JEM reports最新文献_第10页

Acute pyometra in an elderly female patient: A case report 老年女性患者急性脓脓1例

JEM reports Pub Date : 2023-11-22 DOI: 10.1016/j.jemrpt.2023.100065

Nicole M. Franklin , Andrew Lafree , Stephen Gocke , Bryan Corbett , Peter Witucki , Rahul Nene

引用次数: 0

Analgesia administration by sex among pediatric emergency department patients with abdominal pain 儿科急诊科腹痛患者镇痛药的性别差异

JEM reports Pub Date : 2023-11-21 DOI: 10.1016/j.jemrpt.2023.100062

Marie E. Vastola , Bryn E. Mumma , Jeffrey R. Fine , Daniel J. Tancredi , Joshua W. Elder , Angela F. Jarman

{"title":"Analgesia administration by sex among pediatric emergency department patients with abdominal pain","authors":"Marie E. Vastola , Bryn E. Mumma , Jeffrey R. Fine , Daniel J. Tancredi , Joshua W. Elder , Angela F. Jarman","doi":"10.1016/j.jemrpt.2023.100062","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100062","url":null,"abstract":"<div><h3>Background</h3><p>There is conflicting data about sex-based differences in the treatment of acute pain in the ED. Little is known about sex-based disparities in analgesia in pediatric ED patients.</p></div><div><h3>Objectives</h3><p>Our objective was to determine whether analgesic administration rates differ between female and male pediatric patients presenting to the ED with abdominal pain.</p></div><div><h3>Methods</h3><p>We conducted a retrospective cohort study of ED patients 5–21 years old with abdominal pain between 6/1/19 and 6/30/21. The primary outcome was receipt of any analgesia, and secondary outcomes were receipt of opioid analgesia and time to receipt of analgesia. Multivariable regression models were fitted for each outcome.</p></div><div><h3>Results</h3><p>We studied 1087 patients; 681 (63%) were female with a median age of 17 years (IQR 13, 19) and 406 (37%) were male with a median age of 14 years (IQR 9, 18). 371 female patients (55%) and 180 male patients (44%) received any analgesia. 132 female patients (19%) and 83 male patients (20%) received opioid analgesia. In multivariate analyses, female patients were equally likely to receive any analgesia (OR 1.30, 95% CI 0.97–1.74, p = 0.07), but time to analgesia was 14% longer (GMR 1.14, 95% CI 1.00–1.29, p = 0.04). Non-White patients were 32% less likely to receive opioids (OR 0.68, 95% CI 0.47–0.97, p = 0.04).</p></div><div><h3>Conclusions</h3><p>Female pediatric ED patients were equally likely to receive any analgesia as male patients, but their time to analgesia was longer. Non-White patients were less likely to receive opioid analgesia than White patients.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 1","pages":"Article 100062"},"PeriodicalIF":0.0,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232023000585/pdfft?md5=aa8735fb0f9497e52c0656b3f7c4399c&pid=1-s2.0-S2773232023000585-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138448554","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

Operative hysteroscopy intravascular absorption syndrome: A case report and literature review 手术宫腔镜血管内吸收综合征1例报告并文献复习

JEM reports Pub Date : 2023-11-21 DOI: 10.1016/j.jemrpt.2023.100064

Razban Mohammad, Rabhi Hamza

{"title":"Operative hysteroscopy intravascular absorption syndrome: A case report and literature review","authors":"Razban Mohammad, Rabhi Hamza","doi":"10.1016/j.jemrpt.2023.100064","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100064","url":null,"abstract":"<div><h3>Background</h3><p>Operative hysteroscopy intravascular absorption syndrome is a little-known disease traditionally caused by the use of a hypo-osmolar distension fluid during hysteroscopic surgery. Symptoms of OHIA syndrome include pulmonary and cerebral edema, hyponatremia, and metabolic acidosis. Preventive measures include the use of a bipolar current, NaCl 0.9 %, and limiting positive fluid balance to 1000 ml.</p></div><div><h3>Case report</h3><p>This paper describes the curious case of a middle-aged patient who presented to our emergency department with eye congestion, anasarca, and pulmonary edema following hysteroscopy, despite using NaCl 0.9 % as a distension fluid. Only a few cases have been reported in the literature, and it appears that the use of glycine instead of NaCl 0.9 % does not lead to the same complications. To better handle these situations, this article provides treatment suggestions and preventive measures through a literature review to help physicians to rapidly detect and manage this potentially life-threatening syndrome.</p><p>Why Should an Emergency Physician Be Aware of This ? - OHIA syndrome can be life-threatening and may manifest with various complications, requiring different management approaches and complementary examinations depending on the distension fluid used by the surgeon. Physicians should be knowledgeable about this lesser-known syndrome in order to effectively prevent, diagnose, and treat it.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 1","pages":"Article 100064"},"PeriodicalIF":0.0,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232023000603/pdfft?md5=86315ec885a23a2ae47d2d0ab00b17bb&pid=1-s2.0-S2773232023000603-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138466478","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

