American Journal of Emergency Medicine最新文献

{"title":"The critical role of inflammatory markers in acute decompensated heart failure.","authors":"Bülent Özlek, Süleyman Barutçu, Veysel Ozan Tanık","doi":"10.1016/j.ajem.2025.03.037","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.03.037","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694232","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":"Hypertensive pulmonary edema: A dilemma.","authors":"Gökhan Eyüpoğlu","doi":"10.1016/j.ajem.2025.03.036","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.03.036","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744504","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":"Utility of Holter monitoring in pediatric patients with arrhythmia symptoms in the ED: A retrospective cohort study","authors":"Tomas Leng MD ,&nbsp;Alaa Aldalati MBBS ,&nbsp;James L. Homme (Jim) MD","doi":"10.1016/j.ajem.2025.03.032","DOIUrl":"10.1016/j.ajem.2025.03.032","url":null,"abstract":"<div><h3>Background</h3><div>Pediatric patients presenting to an Emergency Department (ED) with symptoms that may represent cardiac arrhythmia can be challenging due to low prevalence of dysrhythmias and variable ability to detect and report symptoms. We aimed to determine the overall diagnostic yield of Holter monitoring (HM) in this population.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of patients ≤21 years of age presenting to an academic urban tertiary care center with embedded pediatric ED between January 2015–June 2023 with symptoms suggestive of cardiac arrhythmia who were discharged with a HM after ED evaluation. Patients with a known cardiac history or an abnormal electrocardiogram (ECG) at presentation were excluded. Positive diagnostic yield for HM was defined as capturing the patient's reported symptoms, regardless of arrhythmia presence, or detecting a silent arrhythmia.</div></div><div><h3>Results</h3><div>There were 159 patients included in the study. Thirty-two patients with a known cardiac history and one patient with an abnormal ECG were excluded. The most common chief complaints were palpitations (<em>n</em> = 51, 32 %), followed by syncope/pre-syncope (<em>n</em> = 47, 30 %), and chest pain (<em>n</em> = 33, 21 %). Out of the 91 patients (57 %) reporting symptoms while wearing the HM, only one patient experienced symptomatic arrhythmia. None of the symptomatic patients with a negative HM result had recorded arrhythmia in their medical charts within one year following the initial ED visit. Holter monitoring recorded “silent” arrhythmias in nine (6 %) patients. These included three cases of supraventricular tachycardia, three cases of non-sustained ventricular tachycardia, and three patients with second-degree (Mobitz 1) atrioventricular block. The overall diagnostic yield for HM in our study cohort was 63 %.</div></div><div><h3>Conclusion</h3><div>Ambulatory HM in low-risk pediatric patients presenting to the ED with symptoms suggestive of cardiac arrhythmia is a useful diagnostic tool in excluding arrhythmias. In addition, a subset of patients will have potentially relevant silent arrhythmia detected.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"93 ","pages":"Pages 1-6"},"PeriodicalIF":2.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674957","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":"Diaphragmatic ultrasonographic evaluation as an assessment guide for predicting noninvasive ventilation failure in acute exacerbation of chronic obstructive pulmonary disease","authors":"Karn Suttapanit MD,&nbsp;Peeraya Lerdpaisarn MD,&nbsp;Chanakan Charoensuksombun MD,&nbsp;Pitsucha Sanguanwit MD,&nbsp;Praphaphorn Supatanakij","doi":"10.1016/j.ajem.2025.03.025","DOIUrl":"10.1016/j.ajem.2025.03.025","url":null,"abstract":"<div><h3>Background</h3><div>Dynamic hyperinflation in severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD) leads to diaphragmatic fatigue and causes acute respiratory failure. Ultrasound is reliable for evaluating diaphragmatic function. In this study, we aimed to assess the ability of diaphragmatic ultrasound to predict noninvasive ventilation (NIV) failure.</div></div><div><h3>Methods</h3><div>This prospective single-center observational cohort study was performed on patients with AECOPD who required NIV in the emergency department between October 1, 2020, and September 30, 2022, at a tertiary healthcare center. The diaphragmatic ultrasound was measured using diaphragmatic excursion (DE) before applying NIV and diaphragmatic thickening fraction (DTF) during NIV use for 2 h. The area under the receiver-operating characteristic (AUROC) curves analysis and multivariable logistic regression was performed to assess the ability of diaphragmatic ultrasound to predict NIV failure in 48 h.