Journal of Emergency Medicine最新文献

{"title":"Distinguishing Peripheral from Central Causes of Dizziness and Vertigo without using HINTS or STANDING","authors":"Jonathan A. Edlow MD, FACEP","doi":"10.1016/j.jemermed.2024.06.009","DOIUrl":"10.1016/j.jemermed.2024.06.009","url":null,"abstract":"<div><div>Three validated diagnostic algorithms for diagnosing patients with acute onset dizziness or vertigo (HINTS, HINTS-plus and STANDING) exist. All are extremely accurate in distinguishing peripheral from central causes of dizziness when done by experienced clinicians. However, uptake of these diagnostic tools in routine emergency medicine practice has been sub-optimal, in part, due to clinicians’ unease with the head impulse test, the most useful component contained of these algorithms. Use of these validated algorithms is the best way to accurately diagnose patients with acute dizziness. For clinicians who are unfamiliar with or uncomfortable performing or interpreting HINTS and STANDING, this article will suggest alternative approaches to help with accurate diagnosis of patients with acute dizziness or vertigo.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e622-e633"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141707458","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":"Increased Human Chorionic Gonadotropin Level in a Nonsexually Active Young Female","authors":"Natalie Mira Elder MD, PharmD,&nbsp;Ashley McCormick DO","doi":"10.1016/j.jemermed.2024.07.020","DOIUrl":"10.1016/j.jemermed.2024.07.020","url":null,"abstract":"<div><h3>Background</h3><div>Quantitative and qualitative human chorionic gonadotropin (hCG) tests are obtained in the emergency department (ED) to determine if a female of child-bearing age is pregnant. A positive hCG result is commonly assumed to indicate an intrauterine or other form of pregnancy. However, elevated hCG levels can also result from various other conditions, such as ovarian tumors, pituitary tumors, and thyroid disorders. Intracranial germ cell tumors, rare central nervous system tumors capable of secreting hCG, primarily affect adolescent and young adult females.</div></div><div><h3>Case Report</h3><div>A 16-year-old female student without significant past medical history presented to our ED with a complaint of intermittent bilateral frontal headache for two days. Last menstrual period started two days prior to presentation. The headache was associated with phonophobia, photophobia, nausea, and vomiting. Serum quantitative hCG was elevated. She denied history of sexual activity or sexual assault. Transabdominal ultrasound was negative for intrauterine pregnancy. Obstetrics and gynecology as well as pediatric oncology were consulted. Subsequent investigations, including brain imaging, revealed a 3.5 cm mass in the right caudate nucleus and corpus callosum. The patient was diagnosed with an intracranial nongerminomatous germ cell tumor, necessitating hospitalization and prompt initiation of chemotherapy.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>An elevated quantitative hCG is not always indicative of pregnancy, especially in a young patient without sexual history. In the case of a nonrevealing transabdominal ultrasound, obstetrics and gynecology should be consulted for discussion of further testing and imaging. Emergency physicians should include malignancy high on their differential since prompt initiation of chemotherapy, evaluation by surgical services, and family planning will be required.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e569-e571"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145772","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":"Anoxic Brain Injury: A Subtle and Often Overlooked Finding in Non-Fatal Intimate Partner Strangulation","authors":"Sean Dugan MD, FAAP ,&nbsp;Michelle Patch PhD, APRN-CNS, DF-AFN, FAAN ,&nbsp;Taman Hoang MD, MS ,&nbsp;Jocelyn C. Anderson PhD, RN, SANE-A","doi":"10.1016/j.jemermed.2024.06.006","DOIUrl":"10.1016/j.jemermed.2024.06.006","url":null,"abstract":"<div><h3>Background</h3><div>A paucity of literature exists dedicated to the identification of anoxic brain injury in patients that survive non-fatal intimate partner strangulation (NF-IPS). While some individuals report experiencing symptoms of brain hypoxia followed by a loss of consciousness, other individuals report symptoms of brain hypoxia prior to amnesia, rendering some unable to recall loss of consciousness (LOC).</div></div><div><h3>Objective</h3><div>Using a standardized clinical assessment tool, the purpose of this retrospective analysis is to describe anoxic brain injury symptom prevalence in a sample of patients reporting NF-IPS.</div></div><div><h3>Methods</h3><div>One hundred and ninety-one unique patients, reporting a total of 267 strangulation events, were assessed by a member of the Shasta Community Forensic Care Team utilizing the Strangulation Hypoxia Anoxia Symptom TBI Assessment (SHASTA) tool. The sample is 98% female and includes adult patients ages 18–68. Examination records were categorized based on the presence or absence of hypoxia and anoxia symptoms. This manuscript utilizes the STROBE checklist.</div></div><div><h3>Results</h3><div>Amnesia was reported in 145 of the 267 strangulations (54.3%). Of those, 74 reported LOC (51.0%) while 71 did not recall LOC (49.0%).</div></div><div><h3>Conclusions</h3><div>Within our sample, 49% of patients with amnesia did not recall losing consciousness, demonstrating that LOC is an imperfect measure of anoxia for patients following NF-IPS. Healthcare providers examining NF-IPS patients should inquire about additional symptoms of hypoxia and amnesia, which can be captured on the SHASTA tool.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e599-e607"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289280","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 Role of Language in Hospital Admissions: The COVID-19 Experience in a Safety-Net Hospital Emergency Department","authors":"Emily Bacon PhD ,&nbsp;Molly E. Thiessen MD ,&nbsp;Jody Vogel MD, MSc ,&nbsp;Jennifer Whitfield MD, MPH ,&nbsp;Lilia Cervantes MD ,&nbsp;Laura Jean Podewils MS, PhD","doi":"10.1016/j.jemermed.2024.06.004","DOIUrl":"10.1016/j.jemermed.2024.06.004","url":null,"abstract":"<div><h3>Background</h3><div>Emergency departments (EDs) are often patients’ first point of contact with the health care system. Race, ethnicity, and language all influence factors leading up to ED visits and patient experiences within the ED. There is limited evidence showing how race, ethnicity, and language interact to shape ED experiences, particularly during the COVID-19 pandemic when EDs were extremely strained.</div></div><div><h3>Objectives</h3><div>Using a retrospective review, we evaluated the association of race, ethnicity and preferred language on hospital admissions from the ED for patients with COVID-19 in an urban, safety-net hospital during the first year of the COVID-19 pandemic before vaccines were widely available.</div></div><div><h3>Methods</h3><div>We performed a nested regression analysis using generalized estimating equation (GEE) logit models to estimate the impact of language, race, and ethnicity on hospital admissions while controlling for other health conditions and healthcare utilization.</div></div><div><h3>Results</h3><div>Patients who spoke Spanish and were Latino had 72% higher odds [95% confidence interval (CI):1.34–2.2] of hospital admission compared to patients who were White and spoke English. Patients who were Asian, the majority of whom also spoke languages other than English, had 130% higher odds (95% CI: 1.39–3.92) of hospital admission compared to patients who were White and English Speaking.</div></div><div><h3>Conclusions</h3><div>Findings suggest multiple mechanisms influence hospital admissions for patients who are racially and ethnically minoritized and speak Spanish. Providers may have admitted patients as a precaution rather than because of more advanced illness. Evaluating race, ethnicity, and language concurrently can reveal how intersectional factors shape patient experiences in the ED.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e578-e589"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141404205","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":"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":"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":"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}