Journal of Emergency Medicine最新文献

{"title":"Selective Use of Positive-Pressure Ventilation for Preoxygenation During Air Medical Rapid Sequence Intubation","authors":"Alexandra Herndon MD ,&nbsp;Kira Chandran MD ,&nbsp;Daniel P. Davis MD","doi":"10.1016/j.jemermed.2024.06.011","DOIUrl":"10.1016/j.jemermed.2024.06.011","url":null,"abstract":"<div><h3>Background</h3><div>Preoxygenation is critical to safe performance of rapid sequence intubation (RSI). The use of positive-pressure ventilation (PPV) has been advocated during preoxygenation but may increase the risk of aspiration.</div></div><div><h3>Objective</h3><div>To explore the risk-benefit analysis of using PPV during air medical RSI.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of the Air Methods Airway Registry using patient data from over 175 bases across the U.S. over a 5-year period. Patients were separated into normoxemic (SpO2 ≥93%) and hypoxemic (SpO2 &lt;93%) and compared in regard to demographics, clinical data, and use of PPV. Primary outcomes were first-attempt intubation success (FAS) and FAS without desaturation (FASWD). Chi-square, <em>t</em>-test, and logistical regression were used to analyze the data.</div></div><div><h3>Results</h3><div>There were 9778 patients who underwent intubations during the study period. FAS was 92% (8966 patients). FASWD was 90% (8775 patients). Mean SpO2 was 94.9%. There were 42% (4118 patients) of patients who received PPV prior to intubation and 1% (94) aspirated during RSI. Multivariate logistical regression showed an association between use of PPV and reduced intubation success for normoxemic patients but improved intubation success for hypoxemic patients. The use of PPV was associated with higher risk of aspiration events (<em>p</em> = 0.007).</div></div><div><h3>Conclusion</h3><div>The use of PPV during preoxygenation prior to RSI appears beneficial for hypoxemic but not normoxemic patients due to lower intubation success and increased aspiration risk with PPV. This data supports selective use of PPV prior to the initial intubation attempt in patients undergoing RSI.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e523-e532"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365516","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 Lipliner Sign: Potential Cause of a False Positive Focused Assessment with Sonography in Trauma (FAST) Examination","authors":"Maria A. Parker MD ,&nbsp;Bryson G. Hicks MD ,&nbsp;Matt Kaili MD, MS ,&nbsp;Aaron Silver MD ,&nbsp;Meihua Zhu MD PhD ,&nbsp;Magdelyn Feuerherdt BS ,&nbsp;Yuan Zhang MD ,&nbsp;Caelan Thomas M-BME ,&nbsp;Cynthia R. Gregory PhD ,&nbsp;Kenton W. Gregory MD ,&nbsp;Nikolai Schnittke MD, PhD","doi":"10.1016/j.jemermed.2024.06.013","DOIUrl":"10.1016/j.jemermed.2024.06.013","url":null,"abstract":"<div><h3>Background</h3><div>The focused assessment with sonography in trauma (FAST) examination plays an essential role in diagnosing hemoperitoneum in trauma patients to guide prompt operative management. The FAST examination is highly specific for hemoperitoneum in trauma patients, and has been adopted in nontrauma patients to identify intraperitoneal fluid as a cause of abdominal pain or distension. However, causes of false positive FAST examinations have been described and require prompt recognition to avoid diagnostic uncertainty and inappropriate procedures. Most causes of false positive FAST examinations are due to anatomic mimics such as perinephric fat or seminal vesicles, however, modern ultrasound machines use a variety of postprocessing image enhancement techniques that can also lead to novel false positive artifacts.</div></div><div><h3>Case Report</h3><div>We report cases where experienced clinicians incorrectly interpreted ultrasound findings caused by a novel mimic of hemoperitoneum: the “lipliner sign.” It appears most prominently at the edges of solid organs (such as the liver and the spleen), which is the same location most likely to show free fluid in FAST examination in trauma patients.</div></div><div><h3>Why Should an Emergency Physician be Aware of This?</h3><div>Clinicians who take care of trauma patients must be familiar with causes of false positive FAST examinations that could lead to a misdiagnosis of hemoperitoneum.