Journal of Emergency Medicine最新文献_第8页

Optimizing Ultrasound Methods for Determining Central Venous Catheter Tip Position. 优化超声确定中心静脉导管尖端位置的方法。

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-20 DOI: 10.1016/j.jemermed.2025.02.020

Peng Shen, Jingmiao Yu, Fengxue Zhu, Jie Lyu, Huiying Zhao

{"title":"Optimizing Ultrasound Methods for Determining Central Venous Catheter Tip Position.","authors":"Peng Shen, Jingmiao Yu, Fengxue Zhu, Jie Lyu, Huiying Zhao","doi":"10.1016/j.jemermed.2025.02.020","DOIUrl":"https://doi.org/10.1016/j.jemermed.2025.02.020","url":null,"abstract":"<p><strong>Background: </strong>In clinical practice, physicians hope to find better techniques for rapidly determining central venous catheter positions.</p><p><strong>Objectives: </strong>This study aimed to investigate the advantages and disadvantages of using various ultrasound techniques to judge the tip positions of central venous catheters and to explore the specific application conditions of various ultrasound techniques.</p><p><strong>Methods: </strong>We selected 194 patients with central venous catheterization admitted to our hospital. Vascular and cardiac ultrasound (CVUS), contrast-enhanced ultrasonography (CEUS), and the \"flush the line and ultrasound the heart\" (FLUSH) test were used to determine the central venous catheter tip position. We analyzed the ultrasound techniques' diagnostic accuracy and advantages.</p><p><strong>Results: </strong>When locating the central venous catheter tip, chest radiography (CXR) took 72.1 ± 32.3 min whereas CVUS, CEUS, and the FLUSH test took 3.7 ± 0.9 min, 6.7 ± 2.3 min, and 6.0 ± 1.8 min, respectively. The time required for ultrasound examinations differed significantly from that for CXR (p < 0.01). Using CXR as the gold standard, CVUS had a sensitivity of 100% (95% confidence interval [CI]: 97.3%-100%) and a specificity of 68.4% (95% CI: 43.5%-86.4%). CEUS and the FLUSH test yielded consistent results (sensitivity: 100% [95% CI: 97.3%-100%]; specificity: 84.2% [95% CI: 59.5%-95.8%]).</p><p><strong>Conclusion: </strong>The FLUSH test, which does not require contrast medium injection, offered higher result accuracies, making it promising for clinical practice. CEUS is recommended more for determining catheter position when the patient is not a good candidate for repeated fluid pushing or when the ultrasound image is not clear.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975587","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

Hand Pain and Swelling after Laceration. 手部撕裂伤后疼痛和肿胀。

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-17 DOI: 10.1016/j.jemermed.2025.02.008

Dawn Penney, Adam Roussas, Victoria Gonzalez

引用次数: 0

Ultrasound-Guided Serratus Anterior Plane Block for Acute Pain Management in Emergency Medicine: A Systematic Review. 超声引导下锯肌前平面阻滞在急诊医学急性疼痛管理中的应用：系统综述。

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-13 DOI: 10.1016/j.jemermed.2025.02.009

Richard J Gawel, Jennifer X Hong, Erin E Hassel, Jeffrey A Kramer

{"title":"Ultrasound-Guided Serratus Anterior Plane Block for Acute Pain Management in Emergency Medicine: A Systematic Review.","authors":"Richard J Gawel, Jennifer X Hong, Erin E Hassel, Jeffrey A Kramer","doi":"10.1016/j.jemermed.2025.02.009","DOIUrl":"https://doi.org/10.1016/j.jemermed.2025.02.009","url":null,"abstract":"<p><strong>Background: </strong>Use of the serratus anterior plane block (SAPB) by emergency physicians is increasing. Clinical evidence supporting its utility in the emergency department (ED) is limited and has not been comprehensively summarized.</p><p><strong>Objective: </strong>The aim of this review was to summarize and evaluate the utility of ultrasound-guided SAPBs performed by emergency physicians for acute pain management in the ED.</p><p><strong>Methods: </strong>Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic literature search of the PubMed, Scopus, and Cochrane databases was performed from database inception to October 2023. Published articles reporting on SAPBs performed by emergency physicians were reviewed and qualitatively summarized.</p><p><strong>Results: </strong>Fourteen articles reporting on 81 patients were identified, among which SAPBs were performed by emergency physicians for five separate indications, including rib fracture, tube thoracostomy, acute herpes zoster, chest wall burns, and unspecified chest wall injury. Overall, SAPBs performed by emergency physicians were associated with improvements in subjective and objective measures of pain, and no complications were reported following the blocks.</p><p><strong>Conclusions: </strong>The SAPB performed by trained emergency physicians may be a reasonable analgesia strategy for managing several causes of acute chest wall pain in the ED, though evidence to date is limited and further higher quality research is needed.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085805","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

