Journal of Emergency Medicine最新文献

{"title":"A Rare Cause of Headache in the Emergency Department: A Case Report","authors":"Erika Jokubauskaite ,&nbsp;Akvile Bucaite ,&nbsp;Vytautas Aukstakalnis","doi":"10.1016/j.jemermed.2025.07.039","DOIUrl":"10.1016/j.jemermed.2025.07.039","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial dermoid cysts are rare congenital tumors, accounting for 0.04%–0.6% of intracranial neoplasms. Though often asymptomatic, rupture can cause headaches, seizures, and neurological deficits due to mass effect or inflammation.</div></div><div><h3>Case Report</h3><div>We report a 23-year-old female with a 10-day history of persistent headaches, initially relieved by nonsteroidal anti-inflammatory drugs (NSAIDs). Ten days prior, she experienced a seizure with unresponsiveness, postictal disorientation, and left-sided weakness. Vital signs showed nonsignificant abnormalities. Neurological examination was unremarkable, and laboratory tests were normal. Computed tomography (CT) revealed an extra-axial fatty density mass in the left anterolateral suprasellar region, consistent with a ruptured dermoid cyst. Magnetic resonance imaging (MRI) confirmed the diagnosis, and electroencephalogram (EEG) showed epileptiform changes. She was started on Levetiracetam and underwent craniotomy for cyst removal, confirmed histologically. She was discharged with follow-up recommendations. Headaches are a common emergency complaint, classified as primary (e.g., migraines) or secondary (e.g., tumors, infections). Secondary headaches require urgent evaluation. This case underscores the importance of recognizing red flags. Prompt diagnosis enabled definitive surgical treatment, preventing complications such as hydrocephalus or blindness.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>This case highlights the need for a high level of suspicion when evaluating headaches and seizures in the emergency setting. Rapid identification of serious conditions can prevent complications and ensure optimal patient care.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"78 ","pages":"Pages 54-56"},"PeriodicalIF":1.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048236","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":"Pseudohyperkalemia in a Patient with Leukemia: A Diagnostic Pitfall in Emergency Medicine","authors":"Xin-Hong Lin MD ,&nbsp;Ying-Chen Hsu MD","doi":"10.1016/j.jemermed.2025.07.041","DOIUrl":"10.1016/j.jemermed.2025.07.041","url":null,"abstract":"<div><h3>Background</h3><div>Pseudohyperkalemia is characterized by a falsely elevated serum potassium concentration, often due to cellular disruption during blood sample collection, processing, or transport. Accurate differentiation between pseudohyperkalemia and true hyperkalemia is vital to prevent inappropriate treatment, which can lead to iatrogenic hypokalemia.</div></div><div><h3>Case Report</h3><div>We present a case of a 67-year-old woman with hypertension and T-cell prolymphocytic leukemia who presented to the emergency department with fever and hypotension. Initial laboratory results indicated hyperkalemia, acute kidney injury, metabolic acidosis, and extreme leukocytosis. Despite aggressive management for hyperkalemia, persistent elevation of potassium levels without electrocardiographic changes raised suspicion for pseudohyperkalemia. Subsequent investigations, including the use of different blood collection tubes, revealed disparate potassium concentrations, confirming pseudohyperkalemia due to potassium leakage from fragile leukemia cells. The patient's potassium levels normalized upon using clot-activator tubes, and she was discharged without complications.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>This case underscores the importance of recognizing pseudohyperkalemia, especially in patients with leukocytosis and incompatible clinical manifestations. Proper blood-sample collection and handling, along with awareness of confounding factors, are essential to prevent misinterpretation of laboratory results and avoid unnecessary treatments. In clinical settings, heparin tubes, while convenient, may contribute to pseudohyperkalemia in patients with fragile blood cells, such as those with leukemia, due to mechanical stress during sample processing. Early recognition and appropriate diagnostic approaches are crucial to ensure accurate patient management and avoid potential harm from unwarranted interventions.