Journal of Emergency Medicine最新文献_第8页

An Uncommon Cause of Testicular Infarct: A Case Report and Review of the Literature of Testicular Infarcts From Laparoscopic Inguinal Hernia Repair 睾丸梗塞的罕见病因：腹腔镜腹股沟疝修补术导致睾丸梗塞的病例报告和文献综述。

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-05-25 DOI: 10.1016/j.jemermed.2024.05.006

引用次数: 0

Postures 姿势

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-05-20 DOI: 10.1016/j.jemermed.2024.05.008

引用次数: 0

The Role of Troponin Testing in Patients with Supraventricular Tachycardia, Systematic Review and Meta-Analysis 心肌肌钙蛋白检测在室上性心动过速患者中的作用，系统回顾与元分析

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-05-19 DOI: 10.1016/j.jemermed.2024.05.010

{"title":"The Role of Troponin Testing in Patients with Supraventricular Tachycardia, Systematic Review and Meta-Analysis","authors":"","doi":"10.1016/j.jemermed.2024.05.010","DOIUrl":"10.1016/j.jemermed.2024.05.010","url":null,"abstract":"<div><h3>Background</h3><p>Supraventricular tachycardia (SVT) is commonly evaluated in the emergency department (ED). While troponin has been shown to be elevated in SVT, its usefulness for predicting coronary artery disease and future adverse cardiovascular outcomes has not been shown.</p></div><div><h3>Objectives</h3><p>We aimed to evaluate the prognostic utility of troponin measurement as part of SVT management in the ED.</p></div><div><h3>Methods</h3><p>We performed a literature search in the PubMed and Scopus databases from inception to August 30, 2023, including all studies reporting troponin measurements in adult patients (age > 18 years) presenting to the ED with supraventricular tachycardia. The primary outcome of interest for this study was the prevalence of elevated troponin in patients with SVT. Secondary outcomes included the prevalence of major adverse cardiac events (MACE) and additional cardiac testing with significant findings.</p></div><div><h3>Results</h3><p>We included 7 studies (500 patients) in our analysis. Six studies reported the number of patients with SVT and elevated troponin, with a pooled prevalence of 46% (95% CI 27–66%, I<sup>2</sup> 93%). The pooled prevalence of all MACE in our study was 6% (95% CI 1–25%), while the prevalence for MACE among patients with elevated serum troponin levels was 11% (95% CI 4–27%).</p></div><div><h3>Conclusions</h3><p>Troponin levels are frequently ordered for ED patients with SVT and are often elevated. However, this review suggests that they have low prognostic value in predicting MACE.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141137405","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}

引用次数: 0

A Perplexing Purple Rash 令人困惑的紫色皮疹

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-05-19 DOI: 10.1016/j.jemermed.2024.04.013

引用次数: 0

Can I Discharge This Adult Patient with Abnormal Vital Signs From the Emergency Department? 我可以让这位生命体征异常的成人患者从急诊科出院吗？

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-05-19 DOI: 10.1016/j.jemermed.2024.05.009

{"title":"Can I Discharge This Adult Patient with Abnormal Vital Signs From the Emergency Department?","authors":"","doi":"10.1016/j.jemermed.2024.05.009","DOIUrl":"10.1016/j.jemermed.2024.05.009","url":null,"abstract":"<div><h3>Background</h3><p>Vital signs are an essential component of the emergency department (ED) assessment. Vital sign abnormalities are associated with adverse events in the ED setting and may indicate a risk of poor outcomes after ED discharge.</p></div><div><h3>Clinical question</h3><p>What is the risk of adverse events among adult patients with abnormal vital signs at the time of ED discharge?</p></div><div><h3>Evidence review</h3><p>Studies retrieved included 6 retrospective studies with adult patients discharged from the ED. These studies evaluated adverse outcomes in adult patients discharged from the ED with abnormal vital signs. Hypotension at discharge was associated with the highest odds of adverse events after discharge. Tachycardia was also a key predictor of adverse events after discharge and may be easily missed by ED clinicians.</p></div><div><h3>Conclusion</h3><p>Based on the available evidence, the specific vital sign abnormality and the number of total abnormalities influence the risk of adverse outcomes after discharge. Vital sign abnormalities at the time of discharge also increase the risk of ED revisit. The most common abnormal vital sign at the time of discharge is tachycardia.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141131978","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}

引用次数: 0

A Rare Case of an Adult with Spinal Cord Injury Without Neuroimaging Abnormality (SCIWONA) 一例罕见的无神经影像异常的成人脊髓损伤病例（SCIWONA）

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-05-17 DOI: 10.1016/j.jemermed.2024.04.008

