American Journal of Emergency Medicine最新文献

{"title":"Nonketotic hyperglycemic hemichorea - A rare presentation of elevated blood sugar.","authors":"Sally L Westcott","doi":"10.1016/j.ajem.2025.03.006","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.03.006","url":null,"abstract":"<p><p>Nonketotic hyperglycemic hemichorea, also known as diabetic striatopathy or hyperglycemia basal ganglia syndrome, is a rare presentation of hyperglycemia that can be the initial manifestation of diabetes or present in patients with long-standing poorly controlled diabetes. Patients will demonstrate ballismus or choreiform movements which are usually unilateral. On evaluation, patients' labs will show hyperglycemia without evidence of diabetic ketoacidosis. If imaging is obtained, CT or MRI images may mimic ischemic stroke, hypertensive hemorrhages or deposition diseases in the basal ganglia. The cause of these imaging findings is currently unknown. Treatment of the patients' hyperglycemia generally results in symptom resolution but symptoms can persist for weeks. Antipsychotics, antiepileptics and benzodiazepines have been used for symptom management though very little data exists on their efficacy. The current report documents this rare presentation of hyperglycemia in a poorly controlled diabetic woman. Her symptoms improved after a single dose of benzodiazepines and this case supports their use for symptom management in the emergency department until euglycemia is achieved. Additionally, the CT images obtained during this case mimicked a possible ischemic or infectious lesion and potentially led to a delay in diagnosis. Nonketotic hyperglycemic hemichorea is likely to become more commonplace as incidence of diabetes increases and the symptom profile, objective findings and treatment are something emergency physicians should be aware of.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588367","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":"Retrospective analysis of low-dose versus higher-dose haloperidol in older emergency department patients","authors":"Katherine G. Coli PharmD,&nbsp;Katie A. Parsels PharmD,&nbsp;Christopher D. Miller PharmD,&nbsp;William Darko PharmD,&nbsp;Robert W. Seabury PharmD","doi":"10.1016/j.ajem.2025.03.009","DOIUrl":"10.1016/j.ajem.2025.03.009","url":null,"abstract":"<div><h3>Background</h3><div>A reduced initial dose of injectable haloperidol is recommended in older patients for treatment of acute agitation based on limited studies.</div></div><div><h3>Objective</h3><div>Assess the effectiveness and safety of higher-dose versus low-dose injectable haloperidol in older patients presenting to the emergency department (ED).</div></div><div><h3>Methods</h3><div>This was a retrospective, propensity-score matched, cohort analysis conducted at a two-campus healthcare system. Patients ≥65 years old administered injectable haloperidol in the ED were classified as receiving low-dose (≤ 0.5 mg) or higher-dose (&gt; 0.5 mg) haloperidol. Exclusion criteria included acute alcohol withdrawal; ED or hospital stay shorter than four hours; and any of the following before injectable haloperidol administration: safety watch, physical restraint requirement, and administration of oral haloperidol, other acute antipsychotics, or benzodiazepines. The primary outcome was composite treatment failure, defined as need for repeat injectable haloperidol, alternative sedative, restraints, or safety watch within four hours of haloperidol administration. Secondary safety outcomes included escalation of respiratory support, extrapyramidal symptoms, falls, and hospital admission.</div></div><div><h3>Results</h3><div>Sixty-nine patients per group were matched. There was no statistically significant difference in composite treatment failure (<em>P</em> = 0.087). However, patients in the higher-dose group were more likely to require alternative sedatives (<em>P</em> = 0.035). There were no significant differences between groups for any safety outcomes.</div></div><div><h3>Conclusion</h3><div>This study suggests low-dose (≤ 0.5 mg) injectable haloperidol may be at least as safe and effective as higher doses (&gt; 0.5 mg) in agitated older adults. Low-dose injectable haloperidol may be preferred in mild to moderately agitated older adults, reserving higher doses for severe agitation.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Pages 37-42"},"PeriodicalIF":2.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143580575","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":"Abdominal pain in the emergency department: 50 years on","authors":"Moira E. Smith MD, MPH ,&nbsp;Noel R. Mukubwa BA ,&nbsp;Robert D. Powers MD MPH","doi":"10.1016/j.ajem.2025.02.021","DOIUrl":"10.1016/j.ajem.2025.02.021","url":null,"abstract":"<div><h3>Objective</h3><div>Emergency Department (ED) patients with abdominal pain continue to represent a diagnostic challenge. This study of demographics, evaluation, and outcomes provides a look at stability and change over a 50-year span at a single institution.</div></div><div><h3>Methods</h3><div>The current study is the fourth version of this exercise, marking the 50th anniversary of the first examination. The charts of 1000 adult patients presenting to a tertiary care ED in 2022 with a chief complaint of abdominal pain were reviewed. Data extracted included demographics, diagnosis, disposition, and use of imaging and laboratory testing. Where possible, comparison between this study and the previous studies was performed.