Journal of Emergency Medicine最新文献

{"title":"Shedding Light: How One Family's Tragedy Became Another's Beacon.","authors":"Alexandra Reens","doi":"10.1016/j.jemermed.2024.10.007","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.10.007","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433047","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":"Use of an Endotracheal Tube for a Thoracostomy in a Child in Cardiac Arrest: A Case Report.","authors":"Kunj Bhatt, Jacob Ziff, Duncan Grossman, Julia Tokarski","doi":"10.1016/j.jemermed.2024.10.006","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.10.006","url":null,"abstract":"<p><strong>Background: </strong>Traditionally, when patients arrive at an emergency department in cardiac arrest with a concern for a pneumothorax, a thoracostomy tube is placed for decompression. A literature review found no case reports of an endotracheal tube being used in lieu of a thoracostomy tube for a pneumothorax in a child in cardiac arrest.</p><p><strong>Case report: </strong>A case of a 4-week-old female infant who presented to the emergency department in cardiac arrest with a pneumothorax is discussed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is important for clinicians to be aware of alternative management strategies for the management of a pneumothorax. This case suggests that an endotracheal tube being used as a thoracostomy tube in a child in cardiac arrest can help acutely treat a pneumothorax by providing immediate and continuous decompression. In a prehospital or low-resource setting, an endotracheal tube may offer benefits similar to a thoracostomy tube as an immediate treatment modality.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449251","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":"Down the Wrong Pipe: Tension Pneumoperitoneum from Esophageal Intubation.","authors":"Joshua Julian, Joseph Wendt, Tina Chen","doi":"10.1016/j.jemermed.2024.09.019","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.09.019","url":null,"abstract":"<p><strong>Background: </strong>Tension pneumoperitoneum (TPP) is a rare but life-threatening pathology in which significant accumulation of free air in the peritoneum pressurizes the abdominal cavity, creating conditions similar to abdominal compartment syndrome. Due to compression of intra-abdominal vasculature, TPP results in hemodynamic instability. While it most commonly occurs due to viscus perforation in the setting of recent endoscopy, gastric perforation from resuscitative efforts can also lead to TPP.</p><p><strong>Case report: </strong>We present a case of a 58-year-old female who was intubated out-of-hospital for unresponsiveness, then subsequently developed abdominal distension, mottled lower extremities, and hemodynamic instability. In the emergency department, the patient self-extubated for a brief time before suffering cardiac arrest. During resuscitative efforts, imaging showed significant abdominal free air concerning for tension pneumoperitoneum. The likely etiology was positive pressure ventilation after esophageal intubation, resulting in gastric perforation and rapid accumulation of air in the peritoneal cavity. Despite emergent abdominal needle decompression and prompt exploratory surgery, the patient expired. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: TPP is a critical pathology that should be on the differential for any patient with recent unverified intubation presenting with hemodynamic instability and abdominal distension. Abdominal needle decompression is a key intervention for the patient with TPP and should be in the emergency physician's skillset. It is also a reminder that intubated patients require confirmation of correct endotracheal tube placement to prevent negative outcomes.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414151","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":"Acute Stroke With Hyperdense Middle Cerebral Artery (MCA) Sign in an Adolescent Female With Tyrosine Kinase Inhibitor Treatment-What You Need to Know.","authors":"Maha Butt, Abdelazim Sirelkhatim, Aicha Medjhoul, Mohammad Fahad, Taimur S Butt","doi":"10.1016/j.jemermed.2024.09.018","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.09.018","url":null,"abstract":"<p><strong>Background: </strong>Acute stroke in an adolescent patient is a rare phenomenon. Tyrosine kinase inhibitors (TKIs) are newer targeted anticancer medications without widespread side effects typically associated with traditional chemotherapy. However, recent literature reveals several potential life-threatening side effects.