Heart Exposed: Strategies for Cardiac Arrest in Ectopia Cordis. 心脏外露：心脏异位患者心脏骤停的策略。

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-12 DOI: 10.1016/j.jemermed.2025.02.007

Raymond Smith, Emily Pena, Kristen Nelson McMillan, Debra Rusk

引用次数: 0

Man with Painful Light-Evoked Skin Lesions. 患有疼痛的光诱发皮肤病变的人。

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-10 DOI: 10.1016/j.jemermed.2025.02.003

Daniel S Brenner

引用次数: 0

Zipper Entrapment of the Eyelid with a Unique Removal Technique. 用独特的去除技术去除眼睑的拉链。

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-08 DOI: 10.1016/j.jemermed.2025.02.002

Arjun Sarin, Purva Grover

引用次数: 0

Ultrasound-Guided Serratus Anterior Plane Block for Acute Zoster Pain in an Immunocompromised Heart Transplant Patient in the Emergency Department. 超声引导下锯肌前平面阻滞治疗急诊科免疫功能低下心脏移植患者急性带状疱疹

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-08 DOI: 10.1016/j.jemermed.2025.02.004

Richard J Gawel, Cesar Soto

引用次数: 0

Predictive Value of Ionized Calcium Level for Sinus Rhythm Conversion in Adenosine Treatment for Paroxysmal Supraventricular Tachycardia. 腺苷治疗阵发性室上性心动过速时，钙离子水平对窦性心律转换的预测价值。

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-07 DOI: 10.1016/j.jemermed.2025.02.006

Ekrem Taha Sert, Kamil Kokulu, Hüseyin Mutlu, Mustafa Önder Gönen, Zekiye Soykan Sert

{"title":"Predictive Value of Ionized Calcium Level for Sinus Rhythm Conversion in Adenosine Treatment for Paroxysmal Supraventricular Tachycardia.","authors":"Ekrem Taha Sert, Kamil Kokulu, Hüseyin Mutlu, Mustafa Önder Gönen, Zekiye Soykan Sert","doi":"10.1016/j.jemermed.2025.02.006","DOIUrl":"https://doi.org/10.1016/j.jemermed.2025.02.006","url":null,"abstract":"<p><strong>Background: </strong>Paroxysmal supraventricular tachycardia (SVT) is a recurrent tachydysrhythmia that often leads to emergency department (ED) visits and is commonly treated with intravenous adenosine.</p><p><strong>Objective: </strong>The objective of this paper is to evaluate the relationship between the initial ionized calcium (iCa) level and the achievement of normal sinus rhythm following 6 mg adenosine administration in patients with SVT.</p><p><strong>Methods: </strong>This retrospective, single-center study was conducted in the ED from 2019 to 2023 and included consecutive adult patients diagnosed with SVT who received adenosine treatment. The patients were categorized into two groups based on their response to adenosine treatment. The receiver operating characteristic (ROC) curves were constructed to evaluate the effectiveness of iCa levels in predicting conversion to sinus rhythm.</p><p><strong>Results: </strong>A total of 326 patients were analyzed. The mean iCa level in patients who achieved a sinus rhythm after the initial 6-mg dose was 1.13 ± 0.08 mmol/L, as compared to 1.03 ± 0.11 mmol/L in those who did not respond to this dose, indicating a statistically significant difference (mean difference [95% confidence interval (CI)]: -0.101 [-0.12 to -0.07]). The area under the ROC curve was calculated to be 0.803 (95% CI: 0.752-0.854). An iCa cut-off value of 1.14 mmol/L was determined to be significant for the prediction of achieving sinus rhythm, with a sensitivity of 64.75% (95% CI: 55.6-73.2) and a specificity of 87.75% (95% CI: 83.6-92.7).</p><p><strong>Conclusion: </strong>Our study suggests that the iCa level may be a useful parameter for predicting the response to the 6 mg adenosine dose in patients with SVT.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078471","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

Associations Between Prenotification and Time to Management in Acute Stroke Patients Transported by Emergency Medical Services. 急诊医疗机构转运急性脑卒中患者的预通知与治疗时间的关系

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-06 DOI: 10.1016/j.jemermed.2025.02.005

