American Journal of Emergency Medicine最新文献

{"title":"Hepatitis C testing and linkage to care in a safety-net hospital emergency department","authors":"Nicole Lue MD ,&nbsp;Jennifer Lom MD ,&nbsp;Elizabeth Manguso MD, MPH ,&nbsp;Brandi Park MS ,&nbsp;Andres Palacio ,&nbsp;Rapheisha Darby MPH ,&nbsp;Bijal Shah MD ,&nbsp;Anna Yaffee MD, MPH ,&nbsp;Lesley Miller MD, FACP","doi":"10.1016/j.ajem.2025.04.046","DOIUrl":"10.1016/j.ajem.2025.04.046","url":null,"abstract":"<div><h3>Background and purpose</h3><div>In 2020, the CDC expanded hepatitis C (HCV) screening recommendations to include universal screening for persons 18 and older. We implemented universal screening in the emergency department (ED) within a safety-net health system. We aimed to measure HCV prevalence and linkage to care (LTC) outcomes in the ED and compare them to the outpatient clinics within the same health system.</div></div><div><h3>Methods</h3><div>Patients aged 18–79 without HCV qualified for screening. We measured prevalence of both anti-HCV+ (exposure) and HCV RNA+ (active infection). Those with active HCV were flagged for LTC and their charts were followed for outcomes. HCV prevalence and LTC in the ED were compared to those in outpatient clinics over the same time.</div></div><div><h3>Results</h3><div>9511 patients were screened for HCV from 2019 to 2022 in the ED. 6.9 % (659) were anti-HCV+. 54.9 % (320 of 582) of anti-HCV+ individuals or 3.4 % of those screened (320 of 9511) were HCV RNA+. The LTC rate was 24.1 % (77 of 320) and a total of 56 individuals (17.8 % of all HCV RNA+ ED patients, 72.7 % of those linked) initiated treatment. HCV prevalence was higher in the ED compared to the outpatient clinic setting. Demographics and LTC rates also significantly differed between these two cohorts.</div></div><div><h3>Conclusions</h3><div>We identified a higher HCV prevalence in the ED relative to the outpatient clinic setting and significant need for improvement in LTC and HCV treatment initiation. Our findings suggest universal screening is an important tool to diagnose HCV infections but may require novel strategies for improved LTC and treatment initiation.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 133-139"},"PeriodicalIF":2.7,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876625","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":"Impact of weather, air pollution and virus variant on COVID-19 with acute respiratory failure in the emergency department","authors":"Man-Ju Ting ,&nbsp;Chien-Chieh Hsieh ,&nbsp;Pau-Chung Chen","doi":"10.1016/j.ajem.2025.04.043","DOIUrl":"10.1016/j.ajem.2025.04.043","url":null,"abstract":"<div><h3>Background</h3><div>Air pollution and meteorological factors are thought to contribute to increased risk of severe COVID-19, but the evidence is still controversial. This study aimed to assess the effects of weather, air pollution and SARS-CoV-2 variants on COVID-19 with acute respiratory failure (ARF) and investigate the respiratory management in the emergency department (ED).</div></div><div><h3>Methods</h3><div>We conducted a prospective observational study of 469 COVID-19 ED visits from March 1, 2020 to December 31, 2023. Data on air pollutant levels and weather variables was obtained from Taiwan Central Weather Bureau (CWB) and Environmental Protection Administration (EPA). The generalized linear models extending bivariate and multivariable Poisson regression models were used to estimate the association between the weather variables, air pollutants, virus variants, and COVID-19 patients with ARF.</div></div><div><h3>Results</h3><div>Among the 469 patients, 64 % were male, and the mean age was 70 ± 6 years. Overall, 18 % (<em>n</em> = 84) of the cohort died, 43 % (<em>n</em> = 200) were intubated, and 70 % (<em>n</em> = 326) were admitted to the ICU. We observed significantly positive associations between PM_2.5, PM₁₀, temperature, and wind speed with ED visits for COVID-19 with ARF. Every 1 μg/m³ increase in PM_2.5, PM₁₀, each 1 m/s increase in wind speed, and 1 °C increase in temperature were significantly associated with a 34.1 % (95 % CI: 8.2 %–66.1 %), 45.4 % (95 % CI: 39.4 %–46.6 %), 19.0 % (95 % CI: 11.4 %–27.0 %), and 10.4 % (95 % CI: 6.9 %–13.9 %) increase in the average daily number of COVID-19 patients respectively. In contrast, NO₂, SO₂, relative humidity, and sunshine were significantly associated with lower average daily numbers of severe COVID-19 patients. Moreover, virus variants were significantly positive associations between humidity and sunshine, 53.9 % (95 % CI: 37.0 %–70.3 %) and 5.4 % (95 % CI: 0.6 %–10.4 %) respectively.