Journal of Emergency Medicine最新文献

{"title":"Doctors, Drop the Jargon: A Case Against Endorsing Symptoms, Appreciating Disease and Blaming Patients","authors":"Tim Bongartz MD, MS","doi":"10.1016/j.jemermed.2025.07.025","DOIUrl":"10.1016/j.jemermed.2025.07.025","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"76 ","pages":"Pages 7-8"},"PeriodicalIF":1.3,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738999","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":"Chilaiditi Syndrome Caused by Fitz-Hugh-Curtis: Ultrasound and Computed Tomography Findings","authors":"Colm Michael Mulvany MD ,&nbsp;Andrew Nguyen MD ,&nbsp;Sarah Bella DO","doi":"10.1016/j.jemermed.2025.07.023","DOIUrl":"10.1016/j.jemermed.2025.07.023","url":null,"abstract":"<div><h3>Background</h3><div>Chilaiditi Syndrome (CS) is the entrapment of the small bowel or colon between the liver and right hemidiaphragm. Risk factors include anatomical distortions of the right upper quadrant, such as adhesions from the anterior hepatic capsule.</div></div><div><h3>Case Report</h3><div>A 50-year-old female with no prior surgical history presented to our emergency department (ED) complaining of right upper quadrant pain. Point of care ultrasound (POCUS) findings were concerning for a bowel obstruction. Contrast-enhanced computed tomography (CT) abdomen and pelvis demonstrated incarcerated small bowel loops into the hepatodiaphragmatic space characteristic of CS and on subsequent laparoscopy adhesions characteristic of Fitz-Hugh-Curtis Syndrome (FHCS) were identified and lysed.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This</h3><div>This case demonstrates the utility of POCUS in visualizing a rare form of bowel obstruction and in identifying CS, in this instance secondary to FHCS.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"77 ","pages":"Pages 34-37"},"PeriodicalIF":1.3,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885959","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 Potential and Pitfalls of ChatGPT in Toxicological Emergencies","authors":"Caglar Kuas MD ,&nbsp;Mustafa Emin Canakci MD ,&nbsp;Nurdan Acar MD ,&nbsp;Altug Kanbakan MD ,&nbsp;Murat Cetin MD ,&nbsp;Ertug Gunsoy MD","doi":"10.1016/j.jemermed.2025.07.002","DOIUrl":"10.1016/j.jemermed.2025.07.002","url":null,"abstract":"<div><h3>Background</h3><div>Poisoning cases involve a wide variety of toxic agents and remain a significant concern for emergency departments. Rapid and accurate intervention is crucial in these cases; however, emergency physicians often face challenges in accessing and applying up-to-date toxicology information in a timely manner. ChatGPT, an AI language model, shows promise as a diagnostic aid in healthcare settings, offering potentially valuable support in the management of toxicological emergencies.</div></div><div><h3>Objectives</h3><div>In this study, we aimed to evaluate the potential of ChatGPT in answering toxicology study guide questions, simulating its utility as a decision-support tool.</div></div><div><h3>Methods</h3><div>This study involves an evaluation of ChatGPT's performance in answering toxicology study guide questions from the Study Guide for Goldfrank's Toxicologic Emergencies, designed to simulate its utility as a decision-support tool in toxicological emergencies. ChatGPT's responses were compared with the accuracy rates of responses from medical trainees using the same toxicology study guide questions. This accuracy rate is categorized as human response.</div></div><div><h3>Results</h3><div>ChatGPT correctly answered 89% of the toxicology questions, outperforming human responders, who had a mean accuracy rate of 56%. However, ChatGPT was less accurate in responding to pediatric and complex case-based questions, highlighting areas where AI models may require further refinement.</div></div><div><h3>Conclusion</h3><div>The study suggests that ChatGPT has substantial potential as an assistive tool for emergency physicians managing toxicological emergencies, particularly in high-stress and fast-paced environments. Despite its strong performance, the AI model's limitations in handling specific clinical scenarios indicate the need for continuous improvement and careful application in medical practice.