Journal of Emergency Medicine最新文献_第5页

Reply to Comment on "The Uncommon Encounter of a Transcranial TASER Injury" 关于“经颅电击伤的罕见遭遇”的回复

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-04-01 DOI: 10.1016/j.jemermed.2024.11.001

Barry Hahn MD

引用次数: 0

A Case of Palpitations in Pregnancy 妊娠心悸1例。

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-04-01 DOI: 10.1016/j.jemermed.2024.10.018

Mario J. Castellanos MD , Hanni M. Stoklosa MD, MPH , Derek L. Monette MD, MHPE , Kathleen A. Wittels MD

引用次数: 0

Comments on "End-Tidal Oxygen as an Effective Noninvasive Measure of Preoxygenation During Rapid Sequence Intubation in the Emergency Department" 对“潮末氧作为急诊科快速序贯插管中一种有效的无创预充氧措施”的评论

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-04-01 DOI: 10.1016/j.jemermed.2024.11.004

Amiya Kumar Barik DM , Anju Gupta MD , Chitta Ranjan Mohanty MD , Rakesh Vadakkethil Radhakrishnan MSN

引用次数: 0

Exertional Heat Stroke: Are We Cool Enough? Retrospective Observational Study of Patients of Running Events 劳累性中暑：我们足够凉爽吗？跑步事件患者的回顾性观察研究。

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-04-01 DOI: 10.1016/j.jemermed.2024.11.002

Nathalie Dollée MD , Jelmer Alsma MD, PhD , Rob Goedhart PhD , Ankie Bultstra , Juanita A. Haagsma PhD , Amber E. Hoek MD, PhD

{"title":"Exertional Heat Stroke: Are We Cool Enough? Retrospective Observational Study of Patients of Running Events","authors":"Nathalie Dollée MD , Jelmer Alsma MD, PhD , Rob Goedhart PhD , Ankie Bultstra , Juanita A. Haagsma PhD , Amber E. Hoek MD, PhD","doi":"10.1016/j.jemermed.2024.11.002","DOIUrl":"10.1016/j.jemermed.2024.11.002","url":null,"abstract":"<div><h3>Background</h3><div>Early recognition and immediate cooling are paramount in the treatment for exertional heat stroke (EHS). The most effective method is cold water immersion, however, practicalities may limit its use in the prehospital setting. An alternative is rotating ice water–soaked towels, which requires fewer personnel, can be deployed quickly, and allows easier patient monitoring.</div></div><div><h3>Objective</h3><div>The authors aimed to investigate the effectiveness of treatment with rotating ice water–soaked towels for patients with EHS to reduce (tympanic) temperature to < 104°F (40°C) within 30 min.</div></div><div><h3>Methods</h3><div>In this retrospective observational study, participants ≥18 years who received medical care at running events with distances between 2.6 mile (4.2 km) and 26.2 miles (42.195 km; i.e., a full marathon) between 2016 and 2019 were included. Primary outcome was the percentage of patients with EHS who reached a temperature < 104°F (40°C) within 30 min by means of cooling with rotating ice water–soaked towels.</div></div><div><h3>Results</h3><div>A total of 374,534 runners participated in one of the running events in the study period, of whom 879 required medical attention. Forty-eight runners had a tympanic temperature ≥ 104°F (40°C), of whom 36 were classified as having EHS based on presence of neurologic symptoms. Median age of patients was 32.5 years and most were male (69%). All patients that were cooled reached temperature < 104°F (40°C) within 30 min. The mean cooling rate was 0.22°F/min (95% CI 0.16–0.27; 0.12°C/min [95% CI 0.09–0.15]). None of the patients with EHS died.</div></div><div><h3>Conclusions</h3><div>All patients with EHS in our study reached a temperature of < 104°F (40°C) within 30 min, which suggests rotating ice water–soaked towels could provide an effective and practical method of cooling in the prehospital setting.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 44-53"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531451","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}

引用次数: 0

Reduced-Dose Tenecteplase in High-Risk Pulmonary Embolism 减少剂量替奈普酶治疗高危肺栓塞。

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-04-01 DOI: 10.1016/j.jemermed.2024.10.011

Jennifer Hammond PharmD , Dean Cataldo DO , Christopher Allison MD , Seth Kelly MD, MBA