</div></div><div><h3>Conclusion</h3><div>The relationship between air pollution, climate change, virus variants, and COVID-19 is highly intricate. Air pollution exacerbates the severity of COVID-19, climate change influences virus transmission and human immune responses, and viral variants make pandemic control more challenging. These interactions are critical for future prediction, prevention and responses to global health crises.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 96-102"},"PeriodicalIF":2.7,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869905","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":"Performance of the artificial intelligence-based Swiss medical assessment system versus Manchester triage system in the emergency department: A retrospective analysis","authors":"Gregor Lindner ,&nbsp;Svenja Ravioli","doi":"10.1016/j.ajem.2025.04.023","DOIUrl":"10.1016/j.ajem.2025.04.023","url":null,"abstract":"<div><h3>Background</h3><div>The emergence of artificial intelligence (AI) offers new opportunities for applications in emergency medicine, including patient triage. This study evaluates the performance of the Swiss Medical Assessment System (SMASS), an AI-based decision-support tool for rapid patient assessment, in comparison with the well-established Manchester Triage System (MTS).</div></div><div><h3>Methods</h3><div>In this retrospective analysis, patients aged 18 years or above presenting to the Department of Emergency Medicine at Kepler University Hospital in Linz, Austria, during November and December 2024 with non-traumatic complaints were included. Each patient underwent emergency triage using MTS, conducted by a registered nurse, with SMASS applied in parallel. SMASS had no influence on clinical decision-making.</div></div><div><h3>Results</h3><div>In the study period, 1021 patients were triaged with both MTS and SMASS. The mean patient age was 60 years (SD: 21), and 53 % were women. Of the patients categorized as “orange” by MTS, 19 % were classified as non-urgent by SMASS. Conversely, 28 % of the patients triaged as “green” by MTS were classified as urgent by SMASS. Additionally, 23 % of patients classified as non-urgent by SMASS required hospitalization following emergency department evaluation and treatment. Agreement between SMASS and MTS in triaging emergency patients was low as measured by a Cohen's kappa of 0.167.</div></div><div><h3>Conclusions</h3><div>In this study of patients presenting to a large tertiary-care emergency department, SMASS demonstrated considerable discrepancies in triage classification compared to MTS, with significant rates of both over- and undertriage. Further validation is necessary before integrating AI-based triage tools into routine clinical practice.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 46-49"},"PeriodicalIF":2.7,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143858952","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":"Comparison of anticoagulation reversal strategies for warfarin associated acute gastrointestinal bleeding","authors":"Kyle A. Hess PharmD ,&nbsp;Alicia E. Mattson PharmD ,&nbsp;Fernanda Bellolio MD ,&nbsp;Daniel Cabrera MD ,&nbsp;Nayantara Coelho-Prabhu MBBS ,&nbsp;Robert D. McBane II MD ,&nbsp;Kristin C. Cole MS ,&nbsp;Kayla Carpenter ,&nbsp;Gia Jackson ,&nbsp;Caitlin S. Brown PharmD","doi":"10.1016/j.ajem.2025.04.029","DOIUrl":"10.1016/j.ajem.2025.04.029","url":null,"abstract":"<div><h3>Objective</h3><div>Gastrointestinal bleeding (GIB) is a common complication associated with warfarin use. However, the optimal approach for anticoagulation reversal—whether with prothrombin complex concentrate (PCC), fresh frozen plasma (FFP), vitamin K (intravenous or oral), or no reversal—remains unclear as current literature and society guidelines do not provide definitive recommendations.</div></div><div><h3>Methods</h3><div>A retrospective analysis of emergency department patients with warfarin-associated GIB who presented to an academic health system was performed, comparing reversal with PCC, FFP, vitamin K only, or no reversal agent. The primary outcome was 30-day all-cause mortality. Secondary outcomes included rebleeding events and 30-day thrombotic events. Standardized guidelines for reporting were followed (STROBE).