Lucas Oliveira J. e Silva MD, PhD , Jefferson Drapkin , Caitlin S. Brown PharmD , Fernanda Bellolio MD, MSc , Murat Cetin MD
{"title":"The authors respond to reader comment regarding “Nebulized ketamine for acute pain management in the emergency department: A systematic review and meta-analysis”","authors":"Lucas Oliveira J. e Silva MD, PhD , Jefferson Drapkin , Caitlin S. Brown PharmD , Fernanda Bellolio MD, MSc , Murat Cetin MD","doi":"10.1016/j.ajem.2025.07.041","DOIUrl":"10.1016/j.ajem.2025.07.041","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Pages 266-267"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769343","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":"Rethinking model evaluation in emergency medicine: A call for decision curve analysis","authors":"Fulden Cantas Turkis","doi":"10.1016/j.ajem.2025.08.041","DOIUrl":"10.1016/j.ajem.2025.08.041","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Pages 289-290"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979802","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 Automated computation of the HEART score with the GPT-4 large language model","authors":"Chen Yu-Tsung , Chien Chieh Hsieh , Chun-Yu Hsieh , Fu-Shan Jaw , Hung-Pin Chang","doi":"10.1016/j.ajem.2025.05.028","DOIUrl":"10.1016/j.ajem.2025.05.028","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Pages 284-285"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175697","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}
William Bleifuss , Sean Boley , Josiah Bardwell , Charlie Goebel , Jenna Wilkinson
{"title":"Severe kava withdrawal managed with phenobarbital","authors":"William Bleifuss , Sean Boley , Josiah Bardwell , Charlie Goebel , Jenna Wilkinson","doi":"10.1016/j.ajem.2025.06.016","DOIUrl":"10.1016/j.ajem.2025.06.016","url":null,"abstract":"<div><div><span><em>Piper methysticum</em></span><span><span><span>, known as “kava”, is a plant endemic to and historically consumed in the Pacific islands. The roots contain psychoactive kavalactones with sedating and anxiolytic effects. While often marketed for anxiety or as a safe alcohol alternative, </span>dermopathy and more rarely </span>hepatotoxicity are well described with heavy use. Reports of withdrawal are rare.</span></div><div>The leaves of <span><span>Mitragyna speciosa</span><em>,</em></span><span> also referred to as “kratom”, contain psychoactive alkaloids with interactions at μ and δ-opioid receptors. Kratom is commonly used for its stimulant and opioid-like effects, for which dependence and withdrawal are much more well documented.</span></div><div><span><span><span>A 45-year-old man presented to the emergency department (ED) with auditory and </span>visual hallucinations, anxiety, insomnia, and diffuse muscle jerking. He had been heavily using a supplemental beverage containing both kava and kratom, but stopped several days prior. His primary physician initiated </span>buprenorphine<span> therapy for suspected kratom withdrawal. Bedside evaluation in the ED was concerning for ongoing GABAergic withdrawal in the setting of kava use. Phenobarbital was given with significant improvement in symptoms, with eventual transition to </span></span>diazepam. He was discharged home several days later in good condition.</div><div><span>Given the increasing popularity of herbal supplements including kratom, and more uncommonly kava, clinicians should be aware of their potential for abuse, dependence and severe withdrawal syndromes. Kratom may be managed in a fashion analogous to that of an opioid. While kava's pharmacologic properties remain poorly understood, withdrawal may be severe enough to warrant hospitalization. Phenobarbital or </span>benzodiazepines may be considered as a potential therapeutic approach.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Pages 298.e5-298.e7"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337216","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}
Sarah Petelinsek , Isabel Shimanski , Megan Fix , Taylor Mendenhall , Patrick G. Hughes