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"77 ","pages":"Pages 63-65"},"PeriodicalIF":1.3,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890958","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":"Emergency Department Preparedness in a Mega Mass Casualty Incident While Under Missile Fire: Lessons Learned From Israel on October 7, 2023","authors":"Baruch Berzon MD ,&nbsp;Debra West MBBS ,&nbsp;Eliana Jacobs ,&nbsp;Maximilian Nerlander MBBS ,&nbsp;Shaden Salameh MD, MHA ,&nbsp;Eran Talor MD ,&nbsp;Tzachi Slutsky MD ,&nbsp;Jonathan Rieck MD ,&nbsp;Evan Avraham Alpert MD","doi":"10.1016/j.jemermed.2025.07.032","DOIUrl":"10.1016/j.jemermed.2025.07.032","url":null,"abstract":"<div><h3>Background</h3><div>On October 7, 2023, approximately 2,500 Hamas terrorists infiltrated southern Israel from Gaza. Over 1,200 people were killed and 1600 were injured in the largest mass casualty incident (MCI) in Israel’s history. Emergency departments (EDs) throughout the country were overwhelmed with patients and working under missile fire. Injuries included high-velocity gunshot wounds, blast injuries, and burns.</div></div><div><h3>Objectives</h3><div>The objective of this article is to outline the lessons learned from the response of EDs in Israel to a large, multi-front MCI, in Israel known as a mega MCI, with a specific focus on the clinical care provided to patients in accordance with Israel’s National Hospital Disaster Preparedness Plan mandates.</div></div><div><h3>Methods</h3><div>This is a retrospective descriptive analysis of the implementation of Israel’s National Hospital Preparedness Plan to the events of October 7, 2023. The working group that performed this analysis are Israeli and international emergency physicians who are involved in disaster preparedness at either their hospital or on a national level. The study is based on institutional after-action reviews. Any data presented is from the Israel Ministry of Health.</div></div><div><h3>Results</h3><div>A total of 1632 victims from October 7 were seen at 19 EDs throughout the country from the morning of the mega MCI until midnight. The EDs of the Soroka Medical Center, and the Barzilai Medical Center saw the most patients- 624 and 323 respectively. Israel’s National Committee for Mass Casualty Incidents (NCMCI) sets comprehensive guidelines and supervises yearly mandatory comprehensive hospital-wide exercises related to MCIs. Based on this, the EDs were able to easily call in additional staff and critical patients were treated using a multidisciplinary approach. Additional patient care areas were opened. There were instances of compromised patient care due to large numbers of arriving patients. Also, there was a need for more secondary transfers.</div></div><div><h3>Conclusion</h3><div>Being the largest MCI in Israel’s history, October 7 tested the performance of the 19 EDs involved. Overall, staffing was sufficient and additional patient care areas were successfully opened. However, there were issues of compromised care and the need for increased numbers of secondary transfers. These lessons are important for the future management of MCIs in Israel and worldwide.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"77 ","pages":"Pages 130-139"},"PeriodicalIF":1.3,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989121","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":"Percutaneous Stellate Ganglion Block in Electrical Storm: A Scoping Review","authors":"Aravind Sreekumar MD,&nbsp;Irtiqa Sheikh MD,&nbsp;Sanjeev Bhoi MD","doi":"10.1016/j.jemermed.2025.07.040","DOIUrl":"10.1016/j.jemermed.2025.07.040","url":null,"abstract":"<div><h3>Background</h3><div>Electrical storm (ES) is characterized by recurrent ventricular dysrhythmias (RVDs) requiring emergent intervention, and associated with poor outcomes. They are classically refractory to conventional treatments like antidysrhythmics and defibrillation, mandating sympathetic blockade. Stellate ganglion block (SGB) is gaining prominence as a feasible bedside intervention, serving as a bridge to definitive management.</div></div><div><h3>Objective</h3><div>This scoping review evaluates the effectiveness and safety of percutaneous SGB in managing ES.</div></div><div><h3>Methods</h3><div>A systematic search was conducted across PubMed, Google Scholar, Embase, and DOAJ for studies from 2001 to 2024 that examined SGB’s role in treating ES. Inclusion criteria were studies involving human subjects, reporting clinical outcomes. Two independent reviewers screened titles and abstracts, followed by full-text evaluations. Data on demographics, procedural characteristics, and outcomes were extracted and analyzed. A total of 74 full-text articles were included, comprising 43 case reports, 15 case series, 13 cohort studies, and 4 systematic reviews.