</div></div><div><h3>Results</h3><div>Of 815 patients, within 12 h of presentation, 10.7 % received reversal with PCC (with or without vitamin K), 12.9 % with FFP (with or without vitamin K), and 34.9 % with vitamin K alone; 41.5 % of patients received no reversal agent. Compared to all other groups, patients receiving PCC had significantly higher 30-day mortality (18.4 % [PCC] vs 5.7 % [FFP] vs 4.6 % [vitamin K] vs 5.6 % [no reversal], <em>p</em> &lt; 0.001), which remained significant after adjusting for hemodynamic instability and ICU admission. There were no significant differences in rates of thrombotic event within 30 days (3.4 % vs 3.8 % vs 1.4 % vs 1.2 %, <em>p</em> = 0.20).</div></div><div><h3>Conclusions</h3><div>Patients who received PCC had a threefold increase in mortality compared to FFP, vitamin K alone, or no reversal, even after adjusting for severity of the bleeding. Further research is necessary to understand factors leading to this observed mortality difference among patients with warfarin related GIB.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 55-62"},"PeriodicalIF":2.7,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143858953","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":"Diagnostic value of ultrasound in detecting forearm fractures in pediatric patients in the emergency department","authors":"Ahmet Furkan Nalbant,&nbsp;Taner Şahin,&nbsp;İsmail Kürtüncü,&nbsp;Fatma Hançer Çelik,&nbsp;İbrahim Toker","doi":"10.1016/j.ajem.2025.04.037","DOIUrl":"10.1016/j.ajem.2025.04.037","url":null,"abstract":"<div><h3>Objective</h3><div>Pediatric forearm trauma is one of the most common reasons for referral to the trauma units of emergency departments. This study investigated the diagnostic value of ultrasonography (US) in comparison with direct radiography in detecting forearm fractures in children aged 2–15 years with incomplete bone development.</div></div><div><h3>Method</h3><div>This prospective, observational, single-center study included patients aged 2–15 years who were conscious, had isolated forearm trauma and closed injuries, and were treated at the Emergency Medicine Clinic of Kayseri City Hospital between January 1 and August 31, 2021. Written consent was obtained from the relatives or guardians of all patients. The physician who first examined the patient filled out a research form and requested a direct radiograph. US of the soft tissue in the forearm was performed by a USG-certified investigator, who was blinded to the diagnosis and radiography results.</div></div><div><h3>Results</h3><div>The study examined 87 patients, including 60 males (69 %) and 27 (31 %) females. Fractures were detected in 69 (79.3 %) patients. There were 47 patients (54 %) who had only radius fractures, 20 (23 %) had radius and ulna fractures, and 2 (2.3 %) had only ulna fractures. The sensitivity of US for displaced radius fractures was 96.67 %, the selectivity was 100 %, and the total accuracy was 98.8 %. The sensitivity of US for radius fractures with no displacement was 94.59 %, the selectivity was 100 %, and the total accuracy was 97.7 %. The sensitivity of US for displaced ulna fractures was 94.1 %, the selectivity was 100 %, and the total accuracy was 98.8 %. For fractures with no ulna displacement, the sensitivity was 60 %, the specificity was 100 %, and the total accuracy was 97.7 %.</div></div><div><h3>Conclusion</h3><div>In this study of pediatric forearm trauma patients with suspected fractures, ultrasound had high sensitivity and specificity.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 21-24"},"PeriodicalIF":2.7,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852179","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":"Triage nurse-initiated orders in pediatric emergency care: A single-center retrospective cohort study of appendix and testicular ultrasounds","authors":"Brandon Ho MD ,&nbsp;Lauren Waterhouse ,&nbsp;Sarah Isbey MD","doi":"10.1016/j.ajem.2025.04.041","DOIUrl":"10.1016/j.ajem.2025.04.041","url":null,"abstract":"<div><h3>Background</h3><div>Triage nurse-initiated imaging orders (TNIO) are a promising strategy to improve emergency department (ED) efficiency and length of stay (LOS). However, limited data exists on the impact of TNIO ultrasounds in pediatric appendicitis and testicular torsion.