American Journal of Emergency Medicine最新文献

{"title":"Corrigendum to \"Early vasopressin plus norepinephrine versus delayed or no vasopressin in septic shock: A systematic review and meta-analysis\" [The American Journal of Emergency Medicine 99 (2026), 225-231].","authors":"Isadora Mamede, Lucas Arêa, Giulia Carvalhal, Rodrigo Bessa, Manoela Lenzi, Marcel Catão Ferreira Dos Santos","doi":"10.1016/j.ajem.2026.04.001","DOIUrl":"10.1016/j.ajem.2026.04.001","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647611","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":"Pulmonary hypertension in cardiac tamponade: An observational cohort study of in-hospital mortality and echocardiographic findings","authors":"Robert James Adrian MD ,&nbsp;Onyinyechi F. Eke MD, MPH ,&nbsp;Nour Al Jalbout MD ,&nbsp;Moustafa Al Hariri PhD ,&nbsp;Kristofer Montoya MD ,&nbsp;Patricia Hernandez MD ,&nbsp;Hamid Shokoohi MD, MPH","doi":"10.1016/j.ajem.2026.01.013","DOIUrl":"10.1016/j.ajem.2026.01.013","url":null,"abstract":"<div><h3>Background</h3><div>Patients with pulmonary hypertension (PHTN) (i.e., chronic PHTN) have right ventricular hypertrophy, elevated right-sided heart pressures, and frequently have pericardial effusions. When evaluating these patients for cardiac tamponade, the hypertrophy and elevated pressure in right heart may be protective from tamponade by counteracting the pressure from the pericardial effusion. However, these patients may be harmed if echocardiographic signs of tamponade (e.g., right ventricular diastolic collapse) are obscured.</div></div><div><h3>Study objective</h3><div>The effect of PHTN on patients with cardiac tamponade remains unclear. We aimed (1) to evaluate whether PHTN influences the echocardiographic findings of tamponade, and (2) to examine whether PHTN is associated with in-hospital mortality among patients undergoing pericardial drainage primarily for cardiac tamponade.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study of adult patients who underwent pericardial drainage within 48 h of emergency department presentation at two academic centers. PHTN probability was classified using the 2022 European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines. We classified patients in four categories: no PHTN, low probability, intermediate probability, and high probability of PHTN. PHTN parameters were manually extracted from cardiologist-interpreted echocardiography reports. The primary outcome was in-hospital mortality. Secondary outcomes included the prevalence of echocardiographic findings of cardiac tamponade and their associations with mortality.</div></div><div><h3>Results</h3><div>A total of 249 patients met the inclusion criteria. In-hospital mortality did not significantly differ across PHTN probability categories: no PHTN (63.8%), low probability (9.3%), intermediate probability (20.9%), and high probability (5.3%) (<em>p</em>-values all &gt;0.2). Among patients who died, 50.0% were in the no PHTN group compared to 7.1% in the high probability group (<em>p</em> = 0.222). The echocardiographic impression of cardiac tamponade was significantly lower among patients with high PHTN probability compared to those with no PHTN (64.3% vs. 85.4%, <em>p</em> = 0.041), with a weak negative correlation (<em>r</em> = −0.493) between increasing PHTN probability and tamponade impression.</div></div><div><h3>Conclusions</h3><div>In this cohort of patients undergoing pericardial drainage primarily for cardiac tamponade, PHTN was not significantly associated with in-hospital mortality. However, patients with a high probability of PHTN showed fewer echocardiographic signs of tamponade, suggesting that PHTN may obscure typical sonographic findings of tamponade.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 55-61"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031711","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 unintended path: Foley catheter-induced biliary obstruction following gastrostomy tube replacement - A case report","authors":"Wed H. Jadallah,&nbsp;Osama Muhtaseb,&nbsp;Daniel D. Gold","doi":"10.1016/j.ajem.2026.01.041","DOIUrl":"10.1016/j.ajem.2026.01.041","url":null,"abstract":"<div><div>Percutaneous endoscopic gastrostomy (PEG) tubes are widely used for long-term enteral access. Accidental dislodgement is a relatively common occurrence, and in many settings a Foley catheter is inserted as a temporary measure to preserve