American Journal of Emergency Medicine最新文献

{"title":"The contribution of end-tidal carbon dioxide monitoring to the management of pediatric patients with diabetic ketoacidosis","authors":"Ozlem Tolu Kendir ,&nbsp;Ceren Kahraman ,&nbsp;Nazan Ulgen Tekerek ,&nbsp;Ramazan Gurlu ,&nbsp;Mesut Parlak ,&nbsp;Nilgun Erkek","doi":"10.1016/j.ajem.2025.09.050","DOIUrl":"10.1016/j.ajem.2025.09.050","url":null,"abstract":"<div><h3>Objective</h3><div>In this study, the aim is to compare end-tidal carbon dioxide (EtCO2) values monitored in real-time via capnography, with venous blood gas partial pressure of carbon dioxide (PaCO2) values in children diagnosed with diabetic ketoacidosis (DKA) during diagnosis and treatment.</div></div><div><h3>Methods</h3><div>A total of 55 patients diagnosed with DKA, aged 0–18 years (mean age: 10.5 ± 4.1 years), were included in this prospective observational study. Of these, 27 had mild-to-moderate DKA and 28 had severe DKA. Patients were grouped as mild-to-moderate or severe based on blood gas values. Vital signs, blood gases and EtCO2 were monitored concomitantly. In this study, the agreement between PaCO2 (blood gas) and EtCO2 (capnography) values was examined, and the diagnostic test performance of EtCO2 and PaCO2 values was evaluated between DKA groups (mild-to-moderate/severe). SPSS (Statistical Package for the Social Sciences) version 25.0 software was used for statistical analysis.</div></div><div><h3>Results</h3><div>A positive linear correlation was found between EtCO2 and PaCO2 values at admission and throughout monitoring. For detecting patients with GCS ≤ 13, the cut-off values were EtCO2 &lt; 12 mmHg and PaCO2 &lt; 12.1 mmHg. The sensitivity, specificity, and AUC for EtCO2 were 78.57 %, 92.59 %, and 0.907, respectively; and for PaCO2, 25 %, 100 %, and 0.665, respectively.</div></div><div><h3>Conclusion</h3><div>Our results show that patients with DKA can be monitored instantly with EtCO2, thereby reducing the need for invasive procedures in children.</div><div>Clinical Trials Number: <span><span>NCT06327737</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 151-154"},"PeriodicalIF":2.2,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207785","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":"Using ice packing and the polar life pod to treat severe hyperthermia","authors":"Kevin C. Miller,&nbsp;Jessie L. Beck,&nbsp;Sofia G. Valadez,&nbsp;Rachel M. Koldenhoven,&nbsp;Nancy A. Uriegas,&nbsp;Erin M. Lally","doi":"10.1016/j.ajem.2025.09.038","DOIUrl":"10.1016/j.ajem.2025.09.038","url":null,"abstract":"<div><h3>Introduction</h3><div>Cold water immersion (CWI) is the fastest method of reducing body temperature of exertional heatstroke (EHS) patients. Treatment delays and/or an inability to quickly cool EHS patients with CWI before or while <em>enroute</em> to hospitals are common contributors to EHS morbidity and mortality. CWI in ambulances and emergency departments (ED) is challenging since they often lack CWI equipment (e.g., tubs). Recently, clinicians demonstrated excellent EHS patient outcomes using CWI with body bags (BAGS). However, using BAGS with CWI in ED creates other challenges (e.g., medical staff slipping, drainage). Ice packing with BAGS may quickly reduce body temperature and resolve these issues. We measured rectal temperature (T_REC) cooling rates with three ice masses and no added water in the Polar Life Pod (PLP), a body-bag-like device.</div></div><div><h3>Methods</h3><div>Twelve subjects (8 males, 4 females; age:22 ± 3y; mass:71.9 ± 10.6 kg; ht.:170.2 ± 7.3 cm) exercised in the heat (wet bulb globe temperature = ∼27 °C) until T_REC was ≥39.75 °C. They laid in PLP while ∼9 kg (SMALL), ∼27 kg (MEDIUM), or ∼ 53 kg (LARGE) of nugget ice was poured into PLP. Cooling stopped when T_REC was 38.25 °C.