</div></div><div><h3>Objectives</h3><div>This study aimed to measure the utilization of TNIO for appendix and testicular ultrasounds and evaluate their impact on LOS. Secondary objectives included assessing effects on time to pain interventions, time to antibiotics, return visits, departures prior to provider evaluation, and need for additional imaging.</div></div><div><h3>Methods</h3><div>A single center, retrospective cohort study of patients aged 0–21 years old presenting to a pediatric ED from 2018 and 2023 who underwent appendix or testicular ultrasounds. Patients bypassing triage or who had pre-triage ultrasound orders were excluded. Patients were grouped by nurse-initiated or provider-initiated ultrasounds. Statistical analyses included descriptive statistics and multivariate regression.</div></div><div><h3>Results</h3><div>Of 9594 appendix ultrasounds, 20.4 % were nurse-initiated, reducing LOS by 12.7 % (<em>p</em> &lt; 0.001). Of 2525 testicular ultrasounds, 41.9 % were TNIO, reducing LOS by 6.4 % (<em>p</em> &lt; 0.001). TNIO for appendicitis reduced time to antibiotics by 11.9 % (<em>p</em> &lt; 0.001) but had no effect on time to pain control. TNIO patients had fewer return visits (<em>p</em> &lt; 0.001) but higher rates of departures prior to provider evaluation (p &lt; 0.001). Disparities were observed, with Non-Hispanic Black and Medicaid patients less likely to receive TNIO for appendicitis.</div></div><div><h3>Conclusion</h3><div>Triage nurse-initiated ultrasounds reduce LOS in cases of suspected appendicitis and testicular torsion. Implementing triage nurse-initiated imaging protocols could potentially optimize the care of pediatric patients with these conditions, ultimately improving ED efficiency.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 119-124"},"PeriodicalIF":2.7,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869906","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":"Perceptions and patterns of Cannabis use in emergency department patients following recreational legalization in Massachusetts","authors":"James D. Whitledge MD ,&nbsp;Michael Ganetsky MD ,&nbsp;Ryan C. Burke MPH PhD ,&nbsp;Katherine L. Boyle MD","doi":"10.1016/j.ajem.2025.04.033","DOIUrl":"10.1016/j.ajem.2025.04.033","url":null,"abstract":"<div><h3>Introduction</h3><div>In Massachusetts, cannabis was legalized for recreational use in 2016. Legalization was associated with an increase in cannabis-related emergency department (ED) visits. The purpose of this study was to characterize cannabis use in an ED population in Massachusetts following legalization.</div></div><div><h3>Methods</h3><div>This was a convenience sample survey study conducted at an academic medical center ED in Massachusetts. Patients aged 18 or older reporting cannabis use within the last month were eligible. Participants were surveyed about cannabis use including: use patterns, risks and benefits, concomitant substance use, and changes in use post-legalization. Patients and treating physicians were asked whether ED visits were attributable to cannabis to determine discordance. Data analysis used descriptive statistics.</div></div><div><h3>Results</h3><div>Between July 2019 and May 2021, 200 patients were enrolled. Relaxation and analgesia were the most common reported benefits of cannabis. 46 % of patients prescribed an opioid reported decreased opioid use due to cannabis. 31 % reported no perceived risks from cannabis, and 22 % believed cannabis impaired driving. Twenty-one patients presented with a cannabis-related chief complaint per the treating physician; 11 (52.4 %) believed their presentation was due to cannabis. Post-legalization, 28.5 % of patients reported increased cannabis use.</div></div><div><h3>Conclusion</h3><div>In this study of patients with cannabis use presenting to a Massachusetts ED, the majority did not report increased use following recreational legalization. Patients reported multiple benefits of cannabis, including decreased opioid use, but minimized risks including intoxicated driving. Almost half of patients with cannabis-related symptoms did not attribute them to cannabis. These findings may inform harm-reduction strategies.