Journal of Emergency Medicine最新文献

{"title":"Carotid Dissection After Performing a Header","authors":"Jan C. Vos MSc , Geesien Simone Anja ter Hoeve-Boersema PhD , George P. Akkersdijk MSc , Walid Moudrous MSc","doi":"10.1016/j.jemermed.2024.08.022","DOIUrl":"10.1016/j.jemermed.2024.08.022","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 146-148"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382379","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":"Landmarks for Positioning and Local Anesthesia to Improve Success and Experience in Reduction of the Dislocated Temporomandibular Joint","authors":"Akshay Govind DMD, MD, MPH, FACS ,&nbsp;Stanley Onuegbu DDS ,&nbsp;Sahm Rafati BS ,&nbsp;Phillip Harrison DDS, MD ,&nbsp;David K. Duong MD, MS","doi":"10.1016/j.jemermed.2024.09.016","DOIUrl":"10.1016/j.jemermed.2024.09.016","url":null,"abstract":"<div><h3>Background</h3><div>Anterior dislocation of the temporomandibular joint (TMJ) occurs when the condylar head slips out of the glenoid fossa and is locked anterior to the articular eminence. Dislocation typically occurs in the setting of wide mouth opening and increased ligament flexibility, but trauma or anatomical variations of the condyle and articular eminence may contribute as well. In cases of muscle spasm following dislocation, local anesthetic, or sedation can be used to relieve muscle tension and reduce pain, thus facilitating successful TMJ reduction.</div></div><div><h3>Discussion</h3><div>An overview of commonly used reduction techniques is presented, including anterior, posterior, and alternative approaches. This paper additionally describes an algorithm for positioning of the provider, the patient, and the room to optimize the vectors of force application during reduction of the anteriorly dislocated TMJ. Previously undescribed detail when using an intraoral, posterior approach is highlighted, with special attention paid to aligning the provider's elbows with the patient's maxillary molars. For adjunctive use of local anesthetic, providers can locate the joint space by first indentifying the root of the zygomatic arch and then redirecting the needle inferiorly to a depth of roughly 25 mm from the skin. Additionally, one can inject directly into the masseter and temporalis muscles. Procedural sedation may also be used, with an anecdotal preference for midazolam, fentanyl, and propofol.</div></div><div><h3>Conclusion</h3><div>Multiple reduction techniques are compared, discussing the advantages and disadvantages of each. A novel decision-making algorithm is offered, detailing positioning, approach selection, use of local anesthesia, sedation, and aftercare instructions.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 117-126"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408697","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 Rare Case of Tetanus With Early Manifestation of Apnea But Without Trismus","authors":"Tsutomu Yasuda MD, PHD ,&nbsp;Yasuhiro Kimura MD ,&nbsp;Mizuki Kitamura MD ,&nbsp;Takahiro Nakayama MD ,&nbsp;Hideo Nishizawa MD ,&nbsp;Ichiro Imafuku MD","doi":"10.1016/j.jemermed.2024.09.023","DOIUrl":"10.1016/j.jemermed.2024.09.023","url":null,"abstract":"<div><h3>Background</h3><div>Tetanus is a life-threatening disease caused by tetanus neurotoxin (TeNT) produced by <em>Clostridium tetani</em>. Early symptoms of tetanus are trismus and muscle stiffness, both caused by spasticity. TeNT mainly exerts its effect by impairment of inhibitory neurons in the spine and brainstem, resulting in the hyperactivity of motor neurons, which causes spasticity and muscle spasms. Apnea is not a symptom that is predicted to occur in the early stages.</div></div><div><h3>Case Report</h3><div>We present a rare case of severe tetanus with an early manifestation of apnea but without trismus. We believe that apnea was caused by spasms of the intercostal muscles and its early manifestation was due to a high load of TeNT, considering that the speed of disease progression is related to disease severity. We hypothesize that the absence of trismus was also due to a high load of TeNT, exerting toxic effect at the neuromuscular junction and causing flaccid paralysis of the masseters.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>Since there is no diagnostic laboratory test for tetanus, emergency physicians must be well aware of symptoms that may or may not appear in tetanus. Tetanus should be considered as a differential diagnosis for patients arriving at the emergency department with apnea as an early symptom. The absence of trismus should not rule out the possibility of tetanus.