JEM reports最新文献_第10页

Wound healing in the vulnerable: A novel case of postauricular wounds caused by mask ties 伤口愈合在脆弱:一个新病例耳后伤口造成的口罩领带

JEM reports Pub Date : 2023-06-01 DOI: 10.1016/j.jemrpt.2023.100038

Andrew Yousef, Olivia La Monte, Matthew Harmon, Deborah Watson

{"title":"Wound healing in the vulnerable: A novel case of postauricular wounds caused by mask ties","authors":"Andrew Yousef, Olivia La Monte, Matthew Harmon, Deborah Watson","doi":"10.1016/j.jemrpt.2023.100038","DOIUrl":"10.1016/j.jemrpt.2023.100038","url":null,"abstract":"<div><h3>Background</h3><p>The COVID-19 pandemic has made facial masks an essential part of daily life. While protective facial masks are crucial to help the spread of viral infections, they are common causes of facial skin breakdown, acne, and superficial injuries. Masks with elastic ear loops are also particularly likely to cause ear pressure injuries.</p></div><div><h3>Case report</h3><p>Herein, we present a case of a patient experiencing homelessness found to have significant postauricular wounds due to prolonged mask use in the context of the Covid-19 pandemic. These injuries led to bilateral erosion of the helix with partial avulsion of the ear and mask ear loops eroding into cartilage.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>We describe a rare complication of mask use and highlight the difficulties the COVID pandemic has made in providing adequate care for chronic head and neck wounds amongst the homeless population. While PPE remains an important part of decreasing the risk of the spread of infections, it is important to recognize the vulnerabilities of the homeless population during the COVID pandemic and how best to care for novel auricular wounds.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 2","pages":"Article 100038"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10188374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9541192","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}

引用次数: 0

Aims and Scope 目标及范围

JEM reports Pub Date : 2023-06-01 DOI: 10.1016/S2773-2320(23)00042-1

引用次数: 0

Trends in interfacility transfer volume by season, day of week, time of day, and federal holiday status 按季节、星期几、一天中的时间和联邦假日状态划分的种族间转移量趋势

JEM reports Pub Date : 2023-06-01 DOI: 10.1016/j.jemrpt.2023.100026

Arnold Moore III , Michael J. Waxman , Symone Reid , Aaron Wu , Ashar Ata , Ashley Telisky , Kanwaldeep Williams , Denis Pauze

{"title":"Trends in interfacility transfer volume by season, day of week, time of day, and federal holiday status","authors":"Arnold Moore III , Michael J. Waxman , Symone Reid , Aaron Wu , Ashar Ata , Ashley Telisky , Kanwaldeep Williams , Denis Pauze","doi":"10.1016/j.jemrpt.2023.100026","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100026","url":null,"abstract":"<div><h3>Background</h3><p>Interfacility transfer patients have poorer outcomes and greater resource needs than the average emergency department (ED) patient, however, trends in transfer rates remain poorly understood.</p></div><div><h3>Objective</h3><p>To quantify temporal trends in the volume of interfacility transfers to the emergency department of an academic referral center.</p></div><div><h3>Methods</h3><p>A retrospective review was performed of all adult patients transferred to the ED of a large, academic medical center in the Northeastern U.S. from 2017 to 2019. The mean transfer and total ED volumes by season, day of week, time of day, and federal holiday status were calculated and compared.</p></div><div><h3>Results</h3><p>A total of 26,555 adult patients were transferred to the hospital ED from 2017 to 2019. Transfer volume increased by 13% over the study period while total ED volume increased by less than 1%. While transfer patients made up, on average, only 8.6% of ED patients during day shifts, this proportion increased to 16.5% during evening shifts and 18.8% during night shifts. A modest, cyclical weekday pattern was also noted, with the proportion of ED volume from transfers reaching its highest on Saturdays and its lowest on Wednesdays. No consistent trends in transfer volume due to season or holiday status were observed.</p></div><div><h3>Conclusion</h3><p>Our center's significant two-year increase in interfacility transfer volume and relative stagnation in total ED volume illustrates an expanding role supporting community facilities. Consequently, transfer patients accounted for an increasing proportion of ED providers' workload during evening shifts and during overnight shifts. Referral centers may benefit from performing similar analyses of their own transfer volume to inform ED resource allocation.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 2","pages":"Article 100026"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49781441","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}

