JEM reports最新文献

{"title":"All choked up; male with foreign body sensation","authors":"Harrison Barnhart, Gordon Tse, Norman Ng, Amin Mohamadi, Barry Hahn","doi":"10.1016/j.jemrpt.2025.100183","DOIUrl":"10.1016/j.jemrpt.2025.100183","url":null,"abstract":"","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100183"},"PeriodicalIF":0.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633785","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":"Leech infestation-a rare cause of upper gastrointestinal bleeding: A case report","authors":"Mengesha Akale ,&nbsp;Dawit Zena ,&nbsp;Fitsum Mesfin ,&nbsp;Nahom Addisu","doi":"10.1016/j.jemrpt.2025.100182","DOIUrl":"10.1016/j.jemrpt.2025.100182","url":null,"abstract":"<div><h3>Background</h3><div>Leeches are rare blood-sucking endoparasites found in fresh water and can cause potentially life-threatening complications. Leech infestations are an uncommon cause of upper gastrointestinal bleeding, often presenting diagnostic challenges and rarely considered in the differential diagnosis. The available literature on leech infestation is limited.</div></div><div><h3>Case presentation</h3><div>A 20-year-old woman from rural Ethiopia presented with bloody vomiting and spitting of saliva mixed with blood of 6 days duration. There was bright red blood over the posterior part of the tongue, palate, and oropharynx. An endoscopy revealed a motile dark brown worm in the hypopharynx, specifically in the pyriform sinus, along with active bleeding. Under conscious sedation, a 5 cm long leech was removed gently using nontoothed forceps. Bleeding was stopped immediately and patient discharged in stable condition.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100182"},"PeriodicalIF":0.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571493","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":"When booming in the ears is more than benign tinnitus","authors":"Bryan Kharbanda,&nbsp;Nicholas San Roman","doi":"10.1016/j.jemrpt.2025.100181","DOIUrl":"10.1016/j.jemrpt.2025.100181","url":null,"abstract":"<div><h3>Background</h3><div>Patients commonly present to the emergency department (ED) after initial outpatient evaluations fail to achieve timely diagnosis or symptom control. Many subjective-seeming neurologic symptoms affect a large portion of the US population at least once in a patient's lifetime (tinnitus 15 %, dizziness 30 %, and vertigo 40 %) but remain a diagnostic and treatment challenge for physicians. The ED in the United States plays a major role in risk stratifying these complex patients.</div></div><div><h3>Case presentation</h3><div>A 49-year-old woman with history of hypertension presents to the ED complaining of hearing a “booming” sensation synchronous with her pulse in her right ear for weeks. She was initially evaluated by her primary care physician and diagnosed “possible tinnitus” and referred to ENT. There, she received an audiogram deemed “normal.” Weeks after her initial evaluation, she mentioned new and progressing symptoms of dizziness to her primary care physician who thus referred her to the ED. In the ED, the patient was found to be hypertensive, anxious, and with slight ataxia. CT angiography of the head and neck found complete occlusion of the left internal carotid throughout the entire left cervical region. The patient was started on heparin, anti-hypertensive medications, and transferred to a comprehensive stroke center after discussion with their neuro-interventionalist.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Pulsatile tinnitus (PT) is rare but the causative differential diagnosis is vast and may be complex. PT should be considered an otologic symptom rather than its own diagnosis. Recent data suggests that an underlying cause can be identified in about 70 % of PT cases through proper diagnostic work-up (6). Failure to recognize the need for further work-up and diagnostics could lead to significant morbidity and mortality. Early recognition is crucial as treatment options are available to mitigate permanent neurologic deficits or death for dangerous causes. The treatment options vary markedly, however, depending on the ultimate etiology for PT. Accurate and timely diagnosis entirely drive effective management of pulsatile tinnitus.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100181"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522379","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":"Small bowel obstruction caused by hiatal hernia","authors":"Jacob Cabrejas,&nbsp;Kara Zweerink,&nbsp;Wesley Eilbert","doi":"10.1016/j.jemrpt.2025.100180","DOIUrl":"10.1016/j.jemrpt.2025.100180","url":null,"abstract":"<div><h3>Background</h3><div>A hiatal hernia is caused by herniation of a portion of the stomach or other abdominal viscera into the thorax through the esophageal hiatus of the diaphragm. It is a common condition and asymptomatic in most cases.</div></div><div><h3>Case report</h3><div>We present the case of a 52-year-old male with a past medical history of previous hiatal hernia repair who presented to the emergency department with one day of diffuse abdominal pain and multiple episodes of emesis. Bowel sounds were heard on auscultation of his left chest. Computed tomography of the abdomen and pelvis demonstrated multiple abdominal contents herniating through the esophageal hiatus. Multiple dilated loops of small bowel were seen in the left hemithorax with decompressed small bowel seen more distally, indicating a small bowel obstruction with a transition point in the thoracic cavity.</div><div><em>Why should an emergency physician be aware of this?</em> Hiatal hernia is a common condition. While rare, large hiatal hernias may result in herniation of small bowel with the potential complication of bowel obstruction.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100180"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501643","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":"Managing acute coccydynia in the ED: A case report of a successful blind sacrococcygeal nerve block","authors":"Aakash A. Setty MD ,&nbsp;Stevin M. Bienfait MD ,&nbsp;Jessica C. Oswald MD","doi":"10.1016/j.jemrpt.2025.100178","DOIUrl":"10.1016/j.jemrpt.2025.100178","url":null,"abstract":"<div><h3>Background</h3><div>Acute traumatic coccydynia typically results from direct trauma and is an often overlooked but significant cause of discomfort that can present acutely in the emergency department (ED). First-line treatment including NSAIDs and acetaminophen aims to provide relief but can be insufficient. The sacrococcygeal nerve block, though underutilized in the ED, is a simple intervention using existing skills to provide pain relief. To our knowledge, this is its first documented use in the ED for coccydynia.