</div></div><div><h3>Results</h3><div>111 patients were included in this study. DTF was an independent variable associated with NIV failure, with an adjusted odds ratio of 0.91 (95 % confidence interval [CI] 0.85–0.98), with a <em>p</em>-value of 0.009. DE and DTF had AUROC of 0.905 (95 % CI 0.835–0.975) and 0.940 (95 % CI 0.894–0.986), respectively, to predict NIV failure within 48 h. The lower DE and DTF increased the probability of NIV failure. The cutoff value of the DTF was 20 %, with a sensitivity of 92.0 % (95 % CI 74.0 % – 99.0 %) and a specificity of 93.0 % (95 % CI 85.4 % – 97.4 %) and the cutoff of the DE was 1.2 cm, with a sensitivity of 88.0 % (95 % CI 68.8 % – 97.5 %) and a specificity of 84.9 % (95 % CI 75.5 % – 91.7 %).</div></div><div><h3>Conclusion</h3><div>Diaphragmatic ultrasound, especially DTF at 2 h during NIV use, is a validated tool for predicting NIV failure in patients with AECOPD. Early detection of diaphragmatic dysfunction with diaphragmatic ultrasound in AECOPD with NIV could help identify high-risk patients and guide clinical decisions. However, further benefits from its implementation in management are required.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"93 ","pages":"Pages 13-20"},"PeriodicalIF":2.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686270","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":"Quick sequential organ failure assessment and Fournier gangrene severity index as predictors for mortality in Fournier gangrene patients: A retrospective cohort study of 153 patients","authors":"Muhammad Garidya Bestari ,&nbsp;Kuncoro Adi ,&nbsp;Akhmad Mustafa","doi":"10.1016/j.ajem.2025.03.031","DOIUrl":"10.1016/j.ajem.2025.03.031","url":null,"abstract":"<div><h3>Introduction</h3><div>Fournier's gangrene (FG) is a rare, rapidly progressing necrotizing fasciitis of the external genitalia and perineum, with mortality rates ranging from 20 % to 50 %. Early identification of high-risk patients is essential for timely intervention. The quick Sequential Organ Failure Assessment (qSOFA) and the Fournier Gangrene Severity Index (FGSI) are commonly used prognostic tools, but their comparative performance in FG remains unclear. This study evaluates their predictive accuracy in a large FG cohort and explores their complementary roles in clinical decision-making.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted on 153 FG patients admitted to Hasan Sadikin General Hospital, Indonesia, from January 2013 to December 2023. Clinical and laboratory data, including qSOFA and FGSI scores, were analyzed to assess in-hospital mortality. The predictive performance of both scoring systems was evaluated using receiver operating characteristic (ROC) curve analysis, with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Multivariate logistic regression estimated adjusted odds ratios (ORs) for mortality while accounting for age and comorbidities.</div></div><div><h3>Results</h3><div>The overall mortality rate was 30 %. Non-survivors were significantly older and had higher rates of comorbidities, including acute kidney injury and cardiovascular disease. Both qSOFA and FGSI demonstrated strong predictive capabilities (AUC = 0.818). qSOFA had a specificity of 94.6 % but lower sensitivity (62.2 %), making it effective for identifying low-risk patients. FGSI demonstrated higher sensitivity (70.3 %) and specificity (85.9 %), making it more suitable for high-risk patient identification. Combining qSOFA's rapid bedside utility with FGSI's comprehensive risk assessment offers a powerful strategy for timely intervention and resource allocation.</div></div><div><h3>Conclusions</h3><div>This study is among the first to compare qSOFA and FGSI in a large FG cohort, highlighting their complementary roles in clinical decision-making. A combined approach can enhance early risk stratification, optimize critical care resource allocation, and improve patient outcomes. Future research should explore integrating biomarkers such as lactate and procalcitonin to refine predictive accuracy, particularly in resource-limited settings.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Pages 156-160"},"PeriodicalIF":2.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671905","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":"A scoping review on the integration of artificial intelligence in point-of-care ultrasound: Current clinical applications","authors":"Junu Kim ,&nbsp;Sandhya Maranna ,&nbsp;Caterina Watson ,&nbsp;Nayana Parange","doi":"10.1016/j.ajem.2025.03.029","DOIUrl":"10.1016/j.ajem.2025.03.029","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) is used increasingly in point-of-care ultrasound (POCUS). However, the true role, utility, advantages, and limitations of AI tools in POCUS have been poorly understood.