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 142-145"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414134","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":"Simultaneous Cases of Familial Hypokalemic Periodic Paralysis Induced by Illicit Injection of Betamethasone","authors":"Brandon Chen PharmD ,&nbsp;Christopher J. Counts MD, MSc ,&nbsp;Phillip Maresca MD ,&nbsp;Howard A. Greller MD ,&nbsp;Mitchell J. Heller MD","doi":"10.1016/j.jemermed.2024.09.021","DOIUrl":"10.1016/j.jemermed.2024.09.021","url":null,"abstract":"<div><h3>Background</h3><div>Periodic paralysis is a rare neuromuscular disorder characterized by episodes of painless muscle weakness. Hypokalemic periodic paralysis (HPP) is the most common subtype of periodic paralysis. HPP may be an acquired illness but, most often, it is associated with an inherited abnormality of calcium or sodium ion channels. Episodes of HPP can be triggered by multiple factors, most commonly strenuous exercise or consuming large amounts of carbohydrates. Other triggers include emotional factors, environmental factors, other dietary factors, toxins, and medicines. Hypokalemia may be due to potassium wasting or intracellular sequestration of potassium. When ordering potassium repletion, it is important to identify hypokalemia due to sequestration in order to avoid iatrogenic hyperkalemia.</div></div><div><h3>Case Report</h3><div>We report the cases of two brothers with previously undiagnosed familial HPP with flaccid paralysis of their limbs after receiving illicit intramuscular injections of betamethasone. Serum potassium concentrations were 1.6 and 1.9 mmol/L. Both ECGs demonstrated U-waves and the older brother's ECG demonstrated widening of the QRS. The brothers were treated with oral and intravenous potassium supplementation. After briefly becoming hyperkalemic, their serum potassium concentrations returned to normal, and their paralysis resolved within 24 hours.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>Hypokalemic periodic paralysis (HPP) is a rare condition with a unique pattern of signs and symptoms and numerous possible inciting factors. Although glucocorticoids are a known trigger for HPP, previous reports have been limited to iatrogenic cases and almost exclusively reported outside the United States and not in emergency department presentations. Emergency physicians should be alert for cases induced by illicit use of steroids, as well as iatrogenic cases. Prompt recognition of HPP and identification of its etiology from history, physical examination, and appropriate laboratory studies can expedite treatment, prevent iatrogenic hyperkalemia, promptly allay patient and clinician fears, and avoid wasteful use of laboratory and imaging resources.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 92-97"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425490","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":"Neuro-Behcet's Masquerading as Status Epilepticus and Meningoencephalitis in the Emergency Department","authors":"Rebecca Merrill MD ,&nbsp;Kristen Septaric MPH ,&nbsp;Negin Ceraolo MD ,&nbsp;Erin L. Simon DO","doi":"10.1016/j.jemermed.2024.09.024","DOIUrl":"10.1016/j.jemermed.2024.09.024","url":null,"abstract":"<div><h3>Background</h3><div>Behcet disease (BD) is a rare small vessel vasculitis that commonly manifests as recurrent painful oral or genital ulcerations, uveitis, and skin lesions. Some patients with BD develop neurological symptoms termed neuro-Behcet's disease. In the emergency department setting, these symptoms can be mistaken for other common acute issues including stroke, infection, epilepsy, multiple sclerosis, toxin ingestion, or psychiatric conditions.</div></div><div><h3>Case Report</h3><div>We present a case of a 28-year-old male with neuro-BD mimicking status epilepticus and meningoencephalitis. He was actively seizing on arrival and febrile at 103.8 F. The patient also had a history of vasculitis, uveitis, and genital lesions which raised suspicion for a rheumatological process. Cerebrospinal fluid samples were obtained and computed tomography of the head revealed no acute findings. The patient was started on treatment for seizure and meningoencephalitis and admitted to neurology for continuous electroencephalogram monitoring with additional consults placed for rheumatology, ophthalmology, and infectious disease. The patient was ultimately diagnosed with neuro-Behcet's disease and treated appropriately.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>In a patient presenting with neurological symptoms and signs of rheumatological disease providers should consider neuro-Behcet's disease as a differential diagnosis. This case exemplifies the vital role of reviewing past medical history to expand differential diagnoses and early coordination with specialists so treatment can be initiated early to prevent morbidity and mortality. The case will also review different presentations of this unfamiliar diagnosis for a more comprehensive understanding.