JEM reports最新文献

{"title":"Adult facial Fractures: A review and guide for emergency medicine clinicians","authors":"Keenan S. Fine ,&nbsp;Caroline C. Bay ,&nbsp;Gina Krause ,&nbsp;Robert E. George ,&nbsp;Camille J. LaLiberte ,&nbsp;Daniel Y. Cho ,&nbsp;C. Corlin Jewell ,&nbsp;Hani I. Kuttab","doi":"10.1016/j.jemrpt.2025.100170","DOIUrl":"10.1016/j.jemrpt.2025.100170","url":null,"abstract":"<div><h3>Background</h3><div>Facial fractures are common injuries in emergency departments across the United States. These can present various challenges for emergency medicine (EM) physicians and other healthcare providers. Managing these injuries can be complex which may be exacerbated by varying availability of specialist support, particularly in rural or community settings.</div></div><div><h3>Objective of review</h3><div>This review aims to provide a comprehensive, evidence-based approach to the management of facial fractures for emergency medicine (EM) clinicians. This review highlights key principles in trauma evaluation, imaging, and indications for surgical consultation to improve decision-making and patient care.</div></div><div><h3>Discussion</h3><div>Facial fracture management begins with systematic trauma evaluation, prioritizing stability, hemorrhage control, and airway patency. Maxillofacial CT without contrast is the preferred imaging modality for most facial fractures with some requiring further imaging. Emergency physicians should recognize high risk features requiring surgical consultation, including displacement, malocclusion, and neurovascular compromise. Orbital and midface fractures may require ophthalmologic consultation if the patient presents with entrapment, globe rupture, or orbital compartment syndrome. In many cases, stable, non-displaced fractures may be managed outpatient with clear return precautions and outpatient surgical follow-up.</div></div><div><h3>Conclusion</h3><div>This review is designed to be accessible and instructive for EM trainees and clinicians. These multidisciplinary guidelines provided can equip EM providers with the knowledge to safely and effectively triage facial fractures.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100170"},"PeriodicalIF":0.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869205","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":"A pilot study on physiological indicators of expertise in pre-hospital emergency medical services (EMS) providers during endotracheal intubation","authors":"Gabriel Gazetta ,&nbsp;Yaoyu Fu ,&nbsp;Kaori Tanaka ,&nbsp;Brian M. Clemency ,&nbsp;Anirban Dutta ,&nbsp;Matthew Hackett ,&nbsp;Jack Norfleet ,&nbsp;Rahul ,&nbsp;Suvranu De ,&nbsp;Steven Schwaitzberg ,&nbsp;Lora Cavuoto","doi":"10.1016/j.jemrpt.2025.100169","DOIUrl":"10.1016/j.jemrpt.2025.100169","url":null,"abstract":"<div><h3>Background</h3><div>Prehospital intubation is a high risk, low frequency skill. Manikin intubations, the most common means of evaluating providers’ competency, may be insufficient to predict procedural success.</div></div><div><h3>Objective</h3><div>The objective of this pilot study was to explore whether physiological measures, including gaze behavior, pupil response, and cortical activation, differed between groups of pre-hospital emergency medical services (EMS) providers during simulated endotracheal intubation.</div></div><div><h3>Methods</h3><div>Fifteen certified paramedics (expert clinicians) and fifteen Advanced Emergency Medical Technicians (intermediate clinicians) participated in this pilot study. Each participant performed three intubations on a standard airway manikin. During the intubations, pupillometry and gaze data were collected using eye tracking glasses and brain activation using functional near infrared spectroscopy (fNIRS). Groups were compared based on the eye tracking and neuroimaging metrics.</div></div><div><h3>Results</h3><div>Twenty-seven out of 30 participants successfully intubated the manikin across all repetitions, and expert clinicians finished the task on average 11.6s faster than intermediate clinicians. Experts spent less task time in gaze fixation (39.8 % vs. 55.2 %, <em>p</em> = 0.03). Peaks in pupil diameter during the task most often occurred during the sub-task of inserting the tube in the trachea (76% of the time). Neuroimaging results revealed significant group-level differences in the left supramarginal gyrus.</div></div><div><h3>Conclusion</h3><div>This study explored physiological responses during simulated intubation by pre-hospital emergency medicine providers. While some group-level differences were observed in gaze behavior and brain activation, these findings were not sufficient to differentiate expertise. Further research is needed to better understand how physiological responses may reflect task demands in clinical settings.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100169"},"PeriodicalIF":0.