引用次数: 0

Diabetic ketoacidosis as a complication of immune checkpoint inhibitor therapy 糖尿病酮症酸中毒是免疫检查点抑制剂治疗的并发症

JEM reports Pub Date : 2023-06-01 DOI: 10.1016/j.jemrpt.2023.100022

Nathan L. Haas , Jordan Sell , Benjamin S. Bassin , Frederick K. Korley

引用次数: 0

Ultrasound-guided superficial fibular nerve block in the emergency department for refractory cancer-related lower extremity pain 超声引导下腓骨浅神经阻滞在急诊科治疗难治性癌症相关下肢疼痛的应用

JEM reports Pub Date : 2023-06-01 DOI: 10.1016/j.jemrpt.2023.100031

Rachna Subramony , Ishan Saha , Colleen Campbell , Rachel Spann , Elaine Yu

{"title":"Ultrasound-guided superficial fibular nerve block in the emergency department for refractory cancer-related lower extremity pain","authors":"Rachna Subramony , Ishan Saha , Colleen Campbell , Rachel Spann , Elaine Yu","doi":"10.1016/j.jemrpt.2023.100031","DOIUrl":"10.1016/j.jemrpt.2023.100031","url":null,"abstract":"<div><h3>Background</h3><p>Ultrasound-guided nerve blocks have been increasingly used in the emergency department (ED) to provide effective regional analgesia without relying on the use of systemic medications, which given in high quantities may cause respiratory depression. Ultrasound-guided nerve blocks of the superficial fibular nerve have been relatively understudied in the context of ED utilization.</p></div><div><h3>Case report</h3><p>We report the case of a 65-year-old woman with a history of acute lymphoblastic leukemia (ALL) on lifelong non-cytotoxic chemotherapy and sarcoma who presented with a chief complaint of right lower extremity pain for one week after minor trauma. She reported severe pain and was unable to bear weight. Her workup was negative for fracture, thrombus, compartment syndrome, and limb ischemia. Pain relief was not achieved even after the utilization of several doses of parenteral analgesics. After 12 hours in the ED, the patient was treated with an ultrasound-guided superficial fibular nerve block. Within one hour of treatment, she was able to ambulate and was discharged. During an oncology follow-up visit, she was found to have a recurrence of malignancy in her area of pain based on an outpatient bone scan and MRI. This case report demonstrates the successful utilization of a superficial fibular nerve block for refractory cancer-related pain.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>Cancer-related refractory pain is one of the most difficult conditions to treat in the emergency department. Patients requiring multiple high doses of opioids and sedatives are at risk for airway compromise. Refractory pain related to cancer can lead to extended ED stays or hospital admission. This case study highlights the use of a superficial fibular nerve block for refractory cancer-related pain in the ED and details the technique for performing the procedure.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 2","pages":"Article 100031"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43083082","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}

引用次数: 0

The corner pocket shot for distal radius fractures in the emergency department: A single targeted anesthetic injection for distal radius fractures 急诊科桡骨远端骨折角袋注射:桡骨远端骨折单次定向麻醉注射