</div></div><div><h3>Results</h3><div>T_REC cooling rates increased as ice mass increased (SMALL:0.15 ± 0.05 °C/min; MEDIUM:0.19 ± 0.07 °C/min; LARGE:0.27 ± 0.10 °C/min, <em>P</em> &lt; 0.001). Minimal water was created from ice melting (SMALL: 3.8 ± 1.1 L; MEDIUM: 5.3 ± 2.1 L; LARGE: 4.9 ± 2.2 L, <em>P</em> = 0.07).</div></div><div><h3>Conclusions</h3><div>Ice packing in the PLP quickly reduced T_REC and resolved many of the challenges of treating EHS in ED and ambulances. The PLP portability, small space footprint, and effectiveness suggest it can be implemented while <em>enroute</em> to ED, potentially reducing the morbidity and mortality caused by lengthy treatment delays.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 201-206"},"PeriodicalIF":2.2,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221738","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":"Prognostic value of the lactate-to-albumin ratio for in-hospital mortality in severe acute pancreatitis with acute kidney injury: A retrospective cohort study","authors":"Qingcheng Zhu ,&nbsp;Ping Geng ,&nbsp;Bingyu Ling,&nbsp;Koumei Chen","doi":"10.1016/j.ajem.2025.09.046","DOIUrl":"10.1016/j.ajem.2025.09.046","url":null,"abstract":"<div><h3>Background</h3><div>Severe acute pancreatitis (SAP) complicated by acute kidney injury (AKI) carries a high mortality risk, and reliable early prognostic markers are needed. This study investigated the prognostic value of the lactate-to-albumin ratio (LAR) for in-hospital mortality in SAP patients with AKI.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 309 SAP patients with AKI admitted to a tertiary hospital between January 2016 and December 2024. Baseline demographics, laboratory data, and outcomes were collected. Logistic regression models identified independent risk factors for mortality. Receiver operating characteristic (ROC) curves, Kaplan–Meier survival analysis, and subgroup analyses evaluated the discriminative ability of LAR. Smooth curve fitting and two-piecewise linear regression assessed non-linear associations.</div></div><div><h3>Results</h3><div>The overall in-hospital mortality was 24.9 %. Non-survivors had significantly higher LAR than survivors (0.94 vs. 0.59, <em>P</em> &lt; 0.001). In multivariable analysis, LAR independently predicted in-hospital mortality (OR: 1.33; 95 % CI: 1.01–1.77; <em>P</em> = 0.046). ROC analysis showed LAR had superior discriminative ability compared with lactate or albumin alone. Kaplan–Meier curves demonstrated significantly reduced survival in patients with high LAR (<em>P</em> &lt; 0.001). A non-linear relationship was identified, with a mortality risk inflection point at LAR 0.69. Subgroup analyses confirmed consistent associations across clinical strata.</div></div><div><h3>Conclusion</h3><div>LAR is an independent and practical biomarker for predicting in-hospital mortality in SAP patients with AKI, outperforming lactate and albumin alone. Incorporating LAR into clinical assessment may improve early risk stratification and guide management decisions.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 207-214"},"PeriodicalIF":2.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245834","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 barium chloride toxicity successfully treated with hemodialysis.","authors":"Dre E Steinwehr, Annika J Strand, Ryan W Brown, Jon B Cole, Gwen E Thompson","doi":"10.1016/j.ajem.2025.09.045","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.09.045","url":null,"abstract":"<p><strong>Introduction: </strong>Barium intoxication presents initially with vague gastrointestinal symptoms and paresthesia but can quickly progress to life-threatening hypokalemia and resultant paralysis, cardiac dysrhythmias, and death.</p><p><strong>Case report: </strong>A 21-year-old male presented to the emergency department after ingestion of barium chloride/barium sulfate powder. The patient required intubation and aggressive potassium replacement at rates up to 60 mEq/h. Continuous veno-venous hemodiafiltration (CVVHDF) was initiated utilizing 4 mEq/L K (potassium) replacement fluid and was transitioned to 0 mEq/L K dialysate solution when hyperkalemia ensued. The patient's paralysis resolved and was able to be extubated 16 h after CVVHDF initiation.