</div></div><div><h3>Aim</h3><div>to conduct a scoping review on the current literature of AI in POCUS to identify (1) how AI is being applied in POCUS, and (2) how AI in POCUS could be utilized in clinical settings.</div></div><div><h3>Methods</h3><div>The review followed the JBI scoping review methodology. A search strategy was conducted in Medline, Embase, Emcare, Scopus, Web of Science, Google Scholar, and AI POCUS manufacturer websites. Selection criteria, evidence screening, and selection were performed in Covidence. Data extraction and analysis were performed on Microsoft Excel by the primary investigator and confirmed by the secondary investigators.</div></div><div><h3>Results</h3><div>Thirty-three papers were included. AI POCUS on the cardiopulmonary region was the most prominent in the literature. AI was most frequently used to automatically measure biometry using POCUS images. AI POCUS was most used in acute settings. However, novel applications in non-acute and low-resource settings were also explored. AI had the potential to increase POCUS accessibility and usability, expedited care and management, and had a reasonably high diagnostic accuracy in limited applications such as measurement of Left Ventricular Ejection Fraction, Inferior Vena Cava Collapsibility Index, Left-Ventricular Outflow Tract Velocity Time Integral and identifying B-lines of the lung. However, AI could not interpret poor images, underperformed compared to standard-of-care diagnostic methods, and was less effective in patients with specific disease states, such as severe illnesses that limit POCUS image acquisition.</div></div><div><h3>Conclusion</h3><div>This review uncovered the applications of AI in POCUS and the advantages and limitations of AI POCUS in different clinical settings. Future research in the field must first establish the diagnostic accuracy of AI POCUS tools and explore their clinical utility through clinical trials.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Pages 172-181"},"PeriodicalIF":2.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674930","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":"No Echo, no problem? Predictors of right heart strain among patients with pulmonary embolism","authors":"Jessica V. Downing MD ,&nbsp;Stephanie Cardona DO ,&nbsp;Quincy K. Tran MD ,&nbsp;Daniel J. Haase MD ,&nbsp;Roumen Vesselinov PhD ,&nbsp;Matthew Dattwyler MD ,&nbsp;Taylor Miller MD ,&nbsp;James A. Gerding PA-C ,&nbsp;Kevin Jones MD","doi":"10.1016/j.ajem.2025.03.030","DOIUrl":"10.1016/j.ajem.2025.03.030","url":null,"abstract":"<div><h3>Introduction</h3><div>Right heart strain (RHS) in pulmonary embolism (PE) is traditionally diagnosed with transthoracic echocardiography (TTE). Given limited access to TTE, clinicians use vital signs, laboratory markers, and computed tomography angiography (CTA) to estimate RHS. We investigate the association between these indicators and RHS on TTE among patients with PE.</div></div><div><h3>Methods</h3><div>We reviewed charts of adult patients with PE transferred to a quaternary center from 2019 to 2022, excluding patients given thrombolytics before transfer. We collected vital signs and laboratory values at the time of transfer request and arrival. All CTAs were reinterpreted by a study radiologist. We used a hybrid Classification and Regression Tree – logistic regression to identify predictors of RHS on TTE.</div></div><div><h3>Results</h3><div>We included 185 patients, 139 (75 %) with RHS on TTE. Patients with serum lactate &lt;2 mmol/L with diastolic blood pressure (DBP) &gt;63 mmHg at initial consult were 77 % less likely to have RHS (OR 0.23, 95 % CI 0.12–0.6, <em>p</em> &lt; 0.001); those under 26 years with heart rate (HR) &gt;90 bpm and lactate 2–8.5 mmol/L were 93.6 % less likely to have RHS (OR 0.064, 95 % CI 0.006–0.67, <em>p</em> = 0.022). Patients with higher HR at initial consult had higher rates of RHS (OR 1.01, 95 % CI 1.00.2–1.05, <em>p</em> = 0.03). Those with signs of RHS on CTA were 2.43 times more likely to have RHS (95 % CI 1.22–5.9, <em>p</em> = 0.014).</div></div><div><h3>Discussion</h3><div>HR, lactate, DBP, and CTA findings of RHS were predictive of RHS on TTE among patients with PE. Clinicians should consider a collection of variables when assessing RHS in patients with PE when TTE is not available.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"93 ","pages":"Pages 37-47"},"PeriodicalIF":2.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686234","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":"Sedation with ketamine, propofol, and dexmedetomidine in pediatric emergency departments","authors":"Nathaniel E. White MD MHS,&nbsp;Wendi-Jo Wendt MD,&nbsp;Amy Drendel DO MS,&nbsp;Patrick S. Walsh MD MS","doi":"10.1016/j.ajem.2025.03.027","DOIUrl":"10.1016/j.ajem.2025.03.027","url":null,"abstract":"<div><h3>Objectives</h3><div>Describe current practices and variation in procedural sedation with ketamine, propofol and dexmedetomidine in pediatric emergency departments (EDs).