{"title":"A Rare Case of an Adult with Spinal Cord Injury Without Neuroimaging Abnormality (SCIWONA)","authors":"","doi":"10.1016/j.jemermed.2024.04.008","DOIUrl":"10.1016/j.jemermed.2024.04.008","url":null,"abstract":"<div><h3>Background</h3><p>Spinal cord injury without radiographic abnormality (SCIWORA) is defined as having clinical symptoms of traumatic myelopathy with no radiographic or computed tomographic features of spinal fracture or instability. An abnormal finding, such as a fracture, subluxation, or abnormal intersegmental motion at the level of the spinal cord injury, excludes SCIWORA as the diagnosis. Prevalence of SCIWORA is highest among children younger than 8 years, and is a diagnosis seen primarily in children, owing to anatomic differences that put children at more risk of this condition. In more recent years, with the increasing use of magnetic resonance imaging in patients with suspected spinal cord injury, a new term, <em>spinal cord injury without neuroimaging abnormality</em> (SCIWONA) has been suggested as a more specific way to describe cases of SCIWORA that have negative neuroimaging.</p></div><div><h3>Case Report</h3><p>Here we describe a case of a woman who presented with symptoms consistent with a spinal cord injury after a traumatic fall. Her presentation and imaging were consistent with SCIWONA. The patient subsequently had rapid and complete recovery of her neurologic function. Why Should an Emergency Physician Be Aware of This? Early recognition of SCIWONA and subsequent medical management is imperative for improved outcomes for these patients. Operative treatment is rare and typically only necessary in patients with consistent spinal cord instability.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141031482","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}

引用次数: 0

Improvising on the Fly: Comparison of a Novel Technique for Emergent Zipper Release to a Well-Established Technique in a Simulated Setting 甜蜜释放：在模拟环境中比较拉链紧急松开的新技术和成熟技术

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-05-17 DOI: 10.1016/j.jemermed.2024.05.001

{"title":"Improvising on the Fly: Comparison of a Novel Technique for Emergent Zipper Release to a Well-Established Technique in a Simulated Setting","authors":"","doi":"10.1016/j.jemermed.2024.05.001","DOIUrl":"10.1016/j.jemermed.2024.05.001","url":null,"abstract":"<div><h3>Background</h3><p>Penile skin zipper entrapment is an emergent medical condition in which the penile skin, scrotal skin, or foreskin gets caught within the teeth of a zipper or the slider itself. This can lead to complications such as urethral involvement, skin loss, or tissue necrosis. We propose a novel technique to aid in the release of entrapped skin utilizing wire cutters directed at the inferior portion of the zipper pull.</p></div><div><h3>Objectives</h3><p>To describe a novel technique to free entrapped penile skin and compare its performance to the well-established median bar technique in a simulated setting.</p></div><div><h3>Methods</h3><p>A randomized cross-over design was used to compare techniques on successful release, time to release and tissue injury using an animal model of raw chicken skin entrapped in a zipper. Statistical significance was assessed at <em>p</em> < 0.05.</p></div><div><h3>Results</h3><p>Twenty-two participants were included. There was no statistically significant difference between the novel technique and the median bar technique regarding successful release (100% vs 95.5%, respectively), median time to release (29.1 vs 26.4 seconds, respectively), or frequency of tissue injury (22.7% vs 27.3%).</p></div><div><h3>Conclusion</h3><p>Performance using our novel technique for removal of penile skin from a zipper is similar to the median bar release technique regarding. Our novel technique may be a valid treatment option for the release of entrapped penile skin in a zipper mechanism in the emergency department setting.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141043120","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}

引用次数: 0

The Combination of Systemic Immune-Inflammation Index and Serum Procalcitonin has High Auxiliary Predictive Value for Short-Term Adverse Prognosis in Septic Shock Patients 全身免疫炎症指数和血清降钙素原的组合对脓毒性休克患者的短期不良预后具有较高的辅助预测价值

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-05-17 DOI: 10.1016/j.jemermed.2024.05.005

{"title":"The Combination of Systemic Immune-Inflammation Index and Serum Procalcitonin has High Auxiliary Predictive Value for Short-Term Adverse Prognosis in Septic Shock Patients","authors":"","doi":"10.1016/j.jemermed.2024.05.005","DOIUrl":"10.1016/j.jemermed.2024.05.005","url":null,"abstract":"<div><h3>Background</h3><p>Septic shock is the most serious complication of sepsis, with more secure and efficient biomarkers urgently needed. Systemic immune-inflammation index (SII) and serum procalcitonin (PCT) show involvement in predicting septic shock prognosis.</p></div><div><h3>Objective</h3><p>Herein, we explored the clinical value of the SII-PCT combination in the short-term prognosis of septic shock patients.</p></div><div><h3>Methods</h3><p>Totally 200 septic shock patients were analyzed retrospectively and allocated into the survival and death groups upon 28-day in-hospital outcomes. Correlations of SII, PCT, acute physiology and chronic health evaluation II (APACHE II)/sepsis-related organ failure assessment (SOFA) scores, C-reactive protein (CRP), and serum creatinine (Scr) were analyzed using Spearman. The influencing factors of SII and serum PCT for short-term poor prognosis were analyzed using logistic multivariate regression model. The auxiliary predictive value of SII, PCT, and their combination for short-term adverse septic shock prognosis was evaluated by the receiver operating characteristic curve. Differences in the area under the curve (AUC) were compared using MedCalc.</p></div><div><h3>Results</h3><p>The death group had higher APACHE II/SOFA scores, LYM, CRP, Scr, SII, and PCT levels than the survival group. SII and PCT were positively correlated with APACHE II and SOFA scores, LYM, CRP, and Scr, and were independent risk factors influencing the adverse septic shock prognosis. The AUC of the SII-PCT combination in predicting short-term adverse septic shock prognosis was 0.893 (0.841-0.932), with 76.12% sensitivity and 87.97% specificity, with the combination showing a higher AUC than SII/PCT alone.</p></div><div><h3>Conclusions</h3><p>The SII-PCT combination helps predict the adverse prognosis of septic shock patients.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141041149","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}