tract patency until definitive replacement can be performed. Although this practice is routinely employed, Foley catheters lack an external flange and are therefore susceptible to distal migration and associated complications. We describe a case of a 97-year-old woman with advanced dementia who presented to the emergency department with recurrent vomiting and coffee-ground material in her gastrostomy drainage bag after her PEG tube had been replaced with a Foley catheter at a nursing facility. Laboratory evaluation revealed cholestatic liver enzyme elevation, and imaging demonstrated distal migration of the catheter with balloon compression of the distal common bile duct, resulting in obstructive biliary pathology. Repositioning of the Foley catheter and delayed reinsertion of a dedicated PEG tube led to prompt clinical improvement. This case illustrates an underrecognized complication of temporary gastrostomy substitutes and emphasizes the importance of considering catheter migration in patients presenting with unexplained gastrointestinal or biliary symptoms after recent tube replacement. Preventive strategies including external marking, temporary securement measures, and routine radiologic confirmation of tube position may reduce morbidity and avoid unnecessary diagnostic evaluations.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 173-175"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079847","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":"Lightweight interpretable AI model using multiple blood parameters for emergency diagnosis of acute appendicitis","authors":"Shun Liao ,&nbsp;Yan Li ,&nbsp;Haoran Tang ,&nbsp;Zixiong Li ,&nbsp;Tianqi Xu ,&nbsp;Zongfang Ren","doi":"10.1016/j.ajem.2026.01.006","DOIUrl":"10.1016/j.ajem.2026.01.006","url":null,"abstract":"<div><div>Background: Acute appendicitis poses diagnostic challenges due to symptom overlap with other abdominal conditions, often leading to misdiagnosis or missed diagnosis. This study aimed to develop and validate an interpretable machine learning model based on routine hematological indicators to facilitate rapid diagnosis. Methods: A retrospective analysis was conducted on 408 patients with acute abdominal pain, including both adult and pediatric patients. The median age of patients in the appendicitis group was 37.5 years (IQR: 26.5 years). Univariate logistic regression revealed significant group differences in hematological indicators (all <em>P</em> &lt; 0.001). Three feature selection methods—LASSO, ElasticNet, and Random Forest—were applied, with neutrophil percentage (NE%) and eosinophil percentage (EO%) consistently identified across all methods, and red blood cell (RBC) and white blood cell (WBC) repeatedly selected by at least two methods. Eleven commonly used machine learning classifiers were developed and evaluated on an independent test set. Results: The support vector machine with a radial basis function kernel (SVM-RBF) using LASSO-selected features achieved the best performance, with an AUC (area under the curve) of 0.903 (95% CI: 0.84–0.96), accuracy of 90.2%, sensitivity of 80.3%, and specificity of 100%. The average precision exceeded 0.92, and the calibration curve demonstrated good agreement (Brier score: 0.092). Interpretability analyses with SHAP (Shapley additive explanations) and LIME (local interpretable model-agnostic explanations) applied to the LightGBM (Light Gradient Boosting Machine) model confirmed EO%, RBC, and WBC as the most influential predictors. Conclusion:This parsimonious and interpretable model, relying solely on routine blood indicators, may enable timely and accurate diagnosis of acute appendicitis while providing additional insights, particularly in resource-limited settings.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 39-48"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031718","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":"Design and development of a Bayesian risk assessment model for bacterial infection (BRAIN) in patients admitted to hospital from ED","authors":"Sandeep Tripathi MD, MS ,&nbsp;Collins Odhiambo PhD ,&nbsp;Jessica Haas MS2","doi":"10.1016/j.ajem.2026.01.001","DOIUrl":"10.1016/j.ajem.2026.01.001","url":null,"abstract":"<div><h3>Background</h3><div>C-reactive Protein (CRP) and Procalcitonin (PCT) are commonly used in conjunction with clinical judgment to assess the risk of bacterial infection. Traditional frequentist methods do not allow the incorporation of clinical suspicion into risk estimation. This study aimed to describe clinical phenotypes based on CRP and PCT levels and develop a Bayesian model to estimate the posterior probability of bacterial infection in emergency department (ED) patients.