Journal of Emergency Medicine最新文献

{"title":"Ropivacaine and Dexamethasone Incompatibility: A Warning for Emergency Physicians","authors":"Chitta Ranjan Mohanty MD , Amiya Kumar Barik DM , Subhasree Das MD , Rakesh Vadakkethil Radhakrishnan MSN","doi":"10.1016/j.jemermed.2024.09.004","DOIUrl":"10.1016/j.jemermed.2024.09.004","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 168-169"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548467","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":"Basic is Better? An Assessment of National Outcomes in Prehospital Airway Management in Critical Acuity Pediatric Trauma","authors":"Laura F. Goodman MD, MPH ,&nbsp;Alice M. Martino MD ,&nbsp;John Schomberg PhD ,&nbsp;Saeed Awan MD ,&nbsp;Peter Yu MD, MPH ,&nbsp;Theodore Heyming MD ,&nbsp;Jeffry Nahmias MD, MHPE ,&nbsp;Yigit S. Guner MD, MS ,&nbsp;David Gibbs MD, MHCM","doi":"10.1016/j.jemermed.2024.08.016","DOIUrl":"10.1016/j.jemermed.2024.08.016","url":null,"abstract":"<div><h3>Background</h3><div>Consensus is lacking regarding prehospital airway management in pediatric trauma patients (PTPs).</div></div><div><h3>Objectives</h3><div>This retrospective study compared prehospital basic-airway procedures (B-AP) vs. advanced-AP (A-AP) among PTPs, comparing scene time, transport time, and improvement in acuity from scene to emergency department.</div></div><div><h3>Methods</h3><div>The 2020 National Emergency Medical Services Information System was used to study patients 1–18 years old with prehospital AP. A-AP were compared with B-AP using chi-square, Wilcoxon rank sum, multivariable logistic, and linear regression models in terms of improvement in acuity, and transport and scene times.</div></div><div><h3>Results</h3><div>The 3325 cases included 672 A-AP and 2653 B-AP; 39 esophageal combi- or dual lumen tubes, 48 laryngeal mask airways, and 585 orotracheal intubations. Overall failure rate: A-AP 8.77% vs B-AP 1.09% (<em>p</em> &lt; 0.0001). Adjusted models identified reduction in scene time for B-AP vs. A-AP (estimate: 4 min 51 s, 95% confidence interval 9 min, 49 s–6 s; <em>p</em> = 0.01). B-APs were associated with improved acuity (odds ratio 1.19, 95% confidence interval 1.11–1.27; <em>p</em> &lt; 0.001) after adjusting for Revised Trauma Score, provider type, urbanicity, time spent at scene, and demographic variables.</div></div><div><h3>Conclusion</h3><div>Prehospital B-APs were associated with shorter scene time and improvement in acuity compared with A-AP in PTPs. Variability in airway management practices across U.S. regions is high, leaving room for improvement in standardization of care and training.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 68-79"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365093","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":"Prehospital Cricothyrotomy: A Narrative Review of Technical, Educational, and Operational Considerations for Procedure Optimization","authors":"Aaron J. Lacy MD ,&nbsp;Michael J. Kim MD ,&nbsp;James L. Li MD, M.Ed ,&nbsp;Alexander Croft MD ,&nbsp;Erin E. Kane MD, MHPE ,&nbsp;Jason C. Wagner MD ,&nbsp;Philip W. Walker MD ,&nbsp;Christine M. Brent MD ,&nbsp;Jeremy J. Brywczynski MD ,&nbsp;Amanda C. Mathews MD ,&nbsp;Brit Long MD ,&nbsp;Alex Koyfman MD ,&nbsp;Bridgette Svancarek MD","doi":"10.1016/j.jemermed.2024.08.018","DOIUrl":"10.1016/j.jemermed.2024.08.018","url":null,"abstract":"<div><h3>Background</h3><div>Definitive airway management is a requisite skill in the prehospital setting, most often accomplished with either an endotracheal tube or supraglottic airway. When clinicians encounter a cannot oxygenate and cannot ventilate scenario, a patient's airway still must be secured. Prehospital cricothyrotomy is a high acuity, low frequency procedure used to secure the airway through the anterior neck. Patients who require cricothyrotomy often have significant comorbid conditions and mortality, and there can be a high rate of procedural complications. The ability to perform a cricothyrotomy is within the scope of practice for many prehospital clinicians and mastery of the procedure is crucial for patient outcomes. Despite this, initial training on the procedure is minimal, and paramedics report discomfort in their ability to perform the procedure.</div></div><div><h3>Objective</h3><div>Review and summarize the best available evidence relating to the performance of cricothyrotomies and propose technical, educational, and operational considerations to minimize complications and optimize success of prehospital cricothyrotomies.</div></div><div><h3>Discussion</h3><div>Technical considerations when performing cricothyrotomy in the prehospital setting can be used to mitigate airway misplacement, mainstem intubation, and hemorrhage. Educational consideration should include focus on a singular technique, use of established curriculum, spaced repetition with either simulation or mental practice, and a focus on intention training of when to perform the procedure. The preferred technique from the National Association of Emergency Medical Service (EMS) Physician guidelines is the surgical technique. Operational considerations to optimize a successful procedure should include checklists, preassembled kits, and robust quality improvement and insurance after a cricothyrotomy is performed.</div></div><div><h3>Conclusions</h3><div>By focusing on technical, educational, and operation considerations relating to prehospital cricothyrotomy, prehospital clinicians can optimize the chance for procedural success.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 19-34"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365105","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":"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 ,&nbsp;Abdelazim Sirelkhatim MD ,&nbsp;Aicha Medjhoul MD ,&nbsp;Mohammad Fahad ,&nbsp;Taimur S. Butt MD","doi":"10.1016/j.jemermed.2024.09.018","DOIUrl":"10.1016/j.jemermed.2024.09.018","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Case Report</h3><div>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.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>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.