</div></div><div><h3>Case report</h3><div>A 20-year-old female presented to the ED with severe coccygeal pain (10/10) following a fall five days prior. Conservative management of NSAIDs, acetaminophen and activity modifications from a prior ED visit failed to improve her symptoms, leaving her requiring significant daily bedrest. In the present ED visit, after failed opioid pain reduction, a sacrococcygeal nerve block was performed using dexamethasone and bupivacaine, resulting in complete pain resolution (0/10) within 15 minutes. The patient experienced 5 h of total relief, a 30 % reduction in pain by 18 hours, and 70 % reduction by week three. She resumed work within a week and reported satisfaction with the procedure.</div><div>Why Should an Emergency Physician Be Aware of This?</div><div>The sacrococcygeal nerve block is a time-efficient intervention for acute coccydynia that aligns well with the skillset and demands of the ED, although further research is required on its effectiveness in the ED setting prior to wide use. It can possibly provide immediate pain relief, reduce opioid requirements, and minimize repeat visits as discussed in this report.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100178"},"PeriodicalIF":0.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522493","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":"Hidden in plain sight: Recognizing TTP in the emergency department","authors":"Heather Silverstein,&nbsp;Christopher Freeman","doi":"10.1016/j.jemrpt.2025.100179","DOIUrl":"10.1016/j.jemrpt.2025.100179","url":null,"abstract":"<div><h3>Background</h3><div>Thrombotic thrombocytopenic purpura (TTP) is a rare but life-threatening thrombotic microangiopathy characterized by thrombocytopenia, microangiopathic hemolytic anemia, neurologic symptoms, renal dysfunction, and fever. Often patients present with only a subset of these abnormalities, many of which are present in other conditions, posing difficulty in the diagnosis. This diagnostic difficulty is compounded in the elderly and those with comorbidities who have varying clinical presentations. Early recognition and diagnosis are imperative as early treatment with plasmapheresis significantly improves outcomes.</div></div><div><h3>Case report</h3><div>We present the case of a 58-year-old female with a history of recent cerebrovascular accident (CVA), diabetes, hypertension, and psychiatric illness, who presented with acute change in mental status. Her confusion was attributed to a urinary tract infection and her chronic neuropsychiatric conditions. Further laboratory evaluation revealed severe thrombocytopenia, elevated lactate dehydrogenase, low haptoglobin, and schistocytes on peripheral smear, raising concern for TTP. The patient was initiated on plasmapheresis, and the diagnosis of TTP was subsequently confirmed via ADAMTS13 testing.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>This case highlights the diagnostic challenge of a patient with overlapping comorbidities that may contribute to a change in mental status, masking the underlying diagnosis of TTP. The rapid identification and early initiation of plasmapheresis prevented further organ damage, improved prognosis, and provided a favorable outcome. This underscores the importance of maintaining a broad differential for patients presenting with altered mental status and remaining conscious of bias and anchoring in these patients with comorbid conditions when alternative explanations exist.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100179"},"PeriodicalIF":0.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501642","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":"Stroke in adolescent patient requiring mechanical thrombectomy: A case report","authors":"Alyssa M. Gill ,&nbsp;Carina Grain ,&nbsp;Christine Dharshika ,&nbsp;Todd Chassee","doi":"10.1016/j.jemrpt.2025.100175","DOIUrl":"10.1016/j.jemrpt.2025.100175","url":null,"abstract":"<div><h3>Background</h3><div>Strokes are rare in pediatric patients, however approximately 80% have an identifiable cause. Risk factors for pediatric stroke include the typical atherosclerotic risk factors for adults, but also unique pediatric conditions such as congenital heart diseases, hematological diseases, vasculitis, inflammatory conditions, and trauma. Treatment for pediatric stroke is also much less researched and often extrapolated from adults. Here we present a case of a large vessel stroke in a pediatric patient, with no identifiable cause, treated successfully with mechanical thrombectomy.</div></div><div><h3>Case Report</h3><div>This case report describes a 12-year-old female who had an ischemic stroke of an unknown etiology. Her case demonstrates a classic stroke presentation and intervention, presenting with acute onset of hemiparesis, facial asymmetry, and dysarthria. Code stroke was promptly activated in the Emergency Department and CTA showed a middle cerebral artery thrombus. She underwent mechanical thrombectomy with Interventional Radiology 4 h after her last known well. Although 78% of pediatric patients have long-standing neurological deficits following ischemic stroke, this patient made a full recovery without long-term neurological deficits. Despite a thorough workup with Pediatric Cardiology, Hematology, and Neurology, the cause of her stroke was never identified.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>The case of idiopathic ischemic stroke in an adolescent patient is an unusual occurrence. Being able to identify these patients presenting to the Emergency Department and ensuring protocols are in place is critical for generating successful outcomes, as evidenced by this case. The complete resolution of her symptoms also demonstrates the potential role of neuroplasticity in pediatric brain recovery.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100175"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144203484","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":"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}