</p><p><strong>Case report: </strong>We present an unusual case of acute stroke with hyperdense middle cerebral artery (MCA) sign, in a 16-year-old female with a history of rhabdomyosarcoma and recent treatment with pazopanib, a tyrosine kinase inhibitor (TKI). The patient developed sudden right-sided weakness at school. She was brought to the emergency department (ED) by her parents. Prompt diagnosis with noncontrast computed tomography (CT)-brain and CT angiogram of head and neck followed by immediate administration of thrombolytic treatment with alteplase and referral for mechanical thrombectomy resulted in a successful restoration of blood flow and a favorable clinical outcome. This paper highlights the importance of recognizing stroke symptoms in young patients with a history of malignancy, discusses the risks associated with TKI treatment, and the efficacy of the treatment modalities employed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be mindful of the many new targeted anticancer therapies and their potential deleterious side effects. Due to the lack of pediatric stroke guidelines, adult stroke guidelines may be applied in the management of adolescent patients with acute stroke. Emergency physicians should also be able to recognize a hyperdense MCA sign on a noncontrast CT scan of the brain in a patient presenting with anterior circulation stroke symptoms.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433024","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":"Aortic Laceration From Posterior Rib Fractures After a Ground-Level Fall: A Case Report.","authors":"Benjamin Travers, Laura Murphy","doi":"10.1016/j.jemermed.2024.09.020","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.09.020","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Case report: </strong>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. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: 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.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-10-11","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}

{"title":"Outcomes for Emergency Presentations of Lung Cancer: A Scoping Review.","authors":"Nicholas Pettit, Marissa Vander Missen, Andrea Noriega, Rebecca Lash","doi":"10.1016/j.jemermed.2024.09.015","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.09.015","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer is frequently detected during visits to the emergency department (ED). The ED is crucial for identifying likely cases of lung cancer and coordinating the subsequent care for these patients.</p><p><strong>Objectives: </strong>This scoping review aims to explore the definitions of emergency presentations (EPs) of lung cancer, along with mortality rates, cancer stage, and treatments for patients diagnosed with lung cancer following an EP.</p><p><strong>Methods: </strong>We conducted a scoping review of the literature on EPs of lung cancer, identifying 27 relevant articles out of 1338 initially screened.</p><p><strong>Results: </strong>Most studies originated from the United Kingdom, collectively reporting over 270,000 EPs of lung cancer. The majority of included studies provided strong evidence. Key findings revealed higher mortality rates among patients diagnosed with lung cancer through emergency presentations, with a significant proportion presenting at advanced stages. Patients with EPs were less likely to undergo surgical removal or receive radiotherapy. Lastly, only 66.7% of the studies defined an EP, with great heterogeneity among EP definitions. Methodological differences precluded meta-analysis.</p><p><strong>Conclusion: </strong>Despite methodological heterogeneity, our synthesis indicates that patients presenting acutely with undiagnosed lung cancer often present at advanced stages and experience high mortality rates. These findings underscore the need for further research to develop evidence-based interventions for improving outcomes among ED patients with suspected lung cancer.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408698","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":"Severe Salicylate Poisoning Due to Teaberry Flavoring Ingestion: A Case Report.","authors":"Jarod Berggren, Chase Jones, Kenneth D Katz","doi":"10.1016/j.jemermed.2024.09.022","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.09.022","url":null,"abstract":"<p><strong>Background: </strong>There are currently many commercial uses for methyl salicylate, including fragrances, flavoring, topical pain relief, and polymer restoration. Most recorded cases of human toxicity due to methyl salicylate are the result of topical or accidental exposures. However, this is a previously unreported case of an adult patient who intentionally ingested teaberry flavoring, causing life-threatening salicylism.</p><p><strong>Case report: </strong>A 22-year-old man presented to the emergency department with the chief symptoms of nausea, vomiting, and abdominal pain. Triage nursing noted the patient's vomit smelled strongly of wintergreen. Further history indicated the patient had ingested approximately 40 mL of teaberry oil while using it to make ice cream. The initial serum salicylate concentration was 111 mg/dL. The medical toxicology team was consulted, and the patient was given a singular dose of activated charcoal by mouth. He was also administered both an intravenous sodium bicarbonate bolus and sodium bicarbonate infusion. He was admitted to the intensive care unit and the nephrology service was consulted to initiate emergent hemodialysis. After the single hemodialysis treatment with concomitant serum and urine alkalization, the patient had progressive improvement of salicylate concentrations. He was discharged on hospital day 3 in normal condition. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be aware of novel etiologies of life-threatening salicylate poisoning.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425486","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 Rare Case of Tetanus With Early Manifestation of Apnea But Without Trismus.","authors":"Tsutomu Yasuda, Yasuhiro Kimura, Mizuki Kitamura, Takahiro Nakayama, Hideo Nishizawa, Ichiro Imafuku","doi":"10.1016/j.jemermed.2024.09.023","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.09.023","url":null,"abstract":"<p><strong>Background: </strong>Tetanus is a life-threatening disease caused by tetanus neurotoxin (TeNT) produced by Clostridium tetani. Early symptoms of tetanus are trismus and muscle stiffness, both caused by spasticity. TeNT mainly exerts its effect by impairment of inhibitory neurons in the spine and brainstem, resulting in the hyperactivity of motor neurons, which causes spasticity and muscle spasms. Apnea is not a symptom that is predicted to occur in the early stages.</p><p><strong>Case report: </strong>We present a rare case of severe tetanus with an early manifestation of apnea but without trismus. We believe that apnea was caused by spasms of the intercostal muscles and its early manifestation was due to a high load of TeNT, considering that the speed of disease progression is related to disease severity. We hypothesize that the absence of trismus was also due to a high load of TeNT, exerting toxic effect at the neuromuscular junction and causing flaccid paralysis of the masseters. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Since there is no diagnostic laboratory test for tetanus, emergency physicians must be well aware of symptoms that may or may not appear in tetanus. Tetanus should be considered as a differential diagnosis for patients arriving at the emergency department with apnea as an early symptom. The absence of trismus should not rule out the possibility of tetanus.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414134","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, Vicken Y Totten, Marna Rayl Greenberg, Gentry Wilkerson, John T Finnell, Wayne Bond Lau, James R Miner, James P d'Etienne, Jason D Brenner, Pridha Kumar, Carlos A Camargo","doi":"10.1016/j.jemermed.2024.10.002","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.10.002","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Evidence review: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-10-10","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":"A Retrospective Cohort Study of Tranexamic Acid Administration for the Treatment of Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema in the Emergency Department.","authors":"Michael Loewe, Eric Rowley, Joel Mosley, Benjamin Gibson, Michael Cerjance, Elizabeth Pearson, Greggory Davis","doi":"10.1016/j.jemermed.2024.10.001","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.10.001","url":null,"abstract":"<p><strong>Background: </strong>Treatment options for angiotensin-converting enzyme inhibitor-induced angioedema (ACEi-AE) are primarily limited to airway monitoring and protection with intubation. The efficacy of tranexamic acid (TXA) in this context remains poorly understood.</p><p><strong>Objective: </strong>Examine outcomes among patients treated with and without TXA for ACEi-AE.</p><p><strong>Methods: </strong>A retrospective cohort study conducted in two hospitals examined emergency department patients with suspected ACEi-AE from 2017 to 2021. Primary outcomes included intensive care unit (ICU) admission, intubation, days intubated, time to administration of TXA, surgical airway required, and death in patients that received TXA compared with those that did not.</p><p><strong>Results: </strong>Of 336 eligible patients, 37 received TXA and 299 did not. ICU admission rate was significantly higher in the TXA group (57%) vs. the no-TXA group (15%), odds ratio (OR) 7.61 (95% confidence interval [CI] 3.69-15.70). There were significantly more intubations in the TXA group (20%) vs. the no-TXA group (5.7%), OR 3.87 (95% CI 1.49-10.08). The median time to TXA administration was 51 min (interquartile range 34-131). The number of days intubated, surgical airway, and 30-day mortality were not significantly different in the TXA group compared with the no-TXA group.</p><p><strong>Conclusion: </strong>TXA use did not improve many of the clinical outcomes involved in the treatment of ACEi-AE. One interpretation of these results may be that TXA use was associated with patients who presented with more severe disease, as TXA use was up to the discretion of the treating physician. Randomized controlled trials are needed to clarify the efficacy of TXA use in ACEi-AE.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425422","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}