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"76 ","pages":"Pages 17-25"},"PeriodicalIF":1.3,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144771060","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":"Risk Factors of Peri-Intubation Cardiac Arrest in Critically Ill Patients Presenting to the Emergency Department of a Low-Income Country: A Case-Control Study","authors":"Noman Ali FCPS ,&nbsp;Nazir Najeeb Kapadia FCPS ,&nbsp;Salman Muhammad Soomar MSc ,&nbsp;Ahmed Raheem MSc ,&nbsp;Naheed Habibullah MBBS ,&nbsp;Zahra Habib BSN ,&nbsp;Shahan Waheed PhD","doi":"10.1016/j.jemermed.2025.07.018","DOIUrl":"10.1016/j.jemermed.2025.07.018","url":null,"abstract":"<div><h3>Background</h3><div>Peri-intubation cardiac arrest incidence ranges from 0.5% to 4.2%, and the risk factors include pre-intubation hypotension, hypoxemia, metabolic acidosis, and elevated shock index. Gaps exist in understanding laboratory parameters, indications for airway protection, and the predictive value of pre-intubation modified shock index for peri‑intubation cardiac arrest.</div></div><div><h3>Study Objective</h3><div>This study aims to identify the risk factors associated with peri‑intubation cardiac arrest in patients presenting to the Emergency Department who require emergent airway protection.</div></div><div><h3>Methods</h3><div>This matched case-control study was conducted at the Emergency Department of a tertiary care hospital from January 2019 to December 2022. All adult patients requiring emergency airway management were included in the study. Cases were defined as patients who experienced cardiac arrest within 20 minutes of induction agent administration. Each case was matched with four adult controls based on age and gender (1:4 ratio). Multivariable logistic regression was performed to identify the risk factors for peri‑intubation cardiac arrest.</div></div><div><h3>Results</h3><div>The study included 47 cases and 188 matched controls. Multivariable regression analysis revealed that pre-intubation modified shock index of ≥ 1.3 (OR: 5.61; 95% CI: 1.9–16.5), lactic acid of ≥ 2 mmol/L (OR: 4.24; 95% CI: 1.46–12.27), arterial blood PH &lt;7.30 (OR:2.58; 95% CI = 1.04–6.39), arterial partial pressure of oxygen &lt;55 mmHg (OR: 5.13; 95% CI: 2.39–10.31), septic shock (OR:5.76; 95% CI: 2.93–17.18), and cardiogenic pulmonary edema (OR:5.76; 95% CI: 2.31–15.13) were predictors of peri‑intubation cardiac arrest.</div></div><div><h3>Conclusion</h3><div>It is imperative to implement therapeutic interventions aimed at reducing risk factors to prevent occurrences of peri‑intubation cardiac arrest.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"76 ","pages":"Pages 26-32"},"PeriodicalIF":1.3,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144771061","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":"Impact of Education for Paramedic-Performed Point-of-Care Ultrasound for Cardiac Function Evaluation: A Pilot Study Assessing Imaging Quality and Interpretation","authors":"Jaelle L. Thorne ,&nbsp;Taylor LaRese MD ,&nbsp;Katie Rong MD ,&nbsp;Catriana R. Thorne ,&nbsp;Lindsay Adelson MD ,&nbsp;Ryan Antonowicz ,&nbsp;Thomas Latosek MD ,&nbsp;Regina Kostyun PhD ,&nbsp;Meghan Kelly Herbst MD","doi":"10.1016/j.jemermed.2025.07.015","DOIUrl":"10.1016/j.jemermed.2025.07.015","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac point-of-care ultrasound (cPoCUS) can detect occlusive myocardial infarction (OMI) in the absence of diagnostic electrocardiogram (ECG) by assessment of left ventricle (LV) function. The feasibility of cPoCUS to assess LV function in the prehospital setting is unknown.</div></div><div><h3>Study Objective</h3><div>To determine image adequacy and interpretation accuracy of paramedics performing cPoCUS for assessment of LV function and wall motion abnormality (WMA).</div></div><div><h3>Methods</h3><div>This was a prospective observation pilot study of ultrasound-naïve paramedics who participated in a clinical education program to identify OMI and performed cPoCUS during transport of adult patients. Primary outcomes were proportion of patients with 12-lead ECG who received cPoCUS, quality of images obtained, and paramedic interpretations (overall LV function and presence of a WMA). Sensitivity and specificity for LV function and WMA were calculated along with Cohen’s kappa (κ) comparing paramedic interpretation to ultrasound fellowship-trained emergency physicians.