American Journal of Emergency Medicine最新文献_第6页

Severe kava withdrawal managed with phenobarbital 用苯巴比妥治疗严重的卡瓦戒断。

IF 2.2 3区医学

American Journal of Emergency Medicine Pub Date : 2025-10-01 DOI: 10.1016/j.ajem.2025.06.016

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}

引用次数: 0

Hidden in plain sight: A malpositioned intrauterine device as the culprit of acute pelvic pain - a case report 隐藏在显而易见的地方：一个放置不当的宫内节育器是急性盆腔疼痛的罪魁祸首——一个病例报告。

IF 2.2 3区医学

American Journal of Emergency Medicine Pub Date : 2025-10-01 DOI: 10.1016/j.ajem.2025.06.037

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}

引用次数: 0

Endophthalmitis due to a retained intraocular metallic object 眼内金属物残留引起的眼内炎。

IF 2.2 3区医学

American Journal of Emergency Medicine Pub Date : 2025-10-01 DOI: 10.1016/j.ajem.2025.07.007

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}

引用次数: 0

Invasive blood pressure monitoring and the survival in critically ill septic patients 有创血压监测与危重症脓毒症患者的生存。

IF 2.2 3区医学

American Journal of Emergency Medicine Pub Date : 2025-10-01 DOI: 10.1016/j.ajem.2025.05.014

Bartosz Maj , Lukasz Szarpak , Andrzej Krupa , Michal Pruc

引用次数: 0

The Authors Respond to Reader Comment Regarding: “Automated Computation of the HEART Score with the GPT-4 Large Language Model” 关于“使用GPT-4大型语言模型自动计算HEART评分”的致编辑信的回复。

IF 2.2 3区医学

American Journal of Emergency Medicine Pub Date : 2025-10-01 DOI: 10.1016/j.ajem.2025.05.027

Richard Andrew Taylor MD, MHS, Donald S. Wright MD, MHS

引用次数: 0

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] “欧洲急诊科可卡因急性毒性临床表现和严重程度的年龄和性别相关差异”的勘误表[美国急诊医学杂志96(2025);151-160]。

IF 2.2 3区医学

American Journal of Emergency Medicine Pub Date : 2025-10-01 DOI: 10.1016/j.ajem.2025.07.024

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

引用次数: 0

Info for authors 作者信息

IF 2.2 3区医学

American Journal of Emergency Medicine Pub Date : 2025-10-01 DOI: 10.1016/S0735-6757(25)00596-0

引用次数: 0

Spontaneous preferences in hand use and side of approach during untrained chest compressions: Implications for dispatcher-assisted CPR 在未经训练的胸部按压中，手部使用和入路侧的自发偏好：对调度员辅助CPR的影响。

IF 2.2 3区医学

American Journal of Emergency Medicine Pub Date : 2025-10-01 DOI: 10.1016/j.ajem.2025.08.050

Nathalie Charlier, Riet Vanfleteren

引用次数: 0

Evaluation of atomized tranexamic acid (TXA) for pediatric epistaxis 雾化氨甲环酸（TXA）治疗小儿鼻出血的疗效评价。

IF 2.2 3区医学

American Journal of Emergency Medicine Pub Date : 2025-10-01 DOI: 10.1016/j.ajem.2025.07.051

Kayla White PharmD, David Rodriguez MD, Kara Quaney PharmD, BCPS, BCPPS

引用次数: 0

Inequities in imaging: The association between patient demographics and use of point-of-care ultrasound in the ED 成像不公平：急诊科患者人口统计学特征与即时超声使用之间的关系

IF 2.2 3区医学

American Journal of Emergency Medicine Pub Date : 2025-09-26 DOI: 10.1016/j.ajem.2025.09.049

Sean V. Brown MD, MBA , Melissa A. Meeker PhD , Margaret E. Samuels-Kalow MD, MSHP , Hamid Shokoohi MD, MPH , Sayon Dutta MD, MPH , Onyinyechi Eke MD, MPH , Yasamin Habibi MD , Andrew S. Liteplo MD

{"title":"Inequities in imaging: The association between patient demographics and use of point-of-care ultrasound in the ED","authors":"Sean V. Brown MD, MBA , Melissa A. Meeker PhD , Margaret E. Samuels-Kalow MD, MSHP , Hamid Shokoohi MD, MPH , Sayon Dutta MD, MPH , Onyinyechi Eke MD, MPH , Yasamin Habibi MD , Andrew S. Liteplo MD","doi":"10.1016/j.ajem.2025.09.049","DOIUrl":"10.1016/j.ajem.2025.09.049","url":null,"abstract":"<div><h3>Background</h3><div>Point-of-care ultrasound (POCUS) is a key diagnostic test in the emergency department (ED), especially in hypotensive patients. While bias exists throughout the health care system, it is unknown if these disparities also influence the use of POCUS. This study aimed to determine whether POCUS use in ED patients with hypotension varies based on demographic factors.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of visits to five EDs over five years. Adult patients with hypotension (systolic blood pressure less than 90 mmHg) were included. The primary outcome was whether a critical POCUS exam was performed. Critical POCUS included cardiac, thoracic, deep vein thrombosis, abdominal fluid (FAST), or aortic exams. We constructed a generalized linear mixed model to examine differences in the odds of receiving a critical POCUS exam between demographic groups.</div></div><div><h3>Results</h3><div>There was no significant difference in the odds of receiving a critical POCUS exam between racial/ethnic groups. However, female patients (aOR: 0.74, 95 % CI [0.70–0.78]) and patients with public insurance (aOR: 0.92, 95 % CI [0.86–0.99]) had significantly lower odds of receiving POCUS compared to male patients and those with private insurance, respectively.</div></div><div><h3>Conclusions</h3><div>There was no significant difference in POCUS use between racial/ethnic groups in this cohort. However, female patients and those with public insurance were at lower odds of receiving a POCUS exam. Additional research is needed to explore the causes of these disparities.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 215-219"},"PeriodicalIF":2.2,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145269611","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}

引用次数: 0