</div></div><div><h3>Methods</h3><div>Retrospective study across 15 hospitals (2019–2023), including patients admitted from the ED with CRP, PCT, and bacterial cultures obtained within 24 h. Patients categorized into four groups: both markers normal (A), both abnormal (B), only PCT abnormal (C), and only CRP abnormal (D). Bayesian logistic regression models developed using priors of 0.3, 0.5, and 0.7 to reflect varying levels of clinical suspicion. Predictors included age, CRP, PCT, fever, white blood cell count, ESR, ferritin, and viral positivity.</div></div><div><h3>Results</h3><div>Among 10,397 patients (median age, 65; 909 &lt; 18 years), 27.5% had positive cultures, with an 11.2% mortality rate. Culture positivity and mortality were highest in group B (35%), followed by D (24%). Posterior probabilities of infection under high, moderate, and low suspicion priors were 25%, 17.5%, and 10.6%, respectively. PCT was the strongest predictor, with a one log-unit increase associated with a 45% rise in infection probability. AUROC was 0.64; AUPRC 0.43. A R Shiny calculator (BRAIN) was created for bedside application.</div></div><div><h3>Conclusion</h3><div>A Bayesian model incorporating inflammatory markers and clinical judgment provides individualized estimates of bacterial infection risk at the bedside.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 34-38"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031743","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":"Empowering front-line physicians with AI: Evaluating large language models in everyday ENT care","authors":"Sholem Hack ,&nbsp;Habib G. Zalzal ,&nbsp;Rebecca Attal ,&nbsp;Armin Farzad ,&nbsp;Lilia Ann Crew ,&nbsp;Idit Tessler ,&nbsp;Talya Frankel ,&nbsp;Ben Gvili ,&nbsp;Shaked Shivatzki ,&nbsp;Amit Wolfovitz ,&nbsp;Noa Rozendorn","doi":"10.1016/j.ajem.2026.01.029","DOIUrl":"10.1016/j.ajem.2026.01.029","url":null,"abstract":"<div><h3>Purpose</h3><div>Artificial intelligence systems known as large language models are being evaluated for clinical decision support, yet their role in emergency and primary care remains limited. Physicians in these settings often encounter ear, nose, and throat conditions where diagnostic uncertainty, unnecessary testing, and inappropriate referrals contribute to patient risk and healthcare inefficiency. This study compared the performance of advanced large language models with physicians in diagnosis, management, and referral across common and high-acuity otolaryngologic scenarios.</div></div><div><h3>Methods</h3><div>Twelve clinical vignettes representing routine and urgent presentations were developed and validated by otolaryngologists. One hundred practicing physicians in family medicine and emergency medicine, including residents and attending physicians, completed all vignettes by providing a diagnosis, management plan, and referral decision. Four large language models (Gemini-2.0, ChatGPT-4.0, ChatGPT-5, and OpenEvidence) were tested using identical prompts. Model outputs were anonymized, randomized, and rated by a blinded expert panel using the Quality Analysis of Medical Artificial Intelligence tool, which assesses accuracy, clarity, completeness, sourcing, relevance, and usefulness.</div></div><div><h3>Results</h3><div>Physicians achieved mean diagnostic accuracy of 91.6% and management accuracy of 87.9%. In non-urgent cases, 30.4% of responses represented inappropriate referral. Only half recognized the need for urgent referral in a cerebrospinal fluid leak scenario. Large language models demonstrated comparable diagnostic and management accuracy with higher referral appropriateness.</div></div><div><h3>Conclusions</h3><div>Large language models showed consistent, guideline-concordant reasoning in simulated emergency and primary-care otolaryngology cases. Their potential lies in supporting, not replacing, clinical judgment through responsible integration and real-world validation.