{"title":"Hidden in plain sight: A malpositioned intrauterine device as the culprit of acute pelvic pain - a case report","authors":"Sarah Petelinsek , Isabel Shimanski , Megan Fix , Taylor Mendenhall , Patrick G. Hughes","doi":"10.1016/j.ajem.2025.06.037","DOIUrl":"10.1016/j.ajem.2025.06.037","url":null,"abstract":"<div><div>Malpositioned intrauterine devices (IUDs) are not yet a well recognized cause of acute pelvic pain. Correct identification relies on recognizing key imaging findings such as low-lying or endocervical positioning, and an understanding that acute pelvic pain may be the result of a malpositioned IUD.</div><div>We report the case of a 28-year-old sexually active female (she/her/hers) with a history of a malpositioned IUD, who presented with sudden onset, unprovoked, right sided pelvic pain. She denied hematuria, dysuria, vaginal discharge, or vaginal bleeding. On physical examination she noted right-sided pelvic tenderness below McBurney's point; however, a pelvic examination was deferred. Ultrasound revealed an IUD in the endocervical canal. A CT confirmed a low-lying IUD. These findings were initially interpreted as normal. Only after follow-up with primary care, the IUD was removed and the patient reported complete resolution of her symptoms.</div><div>This case highlights the importance of recognizing malpositioned IUDs on imaging. As in this case, misdiagnosis can result in overtesting and delays in patient care. Emergency providers should be familiar with radiographic findings and include malpositioned IUDs on their differential diagnosis.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Pages 300.e3-300.e6"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340726","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}
Alan R. Spicer , Mostafa M. Meleis MD , Harry W. Buchanan IV MD , Nicole C. Elliott DO
{"title":"Endophthalmitis due to a retained intraocular metallic object","authors":"Alan R. Spicer , Mostafa M. Meleis MD , Harry W. Buchanan IV MD , Nicole C. Elliott DO","doi":"10.1016/j.ajem.2025.07.007","DOIUrl":"10.1016/j.ajem.2025.07.007","url":null,"abstract":"<div><div><span><span>Endophthalmitis is a sight-threatening infection for which prompt diagnosis and treatment is central to improving patient outcomes. Diagnosing endophthalmitis can be difficult in the </span>emergency department<span><span> (ED), as its symptoms may be nonspecific and definitive testing equipment is delicate, requiring a high degree of familiarity to operate correctly. We present the case of a 42-year-old man who presented to the ED following a traumatic ocular injury. Fluorescein staining revealed a </span>corneal abrasion<span>. The patient was prescribed erythromycin ointment and a follow-up appointment with outpatient </span></span></span>ophthalmology<span> was recommended. Five days later, the patient presented to the ED again complaining of increasing eye pain, inflammation, and blurred vision. Initial examination of the eye revealed chemosis<span> and corneal infiltrate, indicative of endophthalmitis. Repeat fluorescein staining found no corneal abrasion, though a slit lamp exam located a retained metallic foreign body within the anterior chamber<span>. The patient was treated with fluoroquinolone drops and transferred to a comprehensive eye center for aggressive management. This case highlights the importance of comprehensive ocular exam using a slit lamp following ocular trauma. Timely diagnosis and treatment with intravitreal antibiotics are essential to prevent loss of vision.</span></span></span></div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Pages 301.e1-301.e2"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627826","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}
Richard Andrew Taylor MD, MHS, Donald S. Wright MD, MHS
{"title":"The Authors Respond to Reader Comment Regarding: “Automated Computation of the HEART Score with the GPT-4 Large Language Model”","authors":"Richard Andrew Taylor MD, MHS, Donald S. Wright MD, MHS","doi":"10.1016/j.ajem.2025.05.027","DOIUrl":"10.1016/j.ajem.2025.05.027","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Page 286"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133171","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}
Òscar Miró , Miguel Galicia , Paul I. Dargan , David M. Wood , Alison M. Dines , Fridtjof Heyerdahl , Knut Erik Hovda , Matthias Liechti , Odd Martin Vallersnes , Florian Eyer , Guillermo Burillo-Putze
{"title":"Corrigendum to “Age and sex related differences in clinical manifestations and severity of acute cocaine toxicity presentations to European emergency departments” [American Journal of Emergency Medicine 96 (2025);151–160]","authors":"Òscar Miró , Miguel Galicia , Paul I. Dargan , David M. Wood , Alison M. Dines , Fridtjof Heyerdahl , Knut Erik Hovda , Matthias Liechti , Odd Martin Vallersnes , Florian Eyer , Guillermo Burillo-Putze","doi":"10.1016/j.ajem.2025.07.024","DOIUrl":"10.1016/j.ajem.2025.07.024","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Pages 304-305"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692543","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}