Journal of Emergency Medicine最新文献_第9页

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

Is Phenobarbital an Effective Treatment for Alcohol Withdrawal Syndrome? 苯巴比妥能有效治疗酒精戒断综合征吗？

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-05-08 DOI: 10.1016/j.jemermed.2024.05.007

引用次数: 0

Left Ventricular Pseudoaneurysm 左心室假性动脉瘤

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-05-07 DOI: 10.1016/j.jemermed.2024.04.011

引用次数: 0

Exertional Heat Stroke Best Practices in U.S. Emergency Medical Services Guidelines 美国紧急医疗服务指南中的劳累性中暑最佳做法

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-05-03 DOI: 10.1016/j.jemermed.2024.04.005

{"title":"Exertional Heat Stroke Best Practices in U.S. Emergency Medical Services Guidelines","authors":"","doi":"10.1016/j.jemermed.2024.04.005","DOIUrl":"10.1016/j.jemermed.2024.04.005","url":null,"abstract":"<div><h3>Background</h3><p>Exertional heat illnesses (EHIs), specifically exertional heat stroke (EHS), are a top cause of nonaccidental death among U.S. laborers. EHS management requires coordination between Emergency Medical Services (EMS) and workplace officials to implement cold water immersion (CWI) and cool first, transport second (CFTS).</p></div><div><h3>Objective</h3><p>The purpose of this article was to quantify and identify existing statewide EMS guidelines, determine whether statewide EHS guidelines improved outcomes for EHIs in laborers, and examine the odds of laborer EHS fatalities when best practices are present in EMS statewide guidelines.</p></div><div><h3>Methods</h3><p>The Paramedic Protocol Provider database and official EMS websites were examined to determine which U.S. states had statewide EMS guidelines and, for those with statewide guidelines, a two-way χ<sup>2</sup> analysis with associated odds ratios examined EHI outcomes. Statewide EMS guidelines underwent content analysis by three independent reviewers regarding EHS best practices. Significance was set <em>a priori</em> at <em>p</em> < 0.05.</p></div><div><h3>Results</h3><p>Among 50 states, the District of Columbia, and Puerto Rico, 57.7% (n = 30) had statewide EMS guidelines and 42.3% (n = 22) did not. There was a significant association for EHI outcome for states recommending CWI as a cooling method vs. those that did not (χ<sup>2</sup><sub>1</sub> = 3.336; <em>p</em> = 0.049). The odds of EHS deaths for laborers were 3.0 times higher if CWI was not included in the EMS guidelines. There was a significant association in EHI outcomes for states without CFTS (χ<sup>2</sup><sub>1</sub> = 5.051; <em>p</em> = 0.017). The odds of laborers dying from EHS were 3.7 times higher in states without CFTS.</p></div><div><h3>Conclusions</h3><p>Laborers are 3.0 and 3.7 times less likely to die from EHS when statewide EMS guidelines include CWI and CFTS, respectively.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141030443","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

Evaluation of the Efficacy and Safety of Nicardipine Versus Clevidipine for Blood Pressure Control in Hypertensive Crisis 评估尼卡地平和氯维地平在高血压危象中控制血压的有效性和安全性

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-05-03 DOI: 10.1016/j.jemermed.2024.04.006

{"title":"Evaluation of the Efficacy and Safety of Nicardipine Versus Clevidipine for Blood Pressure Control in Hypertensive Crisis","authors":"","doi":"10.1016/j.jemermed.2024.04.006","DOIUrl":"10.1016/j.jemermed.2024.04.006","url":null,"abstract":"<div><h3>Background</h3><p>Hypertensive crisis is an acute increase in blood pressure >180/120 mm Hg. A titratable antihypertensive agent is preferred to lower blood pressure acutely in a controlled way and prevent an abrupt overcorrection. Nicardipine and clevidipine are both dihydropyridine calcium channel blockers that provide unique benefits for blood pressure control.</p></div><div><h3>Objective</h3><p>The purpose of this study was to compare the efficacy and safety of nicardipine or clevidipine for blood pressure control in the setting of hypertensive crisis.</p></div><div><h3>Methods</h3><p>This was a single-center, retrospective cohort study. Eligible patients received either nicardipine or clevidipine for the treatment of hypertensive crisis. The primary outcome was achievement of 25% reduction in mean arterial pressure at 1 h. The secondary outcome was achievement of a systolic blood pressure (SBP) of <160 mm Hg at 2–6 h from the start of the infusion.</p></div><div><h3>Results</h3><p>This study included a total of 156 patients, 74 in the nicardipine group and 82 in the clevidipine group. The SBP on admission and at the start of the infusion were similar between groups. There was no difference between groups in achieving a 25% reduction in mean arterial pressure at 1 h. Nicardipine achieved an SBP goal of <160 mm Hg at 2–6 h significantly more often than the clevidipine group (89.2% vs. 73.2%; <em>p</em> = 0.011).</p></div><div><h3>Conclusions</h3><p>There is no difference between agents for initial blood pressure control in the treatment of hypertensive crisis. Nicardipine showed more sustained SBP control, with a lower risk of rebound hypertension and a significant cost savings compared with clevidipine.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141023620","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

