American Journal of Emergency Medicine最新文献

{"title":"A high-flow nasal cannula versus noninvasive ventilation in acute exacerbations of chronic obstructive pulmonary disease.","authors":"Chien-Chieh Hsieh, Fu-Shan Jaw, Wei-Che Chiu, Chen-Chang Chang, Che-Ming Yeh","doi":"10.1016/j.ajem.2024.11.085","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.11.085","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In reply: Evaluating AI models for ECG interpretation accuracy.","authors":"Serkan Gunay, Ahmet Ozturk, Yavuz Yigit","doi":"10.1016/j.ajem.2024.11.084","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.11.084","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of mortality among adolescents and young adults following hospitalization from an intentional overdose","authors":"Michael Wallum MD ,&nbsp;J. Priyanka Vakkalanka PhD ,&nbsp;Sydney Krispin MPH, MA ,&nbsp;Daniel J. McCabe MD","doi":"10.1016/j.ajem.2024.11.081","DOIUrl":"10.1016/j.ajem.2024.11.081","url":null,"abstract":"<div><h3>Objective</h3><div>Previous self-harm attempts are a known risk factor for subsequent suicide completion in adults but is unestablished among adolescents and young adults. Our objective was to determine the mortality rate for patients 10–24 years of age following discharge from the hospital after a non-lethal, intentional overdose.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted of patients aged 10–24 years seen between 2017 and 2022 by the medical toxicology consultation service (MedTox) at a large tertiary care center who experienced a non-lethal, intentional overdose and survived this encounter. The National Death Index (NDI) was examined to determine whether any of these patients subsequently died. We characterized MedTox consultations by age, sex, and substances used. Among those who died, we descriptively characterized the patient's demographics, exposure, and clinical characteristics.</div></div><div><h3>Results</h3><div>There were 1295 consultations for 1147 patients. Females accounted for 71 % of encounters, and most consults were for those aged 14–17 years (51 %), followed by those 18–21 years (25 %). Most commonly identified substances included acetaminophen (26 %), diphenhydramine (9 %), and ibuprofen (8 %). We identified 4 (&lt;1 %) deaths identified from the NDI: two patients died by asphyxiation, one died by intentional overdose, and one died due to complications from chronic medical conditions.</div></div><div><h3>Conclusion</h3><div>Our observed mortality was lower compared to other studies (0.7 % - 13.3 %), which may have been due to protective factors (e.g., multidisciplinary evaluations) built into the institutional protocols at this center. Future studies will attempt to qualitatively and quantitatively identify individual- and system- level mechanisms in the pathway between self-harm and long-term health outcomes.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"88 ","pages":"Pages 140-144"},"PeriodicalIF":2.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Agitation: Neurobiology and current management guidelines","authors":"Christopher W.T. Miller M.D ,&nbsp;Mario Rullo M.D ,&nbsp;Sarah Van Remmen M.D ,&nbsp;Sara Mahmood M.D","doi":"10.1016/j.ajem.2024.11.068","DOIUrl":"10.1016/j.ajem.2024.11.068","url":null,"abstract":"<div><div>There have been important updates in the guidelines for the management of agitation in emergency room settings, including psychiatric emergency services. This manuscript provides a synthesis of current recommendations, combined with a detailed breakdown of the neurobiology of agitation, linking these neuroscientific dimensions with the pharmacological profiles of the drugs recommended by practice guidelines (as well as the profiles of other important agents). Since Project BETA (Best Practices in Evaluation and Treatment of Agitation) guidelines were published in 2012 (by the American Association for Emergency Psychiatry), there have been several developments in the standard of care, including an increase in use of ketamine and droperidol. Recommended treatment strategies for clinicians will be presented, including consideration of how to address specific causes of agitation.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"88 ","pages":"Pages 110-119"},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142743168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Doing the best we can\": Qualitative study of clinician experiences with opioid use disorder care in emergency departments.","authors":"Lauren A Szczygiel, Forrest Hosea, Keith E Kocher, Chin Hwa Dahlem, Aaron Dora-Laskey, Mark C Bicket, Jennifer Waljee, Mary E Byrnes","doi":"10.1016/j.ajem.2024.11.067","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.11.067","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor: A clinical prediction model for safe early discharge of patients with an infection at the emergency department.","authors":"Chenxi Wang, Huichuan Tian, Jin Shang","doi":"10.1016/j.ajem.2024.11.080","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.11.080","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An emergency medicine review: Multiple myeloma and its complications.","authors":"Brit Long, Arleigh McCurdy, Alex Koyfman, Hans Rosenberg","doi":"10.1016/j.ajem.2024.11.073","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.11.073","url":null,"abstract":"<p><strong>Introduction: </strong>Multiple myeloma (MM) and its complications carry a high rate of morbidity and mortality.