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 45-49"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","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":"Development and Implementation of a Novel Emergency Department-Based Procedure Team for Inpatient Hospital Procedures","authors":"Josh Greenstein MD,&nbsp;Arsalan Shawl MD,&nbsp;Norman Ng MD,&nbsp;Danielle Langan MD,&nbsp;Christina Fazio,&nbsp;Shorok Hassan MD,&nbsp;Joseph Basile MD,&nbsp;Barry Hahn MD","doi":"10.1016/j.jemermed.2024.08.015","DOIUrl":"10.1016/j.jemermed.2024.08.015","url":null,"abstract":"<div><h3>Background</h3><div>Emergency medicine (EM) demands proficiency in a broad set of procedural skills for emergency physicians. However, there is a literature gap on integrating EM expertise into procedure teams, especially in inpatient settings.</div></div><div><h3>Objectives</h3><div>This study aims to outline the development and implementation of a novel ED-based procedure team for inpatient care.</div></div><div><h3>Methods</h3><div>This retrospective study conducted between June 6, 2022, and December 31, 2023, describes the development and implementation of an ED-based procedure team. Key procedures included central lines, arterial lines, and nontunneled dialysis catheters, with specific guidelines to ensure safety and consistency.</div></div><div><h3>Results</h3><div>During the study, the procedure team conducted 525 procedures. Midline insertions and paracentesis were the most common. The team performed an average of 27.3 procedures per month. Additional provider hours needed to complete the procedures averaged 4.8 per month and showed a trend toward stabilization over time. Financially, the team secured reimbursements for 516 cases at $98 per case, observing a positive trend in gross payments.</div></div><div><h3>Conclusion</h3><div>The ED Procedure team has played a pivotal role in delivering essential bedside procedures for the patient, demonstrating improvements in provider proficiency, resident training, and favorable revenue outcomes. The interdepartmental collaborative and well-coordinated efforts have ensured the timely completion of necessary procedures.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 151-159"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189538","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 Family and the Fungi: A Case Series Depicting Toxic Mushroom Ingestion Affecting a Family of Eight","authors":"Jennifer Xu D.O.,&nbsp;Shaylor Klein DO, MSEd,&nbsp;Parmjyot Singh DO,&nbsp;Eric Wetzel DO,&nbsp;Neophytos Zambas DO,&nbsp;Elizabeth Paterek MD","doi":"10.1016/j.jemermed.2024.08.019","DOIUrl":"10.1016/j.jemermed.2024.08.019","url":null,"abstract":"<div><h3>Background</h3><div>Most mushroom exposures are benign and rare, with approximately 7400 yearly exposures. Of these, less than 1% of annual exposures can be attributed to cyclopeptide-containing mushrooms, amatoxins, and phallotoxins, with improved outcomes with early recognition. Notably, toxic ingestion of Amanita genus mushrooms is a rare but notable cause of acute liver failure. Approximately 95% of deaths worldwide associated with mushroom ingestion have been caused by amatoxin, the causative agent found in these mushrooms.</div></div><div><h3>Case Series</h3><div>We present a case series involving eight family members, aged 8–44 years old, who shared a meal of these mushrooms foraged from the greater Northeast Philadelphia area. These individuals developed symptoms 8 hours postingestion and presented to the emergency department 16 hours postingestion. Three of them developed acute liver injury, and all recovered without the need for liver transplantation.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>These cases required a great deal of resources, including uncommonly utilized medications, active resuscitation, a thorough timeline investigation, and complex collaboration with pediatrics, toxicology, and a liver transplant-capable center. This community hospital involved logistical and supply challenges, including limited emergency department space, depletion of activated charcoal, and appropriate disposition despite relatively benign presentation.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 87-91"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370633","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 DO, PhD, MPH ,&nbsp;Marissa Vander Missen BS ,&nbsp;Andrea Noriega BS ,&nbsp;Rebecca Lash PhD","doi":"10.1016/j.jemermed.2024.09.015","DOIUrl":"10.1016/j.jemermed.2024.09.015","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>We conducted a scoping review of the literature on EPs of lung cancer, identifying 27 relevant articles out of 1338 initially screened.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 50-67"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","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":"American Academy of Emergency Medicine","authors":"","doi":"10.1016/S0736-4679(25)00086-1","DOIUrl":"10.1016/S0736-4679(25)00086-1","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 170-171"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548468","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":"Severe Salicylate Poisoning Due to Teaberry Flavoring Ingestion: A Case Report","authors":"Jarod Berggren MD ,&nbsp;Chase Jones MD ,&nbsp;Kenneth D. Katz MD","doi":"10.1016/j.jemermed.2024.09.022","DOIUrl":"10.1016/j.jemermed.2024.09.022","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Case Report</h3><div>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.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>Emergency physicians should be aware of novel etiologies of life-threatening salicylate poisoning.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 98-100"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","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":"Down the Wrong Pipe: Tension Pneumoperitoneum from Esophageal Intubation","authors":"Joshua Julian BA ,&nbsp;Joseph Wendt MD ,&nbsp;Tina Chen MD","doi":"10.1016/j.jemermed.2024.09.019","DOIUrl":"10.1016/j.jemermed.2024.09.019","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Case Report</h3><div>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.</div></div><div><h3>Why should an Emergency Physician be aware of this?</h3><div>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.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 134-138"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","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}