Journal of Emergency Medicine最新文献

{"title":"","authors":"Edward J. Otten MD, FACMT, FAWM","doi":"10.1016/j.jemermed.2024.08.001","DOIUrl":"10.1016/j.jemermed.2024.08.001","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e620-e621"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142212510","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":"Association Between Emergency Medical Services Intervention Volume and Out-of-Hospital Cardiac Arrest Survival: A Propensity Score Matching Analysis","authors":"Thomas Vincent MD ,&nbsp;Tiphaine Lefebvre PhD ,&nbsp;Mikaël Martinez MD ,&nbsp;Guillaume Debaty MD, PhD ,&nbsp;Cyril Noto-Campanella MD, MSc ,&nbsp;Valentine Canon PhD ,&nbsp;Karim Tazarourte MD, PhD ,&nbsp;Axel Benhamed MD, MSc ,&nbsp;RéAC Investigators","doi":"10.1016/j.jemermed.2024.06.008","DOIUrl":"10.1016/j.jemermed.2024.06.008","url":null,"abstract":"<div><h3>Background</h3><div>Out of hospital cardiac arrest (OHCA) survival rates are very low. An association between institutional OHCA case volume and patient outcomes has been documented. However, whether this applies to prehospital emergency medicine services (EMS) is unknown.</div></div><div><h3>Objectives</h3><div>To investigate the association between the volume of interventions by mobile intensive care units (MICU) and outcomes of patients experiencing an OHCA.</div></div><div><h3>Methods</h3><div>A retrospective cohort study including adult patients with OHCA managed by medical EMS in five French centers between 2013 and 2020. Two groups were defined depending on the overall annual numbers of MICU interventions: low and high-volume MICU. Primary endpoint was 30-day survival. Secondary endpoints were prehospital return of spontaneous circulation (ROSC), ROSC at hospital admission and favorable neurological outcome. Patients were matched 1:1 using a propensity score. Conditional logistic regression was then used.</div></div><div><h3>Results</h3><div>2,014 adult patients (69% male, median age 68 [57-79] years) were analyzed, 50.5% (n = 1,017) were managed by low-volume MICU and 49.5% (n = 997) by high-volume MICU. Survival on day 30 was 3.6% in the low-volume group compared to 5.1% in the high-volume group. There was no significant association between MICU volume of intervention and survival on day 30 (OR = 0.92, 95%CI [0.55;1.53]), prehospital ROSC (OR = 1.01[0.78;1.3]), ROSC at hospital admission (OR = 0.92 [0.69;1.21]), or favorable neurologic prognosis on day 30 (OR = 0.92 [0.53;1.62]).</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e533-e543"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381066","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":"The Association of Takotsubo Cardiomyopathy, Left Ventricular Outflow Tract Obstruction, and Hypotension","authors":"Oscar M P Jolobe","doi":"10.1016/j.jemermed.2024.06.012","DOIUrl":"10.1016/j.jemermed.2024.06.012","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e615-e617"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813345","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":"Socioeconomic and Demographic Modifiers of Depression's Impact on Emergency Department Utilization: A Stratified Analysis.","authors":"Wei Chen, Jingjing Wang","doi":"10.1016/j.jemermed.2024.11.015","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.11.015","url":null,"abstract":"<p><strong>Background: </strong>The emergency department (ED) is often considered the last line of defense for urgent health crises, and people with depression may rely more heavily on ED services to address unexpected issues related to mental health or physical health due to the acute onset of symptoms or a lack of routine medical care.</p><p><strong>Objective: </strong>This study aims to investigate the association between depressive symptoms and ED utilization and to systematically evaluate the moderating effects of socioeconomic status (SES), gender, and age on this relationship.</p><p><strong>Methods: </strong>The study utilized data from the National Health and Nutrition Examination Survey (NHANES) covering the period from 2005 to 2018, with a final sample of 26,299 adult participants. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and ED utilization was categorized based on participants' self-reported medical service use.</p><p><strong>Results: </strong>Logistic regression analysis indicated that each 1-point increase in PHQ-9 score was associated with a 6% increase in the likelihood of ED utilization (p < 0.001). The association between depressive symptoms and ED utilization was significantly stronger in women, particularly for those with severe depression (p = 0.021).</p><p><strong>Conclusion: </strong>This study demonstrates that depressive symptoms are significantly associated with a higher likelihood of ED utilization, with this association strongly moderated by SES, gender, and age. The varying impact of specific depressive symptoms, such as delayed movement or speech and sleep problems, on ED utilization highlights the importance of early intervention and targeted mental health support for high-risk groups to help reduce ED visit frequency.