</p><p><strong>Objective: </strong>This review evaluates MM and its complications, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.</p><p><strong>Discussion: </strong>MM is the second most common hematologic cancer and associated with monoclonal plasma cell proliferation. The presentation of MM varies, ranging from few symptoms to end organ injury and failure. The most common presenting findings include anemia, bone pain, renal injury, fatigue, hypercalcemia, and weight loss. While clinical outcomes have improved with known therapies, a variety of complications may occur. Anemia is the most common hematologic complication, though hyperviscosity syndrome, bleeding, and coagulopathy may occur. Renal injury is common, and hypercalcemia is the result of bone demineralization. Infection is a major cause of morbidity and mortality. Osteolytic bone disease is a significant feature of MM, present in 70 % of patients, which may result in pathologic and insufficiency fractures. The most serious neurologic complication includes spinal cord compression, and other neurologic complications include peripheral neuropathy and intracranial involvement. Cardiac toxicity may occur with MM therapies, and there is also increased risk of venous thromboembolism. Endocrine complications may also occur, including adrenal insufficiency and thyroid dysfunction.</p><p><strong>Conclusions: </strong>An understanding of the complications of MM can assist emergency clinicians in diagnosing and managing this potentially deadly disease.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"88 ","pages":"172-179"},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potentially avoidable emergency department transfers among Medicare beneficiaries","authors":"Kathleen Y. Li MD, MS ,&nbsp;John L. Gore MD, MS ,&nbsp;Elizabeth A. Phelan MD, MS ,&nbsp;Jane Hall PhD ,&nbsp;Navya Gunaje MS ,&nbsp;Amber K. Sabbatini MD, MPH","doi":"10.1016/j.ajem.2024.11.078","DOIUrl":"10.1016/j.ajem.2024.11.078","url":null,"abstract":"<div><h3>Introduction</h3><div>Transfer of patients between hospitals is common, costly, and over 20 % are estimated to be avoidable, meaning patients do not receive specialized interventions once transferred. Older adults are more likely to be transferred and may be at increased risk for developing delirium or other complications due to transfer. We aimed to determine the frequency of potentially avoidable transfer (PAT) among older adults; identify conditions most likely to involve a PAT; and describe factors associated with PAT.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of ED visits resulting in transfer to another hospital from 2008 to 2019 among Medicare fee-for-service beneficiaries 65 years and older. We defined PAT based on resource use at the receiving hospital – transfers resulting in a treat-and-release ED visit, observation stay, or inpatient hospitalization for 2 days or less who received no intensive care or advanced procedure and were discharged alive. We identified conditions with the highest rates of PAT and used multivariable logistic regression to identify the independent association of patient, diagnosis, hospital, and community-linked characteristics with PAT.</div></div><div><h3>Results</h3><div>Among ∼3 million transfers, 11.3 % met criteria for PAT. Transferring hospitals varied in their rates of PAT, with a median (IQR) rate of 10.3 % (7.2–14.6). Conditions with high rates of PAT included transient cerebral ischemia (35.3 %), nonspecific chest pain (25.5 %), syncope (22.9 %), other fractures (18.4 %), and intracranial injury (16.9 %). These conditions were also associated with PAT in multivariable logistic regression (average marginal effect [AME] 28.2 % (95 %CI 27.4–29.1), 20.6 % (19.8–21.5), 19.2 % (18.5–19.9), 13.4 % (12.9–13.9), and 12.8 % (12.2–13.4), respectively, compared to transfers for sepsis). Patients who were age 85 and older, female, non-White, had fewer comorbidities, and large, for-profit, teaching, and critical access hospitals, and counties with high uninsurance rates were associated with higher likelihood of PAT. Safety net and rural hospitals, and hospitals in counties with high poverty rates were associated with lower likelihood of PAT.</div></div><div><h3>Discussion</h3><div>PATs were common in transfers of older adults, particularly among a subset of neurologic, cardiovascular, and injury-related conditions. These conditions may represent ideal targets for intervention to decrease rates of avoidable transfer. Research exploring hospital variation in transfer practices and the impact of PAT on older adults' health outcomes are also needed.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"88 ","pages":"Pages 145-151"},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous gas embolism: An early indicator of uterine perforation and its sequelae.","authors":"Chitta Ranjan Mohanty, Santosh Kumar Dora, Amiya Kumar Barik, Rakesh Vadakkethil Radhakrishnan, Tarangini Das","doi":"10.1016/j.ajem.2024.11.051","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.11.051","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Association between multiple intubation attempts and complications during emergency department airway management\".","authors":"Amiya Kumar Barik, Subhasree Das, Rakesh Vadakkethil Radhakrishnan, Chitta Ranjan Mohanty, Snigdha Bellapukonda","doi":"10.1016/j.ajem.2024.11.060","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.11.060","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}