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 76-80"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006566","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 Novel Use of Terbutaline: Persistent Genital Arousal Disorder in the Emergency Department","authors":"Sadaf Luth MS ,&nbsp;James Luth DO ,&nbsp;Kelly A. Murray PharmD, BCACP ,&nbsp;Bobby Abernathy DO","doi":"10.1016/j.jemermed.2024.08.023","DOIUrl":"10.1016/j.jemermed.2024.08.023","url":null,"abstract":"<div><h3>Background</h3><div>Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a highly distressing, multifactorial disorder characterized by persistent unwanted physiologic genital arousal in the absence of sexual desire. This poorly understood disorder is thought to be derived from a complex dysregulation of biopsychosocial factors with common underlying neurological dysfunction that has yet to be adequately studied. With frequently evolving diagnostic criteria, lack of a standardized treatment algorithm, and few evidence-based treatment options, this disease is largely unrecognized and difficult to treat once identified.</div></div><div><h3>Case Report</h3><div>A 25-year-old woman presented to the Emergency Department (ED) with persistent and refractory symptoms of genital arousal not responsive to previously documented treatments, and the novel use of a β-adrenergic agent, terbutaline, leading to cessation of symptoms. With her initial presentation, lorazepam, haloperidol, and viscous lidocaine intravaginally provided relief for approximately 24 h until the patient returned. At her subsequent presentation, the patient received additional doses of lorazepam and intravaginal lidocaine, as well as consults with Urology and Obstetrics and Gynecology. Her symptoms eventually ceased by administration of terbutaline.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>Although presentation of PGAD to the ED is rare, emergency physicians should be prepared with treatment options to assist patients with this distressing diagnosis. This case highlights the novel use of terbutaline, a β-agonist, in cessation of PGAD symptoms when first-line benzodiazepines and antipsychotics fail.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 81-83"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080500","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 Ability to Seal by Supraglottic Airway Device During Human Cadaveric Cardiopulmonary Resuscitation","authors":"Subhasree Das MD ,&nbsp;Rakesh Vadakkethil Radhakrishnan MSN ,&nbsp;Amiya Kumar Barik DM ,&nbsp;Chitta Ranjan Mohanty MD","doi":"10.1016/j.jemermed.2024.09.005","DOIUrl":"10.1016/j.jemermed.2024.09.005","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 98-99"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348184","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":"Assessing Frailty Through Head Impact Locations in Older Adults","authors":"Waseem Jerjes MBBS, MSc, MDres, PhD, MRCGP, FHEA, FAcadMed","doi":"10.1016/j.jemermed.2024.08.010","DOIUrl":"10.1016/j.jemermed.2024.08.010","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 92-93"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348187","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":"Ultrasound-Guided Erector Spinae Plane Nerve Block for Relief of Acute Cholecystitis Pain","authors":"John M. Bowling DO ,&nbsp;Rachael Ray BS ,&nbsp;Robert Stenberg MD","doi":"10.1016/j.jemermed.2024.08.008","DOIUrl":"10.1016/j.jemermed.2024.08.008","url":null,"abstract":"<div><h3>Background</h3><div>Acute cholecystitis is a common surgical emergency and a painful condition that often requires frequent intravenous opioid analgesia. Sometimes, pain control of patients with acute cholecystitis is challenging. In this case, we present a potential alternative to managing acute cholecystitis pain.</div></div><div><h3>Case Report</h3><div>A 40-year-old female presented to the emergency department (ED) with right upper quadrant pain. While awaiting testing and ultrasound, she received multiple doses of opioid analgesia. A point-of-care ultrasound of the right upper quadrant was performed and demonstrated findings of acute cholecystitis. Given that her pain was challenging to manage, even with intravenous opioids, an ultrasound-guided erector spinae plane (ESP) nerve block was discussed and subsequently performed at the T7 level. Thirty minutes after the procedure, the patient reported significant relief of her pain and did not require any opioid analgesia until ten hours later on the inpatient floor.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>ESP nerve blocks can potentially offer an alternative analgesic in the management of acute cholecystitis, subsequently reducing the use of opioids in the ED. ESP nerve blocks can potentially offer patients longer-lasting analgesia. ESP nerve blocks can potentially manage visceral pain in the ED.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 51-53"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074445","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":"Vaginal Pain and Discharge","authors":"Lev Libet MD ,&nbsp;Ty Tran MD ,&nbsp;Yufan Brandon Chen MD ,&nbsp;Minerva Pineda MD","doi":"10.1016/j.jemermed.2024.08.009","DOIUrl":"10.1016/j.jemermed.2024.08.009","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 84-86"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}