</p><p><strong>Discussion: </strong>The mainstay treatment of barium toxicity currently is supportive cares and decontamination. Dialysis can provide both chemical clearance and potassium regulation, mitigating the extracellular hypokalemia during the toxic phase and the expected rebound hyperkalemia. Dialysis should therefore be considered in severe cases of barium toxicity.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202122","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":"Misdiagnosis of cellulitis in the emergency department and potential impact of clinical decision support interventions","authors":"Michael S. Pulia MD PhD ,&nbsp;Rebecca J Schwei PhD MPH ,&nbsp;Meggie Griffin MS ,&nbsp;Ambar Haleem MD ,&nbsp;Jamie Hess MD ,&nbsp;Robert Glinert MD ,&nbsp;Thomas Keenan MD PhD ,&nbsp;Joseph A. McBride MD ,&nbsp;Robert Redwood MD MPH","doi":"10.1016/j.ajem.2025.09.044","DOIUrl":"10.1016/j.ajem.2025.09.044","url":null,"abstract":"<div><h3>Background</h3><div>Cellulitis is misdiagnosed in 19 % to 34 % of emergency department (ED) cases resulting in excess healthcare spending and threatening patient safety. The objectives of this planned secondary analysis was to report the proportion of cellulitis misdiagnosis in the ED. Secondarily, we evaluated the potential impact of diagnostic adjuncts on misdiagnosis rates.</div></div><div><h3>Methods</h3><div>We prospectively enrolled ED patients presenting with acute lower extremity dermatologic complaints involving visible erythema (potential cellulitis). We abstracted the treating physician's diagnosis from the medical chart. Consensus diagnosis was determined by a group of six independent, multidisciplinary physicians. The treating ED physician's diagnosis was compared to the consensus panel diagnosis to identify errors. We evaluated the potential impact of two individual diagnostic adjuncts, skin surface temperature measurement and the ALT-70 score, plus a combination of both, on reducing cellulitis diagnostic errors</div></div><div><h3>Results</h3><div>The final sample included 201 patients. The diagnosis assigned by the treating physician and consensus panel was discordant in 50 of 201 cases (24.9 %). Among patients with an ED physician diagnosis of cellulitis, 35.6 % were overdiagnosed (48/135). In cases diagnosed as cellulitis, utilization of skin surface temperature, the two-level ALT-70 and the combination measure would have yielded an absolute reduction in cellulitis overdiagnosis by 8.9 %, 5.7 % and 13.0 % of cases respectively</div></div><div><h3>Conclusion</h3><div>Consistent with other reports, we observed a high rate of cellulitis overdiagnosis, highlighting the need for diagnostic support interventions. Proposed diagnostic adjuncts had an overall positive theoretical impact on overdiagnosis and should be evaluated in prospective interventional trials</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 188-191"},"PeriodicalIF":2.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221739","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":"Inpatient boarding in the emergency departments and clinical outcomes: A propensity-matched study","authors":"Mohammed Yousufuddin MD, MSc ,&nbsp;Kaitlyn Leopold BS ,&nbsp;Anthony M. Napoli MD, MHL, FACEP ,&nbsp;Zeliang Ma MD ,&nbsp;Ebrahim Barkoudah MD, MPH, MBA ,&nbsp;Zhen Wang PhD ,&nbsp;Kanika Khandelwal MD ,&nbsp;Sandeep Pagali MD ,&nbsp;Meltiady Issa MD ,&nbsp;Muhammad Waqas Tahir MD ,&nbsp;Sumit Bhagra MD ,&nbsp;Paul Y. Takahashi MD ,&nbsp;Mohammad H. Murad MD ,&nbsp;Elizabeth S. Bermudez MD","doi":"10.1016/j.ajem.2025.09.043","DOIUrl":"10.1016/j.ajem.2025.09.043","url":null,"abstract":"<div><h3>Objectives</h3><div>The study evaluated clinical outcomes in patients who experienced inpatient boarding in the ED (boarders) compared to those admitted directly (non-boarders).