JEM reports最新文献_第2页

Case report: Myocardial bridge as cause of STEMI-pattern ECG after supraventricular tachycardia 病例报告：心桥是室上性心动过速后stemi型心电图的病因

JEM reports Pub Date : 2026-03-01 Epub Date: 2026-02-13 DOI: 10.1016/j.jemrpt.2026.100218

Aarish Shahab, Rahul V. Nene

{"title":"Case report: Myocardial bridge as cause of STEMI-pattern ECG after supraventricular tachycardia","authors":"Aarish Shahab, Rahul V. Nene","doi":"10.1016/j.jemrpt.2026.100218","DOIUrl":"10.1016/j.jemrpt.2026.100218","url":null,"abstract":"<div><h3>Background</h3><div>Myocardial bridging (MB) is a congenital coronary anomaly typically considered benign. However, under conditions of increased myocardial demand—such as supraventricular tachycardia (SVT)—MB can lead to transient ischemia or infarction. This case highlights a rare presentation of MB mimicking a left main coronary syndrome following SVT.</div></div><div><h3>Case report</h3><div>A 36-year-old male with no reported past medical history presented to a rural critical access hospital with palpitations after playing basketball and drinking two energy drinks. On arrival, he was afebrile with a heart rate of 208 bpm but was otherwise stable. ECG revealed narrow-complex tachycardia, which resolved after a modified Valsalva maneuver. Post-conversion ECG showed sinus rhythm with marked ST elevation in aVR and diffuse ST depressions. A repeat ECG 20 minutes later showed resolution of the ST changes. Labs were unremarkable aside from significant troponin elevation. Echocardiogram was normal. Cardiac catheterization revealed no obstructive coronary disease but did identify a myocardial bridge over the mid-LAD with moderate systolic compression. The patient was discharged without medications and later underwent ablation for SVT.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Myocardial bridging should be considered in patients with transient ischemic ECG changes post-SVT, especially when coronary angiography is unrevealing. ED recognition of MB may prevent unnecessary thrombolysis or catheterization and guide appropriate follow-up.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"5 1","pages":"Article 100218"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147394653","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

Rare complication of active renal arterial hemorrhage after extracorporeal shockwave lithotripsy (ESWL) in a low-risk patient: A case report 低危病人体外冲击波碎石术后活动性肾动脉出血的罕见并发症1例报告

JEM reports Pub Date : 2026-03-01 Epub Date: 2026-01-11 DOI: 10.1016/j.jemrpt.2026.100205

Danica Anderson , Pallash A. Desai , Hung Nguyen , Faith C. Quenzer , Steven Groke

{"title":"Rare complication of active renal arterial hemorrhage after extracorporeal shockwave lithotripsy (ESWL) in a low-risk patient: A case report","authors":"Danica Anderson , Pallash A. Desai , Hung Nguyen , Faith C. Quenzer , Steven Groke","doi":"10.1016/j.jemrpt.2026.100205","DOIUrl":"10.1016/j.jemrpt.2026.100205","url":null,"abstract":"<div><h3>Background</h3><div>Renal calculi commonly present with flank pain or hematuria. Extracorporeal shockwave lithotripsy (ESWL) is a noninvasive treatment for kidney or proximal ureteral stones ≤10 mm, except in cases of obesity, pregnancy, coagulopathy, high stone attenuation on computerized tomography (CT), or abnormal renal anatomy. Rare complications include ureteral obstruction, urinary tract infection, and hemorrhage. This case report reviews a rare complication of active renal arterial hemorrhage after outpatient ESWL, requiring resuscitation and interventional radiology (IR).</div></div><div><h3>Case report</h3><div>A 44-year-old Caucasian male presented to the emergency department (ED) with mild tachycardia, pallor, and significant right flank pain following an outpatient ESWL hours earlier. A point-of-care ultrasound demonstrated free fluid in the hepatorenal space. The initial non-contrast CT scan of the abdomen and pelvis revealed a large perinephric hematoma but possible extravasation. The CT of the abdomen and pelvis with contrast revealed active intrarenal arterial extravasation with extensive retroperitoneal hemorrhage and perinephric hematoma; his hemoglobin was 8.1 g/dL. The patient underwent emergent IR embolization and received five units of packed red blood cells during his stay in the intensive care unit (ICU). He was discharged on hospital day three.</div></div><div><h3>Why should an emergency medicine physician be aware of this?</h3><div>Less than 1 % of cases report major vascular bleeding following an ESWL. Early recognition by the emergency medicine physician can help significantly decrease morbidity and mortality by initiating early multidisciplinary response through urology, IR, and intensive care.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"5 1","pages":"Article 100205"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076798","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

Balancing bleeding and thrombosis in chronic liver disease: ROTEM-guided management of life-threatening lower GI bleed 平衡慢性肝病的出血和血栓形成：rotem指导下危及生命的下消化道出血的管理

JEM reports Pub Date : 2026-03-01 Epub Date: 2025-11-21 DOI: 10.1016/j.jemrpt.2025.100200