Slow ventricular tachycardia induced by amiodarone overdose 胺碘酮过量致慢性室性心动过速

JEM reports Pub Date : 2023-11-21 DOI: 10.1016/j.jemrpt.2023.100056

Zachary Boivin , Nicholas Pugliese , Peter Quinby

{"title":"Slow ventricular tachycardia induced by amiodarone overdose","authors":"Zachary Boivin , Nicholas Pugliese , Peter Quinby","doi":"10.1016/j.jemrpt.2023.100056","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100056","url":null,"abstract":"<div><h3>Background</h3><p>Slow ventricular tachycardia (VT) can be difficult to diagnose on electrocardiogram given its atypical rate of less than 120 beats per minute. In patients with implanted defibrillators, slow VT can be overlooked and have detrimental consequences for patients given their decreased cardiac output. In this case, slow VT was identified early, and was caused by an overdose of amiodarone.</p></div><div><h3>Case report</h3><p>A 50-year-old male with an extensive past medical history of polysubstance abuse and heart failure with implanted defibrillator (AICD) presented with a suspected heroin overdose, along with cocaine use, and acute overdose of 20–25 200 mg amiodarone tablets over 48 hours. The patient was found to be in a slow, wide-complex rhythm, and after hyperkalemia was ruled out, electrophysiology was contacted, and they diagnosed the patient with slow VT. This was corrected with overdriving pacing, and the patient was discharge home after a brief admission.</p></div><div><h3>Why should an emergency physician be aware of this</h3><p>There are currently no case reports showing an isolated amiodarone overdose causing slow VT, and while cocaine can cause VT due to its sodium channel blocking effects, the slow rate suggests the amiodarone overdose influenced the cardiac myocytes. This patient was predisposed to developing episodes of VT due to his underlying cardiac conditions and substance use, but had no evidence of slow VT prior to his acute amiodarone overdose. We recommend all providers be aware of the potential arrhythmic complications of isolated amiodarone overdoses, and specifically the management of slow VT, with overdrive pacing as opposed to cardioversion potentially having more success.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 4","pages":"Article 100056"},"PeriodicalIF":0.0,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232023000524/pdfft?md5=257166b6c7336f6a31fb57fcccbcc88c&pid=1-s2.0-S2773232023000524-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138430726","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

Unusual clinical course of infectious mononucleosis: Complicating bilateral peritonsillar abscess 传染性单核细胞增多症的异常临床过程:并发双侧囊周脓肿

JEM reports Pub Date : 2023-11-20 DOI: 10.1016/j.jemrpt.2023.100052

Yuji Okazaki, Kenichiro Kashiwa, Toshihisa Ichiba

{"title":"Unusual clinical course of infectious mononucleosis: Complicating bilateral peritonsillar abscess","authors":"Yuji Okazaki, Kenichiro Kashiwa, Toshihisa Ichiba","doi":"10.1016/j.jemrpt.2023.100052","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100052","url":null,"abstract":"<div><h3>Background</h3><p>Infectious mononucleosis (IM) caused by Epstein-Barr virus typically presents with fever, pharyngitis, and lymphadenopathy, and most patients recover within a few weeks. However, bilateral peritonsillar abscess is a rare but serious complication of IM that can lead to airway compromise and descending mediastinitis. Due to its rarity and similarity in clinical presentation of IM, it may be challenging to diagnose bilateral peritonsillar abscess during the course of IM.</p></div><div><h3>Case report</h3><p>A 21-year-old healthy male who initially presented with fever, sore throat, and abdominal discomfort for ten days was diagnosed with IM based on clinical and laboratory findings. Despite initial treatment, the patient returned to the emergency department three times within one week due to persistent symptoms, and on the third visit, he had difficulty opening his mouth and had worsening odynophagia. Contrast-enhanced computed tomography revealed bilateral peritonsillar abscess, and an emergent incision of the right tonsil was performed. Bacterial culture revealed multiple oral organisms. He was diagnosed with bilateral peritonsillar abscess associated with IM and was discharged without complications.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>This case highlights two important clinical issues: the potential for patients with IM to develop bilateral peritonsillar abscess and the significance of trismus and exacerbation of odynophagia as a clue for identifying this complication. The rarity of this complication may result in delayed diagnosis and treatment, leading to serious complications. Prompt diagnosis and treatment are crucial for preventing potentially life-threatening consequences.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 4","pages":"Article 100052"},"PeriodicalIF":0.0,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232023000482/pdfft?md5=a827fa3d9fbee4a6eabcca24e5b7126f&pid=1-s2.0-S2773232023000482-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138412672","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