</div></div><div><h3>Results</h3><div>Of paramedics who passed a clinical evaluation (<em>n</em> = 14) and written test (<em>n</em> = 10), six opted to participate. Of the 201 eligible cases, 88.6% received cPoCUS during their transport to the hospital. Adequate views for LV function and WMA were obtained among 61.2% and 38.8% of patients, respectively. Accurate paramedic interpretations for LV function and WMA were made among 83/94 (88.3%) and 54/56 (96.4%) patients, respectively. There was moderate agreement between paramedics and physicians on LV function (κ = 0.41), with 41.7% sensitivity and 95.1% specificity. No patients presented with WMA.</div></div><div><h3>Conclusion</h3><div>With brief training, paramedics were able to acquire adequate cPoCUS images for LV function assessment, and interpretations were largely accurate.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"76 ","pages":"Pages 33-40"},"PeriodicalIF":1.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144771155","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":"Optimizing Mortality Prediction in Critical Care: Synergistic Value of Serum Uric Acid and APACHE II Score Assessment","authors":"Yugeng Liu ,&nbsp;Jia Wang ,&nbsp;Junyu Wang ,&nbsp;Bing Wei","doi":"10.1016/j.jemermed.2025.07.014","DOIUrl":"10.1016/j.jemermed.2025.07.014","url":null,"abstract":"<div><h3>Background</h3><div>Uric acid (UA) has dual roles as both an antioxidant and pro-oxidant, with its levels linked to either protective or harmful effects depending on concentration and clinical context. While extreme UA levels correlate with poor outcomes in critical care, integrating UA with clinical scores like APACHE II may improve risk stratification for intensive care unit (ICU) patients.</div></div><div><h3>Study Objectives</h3><div>This retrospective cohort study investigated the prognostic significance of admission UA levels combined with APACHE II scores in critically ill patients.</div></div><div><h3>Methods</h3><div>We analyzed 380 patients admitted to the Emergency Intensive Care Unit (EICU) at our Hospital from 2015 to 2021, tracking 28-day postdischarge mortality. Clinical parameters including APACHE II scores, UA, procalcitonin (PCT), C-reactive protein (CRP), D-dimer, creatinine (Cr), white blood cells (WBC), and platelets (PLT) were recorded within 24 h of admission. Multivariate regression models and receiver operating characteristic (ROC) curve analysis were employed for statistical evaluation.</div></div><div><h3>Results</h3><div>The nonsurvival group (n = 72) demonstrated significantly elevated age (68.2 ± 12.1 vs 62.5 ± 15.3 years, <em>p</em> &lt; 0.01), APACHE II scores (24.6 ± 7.2 vs 16.8 ± 6.5), and UA levels (456.3 ± 178.4 vs 342.1 ± 152.6 µmol/L) compared to survivors (n = 308). Multivariate analysis identified APACHE II (OR = 1.32, 95% CI 1.18–1.47, <em>p</em> &lt; 0.001) and UA (OR = 1.01, 95% CI 1.003–1.018, <em>p</em> = 0.007) as independent mortality predictors. The combined UA-APACHE II model achieved superior prognostic accuracy (AUC = 0.788) compared to either parameter alone (UA AUC = 0.627; APACHE II AUC = 0.767).</div></div><div><h3>Conclusions</h3><div>Admission UA levels synergistically enhance the prognostic value of APACHE II scores for mortality prediction in EICU patients. This biomarker combination provides a potentially clinically actionable approach for risk stratification in critical care management.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"76 ","pages":"Pages 79-87"},"PeriodicalIF":1.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826439","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":"Pilot Study Identifying Predictive Factors of Diuretic Effectiveness in Emergency Department Patients with Fluid Overload","authors":"Christoph Hüser MD ,&nbsp;Lena Hartnack MD ,&nbsp;Matthias Johannes Hackl MD ,&nbsp;Sadrija Cukoski MD ,&nbsp;Sascha Macherey-Meyer MD ,&nbsp;Christoph Adler MD ,&nbsp;Kathrin Möllenhoff PhD ,&nbsp;Victor Suárez MD ,&nbsp;Volker Burst MD","doi":"10.1016/j.jemermed.2025.07.013","DOIUrl":"10.1016/j.jemermed.2025.07.013","url":null,"abstract":"<div><h3>Background</h3><div>Effective diuretic therapy in emergency department (ED) patients with fluid overload is challenging.</div></div><div><h3>Objectives</h3><div>The objective of this study was to evaluate clinical and laboratory parameters for predicting an adequate response to initial diuretic therapy in ED patients with edema.</div></div><div><h3>Methods</h3><div>In this prospective, observational study, patients presenting to the ED of a tertiary hospital with edema of cardiac or renal cause were included. Intravenous furosemide was administered according to a prespecified protocol and urine output was recorded. Group comparison and univariable logistic regression analyses were performed to explore the predictive impact of various clinical and laboratory factors on diuretic success defined as urine volume ≥ 600 mL in the first 6 h vs. failure (&lt; 600 mL in the first 6 h)—focusing on urinary sodium and conductivity as a simple and inexpensive test.