</div></div><div><h3>Results</h3><div>The results demonstrated considerably increased use of computed tomography (CT) (+69 %) and ultrasound (+32 %) and a reduction in abdominal radiographs (−68 %) over the past 15 years. Prolonged evaluation time, length of stay, and higher charges accompanied this pattern of increased imaging. Notable findings included continued low frequency of missed surgical illness relative to 1972, but minimal change in the number of patients (~29 %) hospitalized.</div></div><div><h3>Conclusions</h3><div>Over a 50-year span, ED evaluation of abdominal pain has become more effective at diagnosing acute surgical illness, but less efficient and more costly. The percentage of patients hospitalized has been remarkably stable.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Pages 135-137"},"PeriodicalIF":2.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643200","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":"Friday the 13th is not associated with increases in emergency medical services (EMS) patient volume.","authors":"Aditya C Shekhar, Michael McCartin, Joshua Kimbrell, Jacob Stebel, Alexander Zhou, Jacob Desman, Jennifer Carter, Bojana Milekic, Ethan Abbott, Ira J Blumen","doi":"10.1016/j.ajem.2025.03.001","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.03.001","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588363","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":"Use of oxygen therapy in the emergency department. A multicentre observational study.","authors":"Alessandra Fusco, Carlotta Rossi, Guido Bertolini, Giorgio Costantino, Pietro Bellone, Andrea Duca, Giovanni Nattino","doi":"10.1016/j.ajem.2025.02.030","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.02.030","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627179","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":"Second victim syndrome - Prevalence in an emergency department at a comprehensive cancer center.","authors":"Hugh S Feuer, Tami N Johnson","doi":"10.1016/j.ajem.2025.02.050","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.02.050","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588374","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":"In the red zone: How Atlanta Falcons home games impact emergency department and emergency medical services volumes","authors":"Garrett Wallace MD ,&nbsp;Tim P. Moran PhD ,&nbsp;Sumeet Dixit MD ,&nbsp;Rohit Anand MD ,&nbsp;Irfan Husain MD, MPH, FACEP ,&nbsp;Kennen Less MD ,&nbsp;Matthew Wheatley MD ,&nbsp;Taylor Stavely MD ,&nbsp;Steven Lindsey MD, FACEP, FACEM","doi":"10.1016/j.ajem.2025.03.004","DOIUrl":"10.1016/j.ajem.2025.03.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Optimizing Emergency Department (ED) resources based on patient volumes is crucial for patient care and hospital operations. Previous literature demonstrated varied effects of large-scale gatherings on Emergency Medical Services (EMS) call volume and ED volume. We assessed the impact of Atlanta Falcons home games on EMS call and trip volume, and ED volume at Grady Memorial Hospital.</div></div><div><h3>Methods</h3><div>Historical data were obtained between 2014 and 2024, approximately 2 weeks prior to and 2 weeks following completion of each NFL regular season. ED volume was based on patient visits per day at the Grady ED. EMS volume was based on Grady EMS call and trip volumes. Data were evaluated using a mixed-effects time-series Poisson regression with an autoregressive covariance matrix.</div></div><div><h3>Results</h3><div>A total of 497,726 patient visits, 431,255 EMS calls, and 275,437 EMS trips were analyzed. Average ED volumes slightly decreased for home games, with a rate ratio of 0.98 (95 % CI 0.96–0.99, <em>p</em> = 0.008). No differences were noted in EMS metrics. ED volume, EMS trips, and EMS trips per call increased with increasing game attendance.</div></div><div><h3>Conclusion</h3><div>Grady saw an approximate 2 % decrease in average ED volume on Atlanta Falcons home game days, which is not a clinically significant difference and would not warrant operational changes. The same can be said for pre-hospital EMS metrics when considering call center and patient transport staffing. Based on our attendance-to-volume correlations, however, one might expect higher than average volumes for especially large events. These data serve to inform staffing decisions within the ED and EMS sectors.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Pages 48-51"},"PeriodicalIF":2.7,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143592994","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":"Reply to correspondence \"Mortality risk factors in patients receiving ECPR after cardiac arrest\"","authors":"Zhe Li ,&nbsp;Feilong Hei","doi":"10.1016/j.ajem.2025.01.014","DOIUrl":"10.1016/j.ajem.2025.01.014","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"89 ","pages":"Page 276"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967398","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":"Comments on “The smell of sepsis: Electronic nose measurements improve early recognition of sepsis in the ED”","authors":"Hui Xie ,&nbsp;Yaqiong Liu","doi":"10.1016/j.ajem.2025.01.049","DOIUrl":"10.1016/j.ajem.2025.01.049","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"89 ","pages":"Page 300"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068754","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":"Sympathetic crashing acute pulmonary edema: Concerning CT, HFNO, and urapidil","authors":"Brit Long MD ,&nbsp;William J. Brady MD ,&nbsp;Michael Gottlieb MD","doi":"10.1016/j.ajem.2025.01.075","DOIUrl":"10.1016/j.ajem.2025.01.075","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"89 ","pages":"Pages 290-291"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076580","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}