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143847997","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":"Thyrotoxicosis misdiagnosed as anaphylaxis following NSAID use in an adolescent","authors":"Eytan Mendelow,&nbsp;Andrew Weinberger,&nbsp;Crista Cerrone","doi":"10.1016/j.jemrpt.2025.100168","DOIUrl":"10.1016/j.jemrpt.2025.100168","url":null,"abstract":"<div><h3>Background</h3><div>Emergency physicians often encounter patients presenting with symptoms suggestive of common conditions, such as anaphylaxis. However, when clinical findings deviate from the expected course, maintaining a broad differential is critical.</div></div><div><h3>Case report</h3><div>A 17-year-old female presented to the emergency department with flushing, and tachycardia following ibuprofen ingestion.The patient had administered intramuscular epinephrine at home prior to arrival. In the emergency department, she was treated with antihistamines for a presumed anaphylactic reaction. While what was perceived as her facial swelling and hives improved, she remained persistently tachycardic and hypertensive. Further evaluation revealed suppressed TSH and elevated free T4 levels, leading to a diagnosis of thyrotoxicosis. Endocrinology consultation confirmed the findings. The patient was treated with atenolol for symptomatic relief and methimazole to address the underlying thyroid dysfunction.</div><div>Why Should an Emergency Physician Be Aware of This?: This case underscores the importance of re-evaluating initial impressions when a patient's response to treatment is incomplete or atypical. Persistent tachycardia and hypertension after apparent anaphylaxis should prompt consideration of alternative diagnoses, including thyrotoxicosis. Emergency physicians must remain vigilant for less common presentations of thyroid dysfunction, especially when triggered by medications or other stressors, to ensure timely diagnosis and management.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100168"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869204","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":"Wide-complex tachycardia with an unusual response to electrical cardioversion in an adolescent with Chiari 1 malformation: A case report","authors":"Jonathan Mohnkern ,&nbsp;Laura Williams ,&nbsp;Christopher Fullagar","doi":"10.1016/j.jemrpt.2025.100167","DOIUrl":"10.1016/j.jemrpt.2025.100167","url":null,"abstract":"<div><h3>Background</h3><div>Pediatric patients with sustained tachyarrhythmias present unique challenges to prehospital clinicians due to differences in physiology, pathology, compensatory mechanisms, and treatment algorithms. Additionally, pediatric patients require careful thought into the psychosocial impacts that one's demeanor, treatment, and explanations will have on them.</div></div><div><h3>Case report</h3><div>This case illustrates an adolescent male with a history of Chiari 1 malformation who presented to EMS with sustained monomorphic ventricular tachycardia (VT). An unusual rhythm response was experienced during electrical cardioversion, where this intervention resulted in an immediate doubling of his heart rate.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>We discuss approaches to pediatric dysrhythmias, differential diagnosis considerations, appropriate management of wide-complex tachycardia, and methods to reduce the psychological burden on patients and families in a first-encounter clinical situation.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100167"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143837826","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":"QTc prolongation and dysrhythmia risk in emergency department patients administered ondansetron","authors":"Evan Lawyer ,&nbsp;Jessica Krizo ,&nbsp;Kailee Pollock ,&nbsp;Carline Mangira ,&nbsp;Erin L. Simon","doi":"10.1016/j.jemrpt.2025.100166","DOIUrl":"10.1016/j.jemrpt.2025.100166","url":null,"abstract":"<div><h3>Background</h3><div>Ondansetron, an anti-emetic with the potential to cause QT-prolongation and dysrhythmia, is commonly used in the emergency department. It is unclear how often ondansetron is given to patients with prolonged QT intervals and if these patients are more likely to have dysrhythmias.</div></div><div><h3>Objectives</h3><div>We determined the frequency of the use of ondansetron in patients with a corrected QT (QTc) interval ≥500 ms and the rate of dysrhythmias in this population.</div></div><div><h3>Methods</h3><div>This study was a retrospective review of adult patients who presented to one of 17 EDs within a large integrated healthcare system between May 1, 2021, and April 30, 2023. Patients were included if they had an electrocardiogram (ECG) and received ondansetron. Patients were categorized by QTc length. Categorical variables were described using frequencies and percentages and p-values obtained from Pearson Chi square or Fisher's exact tests where appropriate.</div></div><div><h3>Results</h3><div>A total of 42,530 patients were included. Of these, 56 developed dysrhythmias. Patients administered ondansetron with a measured QTc ≥500 (n = 2302), compared to patients with a measured QTc &lt;500 (n = 40,228), were not at increased risk for developing a dysrhythmia (p = 1.000). A total of 11 patients with a QTc &gt;475 (n = 6572), developed a dysrhythmia and there was an increased incidence of supraventricular tachycardia (p = 0.002) and cardiac arrest (p = 0.002).