Journal of Emergency Medicine最新文献

{"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":"American Academy of Emergency Medicine","authors":"","doi":"10.1016/S0736-4679(25)00132-5","DOIUrl":"10.1016/S0736-4679(25)00132-5","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 140-141"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807672","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}

{"title":"An Expert Consensus of Acceptable Scholarly Activities in Emergency Medicine Residency Training Programs","authors":"Nidhi Garg MD ,&nbsp;Vicken Y. Totten MD ,&nbsp;Marna Rayl Greenberg DO, MPH ,&nbsp;Gentry Wilkerson MD ,&nbsp;John T. Finnell II, MD, MSc ,&nbsp;Wayne Bond Lau MD ,&nbsp;James R. Miner MD ,&nbsp;James P. d'Etienne MD, MBA ,&nbsp;Jason D. Brenner ,&nbsp;Pridha Kumar BS ,&nbsp;Carlos A. Camargo Jr. MD, DrPH","doi":"10.1016/j.jemermed.2024.10.002","DOIUrl":"10.1016/j.jemermed.2024.10.002","url":null,"abstract":"<div><h3>Background</h3><div>Scholarly activity (SA) has been interpreted inconsistently between allopathic and osteopathic emergency medicine programs, but the acceptable methods to achieve this requirement must be re-evaluated, particularly in the light of the merger of allopathic and osteopathic programs to form the Single Accreditation System. This paper describes the results of inquiry from a series of meetings of the Research, Scholarly Activity, and Innovation section of the American College of Emergency Physicians.</div></div><div><h3>Objective</h3><div>This study aimed to describe differences between allopathic and osteopathic emergency medicine programs and their SA requirements. The authors set out to scrutinize different forms of SA on the basis of the venerated models of Boyer and Glassick.</div></div><div><h3>Methods</h3><div>The authors conducted a systematic qualitative review of the SA models in academic literature using the criteria of Boyer and Glassick. The authors then compared the allopathic and osteopathic emergency medicine SA requirements and made recommendations about how to evaluate proposed SAs and rated various forms of SA on the basis of the Boyer and Glassick models.</div></div><div><h3>Evidence Review</h3><div>Allopathic programs have required “scholarly activity,” which includes many types of activities, while osteopathic programs have traditionally required “research.” Traditionally, allopathic programs have provided more structural support and faculty involvement in resident SA than have osteopathic programs.</div></div><div><h3>Conclusion</h3><div>Objective criteria, such as those of Boyer and Glassick, should be used to determine if a given activity is truly scholarly. A residency which determines that a proposed activity meets these objective criteria is less likely to be cited by the Accreditation Council for Graduate Medical Education (ACGME), and more likely to fulfill the SA requirements. The authors propose the Individual Scholarly Activity Plan as a method to set agreed-upon goals and track resident and faculty progress towards completion and facilitate career advancement among both residents and faculty.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 91-103"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425426","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 “Ultrasound-Guided Erector Spinae Plane Nerve Block for Relief of Acute Cholecystitis Pain”","authors":"Amiya Kumar Barik DM ,&nbsp;Anju Gupta MD ,&nbsp;Chitta Ranjan Mohanty MD ,&nbsp;Rakesh Vadakkethil Radhakrishnan MSN","doi":"10.1016/j.jemermed.2024.10.019","DOIUrl":"10.1016/j.jemermed.2024.10.019","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 124-125"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808105","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":"Case Report of an Obstructive Endotracheal Mass from a Blood Clot: An Airway Nightmare","authors":"Sara Bradley DO,&nbsp;Verena Schandera MD,&nbsp;Mary L. Bing MD, MPH","doi":"10.1016/j.jemermed.2024.10.005","DOIUrl":"10.1016/j.jemermed.2024.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Central airway obstruction from a mass is a rare but deadly manifestation of advanced primary lung cancer that can cause considerable challenges during endotracheal intubation, including airway debris or bleeding, ventilation difficulties, and prolonged postintubation hypoxia.</div></div><div><h3>Case Report</h3><div>This case report describes a patient presenting with the chief symptom of massive hemoptysis who was difficult to ventilate and oxygenate after an easy intubation. On bedside bronchoscopy, an obstructing mass was found at the carina that was later determined to be caused by a blood clot. Patient course was complicated by tension pneumothoraces, prolonged hypoxia, and cardiopulmonary arrest.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>Early recognition of an obstructing airway mass can be achieved with bedside fiberoptic bronchoscopy and allow for prompt mobilization of specialty services with rigid bronchoscopy capabilities for mass removal.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 78-81"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425431","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 and Outcome of a Protocol-Based Treatment for Diabetic Ketoacidosis in a Tertiary Care Pediatric Emergency Department","authors":"Gulser Esen Besli MD ,&nbsp;Merve Nur Hepokur MD ,&nbsp;Sibel Ergin Sahin MD ,&nbsp;Asan Onder MD ,&nbsp;Metin Yildiz MD ,&nbsp;Irem Bulut MD ,&nbsp;Hamdi Cihan Emeksiz MD","doi":"10.1016/j.jemermed.2024.10.013","DOIUrl":"10.1016/j.jemermed.2024.10.013","url":null,"abstract":"<div><h3>Background</h3><div>The standardization of clinical practice in emergency treatment of diabetic ketoacidosis (DKA) is a prerequisite for improving patient care. For this purpose, a standardized DKA protocol incorporating a two-bag system has been implemented since January 2020 in our center.</div></div><div><h3>Objectives</h3><div>To assess the impact of the development and utilization of the standard treatment pathway for DKA on patient outcomes.</div></div><div><h3>Methods</h3><div>This retrospective cohort study involved patients diagnosed with DKA and admitted to the pediatric emergency department (PED). The entire period of the study was from January 2017 to September 2022. Patients with DKA managed before and after implementation of the protocol were compared in terms of clinical outcomes.</div></div><div><h3>Results</h3><div>Out of 145 patients, 77 (53%) patients were in the pre-protocol group, 68 (47%) were in the protocol group. Age, sex, and severity of DKA were similar between the groups. Implementation of the protocol resulted in shorter resolution time of acidosis and ketosis (<em>p</em> = 0.007, <em>p</em> &lt; 0.001, respectively), higher correction rates of bicarbonate and blood ketones (<em>p</em> = 0.003, <em>p</em> &lt; 0.001, respectively), shorter duration of IV insulin treatment (<em>p</em> = 0.008), more appropriate potassium dosage administrating to IV fluids (<em>p</em> &lt; 0.001), lower incidence of hypokalemia, hypophosphatemia, and hypoglycemia (<em>p</em> = 0.008, <em>p</em> = 0.002, <em>p</em> = 0.036, respectively), and smaller number of IV bags use (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Implementation of a protocol-based pathway for DKA involving a two-bag system provided earlier correction of ketoacidosis, decreased the risk of complications, and reduced resource utilization in the PED.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 10-22"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483231","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}