Mayuri Bhanwar, Naazia Siddiqua, Jamshed Nayer

{"title":"Balancing bleeding and thrombosis in chronic liver disease: ROTEM-guided management of life-threatening lower GI bleed","authors":"Mayuri Bhanwar, Naazia Siddiqua, Jamshed Nayer","doi":"10.1016/j.jemrpt.2025.100200","DOIUrl":"10.1016/j.jemrpt.2025.100200","url":null,"abstract":"<div><h3>Background</h3><div>Chronic liver disease (CLD) often presents with unique coagulation challenges that complicate management of gastrointestinal bleeding. Conventional laboratory tests (PT, aPTT, INR) are often unreliable in predicting the true balance between bleeding and thrombotic risk in CLD. Also, the occurrence of meckel's diverticulum-related bleeding in adults is an uncommon phenomenon.</div></div><div><h3>Case report</h3><div>A 28-year-old male with chronic liver disease presented with life-threatening gastrointestinal bleeding and hemorrhagic shock. Rotational thromboelastometry (ROTEM) used as a point-of-care test, revealed factor deficiency with preserved platelet function. ROTEM-guided transfusion strategy included fresh frozen plasma and PRBCs. Contrast enhanced computed tomography (CECT) abdomen demonstrated small bowel obstruction with intraluminal bleeding. Emergency exploratory laparotomy revealed a bleeding Meckel's diverticulum, which is rare in adults. Segmental resection, including the diverticulum, was performed with creation of double-barrel ileostomy.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Managing bleeding in chronic liver disease is challenging, as it requires controlling bleeding while carefully avoiding an increased risk of thrombosis. ROTEM-by offering a dynamic, whole-blood picture of coagulation, allows for tailored transfusion strategies, avoiding unnecessary correction and associated thrombotic risk while at the same time, facilitating a definitive surgery for bleeding Meckel's diverticulum.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"5 1","pages":"Article 100200"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618581","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

Image quality for Tegaderm™ vs. No Tegaderm for ocular ultrasound Tegaderm™与无Tegaderm用于眼部超声的图像质量

JEM reports Pub Date : 2026-03-01 Epub Date: 2026-02-09 DOI: 10.1016/j.jemrpt.2026.100212

Alfredo Arriaga de la Garza , John Herrick , Kimberly Leeson , Guy Youngblood , Ben Leeson , Grace Leeson , K Tom Xu , Peter B. Richman

{"title":"Image quality for Tegaderm™ vs. No Tegaderm for ocular ultrasound","authors":"Alfredo Arriaga de la Garza , John Herrick , Kimberly Leeson , Guy Youngblood , Ben Leeson , Grace Leeson , K Tom Xu , Peter B. Richman","doi":"10.1016/j.jemrpt.2026.100212","DOIUrl":"10.1016/j.jemrpt.2026.100212","url":null,"abstract":"<div><h3>Background</h3><div>Tegaderm™ is sometimes applied to protect the eye during ocular ultrasound (US), but limited research has assessed whether this reduces image quality for physicians without advanced US training.</div></div><div><h3>Objectives</h3><div>We compared ocular US image quality with and without Tegaderm.</div></div><div><h3>Methods</h3><div>Prospective randomized crossover study at a teaching facility. Residents and faculty without RDMS or fellowship training obtained ocular US images (short- and long-axis) of healthy volunteers. Tegaderm placement was randomized by side. Participants rated their images using ACEP Emergency US Standard Reporting Guidelines (1–5). Images were also scored by a faculty reviewer with advanced US training (raters). Mixed-effects regression modeled image quality in relation to Tegaderm and participant factors.</div></div><div><h3>Results</h3><div>Fifty emergency physicians participated (22% PGY-1, 20% PGY-2, 42% PGY-3, 16% faculty; 74% male). Overall mean score was 3.67. Images without Tegaderm scored higher than with Tegaderm (4.04 vs 3.29, p < 0.01). Advanced reviewers gave lower scores than non-advanced physicians (3.29 vs 4.04, p < 0.01). No significant differences were noted by gender, PGY year, side, or view. In multivariate analysis, Tegaderm use (−0.75; p < 0.01) and raters (−0.75; p < 0.01) predicted lower scores.</div></div><div><h3>Conclusions</h3><div>Ocular US image quality was significantly reduced with Tegaderm. Faculty with advanced US training provided more critical assessments.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"5 1","pages":"Article 100212"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147394655","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

Opioid overdose combined with possible xylazine toxicity: A case report and literature review 阿片类药物过量合并可能的噻嗪毒性：1例报告并文献复习

JEM reports Pub Date : 2026-03-01 Epub Date: 2026-02-12 DOI: 10.1016/j.jemrpt.2026.100215

Christopher Colbert, Kevin Trembley, Wesley Eilbert

引用次数: 0

Diagnosing Neurocysticercosis after a traumatic fall 创伤性跌倒后的神经囊虫病诊断

JEM reports Pub Date : 2026-03-01 Epub Date: 2026-01-22 DOI: 10.1016/j.jemrpt.2026.100209