</div></div><div><h3>Conclusion</h3><div>This study shows that most patients (95 %) who had an ECG and were administered ondansetron have a QTc &lt;500. The incidence of dysrhythmia in patients with a QTc &gt;500 was 0.09 % and in those with a QTc &gt;475 was 0.17 %.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100166"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143820313","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":"A nerve block supply cart and nerve block champions program associated with increased fascia iliaca block use","authors":"Joseph R. Brown ,&nbsp;Michael Heffler ,&nbsp;Peter Alsharif ,&nbsp;Brigit Noon ,&nbsp;Justin Inman ,&nbsp;Eric Bustos ,&nbsp;Juliana Wilson ,&nbsp;Ryan Tucker","doi":"10.1016/j.jemrpt.2025.100164","DOIUrl":"10.1016/j.jemrpt.2025.100164","url":null,"abstract":"<div><h3>Background</h3><div>Ultrasound-guided nerve blocks (UGNBs) are a vital component of a multimodal approach to managing pain in the Emergency Department (ED). However, implementation has not been universally adopted due to their time-consuming nature and provider discomfort with the procedure.</div></div><div><h3>Objectives</h3><div>The primary outcome of this study was to deploy a new UGNB cart and group of nerve block “champions” and evaluate whether the rate of infrainguinal fascia iliaca compartment block (IFICB) use increased in geriatric hip fractures. Secondary outcomes included length of stay in the ED, complications associated with the UGNB and Morphine Equivalents used compared to patients who did not receive the IFICB.</div></div><div><h3>Methods</h3><div>This was a prospective, observational cohort study performed at a single urban, academic site. Inclusion criteria was based on institutional coding of a hip fracture. Each chart was reviewed as to whether the patient received an IFICIB as well as secondary outcomes like ED length of stay (LOS). Finally, the treating physician was surveyed regarding their decision to perform an IFICB.</div></div><div><h3>Results</h3><div>Of the 146 eligible patients, 15.8 % received an IFICB, an increase from 2.6 % in 2019. 55 physicians were enrolled with a 96 % response rate. Commonly cited reasons for not performing the block were controlled pain and lack of training. Of the 23 UGNBs performed, 14 involved a champion. Despite length of time being cited 10.6 % of the time for not performing the IFICB, patients who received a IFICB had a shorter ED LOS.</div></div><div><h3>Conclusion</h3><div>This study showed that the creation of nerve block “champions” and implementation of an UGNB cart was associated with an increase in their utilization of the IFICB.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100164"},"PeriodicalIF":0.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic sclerosis with associated endometrial squamous metaplasia, liver mass, adrenal lesion and bilateral breast masses: Case report","authors":"Ariella Gartenberg ,&nbsp;Capwell Taylor ,&nbsp;Arvind Haran ,&nbsp;Alexander Petrie","doi":"10.1016/j.jemrpt.2025.100165","DOIUrl":"10.1016/j.jemrpt.2025.100165","url":null,"abstract":"<div><h3>Background</h3><div>Systemic sclerosis is a rare and chronic autoimmune connective tissue disease that involves widespread vascular dysfunction, as well as fibrosis of the skin and internal organs. With the development of organ-based treatment, including ACE-inhibitors for renal crisis and goal directed therapy for heart failure, the mortality associated with renal and cardiac involvement has decreased significantly. Consequently, the increased risk of malignancy in patients with systemic sclerosis has become a topic of concern. Once the diagnosis of systemic sclerosis is made, various associated disease processes, including malignancy, must be screened for.</div></div><div><h3>Case report</h3><div>This case report details a 44 year old female presenting to the Emergency Department with abdominal pain, vaginal bleeding, pruritic rash, and two syncopal episodes. The patient was ultimately diagnosed with systemic sclerosis with extensive “salt and pepper” skin pigmentation and tightening over the arms, chest, and back, with associated bilateral breast masses, an adrenal lesion, liver mass, and endometrial squamous metaplasia.</div><div><strong>Why should an emergency physician be aware of this?</strong> A chief complaint as common as “syncope” can be an atypical presentation of less common, difficult to diagnose conditions in the emergency department, such as systemic sclerosis. While systemic sclerosis is not a diagnosis readily made in the emergency department, prompt recognition and appropriate consulting services or referrals can prevent long-term devastating complications and associated morbidity and mortality.