</div></div><div><h3>Methods</h3><div>Retrospective propensity-matched study of consecutive adults presented to 22 emergency departments and were subsequently admitted to 17 hospitals across Southeast Minnesota. The exposure variable was ED boarding. ED boarding was defined as patients flagged by ED physicians for admission and awaiting an inpatient bed, regardless of the time to flagging. The primary outcomes were length of hospital stay (LOS) and in-hospital mortality. The secondary outcome was all-cause mortality within 90 days after hospitalization. Boarders were matched to non-boarders using 86 covariates. Poisson, logistic, and Cox regression models were used to assess associations, with subgroup analyses by age, sex, and ED location.</div></div><div><h3>Results</h3><div>From April 1, 2019, to March 30, 2024, 821,244 ED visits and 151,834 (26.9 %) admissions. Of these, 3173 (1.9 %) were boarders (median time: 4.2 h; IQR, 1.8–9.7). Boarding was not associated with in-hospital mortality (OR, 0.84; 95 % CI, 0.59–1.20; <em>P</em> = 0.340) or LOS (IRR, 1.02; 95 % CI, 0.99–1.04; <em>P</em> = 0.088), but was associated with higher 90-day mortality (HR, 1.30; 95 % CI, 1.15–1.46; <em>P</em> = 0.005). These findings were consistent across age, sex, and ED location.</div></div><div><h3>Conclusions</h3><div>In this multicenter, propensity score–matched study, ED boarding was not associated with LOS or in-hospital mortality but was associated with a 1.3-fold increase in 90-day mortality, consistent across age, sex, and ED location.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 133-142"},"PeriodicalIF":2.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159464","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":"Comparative effectiveness of vasopressin, steroids, and epinephrine-based regimens in cardiac arrest: A network Meta-analysis of clinical trials","authors":"Fatemeh Saghafi ,&nbsp;Mohammad Hossein Dehghani ,&nbsp;Sajjad Erami ,&nbsp;Amin Salehi-Abargouei ,&nbsp;Mohammad Ali Omrani ,&nbsp;Farahnaz Hoseinzade ,&nbsp;Maryam Shojaeifard ,&nbsp;Adeleh Sahebnasagh","doi":"10.1016/j.ajem.2025.09.040","DOIUrl":"10.1016/j.ajem.2025.09.040","url":null,"abstract":"<div><h3>Background</h3><div>Despite extensive efforts to improve survival in cardiac arrest (CA), the optimal pharmacologic strategy during resuscitation remains uncertain. While prior meta-analyses have explored individual drug classes, the relative effectiveness of combined regimens remains inadequately defined. This network meta-analysis (NMA) aims to evaluate and compare the efficacy of triple therapy with vasopressin (VP), steroids, and epinephrine (EP) in CA patients.</div></div><div><h3>Methods</h3><div>A comprehensive electronic search was conducted in PubMed, Scopus, ISI Web of Science, the Cochrane Central Register of Controlled Trials, Google Scholar, and other bibliographic databases. Randomized clinical trials (RCTs) evaluating the use of steroids, epinephrine, and vasopressin in CA patients were included. In trials that involved additional agents (e.g., lidocaine), only the data pertaining to epinephrine/vasopressor-based interventions were extracted and synthesized to ensure comparability with the study scope. Out of 3453 identified studies, 36 RCTs involving 21,768 patients were included. Interventions during cardiopulmonary resuscitation were categorized as monotherapy, double therapy, or triple therapy (VSE). Primary outcomes included return of spontaneous circulation (ROSC), survival to hospital admission, 24-h survival, and survival to hospital discharge. Neurological outcomes were also evaluated to determine functional recovery, when consistently reported, although heterogeneity of measurement tools precluded quantitative synthesis.