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e553-e559"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375560","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":"Letter in Response to Tracheal Intubation and Mechanical Ventilation in Adults with Severe Salicylate Poisoning","authors":"Corey S. Hazekamp ,&nbsp;Anthony D. Scoccimarro","doi":"10.1016/j.jemermed.2024.06.001","DOIUrl":"10.1016/j.jemermed.2024.06.001","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e613-e614"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813344","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":"Clarification of Symptoms in an Emergency Department Must Be Sufficient to Prevent Early Death After Discharge","authors":"Josef Finsterer MD, PhD","doi":"10.1016/j.jemermed.2024.06.014","DOIUrl":"10.1016/j.jemermed.2024.06.014","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e618-e619"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813341","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 Parasite Living Beneath the Conjunctiva","authors":"Mark Curato DO ,&nbsp;Anfei Li MD, PhD","doi":"10.1016/j.jemermed.2024.05.014","DOIUrl":"10.1016/j.jemermed.2024.05.014","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e572-e573"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154351","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":"Low Incidence of Delayed Intracranial Hemorrhage in Geriatric Emergency Department Patients on Preinjury Anticoagulation Presenting with Blunt Head Trauma","authors":"Richard D. Shih MD ,&nbsp;Scott M. Alter MD ,&nbsp;Joshua J. Solano MD ,&nbsp;Gabriella Engstrom PhD, RN ,&nbsp;Mike Wells MBBCh, PhD ,&nbsp;Lisa M. Clayton DO ,&nbsp;Patrick G. Hughes DO ,&nbsp;Lara Nicole Goldstein MBBCh, PhD ,&nbsp;Faris K. Azar MD ,&nbsp;Joseph G. Ouslander MD","doi":"10.1016/j.jemermed.2024.06.002","DOIUrl":"10.1016/j.jemermed.2024.06.002","url":null,"abstract":"<div><h3>Background</h3><div>Delayed intracranial hemorrhage (ICH) after head injury in older patients taking anticoagulants has been reported to be as high as 7.2%. Other studies suggest much lower rates. Its incidence and clinical management are controversial, with some recommending observation and repeat head imaging at 24 h.</div></div><div><h3>Objective</h3><div>Our study aims to assess the incidence of delayed ICH in geriatric Emergency Department (ED) head trauma patients prescribed preinjury anticoagulants.</div></div><div><h3>Methods</h3><div>We performed a prospective cohort study conducted at two hospital EDs from August 2019 to July 2020. All patients aged 65 years or older with acute head injury were eligible for enrollment. We conducted telephone follow-up at 14 and 60 days, and a chart review at 90 days. The primary study outcome was incidence of delayed ICH, which was defined as an initial negative head computed tomography scan followed by subsequent ICH believed to be caused by the initial traumatic event. We compared the rates of delayed ICH between patient cohorts based on anticoagulant use.</div></div><div><h3>Results</h3><div>There were 3425 patients enrolled: 2300 (67.2%) were not on an anticoagulant, 249 (7%) were on preinjury warfarin, 780 (22.7%) were on a direct-acting oral anticoagulant, and 96 (2.8%) were on enoxaparin or heparin. The median age was 82 years (interquartile range 65-107), the majority were female (55.2%), and almost all were Caucasian (84.3%). An acute ICH was identified in 229 of 3425 (6.7%, 95% confidence interval 6–8%) and delayed ICH in 13 (0.4%, 95% confidence interval 0.2–0.6%). There were no differences in rates of delayed ICH between those who had been prescribed anticoagulants vs. those who had not (<em>p</em> = 0.45).</div></div><div><h3>Conclusions</h3><div>The incidence of delayed ICH is very low in older ED head trauma patients on prescribed pre-injury anticoagulants. Our data have important clinical implications for the management of blunt head trauma among older ED patients on anticoagulants.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e516-e522"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141414753","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":"Safety of Diltiazem for Acute Management of Atrial Fibrillation (AF) in Patients with Heart Failure and Reduced Ejection Fraction in the Emergency Department","authors":"Cassandra J. Schmitt PharmD ,&nbsp;Alicia E. Mattson PharmD ,&nbsp;Daniel Cabrera MD ,&nbsp;Aidan Mullan MA ,&nbsp;Coral Marí Chantada BS ,&nbsp;Annelise S. Howick BA ,&nbsp;Garvan C. Kane MD, PhD ,&nbsp;Fernanda Bellolio MD, MSc","doi":"10.1016/j.jemermed.2024.06.010","DOIUrl":"10.1016/j.jemermed.2024.06.010","url":null,"abstract":"<div><h3>Background</h3><div>Diltiazem is an effective rate control agent for atrial fibrillation with rapid ventricular rate (AF RVR). However, its negative inotropic effects may increase the risk for worsening heart failure in patients with a reduced ejection fraction (EF).</div></div><div><h3>Objectives</h3><div>This observational study aims to describe the incidence of worsening heart failure in patients who receive intravenous diltiazem for acute atrial fibrillation management.