</div></div><div><h3>Methods</h3><div>This was a retrospective study of 40 hospitals in the Pediatric Health Information System from 2016 to 2022, including ED visits for children under 18 years old who received sedation with ketamine, propofol, or dexmedetomidine. We described institutional variation in choice of sedation medication, as well as the differences in both frequency and diagnoses associated with procedural sedation by age.</div></div><div><h3>Results</h3><div>There were 189,086 ED encounters included in the study. Ketamine was given in 177,502 (94 %) encounters, propofol in 22,916 (12 %), and dexmedetomidine in 3240 (1.7 %). Ketamine was the primary medication used in nearly all institutions, with only a few outliers using propofol or dexmedetomidine. The highest number of sedations occurred in young children (aged 1–7 years), and the number of ED sedation encounters decreased with each year of age beyond 5 years. Notably, infants under 1 year of age were infrequently sedated (1.4 % of all sedations). The most common diagnoses associated with sedation encounters were fractures/dislocations (60 %), followed by lacerations (19 %), and abscesses (5.8 %). Diagnoses varied with age; fractures/dislocations were more common in older age groups, while lacerations and abscesses were disproportionately more common in younger children.</div></div><div><h3>Conclusions</h3><div>In nearly all institutions, use of ketamine was far more common than use of propofol or dexmedetomidine. The most common diagnoses associated with ED sedation were orthopedic injuries, though diagnoses varied with age. These results illustrate current sedation practices with ketamine, propofol and dexmedetomidine in the pediatric ED and may inform future standardization efforts.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"93 ","pages":"Pages 21-25"},"PeriodicalIF":2.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686233","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":"Emergency medicine updates: Cardiac arrest medications","authors":"Brit Long MD ,&nbsp;Michael Gottlieb MD","doi":"10.1016/j.ajem.2025.03.023","DOIUrl":"10.1016/j.ajem.2025.03.023","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiac arrest is a serious condition frequently managed in the emergency department (ED). Medications are a component of cardiac arrest management.</div></div><div><h3>Objective</h3><div>This paper evaluates key evidence-based updates concerning medications used for patients in cardiac arrest.</div></div><div><h3>Discussion</h3><div>Several medications have been evaluated for use in cardiac arrest. Routes of administration may include intravenous (IV) and intraosseous (IO). IV administration is recommended, though if an attempt at IV access is unsuccessful, IO access can be utilized. Epinephrine is a core component of guidelines, which recommend 1 mg in those with shockable rhythms if initial CPR and defibrillation are unsuccessful, while in nonshockable rhythms, guidelines recommend that epinephrine 1 mg be administered as soon as feasible. While epinephrine may improve rates of ROSC, it is not associated with improved survival with a favorable neurologic outcome. Evidence suggests the combination of vasopressin, steroids, and epinephrine may improve ROSC among those with in-hospital cardiac arrest, but there is no improvement in survival to discharge and survival with a favorable neurologic outcome. Antiarrhythmics (e.g., amiodarone, lidocaine, procainamide) likely do not improve short-term or long-term survival or neurologic outcomes, though guidelines state that amiodarone may be used in those with cardiac arrest and refractory pulseless ventricular tachycardia (pVT)/ventricular fibrillation (VF). Calcium and sodium bicarbonate should not be routinely administered in those with cardiac arrest. Beta-blockers may be considered in those with shock-resistant pVT/VF.</div></div><div><h3>Conclusions</h3><div>An understanding of literature updates concerning medication use in cardiac can improve the ED care of these patients.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Pages 114-119"},"PeriodicalIF":2.7,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643201","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":"Elevated osmol gaps not explained by toxic alcohols: A retrospective review.","authors":"V Vohra, M J Hodgman","doi":"10.1016/j.ajem.2025.03.026","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.03.026","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665514","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}