</div></div><div><h3>Results</h3><div>Triple therapy (VSE) and the combination of epinephrine plus steroids demonstrated the highest probability of improving all major survival outcomes. Ranking analysis consistently favored VSE over monotherapies to improve clinical outcomes of CA patients.</div></div><div><h3>Conclusion</h3><div>This NMA provides comparative evidence supporting the superiority of epinephrine-steroid double therapy and VSE triple therapy in improving resuscitation outcomes in cardiac arrest. These findings may inform future guidelines and clinical decision-making.</div></div><div><h3>Prospero registration</h3><div>CRD42022296508.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 155-166"},"PeriodicalIF":2.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207808","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":"Suprascapular nerve block for analgesia in traumatic scapular fractures performed by emergency physicians: A case series","authors":"Sanjeev Bhoi,&nbsp;Anmol Chanda","doi":"10.1016/j.ajem.2025.09.041","DOIUrl":"10.1016/j.ajem.2025.09.041","url":null,"abstract":"<div><div>Scapular fractures, typically resulting from high-energy trauma, cause severe pain that restricts shoulder girdle movement and delays rehabilitation. Adequate analgesia is essential to facilitate physiotherapy and improve recovery, yet optimal techniques remain underutilized in the Emergency Department (ED). Suprascapular nerve block may offer an effective solution to this challenge.</div><div>We report a series of ten adult patients with traumatic scapular fractures who presented to the ED with severe pain (Defense and Veterans Pain Rating Scale ≥7) and a mean Injury Severity Score (ISS) of 30. All patients underwent ultrasound-guided suprascapular nerve block performed by trained ED physicians using point-of-care ultrasound. Pain scores were recorded at baseline, 30 min, 60 min, and 2 h after the block, and adverse events were monitored for two hours.</div><div>The mean baseline pain score was 8.9 ± 0.7, which reduced to 2.9 ± 0.9 at 30 min, 1.5 ± 0.97 at 60 min, and 1.1 ± 0.3 at two hours post-procedure (<em>p</em> &lt; 0.001). All ten patients achieved at least a 50 % reduction in pain within 30 min. Complications such as pneumothorax, vascular puncture, or local anesthetic toxicity were not observed. All patients were able to move their shoulders without pain within an hour of the block.</div><div>Ultrasound-guided suprascapular nerve block is a rapid, safe, and highly effective analgesic intervention for traumatic scapular fractures in the ED. In the future, a randomized controlled trial should be performed to prove the efficacy of the suprascapular nerve block in providing analgesia for traumatic scapular fractures.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 129-132"},"PeriodicalIF":2.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159466","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":"The paravertebral fascial plane block: A novel, ultrasound-guided technique for paraspinal neck and back pain","authors":"Umar A. Aulia AB ,&nbsp;Richard J. Gawel MD ,&nbsp;Jeffrey A. Kramer MD, MSc ,&nbsp;Michael Gottlieb MD ,&nbsp;Michael Shalaby MD","doi":"10.1016/j.ajem.2025.09.039","DOIUrl":"10.1016/j.ajem.2025.09.039","url":null,"abstract":"<div><h3>Introduction</h3><div>Paraspinal myofascial pain syndrome (MPS) is a common cause of emergency department (ED) visits, but existing therapies often provide incomplete or short-lived relief. Increasing evidence implicates the fascia as a key driver of the pain in MPS, supporting targeted interfascial interventions.