</div></div><div><h3>Methods</h3><div>Adult patients that received diltiazem in the emergency department (ED) for AF RVR (heart rate ≥ 100 beats/min) from 2021 to 2022 and had a prior documented EF were included. The primary outcome is worsening heart failure within 24 h of diltiazem administration. Secondary outcomes include return ED visits and death within 7 days. EF percentage was compared across outcomes using Wilcoxon rank-sum tests. Outcomes were compared by reduced EF (&lt; 50%) and preserved EF (≥ 50%). Continuous data were summarized with medians and interquartile ranges, and categorical features were summarized with frequency counts and percentages. Wilcoxon rank-sum tests were used for numeric outcomes and chi-squared tests or Fisher's exact tests for categorical outcomes, with a <em>p</em>-value &lt; 0.05 considered statistically significant.</div></div><div><h3>Results</h3><div>There were 674 patients with AF RVR that received diltiazem, and 386 patients met the inclusion criteria for analysis. Baseline demographics included a median age of 72 (64–81) years, with 14.5% of patients having a prior diagnosis of congestive heart failure. EF &lt; 50% was identified in 13.7% of patients (n = 53), of which approximately 30% of these patients safely discharged home after receiving i.v. diltiazem. The primary outcome of worsening heart failure occurred in 7/41 (17%) and 10/207 (4.8%) patients with reduced and preserved ejection fractions, respectively, who were admitted to the hospital (<em>p</em> = 0.005).</div></div><div><h3>Conclusion</h3><div>The development of worsening heart failure is multifactorial and may include the use of diltiazem in critically ill patients requiring hospital admission.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e560-e568"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141415447","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":"Epidemiology of Testicular Trauma in Sports: Analysis of the National Electronic Injury Surveillance System Database","authors":"Rishubh Jain BA,&nbsp;Mohnish Nadella BS,&nbsp;Rory Byrne BA,&nbsp;Nishant Jayachandran,&nbsp;Matthew Quinn MD,&nbsp;Brett D. Owens MD","doi":"10.1016/j.jemermed.2024.06.005","DOIUrl":"10.1016/j.jemermed.2024.06.005","url":null,"abstract":"<div><h3>Background</h3><div>The epidemiology of testicular trauma in sports on a national scale has not been well studied. Timely management and treatment after testicular trauma is critical to avoid serious, long-term ramifications of mismanagement.</div></div><div><h3>Objective</h3><div>The aim was to analyze trends in sports-related testicular trauma based on specific sports and patient demographic characteristics over time.</div></div><div><h3>Methods</h3><div>The National Electronic Injury Surveillance System was queried for emergency department cases between 2012 and 2021 with injuries in the pubic region related to 10 commonly played sports. Variables examined included patient age, race, disposition, and sport using incidence rate, incidence rate ratios, and χ² analysis.</div></div><div><h3>Results</h3><div>There were an estimated 28,844 emergency department cases of sports-related testicular trauma between 2012 and 2021. Young patients, aged between 10 and 14 years and 15 and 19 years, accounted for most cases, and results of χ² analysis showed a significant difference in incidence based on age group (<em>p</em> &lt; 0.01). Most injuries occurred while athletes played basketball, football, and soccer (73.6%).</div></div><div><h3>Conclusions</h3><div>Sports-related testicular trauma injury rates remained steady between 2012 and 2021, which suggests greater efforts are necessary to reduce the incidence of sports-related testicular trauma. Education efforts should focus on 10- to 19-year-olds because they have the highest incidence. Given the high incidence in sports like basketball and soccer compared with football and lacrosse, testicular trauma seems to be a risk for athletes competing both recreationally and competitively.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e544-e552"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141705502","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":"Intubation Appears Safe in Moderate Salicylate Poisoning But Not Necessarily in Severe Poisoning","authors":"Michael E. Mullins MD","doi":"10.1016/j.jemermed.2024.06.015","DOIUrl":"10.1016/j.jemermed.2024.06.015","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e608-e609"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813343","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 Young Woman with Apparent Brain Death","authors":"Christiana K. Prucnal MD, ScM ,&nbsp;Paul S. Jansson MD, MS ,&nbsp;Peter R. Chai MD, MS ,&nbsp;Stephen D. Hallisey MD ,&nbsp;Derek L. Monette MD, MHPE ,&nbsp;Kathleen A. Wittels MD","doi":"10.1016/j.jemermed.2024.06.003","DOIUrl":"10.1016/j.jemermed.2024.06.003","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e634-e640"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258905","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}