Priya Shil, Michelle Fowler, Scott Gutovitz

{"title":"Diagnosing Neurocysticercosis after a traumatic fall","authors":"Priya Shil, Michelle Fowler, Scott Gutovitz","doi":"10.1016/j.jemrpt.2026.100209","DOIUrl":"10.1016/j.jemrpt.2026.100209","url":null,"abstract":"<div><h3>Background</h3><div>Neurocysticercosis (NCC) is an infection of the central nervous system caused by the tapeworm, <em>Taenia solium</em>, acquired from the ingestion of contaminated food or water. Larvae travel to various tissues of the human body and form cysts, leading to cysticercosis. NCC is a leading cause of acquired epilepsy worldwide. Immigrants from endemic areas are disproportionately affected by the disease which contributes to healthcare disparities.</div></div><div><h3>Case report</h3><div>This case report discusses a 28-year-old predominantly Spanish speaking male who presented as a trauma activation secondary from a fall off a ladder. He was born in Guatemala and has been working in the United States for six years. His family member noted he was experiencing seizure-like activity and syncopal episodes over the last 3 years, but he did not seek medical evaluation. The initial concern was syncope or seizure causing the fall. CT imaging revealed an indeterminate right frontal lobe hypoattenuating mass, but no traumatic findings. Follow-up MRI showed a cyst with subtle marginal enhancement concerning for NCC. He was treated with levetiracetam, dexamethasone and albendazole for 14 days.</div></div><div><h3>Why should an emergency physician be aware of this</h3><div>This case elucidates the importance of surveillance for NCC, as its exact prevalence is underreported in the United States. NCC should be included in the differential diagnosis of neurological symptoms, especially in populations at risk. This preventable disease when undiagnosed will increase healthcare cost and disease morbidity. The incidence of NCC in the United States is likely to increase due to immigration, international travel, and globalization.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"5 1","pages":"Article 100209"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076792","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

Varices everywhere: Stomal bleeding due to undiagnosed portal hypertension 到处静脉曲张：未确诊的门静脉高压引起的口出血

JEM reports Pub Date : 2026-03-01 Epub Date: 2025-12-30 DOI: 10.1016/j.jemrpt.2025.100203

Anastasia Crenshaw , Kaitlynn Borik , Joshua Julian , Tina H. Chen

引用次数: 0

ED point-of-care ultrasound evaluation of acute splenic sequestration in sickle cell disease 镰状细胞病急性脾隔离的急诊超声评价

JEM reports Pub Date : 2026-03-01 Epub Date: 2025-12-31 DOI: 10.1016/j.jemrpt.2025.100202

James W. Tsung , Sarah McCuskee , Jeffrey A. Glassberg

{"title":"ED point-of-care ultrasound evaluation of acute splenic sequestration in sickle cell disease","authors":"James W. Tsung , Sarah McCuskee , Jeffrey A. Glassberg","doi":"10.1016/j.jemrpt.2025.100202","DOIUrl":"10.1016/j.jemrpt.2025.100202","url":null,"abstract":"<div><h3>Background</h3><div>Acute splenic sequestration is a life-threatening complication of sickle cell disease. While traditionally considered a clinical diagnosis not requiring imaging, the increasing availability of point-of-care ultrasound (PoCUS) in the emergency department (ED) presents an opportunity to re-evaluate its role in expediting diagnosis and management.</div></div><div><h3>Case report</h3><div>This case series reports the use of PoCUS in the ED evaluation of pediatric patients with sickle cell disease presenting with suspected acute splenic sequestration. We describe key sonographic findings, including splenomegaly and altered splenic echogenicity. We present two cases of acute splenic sequestration where PoCUS rapidly identified splenomegaly and increased splenic echogenicity relative to the adjacent left kidney. In one case, these sonographic findings, prompted by left upper quadrant abdominal pain, preceded the characteristic drop in hemoglobin. Serial ultrasound measurements demonstrated a progressive increase in spleen size, correlating with the clinical course. In contrast, an asymptomatic control patient with a remote history of sequestration had normal spleen size and isoechoic parenchyma. These findings suggest that PoCUS may provide objective, real-time data that may be more reliable than physical examination for splenomegaly and can track the progression of sequestration.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>PoCUS may be a simple, rapid, and feasible tool for evaluating suspected acute splenic sequestration in the ED. Measuring spleen size and assessing for increased splenic echogenicity can aid in early diagnosis and inform timely management, potentially improving outcomes for patients with sickle cell disease.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"5 1","pages":"Article 100202"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924742","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

Male with a Tail to Tell 有尾巴的男人

JEM reports Pub Date : 2026-03-01 Epub Date: 2026-02-10 DOI: 10.1016/j.jemrpt.2026.100214

Jamyang Choedon , Ahmad Nama , Josh Greenstein , Alex Song , Barry Hahn

引用次数: 0

Erratum regarding missing statements in previously published articles 关于先前发表的文章中缺失陈述的勘误

JEM reports Pub Date : 2026-03-01 Epub Date: 2026-02-16 DOI: 10.1016/j.jemrpt.2026.100217

引用次数: 0