JEM reports最新文献

{"title":"Thyroid storm in an adolescent presenting with acute sinus tachycardia triggered by Streptococcal and Influenza co-infection","authors":"Bradford Huff","doi":"10.1016/j.jemrpt.2026.100206","DOIUrl":"10.1016/j.jemrpt.2026.100206","url":null,"abstract":"<div><h3>Background</h3><div>Thyroid storm is a rare but life-threatening complication of thyrotoxicosis. It is particularly uncommon in pediatric populations with an incidence of approximately 1–2 % among patients with overt hyperthyroidism (Karger and Fuhrer, 2008) [1]. Thyrotoxicosis has a reported annual incidence of 0.9 per 100,000 in post pubertal children and a prevalence in the US of 1.2 % (Bahn et al., 2011) [2], (Williamson and Greene, 2010) [3]. Symptoms of thyroid storm include hypertension, fever, gastrointestinal symptoms, tachycardia, and altered mental status. These signs and symptoms easily mimic common emergency medicine patient presentations such as sepsis, dysrhythmia, viral infections, pneumonia, or recreational drug use, making diagnosis difficult. Delayed recognition of thyroid storm significantly increases morbidity and mortality, making prompt recognition and treatment critical in the emergency medicine setting.</div></div><div><h3>Case report</h3><div>We present the case of a 14-year-old adolescent who arrived to the emergency department with fever, rapid heart rate, anxiety, and sore throat. The constellation of physical exam findings led to suspicion for thyroid storm. Treatment including IV fluids, beta-blockade, antithyroid therapy, corticosteroids, and iodine therapy were initiated. Laboratory testing later confirmed the diagnosis of thyroid storm. Testing for Streptococcal pharyngitis and Influenza B also resulted positive, likely representing the triggers. The patient improved with the treatment administered in the emergency department and subsequently transferred to the pediatric ICU.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Although rare in pediatric patients, thyroid storm carries a mortality rate of 10–30 % (De Groot and Abalovich, 2022) [4], (Karger and Fuhrer, 2008) [1]. Early diagnosis is essential, yet the clinical presentation can be mistaken for more common emergencies such as sepsis, dysrhythmia, myocarditis, endocarditis, pneumonia, or recreational drug use. Emergency physicians must maintain a high index of suspicion for thyroid storm in patients presenting with unexplained tachycardia, fever, and hypertension, even in the absence of known thyroid disease. Emergency physicians play a critical role in stabilizing these patients and initiating time-sensitive treatment that significantly improves outcomes.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"5 1","pages":"Article 100206"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer pain in the emergency department: A narrative review","authors":"Nam T. Nguyen ,&nbsp;Jace Nguyen ,&nbsp;Rayan Jouny ,&nbsp;Rebecca A. Shatsky ,&nbsp;Christopher J. Coyne","doi":"10.1016/j.jemrpt.2026.100208","DOIUrl":"10.1016/j.jemrpt.2026.100208","url":null,"abstract":"<div><h3>Background</h3><div>Cancer-related pain accounts for up to 62 % of emergency department (ED) visits among patients with malignancy, yet one in three receives inadequate analgesia. Persistent disparities in cancer pain management based on race, age, and insurance status, further exacerbate this issue. To date, there are no reviews evaluating the existing literature on cancer pain management in the emergency department, or strategies to optimize care for this prevalent condition.</div></div><div><h3>Objective</h3><div>To review and synthesize recent evidence (2015–2025) on the burden of cancer-related pain in the ED, focusing on incidence, clinical features, treatment shortcomings, and emerging strategies to improve care.</div></div><div><h3>Discussion</h3><div>Twenty-seven studies were included in the review. Pain recurred or persisted in 40–62 % of encounters, with musculoskeletal and abdominal pain responding poorly. Median time to opioid administration exceeded 1 h; while escalation occurred in only 11 % of undertreated cases. Black patients were nearly twice as likely as White patients to present in severe pain but were less likely to receive opioids. Younger adults, Medicaid/Medicare recipients, and patients with chronic pain or bone metastases also faced higher pain scores and admission rates. Promising interventions, including electronic best-practice advisories, alternative-to-opioid protocols, nerve blocks, and oncology-specific observation units were linked to lower pain scores, reduced opioid use, and fewer revisits or admissions. These strategies are based on single-center studies, with limited validation and sparse data on long-term, patient-centered outcomes. Although there are novel modalities explored, the primary pain management intervention for patients with cancer is opioids.