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 31-36"},"PeriodicalIF":2.7,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143858951","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":"ChatGPT-supported patient triage with voice commands in the emergency department: A prospective multicenter study","authors":"Sinan Pasli ,&nbsp;Metin Yadigaroğlu ,&nbsp;Esma Nilay Kirimli ,&nbsp;Muhammet Fatih Beşer ,&nbsp;İhsan Unutmaz ,&nbsp;Asu Özden Ayhan ,&nbsp;Büşra Karakurt ,&nbsp;Abdul Samet Şahin ,&nbsp;Halil İbrahim Hiçyilmaz ,&nbsp;Melih Imamoğlu","doi":"10.1016/j.ajem.2025.04.040","DOIUrl":"10.1016/j.ajem.2025.04.040","url":null,"abstract":"<div><h3>Background</h3><div>Triage aims to prioritize patients according to their medical urgency by accurately evaluating their clinical conditions, managing waiting times efficiently, and improving the overall effectiveness of emergency care. This study aims to assess ChatGPT's performance in patient triage across four emergency departments with varying dynamics and to provide a detailed analysis of its strengths and weaknesses.</div></div><div><h3>Methods</h3><div>In this multicenter, prospective study, we compared the triage decisions made by ChatGPT-4o and the triage personnel with the gold standard decisions determined by an emergency medicine (EM) specialist. In the hospitals where we conducted the study, triage teams routinely direct patients to the appropriate ED areas based on the Emergency Severity Index (ESI) system and the hospital's local triage protocols. During the study period, the triage team collected patient data, including chief complaints, comorbidities, and vital signs, and used this information to make the initial triage decisions. An independent physician simultaneously entered the same data into ChatGPT using voice commands. At the same time, an EM specialist, present in the triage room throughout the study period, reviewed the same patient data and determined the gold standard triage decisions, strictly adhering to both the hospital's local protocols and the ESI system. Before initiating the study, we customized ChatGPT for each hospital by designing prompts that incorporated both the general principles of the ESI triage system and the specific triage rules of each hospital. The model's overall, hospital-based, and area-based performance was evaluated, with Cohen's Kappa, F1 score, and performance analyses conducted.</div></div><div><h3>Results</h3><div>This study included 6657 patients. The overall agreement between triage personnel and GPT-4o with the gold standard was nearly perfect (Cohen's kappa = 0.782 and 0.833, respectively). The overall F1 score was 0.863 for the triage team, while GPT-4 achieved an F1 score of 0.897, demonstrating superior performance. ROC curve analysis showed the lowest performance in the yellow zone of a tertiary hospital (AUC = 0.75) and in the red zone of another tertiary hospital (AUC = 0.78). However, overall, AUC values greater than 0.90 were observed, indicating high accuracy.</div></div><div><h3>Conclusion</h3><div>ChatGPT generally outperformed triage personnel in patient triage across emergency departments with varying conditions, demonstrating high agreement with the gold standard decision. However, in tertiary hospitals, its performance was relatively lower in triaging patients with more complex symptoms, particularly those requiring triage to the yellow and red zones.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 63-70"},"PeriodicalIF":2.7,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143858954","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":"Retrospective review of thrombolytic use for cardiac arrest due to suspected pulmonary embolism","authors":"Abigail Jansen PharmD ,&nbsp;Cassandra J. Schmitt PharmD ,&nbsp;Daniel Cabrera M.D. ,&nbsp;Erin D. Wieruszewski PharmD","doi":"10.1016/j.ajem.2025.04.036","DOIUrl":"10.1016/j.ajem.2025.04.036","url":null,"abstract":"<div><h3>Background</h3><div>Massive pulmonary embolism (PE) causing obstructive shock can lead to circulatory failure and cardiac arrest. There is a paucity of data describing current practice around thrombolytic use and outcomes in this patient population.</div></div><div><h3>Objective</h3><div>The objective of this study was to describe the characteristics and outcomes of patients who received a thrombolytic agent during cardiac arrest due to suspected PE, including efficacy and safety.</div></div><div><h3>Methods</h3><div>This study was a retrospective, descriptive cohort of 32 adult patients who received alteplase or tenecteplase in the emergency department during active cardiac arrest. Agent selection and dosing were at the discretion of the primary provider.