Bupivacaine overdose requiring multiple administrations of intravenous lipid emulsion therapy: A case report 布比卡因过量需要多次静脉脂乳治疗:一例报告

JEM reports Pub Date : 2023-11-19 DOI: 10.1016/j.jemrpt.2023.100060

Michael L. Behal , Reba A. Hodge , Matthew C. Blackburn

{"title":"Bupivacaine overdose requiring multiple administrations of intravenous lipid emulsion therapy: A case report","authors":"Michael L. Behal , Reba A. Hodge , Matthew C. Blackburn","doi":"10.1016/j.jemrpt.2023.100060","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100060","url":null,"abstract":"<div><h3>Background</h3><p>Bupivacaine, an amide local anesthetic, is commonly used in intrathecal pumps (IT) for pain and spasticity disorders. Pump malfunctions place patients at risk of bupivacaine overdose and local anesthetic systemic toxicity (LAST); however, there are limited reports of this in the literature.</p></div><div><h3>Case report</h3><p>A 24-year-old male with an IT bupivacaine/baclofen pump presented with weakness, numbness, dyspnea, and somnolence secondary to IT pump malfunction with an unknown amount of bupivacaine/baclofen extravasation into the subcutaneous space. The patient required intubation and vasopressor support but remained persistently hypotensive and bradycardic despite aggressive dose titration. Needle aspiration was performed to remove 14 mL of extravasated drug mixture. Due to persistent hemodynamic instability, intravenous lipid emulsion (ILE) therapy was initiated with 20 % lipid emulsion 1.5 mL/kg bolus followed by a continuous infusion of 0.25 mL/kg/min. The patient became hemodynamically stable following 750mL of ILE therapy and was admitted to the intensive care unit. Five hours after ILE therapy cessation, the patient again became hemodynamically unstable, and ILE was re-initiated with a bolus and continuous infusion. Sustained hemodynamic stability was achieved after an additional 450mL of ILE.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>IT pump malfunction involving bupivacaine can lead to severe LAST necessitating ILE therapy. Clinicians should be aware of the potential for drug deposition leading to prolonged or recurrent hemodynamic instability requiring repeated administration of ILE therapy.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 4","pages":"Article 100060"},"PeriodicalIF":0.0,"publicationDate":"2023-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232023000561/pdfft?md5=8db2ee0d9f2cebaa1596f7fbdeb5b23a&pid=1-s2.0-S2773232023000561-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138395467","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

Airbag associated ocular alkaline chemical injury: A case report 安全气囊相关性眼部碱性化学损伤1例

JEM reports Pub Date : 2023-11-18 DOI: 10.1016/j.jemrpt.2023.100053

John P. Korducki , Nicholas Maxwell , Howard R. Day , Aaron J. Lacy

{"title":"Airbag associated ocular alkaline chemical injury: A case report","authors":"John P. Korducki , Nicholas Maxwell , Howard R. Day , Aaron J. Lacy","doi":"10.1016/j.jemrpt.2023.100053","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100053","url":null,"abstract":"<div><h3>Background</h3><p>Airbags are a life-saving apparatus for patients involved in motor vehicle collisions (MVC). However, part of that apparatus includes the presence of alkaline chemicals that can induce ocular injury. Traumatic eye injuries are well documented in the literature in the setting of MVCs, yet ocular alkali burns are under-recognized and a dearth of case reports exists.</p></div><div><h3>Case report</h3><p>A 26-year-old male presented following an MVC complaining of severe unilateral eye pain in the setting of direct airbag related trauma. Ocular pH testing later revealed an alkaline injury of the right eye. Ocular irrigation was initiated in the emergency department until the pH reached normal levels.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>Recognition of airbag-associated alkaline chemical burns of the eye in the setting of an MVC and appropriate management are imperative to avoid deleterious outcomes such as permanent vision loss.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 4","pages":"Article 100053"},"PeriodicalIF":0.0,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232023000494/pdfft?md5=0df7ac0beb56abe88fa56e8acee23316&pid=1-s2.0-S2773232023000494-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138395468","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

