Journal of Emergency Medicine最新文献

{"title":"The Family and the Fungi: A Case Series Depicting Toxic Mushroom Ingestion Affecting a Family of Eight.","authors":"Jennifer Xu, Shaylor Klein, Parmjyot Singh, Eric Wetzel, Neophytos Zambas, Elizabeth Paterek","doi":"10.1016/j.jemermed.2024.08.019","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.08.019","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Case series: </strong>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. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: 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.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-09-05","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":"Basic is Better? An Assessment of National Outcomes in Prehospital Airway Management in Critical Acuity Pediatric Trauma.","authors":"Laura F Goodman, Alice M Martino, John Schomberg, Saeed Awan, Peter Yu, Theodore Heyming, Jeffry Nahmias, Yigit S Guner, David Gibbs","doi":"10.1016/j.jemermed.2024.08.016","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.08.016","url":null,"abstract":"<p><strong>Background: </strong>Consensus is lacking regarding prehospital airway management in pediatric trauma patients (PTPs).</p><p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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% (p < 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; p = 0.01). B-APs were associated with improved acuity (odds ratio 1.19, 95% confidence interval 1.11-1.27; p < 0.001) after adjusting for Revised Trauma Score, provider type, urbanicity, time spent at scene, and demographic variables.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-09-03","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, Michael J Kim, James L Li, Alexander Croft, Erin E Kane, Jason C Wagner, Philip W Walker, Christine M Brent, Jeremy J Brywczynski, Amanda C Mathews, Brit Long, Alex Koyfman, Bridgette Svancarek","doi":"10.1016/j.jemermed.2024.08.018","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.08.018","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Discussion: </strong>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.</p><p><strong>Conclusions: </strong>By focusing on technical, educational, and operation considerations relating to prehospital cricothyrotomy, prehospital clinicians can optimize the chance for procedural success.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-09-03","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":"","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, Arsalan Shawl, Norman Ng, Danielle Langan, Christina Fazio, Joseph Basile, Barry Hahn","doi":"10.1016/j.jemermed.2024.08.015","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.08.015","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>This study aims to outline the development and implementation of a novel ED-based procedure team for inpatient care.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-09-01","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":"Simultaneous Juvenile Stroke and Myocardial Infarction Require Clarification of the Underlying Etiology and Adequate Treatment","authors":"Josef Finsterer MD, PhD","doi":"10.1016/j.jemermed.2023.12.011","DOIUrl":"10.1016/j.jemermed.2023.12.011","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 4","pages":"Pages e382-e383"},"PeriodicalIF":1.2,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120034","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":"Comments on “Opioid Prescribing by Emergency Physicians: Trends Study of Medicare Part D Prescriber Data 2013–2019\"","authors":"Gillian Cooper BS ,&nbsp;Kathy Chu MD ,&nbsp;Jeffrey Rea MD ,&nbsp;Quincy K. Tran MD, PHD ,&nbsp;Tucker Lurie MD","doi":"10.1016/j.jemermed.2024.04.012","DOIUrl":"10.1016/j.jemermed.2024.04.012","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 4","pages":"Pages e386-e387"},"PeriodicalIF":1.2,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120031","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":"Reply to “Multilocular DWI-Hyperintense Cerebral Lesions in a Child with Mild Head Trauma Suggest Embolism Rather Than Thrombosis”","authors":"Sowon Moon MD, MA ,&nbsp;Ji Eun Park MD, PHD ,&nbsp;Da Eun Jung MD, MA ,&nbsp;Jung Heon Kim MD, MA","doi":"10.1016/j.jemermed.2024.05.004","DOIUrl":"10.1016/j.jemermed.2024.05.004","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 4","pages":"Pages e388-e389"},"PeriodicalIF":1.2,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120032","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":"Reply to “Simultaneous Juvenile Stroke and Myocardial Infarction Require Clarification of the Underlying Etiology and Adequate Treatment”","authors":"Carl Pastore MD,&nbsp;Levi Filler DO","doi":"10.1016/j.jemermed.2024.05.002","DOIUrl":"10.1016/j.jemermed.2024.05.002","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 4","pages":"Pages e384-e385"},"PeriodicalIF":1.2,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120033","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(24)00282-8","DOIUrl":"10.1016/S0736-4679(24)00282-8","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 4","pages":"Pages e390-e391"},"PeriodicalIF":1.2,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0736467924002828/pdfft?md5=6dd7c2dd4eeb7642984a4613612c43d6&pid=1-s2.0-S0736467924002828-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122855","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":"Nonresponse Bias Against the Underserved in Emergency Department Patient Experience Surveys: A Cross-Sectional Analysis.","authors":"Tony Zitek, Luke Weber, Daniel Aloise, Adam Roitman, Claudia Corbea, Dana Sherman, Tatiana Nunez, Luis Puron, Michael Shalaby, Frayda Kresch, David A Farcy","doi":"10.1016/j.jemermed.2024.08.017","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.08.017","url":null,"abstract":"<p><strong>Background: </strong>Patient experience scores are used to assess emergency physicians, but only a small fraction of patients actually respond to patient experience surveys. No prior studies have determined patient characteristics that predict emergency department (ED) patient experience survey response.</p><p><strong>Objectives: </strong>To determine which patient characteristics are associated with ED patient experience survey response.</p><p><strong>Methods: </strong>This was a cross-sectional analysis of a random sample of 2500 patients from our hospital system who were discharged from an ED between January 1 and June 30, 2022. Our hospital system has one hospital-based ED and two freestanding EDs, one of which is in an economically disadvantaged area. For each randomly selected patient, we used chart review to gather the following data points: ED visited, patient age, gender, race, preferred language, primary residence, time of arrival, marital status, health insurance, and emergency severity index for that visit. We used multivariable logistic regression to determine which of those variables were associated with patient experience survey response.</p><p><strong>Results: </strong>Among 2500 patients sent surveys, 207 (8.3%) responded. Those with the lowest response rates were from a freestanding ED in an economically disadvantaged area (5.9%), were uninsured (4.9%), or were homeless (2.1%). On multivariable analysis, adjusted odds ratios for survey response for those characteristics were as follows: 0.54 (95% CI 0.33-0.84), 0.56 (95% CI 0.34-0.90), and 0.30 (95% CI 0.02-1.44), respectively.</p><p><strong>Conclusion: </strong>Multiple markers of lower socioeconomic status were associated with decreased patient experience survey response rates, suggestive of nonresponse bias against these individuals.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370629","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}