves treatment retention.</div></div><div><h3>Objective</h3><div>We describe and evaluate a program to implement MOUD at an academic ED using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of patients presenting to the ED who were eligible for MOUD. A multipronged MOUD program consisting of electronic health record (EHR) order set, email communications, and resident education was delivered over 1 year. Clinical processes were measured before and after program implementation, including buprenorphine and naloxone utilization and outpatient referrals for treatment.</div></div><div><h3>Results</h3><div>We identified 319 eligible encounters over the 2-year study period. Patients were predominantly non-Hispanic white men with a mean age of 40 ± 12.8 years. After program initiation, 109/189 patients (57.7%) were offered or initiated on buprenorphine, compared to 46/130 patients (35.4%) before (95% confidence interval). Protocol dosing was used in 92% of initiations. Outpatient treatment provider referrals increased from 46.1% (60/130) to 63% (119/189; 95% confidence interval). More patients in the postintervention group period requested buprenorphine during their visit compared to before the intervention (24.6% vs. 10%).</div></div><div><h3>Conclusions</h3><div>We observed improvements in the rate of buprenorphine prescription and outpatient treatment referrals at an academic ED following a quality improvement program implemented using the RE-AIM framework.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 104-113"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483232","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 (POCUS) Diagnosis of Deep Neck Space Abscess: A Case Series","authors":"Eric Scheier MD ,&nbsp;Efrat Shapira-Levy MD ,&nbsp;Shachar Oren MD","doi":"10.1016/j.jemermed.2024.10.004","DOIUrl":"10.1016/j.jemermed.2024.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Para and Retropharyngeal abscesses are deep neck infections of early childhood that can be complicated by serious sequelae such as airway obstruction, cervical necrotizing fasciitis, mediastinitis, aspiration pneumonia, jugular thrombosis or aneurysm of the carotid artery. Traditionally, these infections were diagnosed with computed tomography (CT) of the neck, which exposes sensitive structures to radiation and may require sedation.</div></div><div><h3>Case Report</h3><div>We present a case series of four children diagnosed using point of care ultrasound (POCUS) with para or retropharyngeal abscess later confirmed on CT. All four had alternative working diagnoses on pediatric emergency physician or otolaryngology physical examination prior to investigation with POCUS. We also describe a novel imaging approach that allows for easier identification of deep neck anatomic landmarks.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?'</h3><div>Pediatric emergency physicians should be skilled in imaging the deep neck spaces in order to avoid delayed diagnosis of deep neck space abscess and its potentially catastrophic sequelae.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 60-66"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472223","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 “The Uncommon Encounter of a Transcranial TASER Injury”","authors":"Amiya Kumar Barik DM ,&nbsp;Chitta Ranjan Mohanty MD ,&nbsp;Rakesh Vadakkethil Radhakrishnan MSN ,&nbsp;Kumar Rajanikant MD","doi":"10.1016/j.jemermed.2024.10.020","DOIUrl":"10.1016/j.jemermed.2024.10.020","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 116-117"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808035","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":"Penile Urethral Stone","authors":"Tse-Ying Lee MD ,&nbsp;Wan-Ching Lien MD, PHD","doi":"10.1016/j.jemermed.2024.10.015","DOIUrl":"10.1016/j.jemermed.2024.10.015","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 88-90"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472221","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}