</div></div><div><h3>Results</h3><div>A total of 101 patients were analyzed. The median 6-h urine output was 1100 mL (interquartile range 600, 1700). A higher systolic blood pressure, estimated glomerular filtration rate, urine sodium, and urine electrical conductivity were each associated with achieving at least 600 mL urine output in 6 h. In univariable analysis, a urine sodium threshold of &gt; 72.5 mmol/L and a urine conductivity &gt; 12.0 mS/cm showed a positive predictive value of 93% and 89%, for sufficient diuresis.</div></div><div><h3>Conclusions</h3><div>Urine sodium and urine electrical conductivity were associated with diuretic success in this pilot study. As these parameters can be determined prior to treatment initiation, their value as predictive markers should be evaluated in further studies.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"76 ","pages":"Pages 9-16"},"PeriodicalIF":1.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144771097","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":"Workplace Violence in an Urban Community Emergency Department: A Deeper Dive into the Antecedents and Circumstances of Violent Behaviors","authors":"Alice K. Bukhman MD, MPH ,&nbsp;Kathleen C. Clifford BA ,&nbsp;Joshua W. Joseph MD, MS, MBE ,&nbsp;Naomi Schmelzer MD, MPH ,&nbsp;Paul Chen MD, MBA ,&nbsp;Regan Marsh MD, MPH ,&nbsp;Da’Marcus Baymon MD ,&nbsp;Thiago Oliveira MD, MPH ,&nbsp;Beth Waters RN, MSN, CPEN ,&nbsp;Leon D. Sanchez MD, MPH ,&nbsp;Thea Patterson RN ,&nbsp;Wendy L. Macias-Kostantopoulos MD, MPH, MBA ,&nbsp;Dana Im MD, MPHIL, MPP","doi":"10.1016/j.jemermed.2025.07.012","DOIUrl":"10.1016/j.jemermed.2025.07.012","url":null,"abstract":"<div><h3>Background</h3><div>Workplace violence (WPV) in emergency departments (EDs) is a growing concern, with significant impacts on staff safety and patient care. While previous studies have largely focused on tertiary care centers, data on WPV in community EDs remain limited. Understanding the characteristics and circumstances surrounding WPV events is critical for developing effective prevention and mitigation strategies.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study of WPV incidents at an urban community teaching hospital ED in Boston, Massachusetts, from January 2021 to April 2023. Using hospital police and security and risk management databases, we identified cases involving completed physical violence against staff. Chart reviews were performed to extract demographic, clinical, and encounter-related data. Circumstances surrounding the violent episodes, including psychiatric holds, substance use, length of stay, and use of pharmacologic and physical interventions, were analyzed.</div></div><div><h3>Results</h3><div>During the 28-month study period, 58 unique ED encounters involved at least one physical assault, resulting in 121 distinct assault incidents. Most patients involved in WPV had significant psychiatric comorbidities, with 50% diagnosed with a schizophrenia spectrum disorder and 70% on involuntary psychiatric holds. Boarding for psychiatric placement was a major risk factor, with 78% of assaults occurring during prolonged ED stays. Most incidents were triggered by behavioral redirection or agitation management. Nurses (46%) and security officers (42%) were the most frequent victims. Pharmacologic interventions were inconsistently administered before assaults, and a substantial proportion of patients ultimately exhibited clinical improvement.</div></div><div><h3>Conclusion</h3><div>WPV in the ED disproportionately involves patients with significant psychiatric illness, prior trauma, and social vulnerability. Psychiatric boarding and prolonged ED stays appear to be key contributors to violent incidents in the community setting. Our findings highlight the need for systemic interventions, including improved psychiatric bed access, structured agitation management strategies, and staff training in de-escalation.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"77 ","pages":"Pages 1-13"},"PeriodicalIF":1.3,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144866512","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":"Early Intubation of Injured Children with Altered Mental Status","authors":"James A. Meltzer MD MS ,&nbsp;Anna Liveris MD ,&nbsp;Stephen M. Blumberg MD ,&nbsp;Srinivas H. Reddy MD","doi":"10.1016/j.jemermed.2025.07.003","DOIUrl":"10.1016/j.jemermed.