{"title":"Comparison of transvaginal ultrasound utilization between radiology and point-of-care ultrasound in first-trimester pregnancy","authors":"Ali Çelik M.D","doi":"10.1016/j.ajem.2025.01.035","DOIUrl":"10.1016/j.ajem.2025.01.035","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"89 ","pages":"Page 294"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030329","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}
Jon B. Cole M.D. , Lesley C. Pepin M.D. , Carrie L. Oakland PharmD , Elisabeth F. Bilden M.D.
{"title":"Should digoxin immune fab be administered based solely on reported ingested amount in acute digoxin poisoning?","authors":"Jon B. Cole M.D. , Lesley C. Pepin M.D. , Carrie L. Oakland PharmD , Elisabeth F. Bilden M.D.","doi":"10.1016/j.ajem.2025.01.038","DOIUrl":"10.1016/j.ajem.2025.01.038","url":null,"abstract":"<div><div>Acute digoxin poisoning is increasingly uncommon in emergency medicine. Furthermore, controversy exists regarding indications for antidotal digoxin immune fab in acute poisoning. In healthy adults, the fab prescribing information recommends administration based on “known consumption of fatal doses of digoxin: ≥10mg,” while many emergency medicine textbooks suggest fab administration be driven by clinical features or potassium concentration. A 54 kg adult, not on digoxin, presented one hour after ingesting 12.5 mg. Electrocardiogram revealed only ST depression and first degree heart block. Initial pulse was 102 beats/min, systolic blood pressure was 170 mmHg. The patient was otherwise asymptomatic. Poison center recommended immediately obtaining serum potassium and digoxin concentrations; call-back was planned for two hours. The emergency physician was instructed to have ≥10 fab vials bedside and to administer if instability ensued. Thirty-five minutes later (≈90 min post-ingestion) ventricular fibrillation cardiac arrest occurred; initial serum potassium resulted at this time at 3.3 mEq/L. Bicarbonate, insulin and glucose, amiodarone, magnesium, calcium, and 10 fab vials were administered. Cardioversion resulted in wide-complex tachycardia which became ventricular fibrillation then asystole and the patient died. Serum digoxin concentration drawn on hospital arrival resulted after death at 44 ng/mL. In this fatal case of acute digoxin poisoning, fab was not empirically recommended because the patient initially did not have significant signs or symptoms that accompanied the history of ingesting ≥10 mg digoxin. While the bedside team was given clear anticipatory guidance by the regional poison center, the patient died despite fab administration once instability occurred.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"89 ","pages":"Pages 309.e3-309.e6"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030342","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 role of renal replacement therapy in managing SCAPE","authors":"Faruk Danış","doi":"10.1016/j.ajem.2025.01.061","DOIUrl":"10.1016/j.ajem.2025.01.061","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"89 ","pages":"Pages 284-285"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061620","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}
Zhuojian Zeng , Minglin Chen , Muyan Diao , Shengyuan Su , Fei Xue , Tuan Li , Yuehui Zhang
{"title":"Fatal disseminated varicella infection in a patient on long-term oral corticosteroids","authors":"Zhuojian Zeng , Minglin Chen , Muyan Diao , Shengyuan Su , Fei Xue , Tuan Li , Yuehui Zhang","doi":"10.1016/j.ajem.2024.12.071","DOIUrl":"10.1016/j.ajem.2024.12.071","url":null,"abstract":"<div><h3>Key clinical message</h3><div>Primary varicella-zoster virus (VZV) infection typically occurs in childhood and is generally mild. However, in immunocompromised patients, VZV-related diseases can be more severe. Fatal cases of disseminated varicella are still rare. We report a fatal case of disseminated varicella in a young adult on long-term oral corticosteroids.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"89 ","pages":"Pages 311.e1-311.e5"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Roth score: A simple tool for assessing acute exacerbations of COPD in emergency care","authors":"Fatma Tortum","doi":"10.1016/j.ajem.2024.12.075","DOIUrl":"10.1016/j.ajem.2024.12.075","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"89 ","pages":"Page 260"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959050","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 uncommon case of ptosis from invasive bacterial sinusitis","authors":"Karishma Patel MD, David J. Barton MD","doi":"10.1016/j.ajem.2025.01.063","DOIUrl":"10.1016/j.ajem.2025.01.063","url":null,"abstract":"<div><div>Acquired palpebral ptosis (also called blepharoptosis, or ptosis) is an abnormally low-positioned upper eyelid and occasionally presents as a chief complaint to the emergency department. Due to the wide range of causes and spectrum of severity, emergency physicians must recognize and initiate appropriate diagnostic and treatment pathways to limit the risk of long-term complications in those affected. We report a case of a 19 year old healthy man who presented with a chief complaint of unilateral eyelid droop in the setting of three days of sinusitis symptoms. Neuroimaging revealed invasive sinusitis with leptomeningeal enhancement and extraconal subperiosteal abscess. He was treated with intravenous antibiotics, admitted to the hospital, and discharged home after 7 days. This uncommon cause of ptosis highlights the need for a broad differential diagnosis for this condition and recognition of uncommon complications of invasive sinusitis.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"89 ","pages":"Pages 308.e1-308.e3"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}