</div></div><div><h3>Conclusion</h3><div>Cancer pain remains a leading, inequitable driver of ED use, highlighting the need for scalable, validated interventions that integrate timely analgesia and address structural disparities.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"5 1","pages":"Article 100208"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Confusional migraine in the emergency department: A case report of an adult patient with altered mental status","authors":"Lindsey Trinchet ,&nbsp;Max Watchmaker ,&nbsp;Zoe Willmer ,&nbsp;Sean Watson ,&nbsp;Douglas Rappaport","doi":"10.1016/j.jemrpt.2026.100211","DOIUrl":"10.1016/j.jemrpt.2026.100211","url":null,"abstract":"<div><h3>Background</h3><div>Acute confusional migraine (ACM) is an under-recognized migraine variant that presents with abrupt, reversible altered mental status and can closely mimic high-stakes neuroemergencies routinely triaged in the ED. It is not formally indexed in the International Classification of Headache Disorders and remains a diagnosis of exclusion guided by proposed criteria from pooled case data. This case report describes an adult ED presentation of ACM, a condition predominantly described in children, to highlight its relevance to emergency practice.</div></div><div><h3>Case report</h3><div>A 41-year-old man with history of complex migraine presented to the ED with a unilateral headache and blurred vision followed by confusion, dysarthria, and reported left-sided weakness. On arrival, he was disoriented with strained, slowed speech and effort-dependent motor function. Neurovascular imaging and laboratory workup revealed no acute pathology. He received migraine-directed therapy with steady improvement to baseline mentation. He was ultimately discharged home in stable condition with a dexamethasone taper and close outpatient follow-up.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>This case underscores how ACM can present in adults and warrants consideration in the ED once time-critical neurologic emergencies have been appropriately excluded. In recurrent, well-characterized presentations, considering ACM may support diagnostic consistency and help limit duplicated evaluation. Still, standardized diagnostic criteria and ED-specific guidelines are needed.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"5 1","pages":"Article 100211"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147394654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initiating buprenorphine in New Jersey emergency departments: a mixed methods study","authors":"Cadence F. Bowden ,&nbsp;Peter Treitler ,&nbsp;Jennifer Miles ,&nbsp;Hannah Shepherd ,&nbsp;Kylie Davidson ,&nbsp;Stephen Crystal","doi":"10.1016/j.jemrpt.2026.100210","DOIUrl":"10.1016/j.jemrpt.2026.100210","url":null,"abstract":"<div><h3>Background</h3><div>Emergency departments (EDs) represent a critical touchpoint in the treatment of opioid use disorder (OUD), yet evidence-based practices such as buprenorphine initiation have not been widely adopted.</div></div><div><h3>Objectives</h3><div>This study describes state-wide uptake of buprenorphine by Medicaid-enrolled patients with OUD who are seen in New Jersey (NJ) EDs and examines related clinical ED practices.</div></div><div><h3>Methods</h3><div>This sequential mixed-methods study used NJ Medicaid claims and qualitative interviews with ED leaders. Quantitative analyses included NJ Medicaid enrollees aged 18–64 treated in NJ EDs for OUD-related diagnoses. The primary quantitative outcome was ED-associated buprenorphine utilization, defined as buprenorphine that was dispensed or filled 0–4 days after ED discharge. Results of the quantitative analyses were used to classify EDs as higher and lower prescribing, from which ED leaders were then purposively sampled to participate in semi-structured interviews. Qualitative data were analyzed inductively.</div></div><div><h3>Results</h3><div>Overall buprenorphine initiation peaked at 14.4 % in 2022 and there was wide variation across EDs. Interviewees commonly reported that peer navigator programs, availability of community-based providers, and a positive culture toward MOUD facilitated buprenorphine initiation. Conversely, provider hesitancy, limited community resources, and regulatory factors were reported as major barriers.</div></div><div><h3>Conclusions</h3><div>While volumes of patients presenting to NJ EDs with OUD remain high, low rates of buprenorphine initiation and prescription persist. Providers and institutions possess great variation in their comfort with and ability to initiate buprenorphine in the ED and future work to standardize this evidence-based practice is needed.