Journal of Emergency Medicine最新文献

{"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., Vinod Krishnagopal M.D., Raj Murugan M.D., 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":"American Academy of Emergency Medicine","authors":"","doi":"10.1016/S0736-4679(25)00013-7","DOIUrl":"10.1016/S0736-4679(25)00013-7","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 122-123"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143098622","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: PEDIATRIC POISONINGS ASSOCIATED WITH INGESTION OF MARIJUANA PRODUCTS","authors":"Fizaa Rasool ,&nbsp;Muhammad Ali Nouman ,&nbsp;Satesh Kumar","doi":"10.1016/j.jemermed.2024.08.004","DOIUrl":"10.1016/j.jemermed.2024.08.004","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 109-110"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006710","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":"Empathy Unmasked: Patient Perception of Physician Empathy in an Oncologic Emergency Setting. A Randomized Controlled Trial Comparing Personal Protective Equipment Wear versus Unmasked Video Communication","authors":"Kathryn J. Burk MD ,&nbsp;John J. Stroh MD ,&nbsp;Kelly Larkin MD ,&nbsp;Patrick Chaftari MD ,&nbsp;Denise M. Langabeer PhD ,&nbsp;Jazmin R. Menendez BS ,&nbsp;Jeanie F. Woodruff BS ,&nbsp;Jan Hargrave EdS ,&nbsp;Hongxu Zhu MS ,&nbsp;James P. Long PhD ,&nbsp;Sai-Ching J. Yeung MD, PhD ,&nbsp;Kumar Alagappan MD ,&nbsp;Aiham Qdaisat MD, MS","doi":"10.1016/j.jemermed.2024.08.005","DOIUrl":"10.1016/j.jemermed.2024.08.005","url":null,"abstract":"<div><h3>Background</h3><div>Amidst the COVID-19 pandemic, telemedicine emerged as an important option that supports and facilitates clinical practice, however, its usefulness in emergency settings that treat patients with cancer is unclear.</div></div><div><h3>Objective</h3><div>To evaluate patient perception of physician empathy in an emergency oncology setting, comparing video interaction to an in-person with personal protective equipment (PPE) approach.</div></div><div><h3>Methods</h3><div>In this single-center, prospective, cross-sectional, survey-based randomized controlled trial, patients were randomized 1:1 for the concluding conversation done in-person which included either interacting with physicians wearing PPE or video interaction with physicians without PPE (virtual). Patients’ perceptions of the physicians’ relational empathy were assessed and compared for each group by using the Consultation and Relational Empathy (CARE) Measure and the Perception of Physician Compassion measure.</div></div><div><h3>Results</h3><div>Patients (n = 106) in both the PPE and virtual arms provided favorable responses to all questions. The mean overall CARE scores for the PPE and virtual arms were 45.02 and 44.43, respectively (difference, 0.58 [95% CI: -2.10, 3.30]). Regarding the linear physician compassion scores, patients in the virtual arm appeared to consider physicians to be warmer (difference, -0.42 [95% CI: -0.87, 0.04]) but less pleasant (difference, 0.33 [95% CI: -0.40, 1.10]) than did patients in the PPE arm.</div></div><div><h3>Conclusions</h3><div>Cancer patients presenting to the emergency department perceive empathy and compassion equally when approached by physicians virtually without PPE or in person while wearing PPE. Virtual services for specific aspects of clinical practice during emergency department visits in an oncology setting can be implemented to ensure safer interactions between patients and physicians without compromising the physician-patient relationship.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 43-53"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971175","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}

{"title":"Gastric Ultrasound in the Management of Emergency Department Patients with Upper Gastrointestinal Bleeding: A Case Series and Sonographic Technique","authors":"Robert James Adrian MD ,&nbsp;Peter Alsharif MD ,&nbsp;Hamid Shokoohi MD, MPH ,&nbsp;Stephen Alerhand MD","doi":"10.1016/j.jemermed.2024.07.015","DOIUrl":"10.1016/j.jemermed.2024.07.015","url":null,"abstract":"<div><h3>Background</h3><div>Gastrointestinal bleeding (GIB) is a common condition in the emergency department (ED) with high incidence and mortality.</div></div><div><h3>Objectives</h3><div>Very early risk stratification of GIB patients can sometimes be a challenge. The decision to intubate these patients is multifactorial and requires careful consideration.</div></div><div><h3>Discussion</h3><div>Gastric ultrasound (GUS) is an adjunct tool that may help make such decisions and is supported by anesthesiology society guidelines to assess aspiration risk.</div></div><div><h3>Conclusion</h3><div>In this manuscript, we present a case series of ED patients with upper GIB in whom emergency physicians (2 fellowship-trained attendings and 2 senior residents facile with point-of-care ultrasound) performed GUS. As a supplement to the clinical examination, this <em>sonographic \"lavage\"</em> (i.e., using GUS in patients with upper GIB) helped predict aspiration risk, support diagnostic reasoning, and expedite early goal-directed management and appropriate disposition. We also provide a step-by-step tutorial using high-quality media, as well as a novel algorithm for translation of this technique to the bedside for emergency physicians.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 66-72"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983705","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":"End-Tidal Oxygen as an Effective Noninvasive Measure of Preoxygenation during Rapid Sequence Intubation in the Emergency Department","authors":"Eric Boccio MD, MPH ,&nbsp;Justin Belsky MD, MPH ,&nbsp;Sandra Lopez MD ,&nbsp;Brian Kohen MD ,&nbsp;James Bonz MD","doi":"10.1016/j.jemermed.2024.07.006","DOIUrl":"10.1016/j.jemermed.2024.07.006","url":null,"abstract":"<div><h3>Background</h3><div>Preoxygenation is intended to extend the duration of apnea until desaturation occurs. End-tidal oxygen (ETO₂) is the standard for measuring preoxygenation, however, peripheral capillary oxygen saturation (SpO₂) is used more commonly within the emergency department.