</div></div><div><h3>Results</h3><div>The most common trigger for ES was acute coronary syndrome. SGB was performed predominantly using ultrasound guidance. Bupivacaine and lidocaine were the most commonly used anesthetics. SGB effectively reduced VD episodes in 59–80% of cases, with dysrhythmia control lasting hours to several months. SGB seemed to improve short-term survival, without affecting long-term outcomes. Minor transient complications like hoarseness of voice were noted, but major complications were rare.</div></div><div><h3>Conclusion</h3><div>Percutaneous SGB appears promising for managing refractory ES, demonstrating efficacy in dysrhythmia control and a favorable safety profile. Further research, including observational studies and randomized controlled trials to study the efficacy and safety of the procedure, is essential to establish treatment protocols and investigate long-term benefits.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"78 ","pages":"Pages 89-104"},"PeriodicalIF":1.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080903","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 Unique and Unusual Umbilicus: A Case of an Infected Urachal Remnant","authors":"Joseph Minichiello MD ,&nbsp;Michelle Crispo MD","doi":"10.1016/j.jemermed.2025.07.042","DOIUrl":"10.1016/j.jemermed.2025.07.042","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"77 ","pages":"Pages 89-92"},"PeriodicalIF":1.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144895459","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":"Unexpected Challenges: A Case Report of Hantavirus Infection in a Pregnant Patient in a Rural Emergency Department","authors":"Rohan S. Janwadkar MD ,&nbsp;Haven M. Ritchie MD ,&nbsp;Clare A. Johnson MD","doi":"10.1016/j.jemermed.2025.07.045","DOIUrl":"10.1016/j.jemermed.2025.07.045","url":null,"abstract":"<div><h3>Background</h3><div>Hantavirus, transmitted primarily by rodents, can cause hantavirus cardiopulmonary syndrome (HCPS) and hemorrhagic fever with renal syndrome (HFRS).</div></div><div><h3>Case Report</h3><div>This case details a 28-year-old female, 6 weeks pregnant, who presented with fever to a rural emergency department (ED) in California. Initially, her symptoms were concerning for a possible urinary tract infection (UTI) or viral syndrome, and she was discharged. She returned to the same ED the next day and rapidly deteriorated to shock and cardiac arrest within hours. Serological testing later confirmed hantavirus infection.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>This case highlights the challenges in identifying and managing hantavirus infections in pregnant patients. An emergency physician should be aware of how to identify and manage HCPS as it has a rapid progression, high mortality rate, and nonspecific early symptoms that can be mistaken for more common illnesses. Emergency physicians should be aware of the management of HCPS in pregnant patients, as the interplay between the physiological adaptations of pregnancy and the pathological effects of the disease can significantly complicate acute resuscitation. These complexities heighten the risk of severe complications for both mother and fetus, underscoring the need for timely diagnosis, meticulous supportive care, and vigilant monitoring to avert potentially life-threatening outcomes.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"77 ","pages":"Pages 84-88"},"PeriodicalIF":1.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144893885","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 One-Sided Flood: A Case of Unilateral Pulmonary Edema","authors":"Mehul K MD, MBBS,&nbsp;Maithili Charan MD, MBBS,&nbsp;Soubhik Chakraborty MBBS","doi":"10.1016/j.jemermed.2025.07.048","DOIUrl":"10.1016/j.jemermed.2025.07.048","url":null,"abstract":"<div><div>Unilateral pulmonary edema (UPE) is an uncommon clinical presentation, accounting for approximately 2% of cardiogenic pulmonary edema cases, and often mimics pulmonary infections, leading to diagnostic delays. We report the case of a 51-year-old woman with rheumatic heart disease who presented with progressive dyspnea and pedal edema. Clinical findings suggested pulmonary edema, but chest radiography revealed predominantly left-sided congestion. Point-of-care ultrasound demonstrated a unilateral B-profile, and bedside transthoracic echocardiography identified severe mitral regurgitation with an eccentric jet directed toward the left pulmonary veins, led to elevated pulmonary venous pressure on left side, resulting in predominantly left sided pulmonary edema. The patient responded well to intravenous diuretics and non-invasive ventilatory support, with antibiotics discontinued after exclusion of infection. She was discharged in stable condition and scheduled for elective mitral valve replacement. This case highlights the diagnostic challenges of UPE, the pivotal role of point-of-care ultrasound in differentiating it from pneumonia, and the importance of considering both cardiac and infectious etiologies to optimize patient outcomes.