Intravenous Acetaminophen Versus Ketorolac for Prehospital Analgesia: A Retrospective Data Review 静脉注射对乙酰氨基酚与酮咯酸用于院前镇痛：回顾性数据综述

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-05-03 DOI: 10.1016/j.jemermed.2024.04.007

{"title":"Intravenous Acetaminophen Versus Ketorolac for Prehospital Analgesia: A Retrospective Data Review","authors":"","doi":"10.1016/j.jemermed.2024.04.007","DOIUrl":"10.1016/j.jemermed.2024.04.007","url":null,"abstract":"<div><h3>Background</h3><p>Parenteral ketorolac<span> and intravenous (IV) acetaminophen have been used for prehospital analgesia, yet limited data exist on their comparative effectiveness.</span></p></div><div><h3>Study Objectives</h3><p>To evaluate the comparative effectiveness of IV acetaminophen<span> and parenteral ketorolac for analgesia in the prehospital setting.</span></p></div><div><h3>Methods</h3><p>We conducted a retrospective cross-sectional evaluation of patients receiving IV acetaminophen or parenteral ketorolac for pain management in a large suburban EMS system between 1/1/2019 and 11/30/2021. The primary outcome was change in first to last pain score. Subgroup analysis was performed on patients with traumatic pain. We used inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) to estimate the treatment effect of acetaminophen versus ketorolac among all patients and the subgroup of those with traumatic pain.</p></div><div><h3>Results</h3><p>Of 2178 patients included, 856 (39.3%) received IV acetaminophen and 1322 (60.7%) received parenteral ketorolac. The unadjusted mean change in pain score was −1.9 (SD 2.4) for acetaminophen group and −2.4 (SD 2.4) for ketorolac. In the propensity score analyses, there was no statistically significant difference in pain score change for the acetaminophen group versus ketorolac among all patients (mean difference, IPTW: 0.11, 95% confidence interval [CI] −0.16, 0.37; PSM: 0.15, 95% CI −0.13, 0.43) and among those with traumatic pain (unadjusted: 0.18, 95% CI −0.35, 0.72; IPTW: 0.23, 95% CI −0.25, 0.71; PSM: −0.03, 95% CI −0.61, 0.54).</p></div><div><h3>Conclusions</h3><p>We found no statistically significant difference in mean pain reduction of IV acetaminophen and parenteral ketorolac for management of acute pain.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141029030","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 late career crisis in emergency medicine 急诊医学的晚期职业危机

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2024-05-03 DOI: 10.1016/j.jemermed.2024.04.010

引用次数: 0

Now You See It, Now You Don't: Point-of-Care Ultrasound Identification of Left Ventricular Thrombus-in-Transit 现在看到，现在看不到：护理点超声波识别左心室血栓在途

IF 1.5 4区医学

Journal of Emergency Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.jemermed.2023.11.014

Zachary Boivin MD , Zhayna Spooner MD , Christina Jiang MS , Kirstin Acus MD , Christina Lu MD , Trent She MD

{"title":"Now You See It, Now You Don't: Point-of-Care Ultrasound Identification of Left Ventricular Thrombus-in-Transit","authors":"Zachary Boivin MD , Zhayna Spooner MD , Christina Jiang MS , Kirstin Acus MD , Christina Lu MD , Trent She MD","doi":"10.1016/j.jemermed.2023.11.014","DOIUrl":"10.1016/j.jemermed.2023.11.014","url":null,"abstract":"<div><p><em><strong>Background</strong></em>: Left-sided intracardiac thrombi are most commonly seen in conditions with decreased cardiac flow, such as myocardial infarction or atrial fibrillation. They can be propagated into the systemic circulation, leading to a cerebrovascular accident. Identification of thrombus-in-transit via point-of-care ultrasound (POCUS) has the potential to change patient management given its association with high patient morbidity and mortality.</p><p><strong><em>Case Report:</em></strong> An intubated 60-year-old man was transferred to our emergency department for management of altered mental status and seizure-like activity. The patient was markedly hypotensive on arrival, and cardiac POCUS was performed to identify potential causes of hypotension. A left ventricular thrombus-in-transit was identified. The thrombus was notably absent on a repeat POCUS examination < 10 min later, which led to concern for thrombus propagation. Furthermore, the patient's vasopressor requirements had significantly increased in that time period. Subsequent emergent neuroimaging revealed a large ischemic stroke in the left internal carotid and middle cerebral artery distribution. The patient was, unfortunately, deemed to not be a candidate for either thrombectomy or thrombolysis and ultimately expired in the hospital.</p><p><strong><em>Why Should an Emergency Physician Be Aware of This?</em></strong> Serial POCUS examinations identified the propagation of this patient's thrombus-in-transit, leading the physician to change the initial presumptive diagnosis and treatment course, and pursue further imaging and workup for ischemic stroke. Identification of a thrombus-in-transit is a clue to potentially underlying critical pathology and should be followed with serial POCUS examinations to assess for treatment efficacy and thrombus propagation.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138569542","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