{"title":"Reduced-Dose Tenecteplase in High-Risk Pulmonary Embolism","authors":"Jennifer Hammond PharmD , Dean Cataldo DO , Christopher Allison MD , Seth Kelly MD, MBA","doi":"10.1016/j.jemermed.2024.10.011","DOIUrl":"10.1016/j.jemermed.2024.10.011","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary embolism (PE) is a venous thromboembolic disease occurring when thrombi detach and embolize to pulmonary arteries, causing substantial morbidity and mortality in older adults yearly. In patients experiencing hemodynamic compromise, systemically administered thrombolytic therapy followed by anticoagulation over anticoagulation alone is recommended for initial management.</div></div><div><h3>Case Report</h3><div>This report describes successful treatment of a patient over 90 years of age presenting to the Emergency Department with an acute, high-risk PE who received low-dose, systemically administered tenecteplase followed by systemic anticoagulation with unfractionated heparin. The patient was initiated on norepinephrine 0.5 µg/kg/min for hemodynamic support. They were administered a reduced dose of tenecteplase (17.5 mg or 0.37 mg/kg) bolus followed by unfractionated heparin and subsequent transfer to the medical intensive care unit. At 1 h post-tenecteplase, norepinephrine was decreased to 0.2 µg/kg/min. At 14 h post-tenecteplase, the norepinephrine requirement was minimal at 0.02 µg/kg/min and resolved with extubation 15 h post-tenecteplase. The patient did not develop any clinically significant bleeding and was discharged to an acute rehabilitation facility on hospital day 7.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>Available evidence suggests positive outcomes and dosing guidance for low-dose alteplase for PE treatment, though at the time of this report the authors identified a gap in existing literature surrounding the same concept with reduced-dose tenecteplase. Further studies are needed to investigate this intervention further.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 67-70"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483239","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}

引用次数: 0

A Change of Pace: Modifying Pacemaker Settings in the Emergency Department as Emergency Physicians, A Case Report 心律的改变：急诊医生在急诊科修改起搏器设置的案例报告。

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-04-01 DOI: 10.1016/j.jemermed.2024.10.012

Maritza Kelesis MD, Martin Huecker MD, FAAEM, FACEP, Robert Whitford MD, FAAEM

{"title":"A Change of Pace: Modifying Pacemaker Settings in the Emergency Department as Emergency Physicians, A Case Report","authors":"Maritza Kelesis MD, Martin Huecker MD, FAAEM, FACEP, Robert Whitford MD, FAAEM","doi":"10.1016/j.jemermed.2024.10.012","DOIUrl":"10.1016/j.jemermed.2024.10.012","url":null,"abstract":"<div><h3>Background</h3><div>Pacemakers are implantable or external devices that send electrical impulses, allowing the heart to contract. Some common indications for permanent pacemaker placement include symptomatic bradycardia due to high-grade atrioventricular (AV) block, sick sinus syndrome, chronic bifascicular block, and postcardiac transplantation. Like all devices, pacemakers can malfunction or stop working entirely. We present a patient with an implantable pacemaker/cardioverter and defibrillator (ICD) displaying symptomatic failure to capture, and settings were adjusted in the emergency department (ED). Adjustment in the ED resolved the patient's symptoms and required no further interventions.</div></div><div><h3>Case Report</h3><div>An 82-year-old woman with atrial fibrillation, heart failure, and a Medtronic dual chamber pacer/ICD (Medtronic, Minneapolis, Minnesota) presented to the ED for complaints of weakness and lightheadedness. Emergency medical services noted intermittent bradycardia, hypotension, and decreased responsiveness. Electrocardiogram (ECG) revealed failure to capture. The Medtronic application was used to interrogate and reprogram the device. The settings were DDD at a rate of 60 beats/min with ventricular output of 4.5 millivolts (mV) and atrial output of 4.5 mV, which were changed to ventricular lead outputs from 4.5 mV to 8.0 mV and rate from 60 to 80 for additional cardiac output. After this adjustment, the bradycardia resolved, and ECG showed a successful AV-paced rhythm. Transcutaneous pacing was never required.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>Adjustment of pacer settings in the ED to stabilize the critically ill patient is within the scope of the emergency physician. We can reduce stress to the patient and prevent hospitalizations. Pacemakers can become a tool to optimize treatment plans for an aging population in whom pacemakers are becoming more common.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 82-87"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476696","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}

引用次数: 0

Aortic Laceration From Posterior Rib Fractures After a Ground-Level Fall: A Case Report 地面坠落后后肋骨骨折导致主动脉裂伤1例。

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-03-01 DOI: 10.1016/j.jemermed.2024.09.020

Benjamin Travers MD, Laura Murphy MD

{"title":"Aortic Laceration From Posterior Rib Fractures After a Ground-Level Fall: A Case Report","authors":"Benjamin Travers MD, Laura Murphy MD","doi":"10.1016/j.jemermed.2024.09.020","DOIUrl":"10.1016/j.jemermed.2024.09.020","url":null,"abstract":"<div><h3>Background</h3><div>Rib fractures represent a common injury after blunt chest wall trauma with known complications including pneumothorax, hemothorax, pulmonary contusion, and pneumonia. This case report describes an emergency department patient with acute decompensation from aortic laceration as a rare complication of rib fractures. There are rare documented cases of this complication occurring in admitted patients with rib fractures, but this is one of the only cases that describes this complication occurring in a patient presenting to the emergency department.</div></div><div><h3>Case Report</h3><div>This case describes a patient who was found down at her home and presented to the emergency department in acute distress. She was found to have three left-sided posterior rib fractures, which had lacerated her thoracic aorta causing a large left hemothorax and acute decompensation. The patient was resuscitated in the emergency department followed by thoracic endovascular aortic repair in the operating room. The patient did well after surgical repair and was discharged from the hospital at her baseline mental and functional status.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>It remains important to resuscitate an acutely ill patient based on history, physical examination, and vital signs. The key takeaway from this case report is that, although rare, aortic laceration remains a possible complication of posterior rib fractures in a patient who acutely decompensates.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 139-141"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408694","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}