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605015","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":"Exertional Heat Stroke: Are We Cool Enough? Retrospective Observational Study of Patients of Running Events.","authors":"Nathalie Dollée, Jelmer Alsma, Rob Goedhart, Ankie Bultstra, Juanita A Haagsma, Amber E Hoek","doi":"10.1016/j.jemermed.2024.11.002","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.11.002","url":null,"abstract":"<p><strong>Background: </strong>Early recognition and immediate cooling are paramount in the treatment for exertional heat stroke (EHS). The most effective method is cold water immersion, however, practicalities may limit its use in the prehospital setting. An alternative is rotating ice water-soaked towels, which requires fewer personnel, can be deployed quickly, and allows easier patient monitoring.</p><p><strong>Objective: </strong>The authors aimed to investigate the effectiveness of treatment with rotating ice water-soaked towels for patients with EHS to reduce (tympanic) temperature to < 104°F (40°C) within 30 min.</p><p><strong>Methods: </strong>In this retrospective observational study, participants ≥18 years who received medical care at running events with distances between 2.6 mile (4.2 km) and 26.2 miles (42.195 km; i.e., a full marathon) between 2016 and 2019 were included. Primary outcome was the percentage of patients with EHS who reached a temperature < 104°F (40°C) within 30 min by means of cooling with rotating ice water-soaked towels.</p><p><strong>Results: </strong>A total of 374,534 runners participated in one of the running events in the study period, of whom 879 required medical attention. Forty-eight runners had a tympanic temperature ≥ 104°F (40°C), of whom 36 were classified as having EHS based on presence of neurologic symptoms. Median age of patients was 32.5 years and most were male (69%). All patients that were cooled reached temperature < 104°F (40°C) within 30 min. The mean cooling rate was 0.22°F/min (95% CI 0.16-0.27; 0.12°C/min [95% CI 0.09-0.15]). None of the patients with EHS died.</p><p><strong>Conclusions: </strong>All patients with EHS in our study reached a temperature of < 104°F (40°C) within 30 min, which suggests rotating ice water-soaked towels could provide an effective and practical method of cooling in the prehospital setting.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531451","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":"Implementation of an Emergency Department Opioid Use Disorder Initiative: Clinical Processes and Institution Specific Education Improve Care.","authors":"Aaron Krumheuer, Alexander T Janke, Alex Nickel, Erin Kim, Carrie Bailes, Emily E Ager, Ella K Purington, Syed Mohammad Mahmood, Mitchell Hooyer, Mary Loretta Ryan, Jessica E Baker, Megan Purdy, Colin F Greineder, Carolyn V Commissaris, Shawna N Smith, Christopher M Fung, Eve D Losman","doi":"10.1016/j.jemermed.2024.10.009","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.10.009","url":null,"abstract":"<p><strong>Background: </strong>Emergency department (ED) visits associated with opioid use and fatal overdoses increase annually. Emergency clinician-initiated medication for opioid use disorder (MOUD) reduces mortality and improves treatment retention.</p><p><strong>Objective: </strong>We describe and evaluate a program to implement MOUD at an academic ED using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework.</p><p><strong>Methods: </strong>This was a retrospective cohort study of patients presenting to the ED who were eligible for MOUD. A multipronged MOUD program consisting of electronic health record (EHR) order set, email communications, and resident education was delivered over 1 year. Clinical processes were measured before and after program implementation, including buprenorphine and naloxone utilization and outpatient referrals for treatment.</p><p><strong>Results: </strong>We identified 319 eligible encounters over the 2-year study period. Patients were predominantly non-Hispanic white men with a mean age of 40 ± 12.8 years. After program initiation, 109/189 patients (57.7%) were offered or initiated on buprenorphine, compared to 46/130 patients (35.4%) before (95% confidence interval). Protocol dosing was used in 92% of initiations. Outpatient treatment provider referrals increased from 46.1% (60/130) to 63% (119/189; 95% confidence interval). More patients in the postintervention group period requested buprenorphine during their visit compared to before the intervention (24.6% vs. 10%).</p><p><strong>Conclusions: </strong>We observed improvements in the rate of buprenorphine prescription and outpatient treatment referrals at an academic ED following a quality improvement program implemented using the RE-AIM framework.