</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective observational cohort study of adult ED patients who received a novel, ultrasound-guided paravertebral fascial plane block (PFPB) between September 1, 2024 – August 31, 2025. Eligible patients presented with focal cervical, thoracic, or lumbar paraspinal pain consistent with MPS and had either inadequate response to ED analgesics or a history of refractory paraspinal MPS. The PFPB procedure consisted of two components: (1) injection of a combination of anesthetic, normal saline, and dexamethasone within the fascial planes between the paraspinal muscles, and (2) needling of the muscular fasciae. Numeric Rating Scale (NRS) pain scores were documented for clinical care purposes at pre-block baseline, ED discharge, and 24–48-h follow-up.</div></div><div><h3>Results</h3><div>Eleven patients (median age 48 years, 64 % female) underwent the PFPB. Median NRS pain score decreased significantly from 9/10 (interquartile range [IQR] 8–9) pre-block to 3/10 (IQR 0–4) at discharge (<em>n</em> = 11, <em>p</em> = 0.004). At 24–48 h (<em>n</em> = 10), the median pain score was 1/10 (IQR 0–2.75), with 80 % reporting sustained or improved relief relative to discharge. No complications occurred, and none of the treated patients returned to any of our health system's EDs within 48 h following initial discharge.</div></div><div><h3>Conclusions</h3><div>The PFPB provided rapid and sustained pain reduction for ED patients with intractable paraspinal MPS. These preliminary findings support further prospective studies to validate the PFPB's efficacy and inform its implementation in emergency care.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 123-128"},"PeriodicalIF":2.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159465","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":"Comparing physician and advanced care provider use of opioids for treatment of acute chest pain in the emergency department","authors":"Chase Laughter ,&nbsp;Aref Alsayyed ,&nbsp;Mohamed Shubair ,&nbsp;Austin Johnson ,&nbsp;Emad Awad","doi":"10.1016/j.ajem.2025.09.037","DOIUrl":"10.1016/j.ajem.2025.09.037","url":null,"abstract":"<div><h3>Background</h3><div>Acute chest pain is a common and high-stakes emergency department (ED) presentation, frequently associated with acute coronary syndrome (ACS). Opioids such as morphine and fentanyl are used when symptoms persist despite nitrates, but little is known about whether prescribing differs between advanced care providers (ACPs) and physicians.</div></div><div><h3>Objective</h3><div>To compare intravenous (IV) morphine and fentanyl prescribing patterns for ACS-related chest pain between ACPs and physicians in an academic ED.</div></div><div><h3>Methods</h3><div>We performed a retrospective study of adult patients with ACS presenting to an academic ED from January 2021 to January 2024. The primary outcome was IV morphine administration; the secondary outcome was IV fentanyl administration. Multivariable logistic regression adjusted for demographics, clinical factors, and nitroglycerin administration prior to opioid. Firth's penalized logistic regression was conducted as sensitivity analysis.</div></div><div><h3>Results</h3><div>Among 2055 patients, 154 (7.5 %) were treated by ACPs and 1901 (92.5 %) by physicians. Morphine use was similar between groups (42.2 % vs 42.8 %, <em>p</em> = 0.93), while fentanyl was less common with ACPs (5.8 % vs 11.6 %, <em>p</em> = 0.03). In adjusted models, ACP vs Physician status was not significantly associated with morphine (OR 0.78, 95 % CI 0.49–1.24) or fentanyl use (OR 1.10, 95 % CI 0.50–2.49). Nitroglycerin prior to opioid was strongly associated with reduced opioid administration. Sensitivity analyses confirmed these findings.</div></div><div><h3>Conclusion</h3><div>Opioid prescribing for ACS-related chest pain did not differ significantly between ACPs and physicians after adjustment. Prescribing decisions were driven more by patient factors and treatment sequencing, supporting comparable roles for ACPs and physicians in ED ACS pain management.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 110-113"},"PeriodicalIF":2.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159468","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}