JEM reports Pub Date : 2023-06-01 DOI: 10.1016/j.jemrpt.2023.100034

Nathaniel Leu , Brian Lentz , Daniel Mantuani , Arun Nagdev

{"title":"The corner pocket shot for distal radius fractures in the emergency department: A single targeted anesthetic injection for distal radius fractures","authors":"Nathaniel Leu , Brian Lentz , Daniel Mantuani , Arun Nagdev","doi":"10.1016/j.jemrpt.2023.100034","DOIUrl":"10.1016/j.jemrpt.2023.100034","url":null,"abstract":"<div><p>Background.</p><p>Distal radius fractures are a common Emergency Department (ED) presentation and often require procedural sedation for adequate pain control in order to facilitate closed reduction. Ultrasound-guided supraclavicular brachial plexus blocks are classically used for wrist and forearm surgeries, but have begun to be performed in the ED for distal radius fracture reductions. This procedure is not without its complications, including local anesthetic systemic toxicity, complications from needle insertion (peripheral nerve injury, vascular injury, pneumothorax), and phrenic nerve involvement leading to hemidiaphragmatic paralysis. This case series reviews using a single injection with a low volume of anesthetic to mitigate the risk of these complications.</p><p>Case Series</p><p>Three cases of distal radius fractures presented to the ED requiring reductions. Targeting the C8/T1 nerve roots, low-volume supraclavicular nerve blocks were performed. With concomitant non-opioid analgesia, closed reductions were performed with minimal reported pain. No complications were identified.</p><p>Why should an emergency physician be aware of this?</p><p>Patients requiring sedation often present to the ED with poorly controlled comorbidities or other contraindications making nerve blocks an excellent alternative. Contrary to the dense surgical anesthesia required by anesthesiologists, the emergency clinician should tailor the block to the specific pathology. In the case of distal radius fracture reductions, we recommend targeting the C8-T1 nerve roots. Through a single targeted injection with accompanying multimodal pain relief, adequate analgesia can be obtained while mitigating the risks that accompany high volume anesthetic and needle redirection.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 2","pages":"Article 100034"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44961634","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}

引用次数: 0

Greater cervical nerve block with bupivacaine resulting in neurotoxicity: A case report 布比卡因导致更大的颈神经阻滞神经毒性:1例报告

JEM reports Pub Date : 2023-06-01 DOI: 10.1016/j.jemrpt.2023.100027

Alexander T. Clark , Aaron J. Lacy , Michael D. Simpson , Sara G. Lin , James O. Jordano , Saralyn R. Williams

{"title":"Greater cervical nerve block with bupivacaine resulting in neurotoxicity: A case report","authors":"Alexander T. Clark , Aaron J. Lacy , Michael D. Simpson , Sara G. Lin , James O. Jordano , Saralyn R. Williams","doi":"10.1016/j.jemrpt.2023.100027","DOIUrl":"10.1016/j.jemrpt.2023.100027","url":null,"abstract":"<div><h3>Background</h3><p>Local anesthetics are critical in the management of acute and chronic pain in various procedures and medical specialties. Their anesthetic properties derive from the ability to reversibly block sodium channels embedded within nerve fibers, and thus inhibit the conduction of painful stimuli from an affected area. In supratherapeutic dosing, local anesthetic toxicity is directly related to the drug's propensity to distribute systemically. Onset and amplitude of toxicity may be increased in the setting of inadvertent intra-circulatory injection. One toxic manifestation is the direct inoculation of local anesthetics within the central nervous system (CNS).</p></div><div><h3>Case report</h3><p>We present the case of a 34-year-old-female with neurotoxicity secondary to bupivacaine injection during a greater occipital nerve block. Emergent management of the patient required intubation, seizure control, and intravenous lipid emulsion therapy.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>Direct central nervous system (CNS) toxicity from local anesthetics leads to rapid clinical decline and the need for extensive immediate resuscitative efforts. Early in the resuscitation, emergency physicians must recognize that the symptoms of local anesthetic toxicity require prompt specialty consultation with medical toxicologists and treatment with intralipid therapy to help reduce morbidity and mortality. Knowledge of toxic doses of local anesthetic and the dose related toxic effects can prompt recognition of either direct CNS or intra-vessel injection.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 2","pages":"Article 100027"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47355707","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}

引用次数: 0

Visual Diagnosis: Time is tongue! How to rescue an ischemic tongue due to carotid artery stenosis? 视觉诊断：时间就是舌头！如何抢救颈动脉狭窄引起的舌头缺血性病变？

JEM reports Pub Date : 2023-06-01 DOI: 10.1016/j.jemrpt.2023.100023

Haris Iftikhar , Huma Hussain , Syeda Turab Fatima Abidi

引用次数: 0

Do emergency department transfers require specialist consultation or admission? 急诊科转院是否需要专科会诊或入院?

