JEM reports最新文献

{"title":"Severe pentobarbital poisoning treated after two sessions of intermittent hemodialysis: A case report","authors":"Sohma Miyamoto ,&nbsp;Shutaro Isokawa ,&nbsp;Norio Otani ,&nbsp;Masatoshi Miyamoto ,&nbsp;Yoshito Kamijo","doi":"10.1016/j.jemrpt.2025.100174","DOIUrl":"10.1016/j.jemrpt.2025.100174","url":null,"abstract":"<div><h3>Background</h3><div>Pentobarbital is a short-acting barbiturate that can cause life-threatening central nervous system, respiratory, and cardiovascular depression if massively overdosed.</div></div><div><h3>Case report</h3><div>This case report describes a 38-year-old female who entered a deep coma after ingesting 2.45 g of pentobarbital. She had severe respiratory depression and hypotension refractory to fluid administration. The patient was intubated, placed under mechanical ventilation, and given continuous intravenous administration of norepinephrine. She then underwent 2 sessions of intermittent hemodialysis (IHD) lasting 4 h each, after which her clinical condition rapidly improved. The serum pentobarbital concentration determined using liquid chromatography-tandem mass spectrometry (LD/MS/MS) decreased rapidly from 60.61 to 23.75 μg/ml after the first session and from 26.16 to 9.34 μg/ml after the second session. The half-lives of pentobarbital were estimated to be 3.8 and 4.1 h during the first and second sessions, respectively, 157.5 h between the two sessions, and 20.4 h after the second session. The case highlights the potential benefit of IHD in managing pentobarbital toxicity, where enhanced drug clearance may shorten intubation and intensive care unit stay.</div></div><div><h3>Why should an emergency physician should be aware of this?</h3><div>In severe pentobarbital poisoning, hemodialysis may be effective to enhance drug clearance.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100174"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941192","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":"From the emergency department to veno-venous ECMO- a case of refractory hypoxia","authors":"Joshua Fuller,&nbsp;Cameron Harrison","doi":"10.1016/j.jemrpt.2025.100173","DOIUrl":"10.1016/j.jemrpt.2025.100173","url":null,"abstract":"<div><h3>Background</h3><div>A known rare side effect of naloxone administration is non-cardiac pulmonary edema. There have been multiple proposed mechanisms for this, the most accepted one being a catecholamine surge causing physiologic changes favoring the development of pulmonary edema. The literature is sparse on this clinical entity, mostly consisting of case reports and a case series.</div></div><div><h3>Case report</h3><div>Here we present a case of a young male who presents with refractory hypoxia and shock requiring emergent Extracorporeal Membrane Oxygenation (ECMO) consultation and cannulation for veno-venous ECMO(VV-ECMO) from the emergency department. The patient responded well and was decannulated and extubated within 50 hours and ultimately discharged on hospital day 6.</div></div><div><h3>Why should an emergency physician be aware of this</h3><div>This would be a rare publication of VV-ECMO being used emergently for hypoxic respiratory failure secondary to naloxone-induced pulmonary edema compounded by subsequent aspiration in the Emergency Department.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100173"},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089152","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":"Case report:Acute hepatic and renal failure caused by alcohol and acetaminophen poisoning","authors":"Liu Yiyang,&nbsp;He Xinhua","doi":"10.1016/j.jemrpt.2025.100171","DOIUrl":"10.1016/j.jemrpt.2025.100171","url":null,"abstract":"<div><h3>Background</h3><div>Acetaminophen, a commonly used antipyretic and analgesic in clinical practice, is widely applied due to its effectiveness in relieving pain and reducing fever, as well as its low gastrointestinal irritation. However, taking large doses or using it long - term, taking it while drinking alcohol, or taking two or more drugs containing acetaminophen can lead to severe drug - induced liver damage, and in rare cases, kidney function damage and even death.</div></div><div><h3>Case</h3><div>This article reports a case of a young female patient who experienced coma after excessive alcohol consumption and overdose of acetaminophen due to emotional breakdown. After rescue, the patient concealed her medication history and left the hospital on her own after regaining consciousness. Six days later, the patient was re - admitted due to coagulation disorders, and it was found that she had severe acute hepatic and renal function damage. After a clear diagnosis through toxicological analysis, the patient received active treatment and recovered.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Combining with literature reports, this article analyzes the phenomenon of young female patients attempting suicide by taking acetaminophen while drinking heavily in an emotionally out - of - control state, and explores the mechanism of liver and kidney function damage caused by excessive use of acetaminophen, aiming to draw the attention of clinicians and society.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100171"},"PeriodicalIF":0.0,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143894962","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":"Dystonic reaction to haloperidol causing severe tongue swelling requiring cricothyroidotomy","authors":"Carmen Estrada Huerta,&nbsp;Emily White","doi":"10.1016/j.jemrpt.2025.100172","DOIUrl":"10.1016/j.jemrpt.2025.100172","url":null,"abstract":"<div><h3>Background</h3><div>Haloperidol is a widely used drug in both the prehospital setting and the emergency department (ED) for agitation. Though rare, haloperidol can lead to severe dystonic reactions that can cause traumatic tongue swelling. Severe tongue swelling can lead to airway compromise.</div></div><div><h3>Case Report</h3><div>A 31-year-old female was given haloperidol in the pre-hospital setting by EMS for agitation to allow for transport and medical evaluation. She had a delayed dystonic reaction that led to tongue protrusion, jaw clenching, and subsequent traumatic oral swelling. The severe tongue swelling caused airway compromise requiring an emergency cricothyroidotomy. She recovered in the ICU with removal of airway support on day five.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Agitation in patients needing emergency care is not infrequent. Haloperidol is a common medication to treat agitation in both the pre-hospital and emergency department settings. A key to the safe administration of this drug is awareness of life-threatening adverse reactions such as severe dystonic reactions. It is important for emergency providers to be aware that dystonic reactions can cause tongue protrusion, tongue biting, and resultant traumatic tongue swelling. Anti-cholinergic medications are a critical intervention as the first line treatment of dystonia. It is also essential that emergency providers look for medical bracelets prior to giving medications if the patient is unable to communicate allergies. It was discovered in the ED that the patient had a bracelet noting her prior reactions to haloperidol.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100172"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143894938","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":"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}