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"5 1","pages":"Article 100210"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147394663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-care ultrasound for the detection of sigmoid colon foreign body: A case report","authors":"Brooke Johnson ,&nbsp;Camille Mulcahy ,&nbsp;Nathan Roberts ,&nbsp;Nigel Bowe ,&nbsp;Ahmed Naseem ,&nbsp;Christopher Clark","doi":"10.1016/j.jemrpt.2025.100204","DOIUrl":"10.1016/j.jemrpt.2025.100204","url":null,"abstract":"<div><h3>Background</h3><div>Emergency department (ED) visits for colorectal foreign bodies are not uncommon across the United States, with increasing incidence over recent years. Plain abdominal radiographs (XR) are the standard initial imaging modality of choice in cases of retained colorectal foreign bodies; however, they are limited in their ability to detect radiolucent objects. The use of point-of-care ultrasound (POCUS) in identification of radiolucent colorectal foreign bodies remains poorly studied and may even be underutilized. Case Report: This case report examines the use of POCUS in the ED for a patient presenting with a retained sigmoid colon foreign body. Why Should An Emergency Physician Be Aware Of This? Our findings highlight the potential role of POCUS as a valuable adjunct to traditional imaging in the assessment and management of colorectal foreign bodies.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"5 1","pages":"Article 100204"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided interscalene block for shoulder avascular necrosis pain in the emergency department: A case report","authors":"Jennifer X. Hong ,&nbsp;Richard J. Gawel ,&nbsp;Jeffrey A. Kramer","doi":"10.1016/j.jemrpt.2025.100201","DOIUrl":"10.1016/j.jemrpt.2025.100201","url":null,"abstract":"<div><h3>Background</h3><div>Avascular necrosis (AVN) of the humeral head may cause severe pain requiring ED management, particularly in patients awaiting surgical treatment.</div></div><div><h3>Case report</h3><div>A 38-year-old woman presented with severe left shoulder AVN pain refractory to oral and intravenous opioids. She received an ultrasound-guided interscalene brachial plexus block (ISB) with complete relief. She was discharged without the need for any subsequent analgesics in the ED.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>This case highlights the novel use of an emergency physician-performed ISB for AVN-related shoulder pain and supports the potential role of ultrasound-guided regional anesthesia as an opioid-sparing intervention for AVN-related pain in the ED.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"5 1","pages":"Article 100201"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145584378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum regarding missing statements in previously published articles","authors":"","doi":"10.1016/j.jemrpt.2026.100216","DOIUrl":"10.1016/j.jemrpt.2026.100216","url":null,"abstract":"","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"5 1","pages":"Article 100216"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147394666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency medical kits on commercial flights: A policy analysis and FAA recommendations using disaster medicine principles","authors":"Justin S. Yang","doi":"10.1016/j.jemrpt.2026.100213","DOIUrl":"10.1016/j.jemrpt.2026.100213","url":null,"abstract":"<div><h3>Background</h3><div>Medical emergencies occur in approximately 1 in every 604 commercial flights. Responders must provide care in a disaster medicine environment with limited space, minimal monitoring, finite oxygen, and delayed access to definitive treatment. Emergency Medical Kits (EMKs) serve as the primary clinical resource, yet Federal Aviation Administration (FAA) regulations governing EMK contents and maintenance have changed little in more than two decades.</div></div><div><h3>Objective</h3><div>This review evaluates FAA EMK requirements, airline maintenance practices, and documented EMK deficiencies using a disaster medicine framework to determine whether current oversight supports reliable in-flight medical care.</div></div><div><h3>Discussion</h3><div>FAA regulations specify only minimum EMK contents and do not define inspection intervals, expiration tracking, device functionality checks, or standardized documentation. Airlines instead rely on visual seal checks and inconsistent vendor refurbishment, resulting in wide variability in EMK readiness. Published in-flight emergencies describe missing airway adjuncts, expired or depleted medications, inadequate anaphylaxis treatments, and nonfunctional diagnostic equipment. In contrast, disaster response systems such as Disaster Medical Assistance Teams, Urban Search and Rescue task forces, and state EMS agencies use structured cache management with designated supply roles, real time digital inventory tools, required reconciliation after use, and scheduled audits.