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Emergency resuscitation guidelines recommend early intubation for injured patients with a Glasgow Coma Scale (GCS) score of ≤8. Supportive research is lacking, particularly in children.</div></div><div><h3>Objective</h3><div>To determine if injured children with a GCS of ≤8 who are intubated early after Emergency Department (ED) arrival have a lower morbidity and mortality when compared to those that are not.</div></div><div><h3>Methods</h3><div>This was a retrospective study of injured children &lt;18 years with a GCS ≤8 from the National Trauma Data Bank (2017 to 2021). Patients were classified as receiving early intubation if they were intubated within 1 hour of ED arrival. The main outcomes were 24-hour and 30-day mortality as well as poor functional outcome. To adjust for potential confounding, propensity score inverse probability weighting was used.</div></div><div><h3>Results</h3><div>Of the 25,355 injured children with a GCS ≤8, 6698 patients were eligible for analysis. The median age was 14 years (IQR 6, 16) and 4579 (68%) were male. A total of 4883 (73%) were intubated in the first hour of arrival to the ED. After propensity score weighting, we found no significant difference in 24-hour mortality (adjusted risk difference [ARD], 0.1% [95% CI: −2.0, 2.3]) or risk of poor functional outcome (ARD, 2.6% [95% CI: −0.2, 5.5]), between those who were intubated in the first hour compared to those who were not. Patients who were intubated in the first hour had a small but significantly higher 30-day mortality risk (ARD, 3.1% [95% CI: 0.7, 5.4]).</div></div><div><h3>Conclusion</h3><div>This study questions the guidance that all injured children with GCS ≤8 should be intubated upon arrival.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"78 ","pages":"Pages 78-88"},"PeriodicalIF":1.3,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080889","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 Encounter: Locally Acquired Furuncular Myiasis (Botfly) in Ohio","authors":"Thomas Rench MD ,&nbsp;Paul Orefice MD ,&nbsp;Erin L. Simon DO","doi":"10.1016/j.jemermed.2025.07.005","DOIUrl":"10.1016/j.jemermed.2025.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Furuncular myiasis is a rare parasitic infestation caused by fly larvae in the skin, typically presenting as painful, inflammatory nodules. In the United States, the most common causative agent is <em>Dermatobia hominis</em> (human botfly), though autochthonous cases are exceedingly rare. These are caused by the rodent botfly <em>Cuterebra</em>, which is endemic to North America. Humans are incidental hosts, often through outdoor activities near rodent burrows. Diagnosis can be challenging, as it may resemble more common conditions such as an abscess or cellulitis.</div></div><div><h3>Case Report</h3><div>A 28-year-old female presented to the emergency department with swelling, erythema, and intermittent pain in the left cheek, following a suspected insect bite during a camping trip in Northeast Ohio. Despite treatment for a suspected abscess, the lesion worsened, and the patient reported movement under the skin. Ultrasound confirmed a 2cm larva with spicules, consistent with furuncular myiasis. The larva was successfully removed via a small incision under local anesthesia. Postprocedure, the wound was cleaned, sutured, and dressed, and the patient was discharged with antibiotics and follow-up instructions.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>Furuncular myiasis, though rare in the U.S., should be considered when a patient presents with a slow-growing nodule following outdoor activities. Diagnosis can be made quickly using point-of-care ultrasound (POCUS), which can differentiate myiasis from common soft tissue infections like abscesses. Early identification enables appropriate management and prevents unnecessary interventions, such as prolonged antibiotic therapy. Emergency physicians should be aware of this rare but significant condition, especially in patients with a history of outdoor exposure or travel to Central or South America.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"77 ","pages":"Pages 30-33"},"PeriodicalIF":1.3,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879738","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}