</div></div><div><h3>Objective</h3><div>The primary aim was to determine whether patients were optimally preoxygenated as measured by ETO₂ vs. SpO₂ during rapid sequence intubation. Secondary aims investigated changes in these measurements before and after intubation and whether patient characteristics influenced the likelihood of preoxygenation success as measured by each of the modalities.</div></div><div><h3>Methods</h3><div>A multicenter, prospective observational study of a convenience sample of patients undergoing rapid sequence intubation was performed. ETO₂ and SpO₂ were recorded at the cessation of preoxygenation (T₁) and intubation completion (T₂). Optimal preoxygenation was defined by an observed ETO₂ level ≥ 90% and SpO₂ level equal to 100% at T₁.</div></div><div><h3>Results</h3><div>Thirty patients were intubated and included in the analysis. Median ETO₂ and SpO₂ at T₁ were 90.5% (interquartile range 86–93%) and 100% (interquartile range 97–100%), respectively. Preoxygenation success rates as measured by ETO₂ and SpO₂ were 56.7% and 53.3%, respectively (<em>p</em> = 0.431). The mean (SD) decrease in ETO₂ during the intubation attempt was larger and more variable than that for SpO₂ (25.8% [22.5%] vs. 2.1% [3.3%]; <em>p</em> &lt; 0.001). Patient age, sex, and body mass index were not associated with likelihood of preoxygenation success for either modality.</div></div><div><h3>Conclusions</h3><div>Preoxygenation success was similar when measured by strict ETO₂ and SpO₂ criteria. ETO₂ is more sensitive to periods of apnea than SpO₂ and may serve as an early indicator of an imminent desaturation event.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 34-42"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785969","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":"Intermittent High-Degree AV Block, Rash, and Facial Droop with Negative Lyme PCR","authors":"Amber N. Brooks DO","doi":"10.1016/j.jemermed.2024.08.006","DOIUrl":"10.1016/j.jemermed.2024.08.006","url":null,"abstract":"<div><h3>Background</h3><div>Lyme disease is the most common tick-borne illness in the United States, and cases of Lyme disease have nearly doubled since the early 2000s. Symptoms and presentation vary based on severity of illness, with more serious complications of disease consisting of neurologic and cardiac dysfunction. Testing is often unreliable, which can lead to delayed diagnosis and management.</div></div><div><h3>Case Report</h3><div>A 38-year-old woman presented to the Emergency Department with left-sided facial droop and was subsequently diagnosed with Lyme carditis. This case depicts a classic but unique triad of symptoms caused by Lyme disease: high-degree atrioventricular (AV) blockade, Bell's palsy, and erythema migrans. The patient was promptly treated with empiric i.v. antibiotics pending serology testing for Lyme disease, and her high-degree AV block improved. Initial polymerase chain reaction testing for this patient was negative, but diagnosis was later confirmed with a positive two-tiered test. Intravenous ceftriaxone therapy improved this patient's heart block, allowing for discharge on oral antibiotics.</div><div>Why Should an Emergency Physician Be Aware of This? It is important to recognize potential cases of Lyme disease early so that appropriate treatment can be initiated. Lyme disease is difficult to diagnose given the wide variety of symptoms and clinical presentations coupled with routine testing that has relatively low sensitivity. Lyme cases have been increasing over the last several years, even in areas in which Lyme disease is not generally endemic. Testing limitations make obtaining a definitive diagnosis difficult, which the emergency physician should be aware of.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 84-88"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971176","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 thoracic nerve blocks for emergency department patients with rib fractures: A review","authors":"Bushra Hussein MD ,&nbsp;Daniel Mercader MD ,&nbsp;Rebecca G. Theophanous MD MHSc","doi":"10.1016/j.jemermed.2024.07.016","DOIUrl":"10.1016/j.jemermed.2024.07.016","url":null,"abstract":"<div><h3>Background</h3><div>Rib fractures are frequently diagnosed and treated in the emergency department (ED). Thoracic trauma has serious morbidity and mortality, particularly in older adults, with complications including pulmonary contusions, hemorrhage, pneumonia, or death. Bedside ED-performed ultrasound-guided anesthesia is gaining in popularity, and early and adequate pain control has shown improved patient outcomes with rare complications.</div></div><div><h3>Objective of the Review</h3><div>We describe thoracic nerve block options that can be used clinically for rib fractures or other thoracic pain or trauma. We identify the pros and cons of each type of block, describe their risk profile and advantages, and summarize the steps on how each is performed.</div></div><div><h3>Discussion</h3><div>Thoracic epidural and paravertebral blocks are more invasive, targeting the nerves closer to the spinal cord, thus they are primarily used in the operating room or by anesthesiology for surgical cases. However, newer blocks are gaining in popularity, particularly the erector spinae block (ESP), serratus anterior plane nerve block (SANB), and intercostal nerve block (ICNB). These blocks provide adequate anesthesia and can be performed in an ED setting.</div></div><div><h3>Conclusions</h3><div>Thoracic nerve blocks (e.g., ESP, SANB, ICNB) can be performed safely by appropriately trained emergency physicians, provide excellent anesthesia for rib fractures and thoracic trauma, and should be strongly considered for improved patient-centered outcomes. Furthermore, performing regional nerve blocks in the emergency department can reduce complications including adverse effects from opioids or other delirium-inducing medications.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 1-14"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983725","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}