How to pull off nasal magnetic foreign body removal in the emergency department 如何在急诊科完成鼻腔磁性异物去除术

JEM reports Pub Date : 2023-11-18 DOI: 10.1016/j.jemrpt.2023.100057

Jamie L. Holland, Danny G. Thomas

{"title":"How to pull off nasal magnetic foreign body removal in the emergency department","authors":"Jamie L. Holland, Danny G. Thomas","doi":"10.1016/j.jemrpt.2023.100057","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100057","url":null,"abstract":"<div><h3>Background</h3><p>Nasal foreign body removal is a common procedure performed in the emergency department. However, the removal of magnetic nasal foreign bodies presents a unique challenge, and traditional removal techniques are often unsuccessful. These patients frequently warrant otolaryngology consultation (OC) and foreign body removal under general anesthesia.</p></div><div><h3>Discussion</h3><p>This case report describes an innovative technique for removal of two magnetic foreign bodies across the nasal septum in a pediatric patient presenting to the emergency department by utilizing equipment commonly on hand, including a small Magill forceps and the plastic handle of an 11-blade scalpel. The tapered/wedge shaped handle of the 11-blade scalpel was directed towards and glided between the nasal septum and the magnetic foreign body, thus separating them. The magnets were then drawn to the metal forceps by magnetic attraction.</p></div><div><h3>Conclusion</h3><p>The use of the technique described here can result in successful magnetic foreign body removal in the emergency department, reduce the likelihood of tissue trauma, and avoid the need for OC and removal under general anesthesia.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 4","pages":"Article 100057"},"PeriodicalIF":0.0,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232023000536/pdfft?md5=df7f8fa86d2168580ec36ac3e29056d9&pid=1-s2.0-S2773232023000536-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138412673","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

Unusual cause of sudden-onset pleuritic chest pain: Torsion of extralobar pulmonary sequestration 突发性胸膜炎性胸痛的不寻常原因:叶外肺隔离扭转

JEM reports Pub Date : 2023-09-01 DOI: 10.1016/j.jemrpt.2023.100043

Yuji Okazaki , Toshihisa Ichiba , Yuho Maki

{"title":"Unusual cause of sudden-onset pleuritic chest pain: Torsion of extralobar pulmonary sequestration","authors":"Yuji Okazaki , Toshihisa Ichiba , Yuho Maki","doi":"10.1016/j.jemrpt.2023.100043","DOIUrl":"10.1016/j.jemrpt.2023.100043","url":null,"abstract":"<div><h3>Background</h3><p>Extralobar pulmonary sequestration (EPS) is often diagnosed in neonates due to accompanying congenital anomalies. However, even in adulthood, this condition can, in rare cases, be complicated with torsion and may present with pleuritic chest pain at an emergency department in an undiagnosed state. We describe a case with torsion of ELS in a healthy adult female.</p></div><div><h3>Case report</h3><p>A 21-year-old woman presented with acute-onset back pain and pleuritic chest pain at our emergency department and was initially diagnosed with pleurisy based on normal results of investigations. However, she revisited our department due to flare-ups of pain, and a subsequent CT scan revealed an expanding homogeneous opacity in the left lower lobe of the lung. Magnetic resonance imaging (MRI) confirmed the presence of an encapsulated mass with a hypointense signal on T2-weighted imaging and a feeding artery from the aorta to the mass, leading to a preoperative diagnosis of EPS with hemorrhagic infarction. Video-assisted thoracoscopic surgery was performed, and the cause of hemorrhagic infarction was found to be a torsion. The diagnosis was confirmed histologically.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>This case highlights the importance of recognizing torsion of EPS as an unusual cause of pleuritic chest pain and emphasizes the need for early diagnosis in order to perform surgery as soon as possible. Changes in CT findings of torsion of EPS over time can help physicians understand this rare condition. MRI may also be useful for the perioperative diagnosis.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 3","pages":"Article 100043"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48021399","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

Expanding the differential of adolescent hip pain to include arteriovenous malformations 扩大青少年髋关节疼痛的鉴别包括动静脉畸形

JEM reports Pub Date : 2023-09-01 DOI: 10.1016/j.jemrpt.2023.100033

Brenda Sokup , Michael Cydylo , Ivan Ivanov , Adam Rhodes

引用次数: 0