</div></div><div><h3>Conclusions</h3><div>Current FAA oversight does not reflect the operational demands or safety expectations of modern emergency care. Aligning EMK policy with established disaster medicine practices, including updated contents, accountable oversight roles, digital inventory systems, post use reconciliation, and routine audits, would improve EMK reliability and strengthen patient safety during in-flight medical emergencies.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"5 1","pages":"Article 100213"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147394665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid reversal of severe hepatotoxicity from carp gallbladder poisoning with combined plasma exchange and DPMAS: A case report","authors":"Jun Sun ,&nbsp;Xueqin Du ,&nbsp;Rui Zang ,&nbsp;Ling Pan ,&nbsp;Menglin Zhao","doi":"10.1016/j.jemrpt.2026.100219","DOIUrl":"10.1016/j.jemrpt.2026.100219","url":null,"abstract":"<div><h3>Background</h3><div>Fish gallbladder ingestion is a rare but potentially life-threatening toxic exposure that may result in fulminant hepatic failure, acute kidney injury, and multiorgan dysfunction. Optimal management strategies for severe toxin-mediated hepatotoxicity remain unclear.</div></div><div><h3>Case report</h3><div>A 61-year-old woman developed massive hepatocellular injury after ingesting the gallbladder of a dying black carp (<em>Mylopharyngodon piceus</em>). Laboratory testing revealed rapidly progressive and markedly elevated transaminases accompanied by early renal involvement. Given the severity and progression of organ injury, plasma exchange (PE) combined with a double plasma molecular adsorption system (DPMAS) was initiated. After two treatment sessions, liver enzymes declined dramatically, renal function stabilized without further deterioration, and the patient achieved full clinical recovery.</div><div>Why should an emergency physician be aware of this?Fish gallbladder poisoning may present initially with nonspecific gastrointestinal symptoms but can rapidly progress to severe liver and kidney injury. Early recognition and timely initiation of blood purification therapy may be critical for preventing multiorgan failure and improving outcomes.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"5 1","pages":"Article 100219"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147394851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetic ketoacidosis induced by Alpelisib: A case report on a rare complication requiring emergency management","authors":"Gizem Candemir ,&nbsp;Gulcan Candemir Ergene ,&nbsp;Cansu Alyesil Ozturan ,&nbsp;Ayse Dilara Oztermeli ,&nbsp;Huseyin Cahit Halhalli","doi":"10.1016/j.jemrpt.2026.100207","DOIUrl":"10.1016/j.jemrpt.2026.100207","url":null,"abstract":"<div><h3>Background</h3><div>Alpelisib is a PI3K inhibitor used for the treatment of hormone receptor-positive (HR+), HER2-negative advanced breast cancer with a PIK3CA mutation. Hyperglycemia is its most common adverse effect, which can rarely lead to life-threatening complications such as diabetic ketoacidosis (DKA). This complication can develop even in patients with no prior history of diabetes and requires rapid intervention in the emergency department (ED).</div></div><div><h3>Case presentation</h3><div>A 62-year-old female patient presented to the ED with complaints of reduced oral intake, fatigue, and oral sores 15 days after initiating alpelisib therapy. Laboratory investigations revealed severe hyperglycemia (593.9 mg/dL), metabolic acidosis (pH 7.159, HCO₃⁻ 6.8 mmol/L), positive urinary ketones, and an HbA1c level of 9.4 %, suggesting previously undiagnosed diabetes. A prompt diagnosis was made of alpelisib-induced DKA in a patient with previously undiagnosed diabetes mellitus. Her acidosis resolved on the second day of admission.</div><div>While hyperglycemia is observed in patients treated with alpelisib, the incidence of Grade 3–4 hyperglycemia is 36.6 %, emerging within the first few weeks of treatment. The incidence of DKA is low (0.7 %) but is a life-threatening condition. The underlying mechanism is attributed to severe insulin resistance and increased hepatic gluconeogenesis due to the inhibition of the PI3K/AKT pathway.</div></div><div><h3>Why should an emergency physician be aware of this</h3><div>This case report underscores that alpelisib therapy can precipitate DKA, especially in patients with underlying, potentially undiagnosed, diabetes. A multidisciplinary approach, including close glycemic monitoring, assessment of risk factors, and preparedness for hyperglycemic emergencies, is critical for patients starting alpelisib.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"5 1","pages":"Article 100207"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}