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483232","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":"Male With Wrist Pain.","authors":"Branden Kahen, Alexander Song, Amin Mohamadi, Josh Greenstein, Barry Hahn","doi":"10.1016/j.jemermed.2024.11.005","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.11.005","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710288","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":"A Case of Palpitations in Pregnancy.","authors":"Mario J Castellanos, Hanni M Stoklosa, Derek L Monette, Kathleen A Wittels","doi":"10.1016/j.jemermed.2024.10.018","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.10.018","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476695","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":"Continuous QTc Monitoring for Patients Intoxicated with QTc Prolonging Medication in the Emergency Department: A Proof of Principle Study.","authors":"Marit Bot, Raymond J van Wijk, Hermie J Hermens, David N van der Kooi, Thomas Luttmer, Eva M Boetje, Jan C Ter Maaten, Hjalmar R Bouma, Ewoud Ter Avest","doi":"10.1016/j.jemermed.2024.11.007","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.11.007","url":null,"abstract":"<p><strong>Background: </strong>It can be challenging to determine when patients presenting with an overdose of QT interval prolonging drugs can be discharged safely, especially when the moment of intoxication or the substance ingested is unknown.</p><p><strong>Objective: </strong>In a proof of principle study, we aimed to determine whether continuous corrected QT interval (QTc) analysis can be used to establish optimal observation duration of patients intoxicated with QTc prolonging medication.</p><p><strong>Methods: </strong>For patients presenting with an intoxication with QT interval prolonging drugs in the emergency department, electrocardiography signals sampled at 500 Hz were preprocessed and the mean heart rate QTc per 5 min was calculated and plotted against time. A third order polynomial was fitted to visualize when the QTc would be highest (i.e., electrophysiological time to maximum concentration [T_max]). This point in time was compared with the estimated T_max based on pharmacokinetic properties of the ingested substance.</p><p><strong>Results: </strong>In a retrospective biobank-based study, a total of 22 emergency department visits (of 15 patients) were analyzed. An electrophysiological T_max could be calculated for 17 of 22 visits. The remaining 5 patients presented either long after the electrophysiological T_max (n = 4) or were admitted to the ward before reaching the T_max (n = 1). The mean (SD) difference between the estimated T_max based on drug properties and the calculated electrophysiological T_max was 18 (133) min (range -158 to 296 min). Despite the wide range, there was a significant correlation between recorded electrophysiological T_max and estimated T_max (r = 0.67, p = 0.012).</p><p><strong>Conclusions: </strong>Continuous electrophysiological monitoring can be used as an adjunct to determine the toxicokinetic T_max for patients presenting with an intoxication, especially when the time of ingestion or the substance ingested is unknown.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753059","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":"Coagulation Studies are Frequently Ordered in Emergency Department Chest Pain Patients and do not Change Emergency Department Management.","authors":"Jarryd Rivera, Samidha Dutta, Karly Castellaw, Priyanka Dharampuriya, Michael Weinstock","doi":"10.1016/j.jemermed.2024.11.003","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.11.003","url":null,"abstract":"<p><strong>Background: </strong>Despite research findings, implementation into clinical practice is often delayed. Coagulation panels are still ordered as part of an emergency department (ED) chest pain evaluation, despite multiple studies showing that it is unnecessary and does not change management.</p><p><strong>Objective: </strong>Our primary outcome is to determine if the practice of ordering coagulation studies (prothrombin time [PT]/international normalized ratio [INR]) is still occurring in ED chest pain patients. Our secondary outcome is to determine if abnormal results change management.</p><p><strong>Methods: </strong>We performed an institutional review board (IRB) approved retrospective chart review of patients with chest pain presenting to three rural-community EDs over 49 months. Medical students, blinded to the study intent, performed data abstraction using the approach of Gilbert and Lowenstein to determine if coagulation testing (PT/INR) was \"indicated\" based on a preexisting condition (i.e., liver disease) or medication use (warfarin). Next, the data abstractors determined if the abnormal coagulation results prompted a therapeutic intervention or change in the management in the ED.</p><p><strong>Results: </strong>We randomly identified 1,200 patients with chest pain before covid-19 and, after exclusions, analyzed 830 patient charts. 440 patients (53.0%) had coagulation panels completed, but they were only indicated in 55 of the 440 patients (12.5%). Of the 385 patients without indications, 378 (98.2%) had an INR level in the normal range and 7 patients (1.8%) had an elevated INR. None of these 7 patients had a change in ED management.</p><p><strong>Conclusions: </strong>In this multicenter study, 53% of ED patients with chest pain had coagulation studies ordered. Only 12.5% were indicated. None of the abnormal results in patients without indications resulted in a change in ED management.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531432","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}