JEM reports Pub Date : 2023-06-01 DOI: 10.1016/j.jemrpt.2023.100035

Erin L. Simon , Adriana Morra , Kristen Septaric , Courtney M. Smalley , Jessica Krizo , Caroline Mangira , Baruch S. Fertel

{"title":"Do emergency department transfers require specialist consultation or admission?","authors":"Erin L. Simon , Adriana Morra , Kristen Septaric , Courtney M. Smalley , Jessica Krizo , Caroline Mangira , Baruch S. Fertel","doi":"10.1016/j.jemrpt.2023.100035","DOIUrl":"10.1016/j.jemrpt.2023.100035","url":null,"abstract":"<div><h3>Background</h3><p>When emergency department (ED) patients require a higher level of care, transferring patients for specialized services to another ED may be needed. Previous studies have characterized risks and cost factors involved with transfers; however, few have evaluated the appropriateness of transfers.</p></div><div><h3>Objectives</h3><p>The objective of this study was to determine if a specialty consultation or admission was required for ED-to-ED transfers.</p></div><div><h3>Methods</h3><p>This was a retrospective cohort of all adult patients aged 18 and older who presented one of 17 EDs between January 1, 2018, and December 31, 2020, and were transferred to another ED within the healthcare system. Categorical variables are presented as frequencies and percentages. Continuous variables are presented as mean and standard deviations or median and quartiles. Multiple logistic regression was utilized to determine if the variables collected were predictive of hospital admission.</p></div><div><h3>Results</h3><p>A total of 7486 encounters were included in the study. The mean age of participants was 54. Most patients were white (76.5%), male (50.6%), and had private insurance (39.0%). At the receiving ED, 64.0% (n = 4750) received a specialty consult, and 61.3% (n = 4549) were admitted to inpatient services. A total of 1430 (19.3%) patients did not receive a specialty consult and were discharged from the ED.</p></div><div><h3>Conclusion</h3><p>The majority all ED-to-ED transfers involved a specialty consultation, and 61.3% of patients transferred were admitted to the hospital. Further research to determine why patients did not require specialty consultation or admission may help reduce unnecessary transfers.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 2","pages":"Article 100035"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45298685","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}

引用次数: 0

Case report kidney rupture: An unusual cause of abdominal pain, flank pain and hematuria in a 72-year-Old female 病例报告肾破裂:一个不寻常的原因腹部疼痛，腹部疼痛和血尿在一个72岁的女性

JEM reports Pub Date : 2023-06-01 DOI: 10.1016/j.jemrpt.2023.100021

Monica Diep , Neelesh Parikh , James Espinosa , Alan Lucerna , Henry Schuitema

{"title":"Case report kidney rupture: An unusual cause of abdominal pain, flank pain and hematuria in a 72-year-Old female","authors":"Monica Diep , Neelesh Parikh , James Espinosa , Alan Lucerna , Henry Schuitema","doi":"10.1016/j.jemrpt.2023.100021","DOIUrl":"10.1016/j.jemrpt.2023.100021","url":null,"abstract":"<div><h3>Background</h3><p>Flank pain, abdominal pain and hematuria are common complaints in emergency medicine.</p></div><div><h3>Case report</h3><p>We describe the case of a 72-year-old female who presented to the emergency department for worsening left lower quadrant abdominal pain and left flank pain associated with new-onset hematuria. The patient reported that the pain began immediately after she accidently tripped on a rock which resulted in a forceful twist of her body and catching herself with her hands without any direct impact to her body. A delayed contrast enhanced CT showed evidence of left kidney rupture with leakage of the contrast dye through the left renal calyx into the lower part of the abdomen and musculature.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>Flank/abdominal pain with or without hematuria are common ED complaints. In this case, the combination of a good history and physical examination in conjunction with delayed CT imaging ultimately led to the correct diagnosis of a kidney rupture. It is important to note that immediate and delayed contrast enhanced CT remains the gold standard in diagnosis of this condition. The treatment of kidney rupture is dependent on the stability of the patient. Hemodynamically stable patients should be treated with conservative management, while hemodynamically unstable patients should be treated with either angioembolization by interventional radiology or with stenting or nephrectomy by surgery.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 2","pages":"Article 100021"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44071643","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}

引用次数: 0