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100165"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When itching signals more: A case of chronic pruritus leading to cancer diagnosis","authors":"Christine E. Maloney,&nbsp;William B. Prince","doi":"10.1016/j.jemrpt.2025.100163","DOIUrl":"10.1016/j.jemrpt.2025.100163","url":null,"abstract":"<div><h3>Background</h3><div>Pruritus is a common complaint seen by emergency medicine physicians and carries a broad differential encompassing dermatologic, systemic, neurologic, and psychogenic etiologies.</div></div><div><h3>Case report</h3><div>A 16-year-old girl presented to the emergency department with two months of pruritus and rash. Prior diagnoses for her symptoms included atopic dermatitis, medication-induced tactile hallucinations, and scabies. Physical examination in the emergency department was notable for a firm supraclavicular lymph node and laboratory studies were notable for systemic inflammation. Biopsy revealed a new diagnosis of classical Hodgkin lymphoma.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Recognition of refractory chronic pruritus by frontline providers as a presenting symptom of Hodgkin lymphoma can prevent diagnostic delay.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100163"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous peroneal pseudoaneurysm in the young athlete","authors":"Nina C. Lund,&nbsp;Jennifer L. Hemberg","doi":"10.1016/j.jemrpt.2025.100162","DOIUrl":"10.1016/j.jemrpt.2025.100162","url":null,"abstract":"<div><h3>Background</h3><div>Pseudoaneurysm represents an unusual cause of unilateral extremity pain in the acute care setting. However, a growing body of literature supports its inclusion in the standard differential for acute-onset extremity pain. Consideration for pseudoaneurysm is particularly justified in management of pediatric patients, who may bear undiagnosed syndromes conferring increased risk of vascular injury.</div></div><div><h3>Case report</h3><div>We present an unusual case of acute onset unilateral extremity pain in an otherwise healthy 17-year-old male resulting from spontaneous peroneal artery rupture with pseudoaneurysm identified on emergent angiography. In this case, pseudoaneurysm was complicated by compartment syndrome necessitating four compartment fasciotomy and washout with delayed closure.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Our discussion reviews current evidence for emergent vascular imaging in the pediatric population. If there is a high suspicion for pseudoaneurysm or other vascular emergency, providers should prioritize computed tomography with angiography over magnetic resonance. Prompt diagnosis is critical to avert progression to compartment syndrome and/or disability. We also discuss the known causes of pseudoaneurysm and conclude that the finding of spontaneous pseudoaneurysm should trigger evaluation for related genetic and rheumatologic disorders with the aim of mitigating morbidity and mortality related to the underlying disease process.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100162"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided interscalene block for the reduction of luxatio erecta in a high-risk patient: A case report","authors":"Alexandra Over,&nbsp;Tyler Nghiem,&nbsp;Pamela Santivanez,&nbsp;Amin Mohamadi,&nbsp;Josh Greenstein,&nbsp;Barry Hahn,&nbsp;William Caputo","doi":"10.1016/j.jemrpt.2025.100161","DOIUrl":"10.1016/j.jemrpt.2025.100161","url":null,"abstract":"<div><h3>Background</h3><div>Inferior glenohumeral dislocation (IGD), or luxatio erecta humeri, is a rare shoulder dislocation, accounting for 0.5 % of all cases. It often results from hyperabduction of the arm, causing the humeral head to dislocate inferiorly. IGD is associated with neurovascular complications, particularly in elderly patients with comorbidities. Traditional management involves procedural sedation, which may be risky in high-risk patients. Ultrasound-guided interscalene nerve blocks offer a safer alternative by providing localized pain control without sedation.</div></div><div><h3>Case report</h3><div>We report the case of an 85-year-old male with multiple comorbidities who presented with IGD after a fall. Given the patient's risks, an ultrasound-guided interscalene block was used for reduction. Reduction was achieved using the traction-countertraction method, confirmed by post-reduction radiographs. The patient experienced no immediate complications, and at follow-up, showed no signs of re-dislocation or neurological deficits.<strong>Why should an emergency physician be aware of this?</strong> Ultrasound-guided interscalene nerve blocks provide a safe and effective alternative to procedural sedation for IGD reduction, especially in high-risk patients. This approach minimizes opioid use, improves outcomes, and reduces emergency department resource utilization. Future guidelines should consider incorporating this technique for similar cases, with further studies needed to evaluate long-term outcomes.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100161"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}