</div></div><div><h3>Results</h3><div>Most patients presented with a witnessed out-of-hospital cardiac arrest with a non-shockable rhythm. The mean age was 63 years. Dyspnea was most commonly reported prior to cardiac arrest. The median dose for alteplase was 50 mg and for tenecteplase was 45 mg. Eleven patients achieved ROSC after thrombolytic administration; seven of these patients survived to hospital admission. All but one patient experienced a major bleeding event during admission. Ultimately, only two patients survived to hospital discharge. A subgroup analysis compared patients administered alteplase to those administered tenecteplase. Nine of the eleven patients that achieved ROSC were administered alteplase, five of which survived to hospital admission. All five patients experienced a major bleeding event. Two of the eleven patients that achieved ROSC were administered tenecteplase, both of which survived to hospital admission. One patient experienced a major bleeding event. Ultimately, only one patient in each group survived to hospital discharge.</div></div><div><h3>Conclusion</h3><div>This study provides new data regarding the outcomes of thrombolytic therapy in patients experiencing cardiac arrest due to suspected massive PE. Despite administration of thrombolytics, survival to hospital admission and subsequent survival to hospital discharge were seen in only a very small proportion of patients. Further research is necessary to optimize the management of this life-threatening condition.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 76-80"},"PeriodicalIF":2.7,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869904","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":"Feasibility and efficacy of simulation training for joint dislocation management in residency","authors":"Cedric W. Lefebvre MD ,&nbsp;Nicholas D. Hartman MD, MPH ,&nbsp;Casey Glass MD ,&nbsp;Eric Daubach MD ,&nbsp;Tewodros Wodajo MD ,&nbsp;Benjamin Hutchison MD ,&nbsp;Thea Lance ,&nbsp;Nicole J. Prendergast MD ,&nbsp;Nicklaus P. Ashburn MD, MS","doi":"10.1016/j.ajem.2025.04.038","DOIUrl":"10.1016/j.ajem.2025.04.038","url":null,"abstract":"<div><h3>Background</h3><div>Residents in EM training programs are required by the Accreditation Council of Graduate Medical Education (ACGME) to achieve competency in joint dislocation management. Our study group developed three large joint dislocation task trainers and evaluated their feasibility and efficacy in residency training.</div></div><div><h3>Methods</h3><div>During the study period, participants attempted reduction of the dislocation task trainers. Study personnel collected data from these attempts, including procedural success, time to hand placement, and time to joint reduction. Hands-on education was then provided. Learners participated a second time during the study period, and collection of data was repeated. Rates of successful joint dislocation reductions were determined and reported with exact 95 % binomial confidence intervals (95 % CI). Medians and upper and lower quartiles for time to hand placement and time to successful reduction were calculated and reported.</div></div><div><h3>Results</h3><div>Among first-time users, the successful reduction rates for the shoulder, hip and elbow were 63 % (19/30, 95 % CI 43–80 %), 83 % (25/30, 95 % CI 62–94 %), and 90 % (27/30, 95 % CI 73-97 %) respectively. For second-time users, successful reduction rates were 100 % (30/30, 95 % CI 88–100 %) for all joints. Among first-time participants, the median times to achieve successful shoulder, hip, and elbow reduction were 69 s (IQR 32, 92), 35 s (IQR 22, 49), and 16 s (IQR 13, 24) respectively. For second-time users, the median times to reduce these joints were 24 s (IQR 14, 40), 14 s (IQR 11, 17) and 10 s (IQR 7, 12).</div></div><div><h3>Conclusion</h3><div>Our data suggest that large joint dislocation management training is feasible using high-fidelity simulation task trainers. Additional study is planned to assess the potential role of this approach for improving procedural competency in the clinical realm.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 50-54"},"PeriodicalIF":2.7,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143858837","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}