Young Ju Jeong, Ki Hong Kim, Jeong Ho Park, Young Sun Ro, Kyoung Jun Song, Sang Do Shin

{"title":"Associations Between Prenotification and Time to Management in Acute Stroke Patients Transported by Emergency Medical Services.","authors":"Young Ju Jeong, Ki Hong Kim, Jeong Ho Park, Young Sun Ro, Kyoung Jun Song, Sang Do Shin","doi":"10.1016/j.jemermed.2025.02.005","DOIUrl":"https://doi.org/10.1016/j.jemermed.2025.02.005","url":null,"abstract":"<p><strong>Background: </strong>Acute stroke is a major health burden and prompt management at the emergency department (ED) is crucial for favorable outcomes.</p><p><strong>Objectives: </strong>This study aimed to evaluate the associations between prehospital notification to the ED and time to management in acute ischemic stroke patients.</p><p><strong>Methods: </strong>Patients with acute ischemic stroke who visited a thrombolysis-available ED through an emergency medical service (EMS) from July 2020 to December 2021 were included. The main exposure was prenotification by EMS personnel. The primary outcome was the time to management in acute stroke care metrics in ED-stroke critical pathway (CP) activation, brain radiographic evaluation, intravenous thrombolysis, mechanical thrombectomy, and stroke unit admission. Multivariable linear regression analysis was conducted.</p><p><strong>Results: </strong>A total of 1107 acute ischemic stroke patients were included. The time to management was shorter in the prenotification group than in the control group; CP activation was 10 vs. 13.5 min, brain radiographic evaluation was 27 vs. 35 min, intravenous thrombolysis was 50.5 vs. 56.5 min, mechanical thrombectomy was 126.5 vs. 151.0 min, and stroke unit admission was 270.5 vs. 295.5 min. The prenotification group had a greater probability of a shorter time to management: Estimate (95% confidence intervals) was -15.7 min (-22.7 to -8.8) for CP activation, -13.8 min (-19.9 to -7.6) for brain radiographic evaluation, -20.9 min (-32.6 to -9.2) for intravenous thrombolysis, -81.6 min (-149.0 to -14.2) for mechanical thrombectomy, and -20.8 (-66.7 to -25.1) for stroke unit admission.</p><p><strong>Conclusion: </strong>In acute ischemic stroke patients, prehospital prenotification was found to be associated with a shorter time to management.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078397","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 Novel Use of Terbutaline: Persistent Genital Arousal Disorder in the Emergency Department 特布他林的新用法：急诊科的持续性生殖器兴奋障碍。

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jemermed.2024.08.023

Sadaf Luth MS , James Luth DO , Kelly A. Murray PharmD, BCACP , Bobby Abernathy DO

{"title":"A Novel Use of Terbutaline: Persistent Genital Arousal Disorder in the Emergency Department","authors":"Sadaf Luth MS , James Luth DO , Kelly A. Murray PharmD, BCACP , Bobby Abernathy DO","doi":"10.1016/j.jemermed.2024.08.023","DOIUrl":"10.1016/j.jemermed.2024.08.023","url":null,"abstract":"<div><h3>Background</h3><div>Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a highly distressing, multifactorial disorder characterized by persistent unwanted physiologic genital arousal in the absence of sexual desire. This poorly understood disorder is thought to be derived from a complex dysregulation of biopsychosocial factors with common underlying neurological dysfunction that has yet to be adequately studied. With frequently evolving diagnostic criteria, lack of a standardized treatment algorithm, and few evidence-based treatment options, this disease is largely unrecognized and difficult to treat once identified.</div></div><div><h3>Case Report</h3><div>A 25-year-old woman presented to the Emergency Department (ED) with persistent and refractory symptoms of genital arousal not responsive to previously documented treatments, and the novel use of a β-adrenergic agent, terbutaline, leading to cessation of symptoms. With her initial presentation, lorazepam, haloperidol, and viscous lidocaine intravaginally provided relief for approximately 24 h until the patient returned. At her subsequent presentation, the patient received additional doses of lorazepam and intravaginal lidocaine, as well as consults with Urology and Obstetrics and Gynecology. Her symptoms eventually ceased by administration of terbutaline.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>Although presentation of PGAD to the ED is rare, emergency physicians should be prepared with treatment options to assist patients with this distressing diagnosis. This case highlights the novel use of terbutaline, a β-agonist, in cessation of PGAD symptoms when first-line benzodiazepines and antipsychotics fail.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 81-83"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080500","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