引用次数: 0

Is There an Association Between Emergency Department Overcrowding and Emergency Medical Services Redirection? 急诊科过度拥挤与急诊医疗服务重定向之间是否存在关联？

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-03-01 DOI: 10.1016/j.jemermed.2024.09.011

Kurien Mathews MD, Mukund Mohan MD, Paul Barbara MD, Arsalan Shawl DO, Norman Ng DO, Joseph Basile MD, Barry Hahn MD, Amin Mohamadi MD

{"title":"Is There an Association Between Emergency Department Overcrowding and Emergency Medical Services Redirection?","authors":"Kurien Mathews MD, Mukund Mohan MD, Paul Barbara MD, Arsalan Shawl DO, Norman Ng DO, Joseph Basile MD, Barry Hahn MD, Amin Mohamadi MD","doi":"10.1016/j.jemermed.2024.09.011","DOIUrl":"10.1016/j.jemermed.2024.09.011","url":null,"abstract":"<div><h3>Background</h3><div>Emergency Medical Systems (EMS) has developed policies to manage patient flow. In New York City, these practices include both diversion and redirection. Currently, gaps in the literature exist regarding the correlation between emergency department (ED) operational metrics and EMS redirection triggers.</div></div><div><h3>Objectives</h3><div>This study analyzes the relationship between ED operational metrics and EMS redirection practices.</div></div><div><h3>Methods</h3><div>This single-center retrospective cohort analysis analyzed EMS patient transports from April 2021 to May 2022. Data on EMS redirection was obtained from Fire Department of New York (FDNY) notifications, and ED operational metrics were collected from the hospital's data repository. Metrics included ED length of stay, admission rates, and times from door-to-triage and door-to-room.</div></div><div><h3>Results</h3><div>During the study, 93,783 patient visits were recorded, with 22,734 (24%) transported by EMS. Redirection was activated on 250 days, predominantly on Mondays. A slight association was found between overall ED volume and redirection occurrences (OR 1.02), but no significant correlations were identified with other specific ED operational metrics.</div></div><div><h3>Conclusions</h3><div>Our findings indicate no substantial correlation between these practices and ED operational metrics. These results suggest a need for a paradigm shift toward more objective, data-driven measures to inform EMS redirection, ensuring decisions are grounded in the ED's actual operational capacity.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 80-86"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457836","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}

引用次数: 0

Promethazine: A Review of Therapeutic Uses and Toxicity 异丙嗪：治疗用途和毒性综述。

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-03-01 DOI: 10.1016/j.jemermed.2024.09.013

Christina K. Le PharmD, BCPS , Craig A. Stevens PharmD, BCPS , Jung Hoon Park PharmD, BCPS, BCCCP , Richard F. Clark MD

{"title":"Promethazine: A Review of Therapeutic Uses and Toxicity","authors":"Christina K. Le PharmD, BCPS , Craig A. Stevens PharmD, BCPS , Jung Hoon Park PharmD, BCPS, BCCCP , Richard F. Clark MD","doi":"10.1016/j.jemermed.2024.09.013","DOIUrl":"10.1016/j.jemermed.2024.09.013","url":null,"abstract":"<div><h3>Background</h3><div>Promethazine was first approved in 1951 and has since been used as a treatment option for a variety of indications. A histamine H<sub>1</sub> receptor competitive antagonist with antihistaminic, sedative, anti-kinetotic, antiemetic, and antimuscarinic effects, promethazine is utilized for the treatment of nausea and vomiting, a common reason for emergency department (ED) visits.</div></div><div><h3>Objective</h3><div>This review of promethazine explores its pharmacology and history of toxicities, and discusses current recommendations from patient safety organizations, which implicate its role in therapy.</div></div><div><h3>Discussion</h3><div>Injectable promethazine utilization should take into consideration patient-specific factors, institutional policies, medication shortages of alternative agents, and the efficacy and toxicities of injectable promethazine itself. For decades, injectable promethazine has been associated with rare but serious limb-threatening adverse effects after extravasation or inadvertent intra-arterial injection. Patient safety organizations have called for hospitals to remove injectable promethazine from formularies, and the U.S. Food and Drug Administration acted in December of 2023 to change the product labeling, adding dilution and administration recommendations for intravenous administration and stating a preference for intramuscular administration.</div></div><div><h3>Conclusion</h3><div>Promethazine offers a suitable alternative antiemetic for use in the ED due to its distinct mechanism of action. Injectable promethazine, however, must be used with caution to minimize risk of serious patient harm in the event of intra-arterial or perivascular extravasation when given parenterally.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 127-133"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414228","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}

引用次数: 0

Ropivacaine and Dexamethasone Incompatibility: A Warning for Emergency Physicians 罗哌卡因和地塞米松不相容：对急诊医生的警告

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-03-01 DOI: 10.1016/j.jemermed.2024.09.004

Chitta Ranjan Mohanty MD , Amiya Kumar Barik DM , Subhasree Das MD , Rakesh Vadakkethil Radhakrishnan MSN

引用次数: 0