引用次数: 0

It's Not Cyclic Vomiting Syndrome Until Dietl's is Ruled Out: A Case for Point of Care Renal Ultrasound "在排除迪特尔综合征之前，这不是周期性呕吐综合征：肾脏超声检查的案例"

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-05-16 DOI: 10.1016/j.jemermed.2024.05.003

{"title":"It's Not Cyclic Vomiting Syndrome Until Dietl's is Ruled Out: A Case for Point of Care Renal Ultrasound","authors":"","doi":"10.1016/j.jemermed.2024.05.003","DOIUrl":"10.1016/j.jemermed.2024.05.003","url":null,"abstract":"<div><h3>Background</h3><p>Abdominal pain and vomiting are frequent complaints for pediatric patients presenting to the Emergency Department (ED). When a diagnosis such as chronic abdominal pain, cyclic vomiting, or abdominal migraine has previously been made, it can lead to diagnostic momentum and confirmation bias on behalf of the treating physician. Dietl's crisis is a commonly missed diagnosis in the pediatric population that presents with intermittent episodes of pain and vomiting. It can be readily diagnosed at the bedside by the emergency physician (EP) through the employment of point of care ultrasound (POCUS).</p></div><div><h3>Case Series</h3><p>We present two cases of pediatric patients with episodic abdominal pain and vomiting who were previously diagnosed with cyclic vomiting syndrome. In both cases, pediatric gastroenterology evaluations had occurred with negative diagnostic testing having been performed. Both patients also presented to their primary pediatrician and the ED multiple times with each encounter resulting in treatment of symptoms and discharge. Each patient eventually presented to the ED when an EP was present who performed a renal POCUS. In each patient, the POCUS revealed severe unilateral hydronephrosis. Subsequent workup confirmed the diagnosis of Dietl's crisis as the etiology of symptoms.</p></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><p>In pediatric patients, EPs should be wary of the diagnosis of cyclic vomiting syndrome until ureteral obstruction has been ruled out. A bedside POCUS can rapidly establish this diagnosis and potentially preclude recurrent health care visits, unnecessary diagnostic testing, and permanent loss of renal function.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141054336","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}

引用次数: 0

Utilization of Multi-Parameter Blood Gas Analysis in Prehospital Emergency Medicine—A Scoping Review 院前急救医学中多参数血气分析的应用--范围审查

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-05-09 DOI: 10.1016/j.jemermed.2024.04.014

{"title":"Utilization of Multi-Parameter Blood Gas Analysis in Prehospital Emergency Medicine—A Scoping Review","authors":"","doi":"10.1016/j.jemermed.2024.04.014","DOIUrl":"10.1016/j.jemermed.2024.04.014","url":null,"abstract":"<div><h3>Background</h3><p>Prehospital blood gas analysis (BGA) is an evolving field that offers the potential for early identification and management of critically ill patients. However, the utility and accuracy of prehospital BGA are subjects of ongoing debate.</p></div><div><h3>Objectives</h3><p>We aimed to provide a comprehensive summary of the current literature on prehospital BGA, including its indications, methods, and feasibility.</p></div><div><h3>Methods</h3><p>We performed a scoping review of prehospital BGA. A thorough search of the PubMed, Embase, and Web of Science databases was conducted to identify relevant studies focusing on prehospital BGA in adult patients.</p></div><div><h3>Results</h3><p>Fifteen studies met the inclusion criteria. Prehospital BGA was most frequently performed in patients in out-of-hospital cardiac arrest, followed by traumatic and nontraumatic cases. The parameters most commonly analyzed were pH, pCO<sub>2</sub>, pO<sub>2</sub>, and lactate. Various sampling methods, including arterial, venous, and intraosseous, were reported for prehospital BGA. While prehospital BGA shows promise in facilitating early identification of critical patients and guiding resuscitation efforts, logistical challenges are to be considered. The handling of preclinical BGA is described as feasible and useful in most of the included studies.</p></div><div><h3>Conclusion</h3><p>Prehospital BGA holds significant potential for enhancing patient care in the prehospital setting, though technical challenges need to be considered. However, further research is required to establish optimal indications and demonstrate the benefits for prehospital BGA in specific clinical contexts.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0736467924001434/pdfft?md5=90e9f46ac8217d3c49f6f7d6b9974e0b&pid=1-s2.0-S0736467924001434-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141041766","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}

引用次数: 0