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 90-97"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039486","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":"New world screwworm: A focused review for the emergency medicine clinician","authors":"Brit Long MD ,&nbsp;Anissa Finley DO ,&nbsp;Stephen Y. Liang MD, MPHS ,&nbsp;Heather A. Heaton MD","doi":"10.1016/j.ajem.2026.01.007","DOIUrl":"10.1016/j.ajem.2026.01.007","url":null,"abstract":"<div><h3>Introduction</h3><div>New World Screwworm (NWS), or <em>Cochliomyia hominivorax</em>, is a potentially fatal disease due to severe larvae infestation and tissue destruction. A resurgence has been reported.</div></div><div><h3>Objective</h3><div>This narrative review provides a focused overview of NWS for the emergency clinician, including the epidemiology, presentation, diagnosis, and management of the disease.</div></div><div><h3>Discussion</h3><div>NWS is endemic to tropical and subtropical America. While previously eradicated in the U.S., several human cases have been recently reported. This insect primarily infests livestock but may also affect humans. Female flies are attracted to mucosal surfaces and wounds and lay hundreds of eggs. Once hatching, larvae burrow into these surfaces and cause extensive damage by ingesting live tissue. Humans at risk include those with significant immunocompromise, open wounds, and those around animals. Infested patients present with severe swelling, bleeding, pain, and open, malodorous wounds. Larvae are usually visible in the wound. Bacterial superinfections may also occur. Suspected cases should be reported to the local or state public health department and the Centers for Disease Control and Prevention. Diagnosis includes morphologic identification of larvae removed from a wound. Larvae should be placed in a leak-proof container with 70% ethanol. Serum laboratory testing may also be needed in patients with evidence of bacterial superinfection and sepsis. Treatment includes removal of all larvae and often extensive debridement. Reevaluation of the wound within 48 h is recommended. Antibiotics are necessary for those with bacterial superinfection.</div></div><div><h3>Conclusion</h3><div>Emergency clinicians should be aware of the presentation, diagnosis, evaluation, and management of NWS to ensure optimal outcomes.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 8-12"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963173","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 the coronavirus pandemic on bystander CPR, dispatcher-assisted CPR, EMS response time, and survival outcomes in China","authors":"Yaping Hou MPH ,&nbsp;Wentao Sang PhD ,&nbsp;Ying Deng PhD ,&nbsp;Jiaqi Zheng PhD ,&nbsp;Zhepei Yuan PhD ,&nbsp;Dong Xia MB ,&nbsp;Xue Zhao MD ,&nbsp;Wen Zheng PhD ,&nbsp;Mingjie Wang MPH ,&nbsp;Peiwu Li PhD ,&nbsp;Feng Xu PhD ,&nbsp;Yuguo Chen PhD","doi":"10.1016/j.ajem.2026.01.024","DOIUrl":"10.1016/j.ajem.2026.01.024","url":null,"abstract":"<div><h3>Aim</h3><div>This study aimed to evaluate whether the COVID-19 pandemic affected out-of-hospital cardiac arrest (OHCA) care and outcomes across multiple regions in China, despite the country's strict containment measures.</div></div><div><h3>Methods</h3><div>Data from the BASeline Investigation of Out-of-hospital Cardiac Arrest (BASIC-OHCA) Utstein Registry between 2019 and 2020 were analyzed. OHCA cases from 18 Emergency Medical Services (EMS) agencies were included. The primary outcome was survival to hospital discharge or 30 days, while secondary outcomes included return of spontaneous circulation (ROSC), and favorable neurologic outcome (Cerebral Performance Category [CPC] score 1–2). Three periods were compared: pre-COVID-19, outbreak, and regular prevention and control. Multilevel logistic regression adjusted for Utstein variables and center-level clustering was used.</div></div><div><h3>Results</h3><div>A total of 16,595 patients received CPR (pre-COVID-19 <em>n</em> = 3890; outbreak <em>n</em> = 5939; regular prevention and control <em>n</em> = 6766). Survival to hospital discharge or 30 days did not differ significantly across periods. ROSC was lower during the outbreak (5.3% vs. 3.6%, AOR 0.80, <em>P</em> = 0.045) and regular prevention and control periods (5.3% vs. 3.5%, AOR 0.80, P = 0.045). Bystander CPR and dispatcher-assisted CPR were significantly less frequent during the regular prevention and control period. EMS response time was longer in the regular prevention and control period (median 12 min vs. 11 min; AOR 1.25, <em>P</em> = 0.006).