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"77 ","pages":"Pages 127-129"},"PeriodicalIF":1.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144926238","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 Emergency Severity Index (ESI) Version 5: Simulation of Predictive Validity and Triage Level Distribution","authors":"Tanguy Espejo MD ,&nbsp;Florian F. Grossmann ,&nbsp;Henk B. Riedel MD ,&nbsp;Roland Bingisser MD ,&nbsp;Christian H. Nickel MD","doi":"10.1016/j.jemermed.2025.07.035","DOIUrl":"10.1016/j.jemermed.2025.07.035","url":null,"abstract":"<div><h3>Background</h3><div>The Emergency Severity Index (ESI) was updated to the 5th version which emphasizes identification of abnormal vital signs in low acuity patients (ESI levels 3, 4, and 5) to prevent undertriage.</div></div><div><h3>Objective</h3><div>We conducted a simulation of the ESI 5th version (sESI-v5) with data of consecutive emergency department (ED) patients to (1) investigate changes in triage level distribution caused by vital signs assessment, (2) investigate the predictive validity (assessing resource utilization, length of stay, disposition, and mortality), and (3) identify individual cases with potential benefits from the ESI update.</div></div><div><h3>Methods</h3><div>In this prospective cohort, ESI 4th version (ESI-v4) was used for triage. sESI-v5 was applied retrospectively, and predictive validity (resource utilization, ED length of stay, disposition, and mortality) was compared. Patients with potential benefits from sESI-v5 (uptriage from ESI-v4 level 3, 4, or 5 to sESI-v5 level 2 with admission to intensive care unit [ICU] or early death) were identified.</div></div><div><h3>Results</h3><div>In 6,230 adult ED patients, uptriage to ESI level 2 would have occurred in 636 patients (10.2%). The sESI-v5 showed a similar predictive validity to ESI-v4. We identified 30 (0.5%) patients with potential benefits from sESI-v5, as they were admitted to ICU or died within 30 days (29 were uptriaged from ESI-v4 level 3, 1 from ESI-v4 level 4, and none from ESI-v4 level 5).</div></div><div><h3>Conclusions</h3><div>Adopting ESI-v5 could increase the identification of high-risk patients but at the cost of significantly expanding the number of patients classified as ESI level 2. This shift may overwhelm ED resources and delay care for truly critical patients without clear evidence of improved outcomes. While ESI-v5 demonstrated similar predictive validity to ESI-v4, only a small subset of patients would have potentially benefited from the update.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"78 ","pages":"Pages 57-70"},"PeriodicalIF":1.3,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048238","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":"Chronic Dermal Isopropanol Exposure Resulting in Central Nervous System Depression in a Hemodialysis Patient","authors":"Megan Audette MD,&nbsp;Merritt Tuttle MD,&nbsp;Sehr Khan MD,&nbsp;Justin Corcoran MD","doi":"10.1016/j.jemermed.2025.07.036","DOIUrl":"10.1016/j.jemermed.2025.07.036","url":null,"abstract":"<div><h3>Background</h3><div>Isopropanol is a volatile alcohol that is easily accessed but generally not thought to cause significant toxicity. It has been shown to be dermally absorbed in the past, but typically not to a significant extent.</div></div><div><h3>Case Report</h3><div>We present a case of chronic dermal isopropanol exposure in a hemodialysis (HD) dependent patient that resulted in central nervous system depression due to chronic accumulation of acetone. Symptoms resolved following 3 hours of HD.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>Given that isopropanol and acetone are primarily renally cleared, patients with poor intrinsic renal function are at risk for developing significant toxicity beyond what would typically be expected from an isopropanol exposure.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"77 ","pages":"Pages 42-44"},"PeriodicalIF":1.3,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890959","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)00279-3","DOIUrl":"10.1016/S0736-4679(25)00279-3","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"75 ","pages":"Pages 342-343"},"PeriodicalIF":1.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680249","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}