American Journal of Emergency Medicine最新文献

{"title":"TOC","authors":"","doi":"10.1016/S0735-6757(25)00615-1","DOIUrl":"10.1016/S0735-6757(25)00615-1","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"Pages A3-A7"},"PeriodicalIF":2.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265490","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":"Info for authors","authors":"","doi":"10.1016/S0735-6757(25)00616-3","DOIUrl":"10.1016/S0735-6757(25)00616-3","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"Page A8"},"PeriodicalIF":2.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265492","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":"Erratum to \"Duration of resuscitation interruption using point-of-care ultrasound versus traditional manual pulse check: A systematic review and meta-analysis\" [American Journal of Emergency Medicine 98C (2025) 145-152].","authors":"Eduardo Saadi Neto, Murilo Scapin, Francisco Lazaro-Paulina, Ronna L Campbell, Daniel Fiterman Molinari, Tobias Kummer","doi":"10.1016/j.ajem.2025.09.047","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.09.047","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253971","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":"Rapid diagnosis of pediatric nonconvulsive status epilepticus using point-of-care EEG","authors":"Leopold Simma MD ,&nbsp;Katharina Moser MD ,&nbsp;Michelle Seiler MD ,&nbsp;Andrea Rüegger MD ,&nbsp;Bigna K. Bölsterli MD ,&nbsp;Georgia Ramantani MD, PhD","doi":"10.1016/j.ajem.2025.10.017","DOIUrl":"10.1016/j.ajem.2025.10.017","url":null,"abstract":"<div><h3>Background</h3><div>Nonconvulsive status epilepticus (NCSE) is a time-critical diagnosis in children presenting to pediatric emergency departments (PEDs). Diagnostic delays are common, particularly when isolated altered mental status (AMS) is the only symptom. A standard electroencephalogram (EEG) is essential for diagnosis but rarely available outside regular working hours. Point-of-care EEG (pocEEG) is a rapid, bedside alternative that may support earlier recognition and treatment of NCSE in such situations.</div></div><div><h3>Methods</h3><div>This study describes the use of a rapid, low-cost, two-channel pocEEG device during a quality improvement project at our tertiary PED. We report descriptive data of all cases, and focused on children with AMS following convulsive seizures but without apparent ongoing seizure activity.</div></div><div><h3>Results</h3><div>Of 5 children diagnosed with NCSE, 4 were identified in the PED by using pocEEG. All presented outside regular working hours and had received prehospital benzodiazepines, and 4 had underlying neurological conditions. Levetiracetam was the initial intravenous in-hospital treatment in all cases; 2 required additional phenobarbital. In one case, standard EEG 23 h after presentation revealed focal seizures; retrospective review of the initial pocEEG showed an ictal-interictal continuum.</div></div><div><h3>Conclusions</h3><div>Although all cases followed convulsive seizures, pocEEG may also assist in detecting NCSE in children with unexplained AMS and no seizure history. In our PED, pocEEG provided a pragmatic alternative that enabled early diagnosis and treatment of NCSE when standard EEG was unavailable. PocEEG may be a valuable tool for timely seizure detection and clinical decision-making in pediatric emergency care.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 241-247"},"PeriodicalIF":2.2,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268924","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":"Upper extremity injuries in combat sports: A comparative analysis from US emergency departments","authors":"Brandon Zakeri ,&nbsp;Christopher Fox-Good ,&nbsp;Fehmi Berkay ,&nbsp;Alexander Chase ,&nbsp;Arjun Minhas ,&nbsp;Andrew W. Froehle","doi":"10.1016/j.ajem.2025.10.007","DOIUrl":"10.1016/j.ajem.2025.10.007","url":null,"abstract":"<div><h3>Background</h3><div>Combat sports continue to be popular recreational activities in the United States (US). Despite increasing popularity, relatively few studies have characterized patterns, types, and anatomic distributions of combat sport injuries requiring emergency medical care. This study provides updated descriptive epidemiology of upper extremity injuries sustained from combat sports presenting to US emergency departments.