</div></div><div><h3>Conclusion</h3><div>The COVID-19 pandemic impacted the EMS system in China, reducing bystander CPR, dispatcher-assisted CPR, and ROSC, and increasing EMS response times. However, survival and neurological outcomes did not deteriorate significantly.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 135-140"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079848","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":"Photic sneeze reflex: When light becomes lethal","authors":"Subramanian Senthilkumaran ,&nbsp;S.V. Arathisenthil ,&nbsp;Sivakumar Girija ,&nbsp;Patne Sanjay ,&nbsp;Ponniah Thirumalaikolundusubramanian","doi":"10.1016/j.ajem.2026.01.042","DOIUrl":"10.1016/j.ajem.2026.01.042","url":null,"abstract":"<div><h3>Background</h3><div>Photic sneeze reflex (PSR) is an autosomal dominant condition characterized by paroxysmal sneezing in response to bright light exposure. This is also known by the acronym ACHOO (Autosomal Dominant Compelling Helio-Ophthalmic Outburst) syndrome. Even though it has precipitated motor vehicle accidents (MVAs) leading to trauma, it remains yet as an underrecognized entity in emergency settings.</div></div><div><h3>Case presentation</h3><div>A 26-year-old male delivery boy who drives a scooter presented to ED with left periorbital swelling following an MVA triggered by PSR, while exiting a covered parking into sunlight. This was his third MVA in three months, all linked to photic transitions, with prior episodes causing vehicle damage only. He reported a three-month history of sneezing (10–15 bursts) triggered by sunlight and during tooth brushing, unresponsive to toothpaste changes. Examination revealed a left orbital floor fracture with inferior rectus entrapment, confirmed by CT scan. Allergy evaluation showed low total IgE (5 IU/mL) and negative specific IgE, ruling out allergic etiology. PSR was diagnosed and he underwent surgical repair, and received preventive counseling.</div></div><div><h3>Conclusion</h3><div>Life-threatening MVAs are likely <strong>to</strong> occur following PSR. In order to overcome such events, an early diagnosis, occupational counseling and prevention strategies are suggested. Emergency physicians should suspect light-induced sneezing, if vital signs are stable and the allergy workup is negative in such cases.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 170-172"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079957","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":"Acute pharyngeal obstruction from a glass methamphetamine pipe: A case report","authors":"Jacob N. Watson MD ,&nbsp;AJ Graham DO","doi":"10.1016/j.ajem.2026.01.021","DOIUrl":"10.1016/j.ajem.2026.01.021","url":null,"abstract":"<div><div>Acute airway foreign bodies are an uncommon but life-threatening pathology encountered in the emergency department.</div><div>We present the case of a 41 year old female who presented for acute obstruction of the posterior pharynx following attempted ingestion of a glass methamphetamine pipe in efforts to conceal evidence from law enforcement officers. She exhibited mild trismus and muffled voice. No respiratory distress, stridor or hypoxia was appreciated. Workup revealed a vertically oriented cylindrical glass foreign body, approximately 10 cm spanning the distance between the proximal esophagus and posterior nasopharynx.</div><div>Treatment was initiated with low-dose benzodiazepine therapy for anxiolysis, administered nebulized lidocaine while preparations were made for emergency cricothyroidotomy and rapid sequence intubation with fiberoptic support. Otolaryngology was emergently consulted and ultimately the decision was made to attempt removal, with a plan for emergent surgical airway placement if unsuccessful. The patient was positioned with the neck hyperextended and ketamine was given for sedation. Using a pair of rubberized Magill forceps that we created, the glass pipe was successfully removed. The patient returned to her pre-procedural baseline and was discharged.</div><div>Patients with acute airway obstruction can rapidly decline and otolaryngology support is often not readily available. In this report we will discuss the considerations in managing acute airway foreign bodies, maneuvers and specialized tools to assist with bedside removal.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 123-125"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146068813","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}