</div></div><div><h3>Methods</h3><div>The study analyzes retrospective data from a nationally representative database, the US Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS; years 2003–2022). A sample of <em>n</em> = 12,619 injuries met inclusion criteria and were included for analysis of injury types and injured body regions, effects of specific combat sport (wrestling, boxing, other martial arts), demographic variables (age, gender), reporting hospital type, and variation over time. Statistical methods included chi square tests, logistic regression analysis, and derivation of odds ratios.</div></div><div><h3>Results</h3><div>Wrestling accounted for 49.4 % of reported injuries, with boxing making up 26.2 %, and martial arts 24.4 %. Fractures (46.5 %) were the most common injury type, followed by strains/sprains (40.7 %) and then dislocations (12.7 %). Shoulders (28.0 %) were most commonly injured, followed by fingers (16.8 %) and hands (16.4 %). Age, gender, and reporting hospital type varied between sports.</div></div><div><h3>Conclusions</h3><div>This study demonstrates significant variability in pattern and location of injuries sustained from wrestling, boxing, and martial arts. By providing updated insight regarding upper extremity temporal trends and injury patterns in boxing, wrestling, and martial arts, this study may assist in efforts to continue advancing safety measures in a group of sports that continues to gain interest in the US, as well as improve the efficiency and effectiveness of care provided to these athletes by emergency medicine physicians.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 248-255"},"PeriodicalIF":2.2,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145269612","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":"Cephalexin use in a pediatric emergency department during the shortage of amoxicillin suspension","authors":"Waleed Alquarshi MD, MSc ,&nbsp;Roisin O'Donnell MD ,&nbsp;Eric Eckbo MD ,&nbsp;Nguyen Khoi Pham MSc(c) ,&nbsp;Nick Barrowman PhD ,&nbsp;Jennifer Bowes MSc ,&nbsp;Nicole Le Saux MD","doi":"10.1016/j.ajem.2025.10.006","DOIUrl":"10.1016/j.ajem.2025.10.006","url":null,"abstract":"<div><h3>Purpose</h3><div>During a significant shortage of amoxicillin suspension in Canada in late 2022, local guidelines recommended cephalexin as an alternative with restricted use of amoxicillin-clavulanate (AC). The aim of the study was to determine outcomes of patients with a diagnosis of acute otitis media (AOM), community acquired pneumonia (AOM) and pharyngitis who were prescribed cephalexin compared to other antibiotics in the emergency department (ED).</div></div><div><h3>Materials and methods</h3><div>We conducted a retrospective cohort analysis of pediatric patients diagnosed with AOM, CAP, and pharyngitis who received antibiotic prescriptions upon discharge from the ED between July 2020 and June 2023. Cases were identified using ICD-10 diagnostic codes, and data were extracted from the EPIC™ electronic health record system. We compared return visits within 3 days and 21 days of the index encounter as measures of potential treatment failure and adverse events, respectively.</div></div><div><h3>Results</h3><div>Among 7387 eligible patient encounters, cephalexin and AC emerged as the most frequently prescribed alternatives to amoxicillin during the shortage period. Comparative analysis revealed no statistically significant differences in the rates of return visits or adverse events within 21 days post-treatment initiation across the different antibiotic regimens.</div></div><div><h3>Conclusions</h3><div>Cephalexin represents a suitable alternative for AOM, CAP, and pharyngitis during an amoxicillin shortage, with potential antimicrobial stewardship benefits due to its narrower spectrum.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 237-240"},"PeriodicalIF":2.2,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145269615","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":"Reader comment regarding is high-flow nasal oxygen as effective as non-invasive ventilation in acute cardiogenic pulmonary edema?","authors":"Wangfei Ji, Xiaobai Zhang","doi":"10.1016/j.ajem.2025.10.014","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.10.014","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276780","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":"Bedside guillotine foot and ankle amputation in the emergency department due to necrotizing fasciitis.","authors":"Joslyn F Joseph, Karl Bischoff","doi":"10.1016/j.ajem.2025.10.002","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.10.002","url":null,"abstract":"<p><p>A 54-year-old male with a history of poorly controlled diabetes mellitus presents to the emergency department after being found unresponsive at home. His last known well was approximately nine hours prior to arrival. He was intubated in the field for airway protection and transported emergently. His initial blood glucose was >600 mg/dL. On arrival, he was hypotensive (BP 67/56 mmHg) and hypothermic (35.7 °C). Examination revealed an unresponsive male with an endotracheal tube in place and a cold, pulseless left foot with necrotic wounds and palpable subcutaneous emphysema. He was immediately initiated on broad-spectrum antibiotics (vancomycin, piperacillin-tazobactam, and clindamycin), received a 30 mL/kg bolus of normal saline, and was started on norepinephrine, bicarbonate, and insulin drips. Vascular surgery was emergently consulted. Computed tomography imaging confirmed extensive lower extremity cellulitis, fasciitis, myositis, osteomyelitis, and air in soft tissues concerning for necrotizing infection. Labs confirmed an additional diagnosis of diabetic ketoacidosis. Due to the patient's unstable condition and anesthesiology deeming him unfit for the operating room, a bedside guillotine amputation of the foot and ankle was performed by vascular surgeon and emergency physician. The patient was admitted to the intensive care unit for ongoing management. The patient initially improved and became more responsive. However, after discussion with family regarding goals of care, the patient was transitioned to comfort care measures, terminally extubated, and ultimately expired. This case highlights the challenges of managing fulminant necrotizing infections in critically unstable patients and underscores the need for rapid, multidisciplinary intervention in the emergency department.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276792","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":"Outcomes of Emergency Department Visits for Urticaria in an Urban Safety-net Hospital Without Allergy-Immunology Consult Service.","authors":"Dorde Jevtic, Harleen Sidhu, Yujin Jeong, Gabriela Parra Riveros, Bobby Thomas, Julie Kanevsky, Manish Ramesh, Denisa Ferastraoaru","doi":"10.1016/j.ajem.2025.10.015","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.10.015","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276775","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":"Early vasopressin plus norepinephrine versus delayed or no vasopressin in septic shock: A systematic review and meta-analysis","authors":"Isadora Mamede MD ,&nbsp;Lucas Arêa ,&nbsp;Giulia Carvalhal ,&nbsp;Rodrigo Bessa ,&nbsp;Manoela Lenzi ,&nbsp;Marcel Catão Ferreira dos Santos MD","doi":"10.1016/j.ajem.2025.10.003","DOIUrl":"10.1016/j.ajem.2025.10.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Norepinephrine is the first-line vasopressor in septic shock, with vasopressin commonly added if shock persists. Evidence suggests that early initiation of vasopressin may improve hemodynamic and clinical outcomes; however, data remain conflicting. This meta-analysis evaluates early vasopressin administration.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, and Cochrane for studies comparing early vasopressin plus norepinephrine versus norepinephrine alone or later vasopressin initiation in septic shock. Outcomes included hospital and ICU length of stay (LOS), SOFA score, vasopressor duration, mortality (in-hospital and 28-day), arrhythmias, and renal replacement therapy (RRT). A random-effects model was used. Risk of bias was assessed using RoB2 and ROBINS-I tools.</div></div><div><h3>Results</h3><div>Six studies (<em>n</em> = 1167 patients) met inclusion criteria, including two RCTs. Early vasopressin was associated with a significantly shorter hospital LOS (mean difference [MD] -4.48 days; 95 % CI -8.37 to −0.60; <em>p</em> = 0.02; I² = 44 %). No significant differences were observed for ICU LOS (MD -0.73 days; <em>p</em> = 0.42), vasopressor duration (MD -8.77 h; <em>p</em> = 0.18), SOFA scores at 24 or 72 h, in-hospital mortality (OR 0.86; <em>p</em> = 0.38), 28-day mortality (OR 0.84; <em>p</em> = 0.20), arrhythmia risk (OR 0.99; <em>p</em> = 0.98), or RRT use (OR 1.02; <em>p</em> = 0.91). Risk of bias was high in most included studies, particularly among observational designs.</div></div><div><h3>Conclusion</h3><div>Early vasopressin may reduce hospital LOS in septic shock but does not improve mortality or other outcomes. Even though there is a possible benefit, current evidence does not support routine early use.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 225-231"},"PeriodicalIF":2.2,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260011","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}