JEM reports最新文献_第3页

Lemierre's syndrome diagnosed using bedside ultrasound in the emergency department

JEM reports Pub Date : 2024-12-19 DOI: 10.1016/j.jemrpt.2024.100135

Anis Adnani , Wesley Eilbert

{"title":"Lemierre's syndrome diagnosed using bedside ultrasound in the emergency department","authors":"Anis Adnani , Wesley Eilbert","doi":"10.1016/j.jemrpt.2024.100135","DOIUrl":"10.1016/j.jemrpt.2024.100135","url":null,"abstract":"<div><h3>Background</h3><div>Lemierre's syndrome (LS) is a rare disease, typically occurring after a recent oropharyngeal infection. It is characterized by septic thrombophlebitis of the internal jugular (IJ) vein and bacteremia with metastatic septic emboli. Computed tomography (CT) of the neck with intravenous contrast is the imaging study of choice to diagnose the IJ vein thrombosis present with LS.</div></div><div><h3>Case report</h3><div>We present the case of an 18-year-old male who presented to the emergency department (ED) with right sided neck pain and shortness of breath. He had been seen in the ED two days earlier complaining of sore throat and was diagnosed with a viral infection. CT examinations of the neck and chest with intravenous contrast found multifocal bilateral nodular pulmonary densities with some soft tissue stranding adjacent to the right carotid sheath. No intraluminal filling defects of the right IJ vein were noted. A bedside ultrasound revealed a non-compressible hyperechoic thrombus in the right IJ vein, confirming the diagnosis of LS. To our knowledge, this is only the second reported case of LS diagnosed using bedside ultrasound that was initially missed on CT.</div><div><em>Why should an emergency physician be aware of this?</em> Rapid recognition of LS, a potentially fatal illness, is paramount to optimize outcome. Bedside ultrasound is a useful tool available to emergency physicians to diagnose this disease and initiate prompt treatment.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100135"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143157423","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

A case report: Point-of-care ultrasound revealing cystolithiasis in a bladder diverticulum as the cause of sepsis and encephalopathy

JEM reports Pub Date : 2024-12-12 DOI: 10.1016/j.jemrpt.2024.100133

Kahra Nix , Alexandra Parson , Nicholas DiMeo , Jeffery Baker

引用次数: 0

Waiting room zero until noon: An emergency department quality improvement initiative with downstream effects

JEM reports Pub Date : 2024-12-08 DOI: 10.1016/j.jemrpt.2024.100131

Alice Kidder Bukhman , Joshua W. Joseph , Chandler R. Bianchi , Paul C. Chen , Da’Marcus Eugene Baymon , Robin Powell , Beth Waters , Patrick Hollowell , Leon Dahomey Sanchez

{"title":"Waiting room zero until noon: An emergency department quality improvement initiative with downstream effects","authors":"Alice Kidder Bukhman , Joshua W. Joseph , Chandler R. Bianchi , Paul C. Chen , Da’Marcus Eugene Baymon , Robin Powell , Beth Waters , Patrick Hollowell , Leon Dahomey Sanchez","doi":"10.1016/j.jemrpt.2024.100131","DOIUrl":"10.1016/j.jemrpt.2024.100131","url":null,"abstract":"<div><h3>Background</h3><div>Rising ED boarding and visit volumes are challenges to maintaining patient flow and avoiding patients leaving without being seen.</div></div><div><h3>Objectives</h3><div>We aimed to decrease left without being seen and improve ED patient flow by minimizing time patients spent in the waiting room in the early hours of the day when treatment spaces are usually available.</div></div><div><h3>Methods</h3><div>We implemented a “Waiting room zero before noon” campaign in our urban community emergency department. Providers and nurses were messaged about this goal and the expectation was set that patients should be brought to a room even if a nurse was not immediately available to care for them.</div></div><div><h3>Results</h3><div>In the three months following this campaign, we experienced a significant decrease in left without being seen. This decrease persisted over the subsequent two years, despite increasing patient volume.</div></div><div><h3>Conclusion</h3><div>A simple, cost-neutral campaign aimed at changing workflow culture was able to achieve improvements in patient flow despite continued challenges of rising boarding and volume.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100131"},"PeriodicalIF":0.0,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143157422","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

Implementing artificial intelligence for electrocardiogram interpretation: A case study

JEM reports Pub Date : 2024-12-07 DOI: 10.1016/j.jemrpt.2024.100132

Jace C. Bradshaw , Emily Nagourney , McKenzie Warshel , P Logan Weygandt

{"title":"Implementing artificial intelligence for electrocardiogram interpretation: A case study","authors":"Jace C. Bradshaw , Emily Nagourney , McKenzie Warshel , P Logan Weygandt","doi":"10.1016/j.jemrpt.2024.100132","DOIUrl":"10.1016/j.jemrpt.2024.100132","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) is expected to have a growing role in medical diagnostic interpretation and existing programs should be challenged with difficult cases in clinical practice senerios. An isolated posterior myocardial infarction (MI) is suggested by ST segment depression in the anteroseptal leads on a standard 12-lead electrocardiogram (ECG) and confirmed by the presence of 0.5mm ST segment elevation in any of the posterior leads (V7-V9). Isolated posterior MI is rare (potentially <4 % of all MIs).</div></div><div><h3>Case report</h3><div>We present a case of a 79-year-old man who presented with intermittent chest pain and subtle ECG changes concerning for a posterior MI. His catheterization images confirm a completely occluded LCx artery. We also present the AI analysis of the ECG's crucial for making the diagnosis in this case.</div><div>Why should an Emergency Physician be aware of this?</div><div>Given the diagnostic challenge of posterior wall MIs with a standard 12-lead ECG, clinical suspicion for a posterior MI should remain high with any degree of ST segment depression in the anterior leads and prompt the emergency physician to obtain a posterior ECG. AI-based ECG interpretation was able to determine that this patient was having an occlusive myocardial infarction. We discuss how to utilize the third-party AI for diagnostic aid.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100132"},"PeriodicalIF":0.0,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100248","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

A rare case of yellow nail syndrome in the emergency room setting: A case report 急诊室中罕见的黄指甲综合征1例：1例报告

JEM reports Pub Date : 2024-11-30 DOI: 10.1016/j.jemrpt.2024.100130

Jordan S. Elmowitz , Michael E. Nelson

引用次数: 0

Spontaneous perinephric hematoma in an emergency department patient with flank pain: A case report 急诊科一名侧腹疼痛患者的自发性肾周血肿：病例报告

JEM reports Pub Date : 2024-11-20 DOI: 10.1016/j.jemrpt.2024.100127

Amna Nawaz , Denise Elizondo , Rebecca G. Theophanous

{"title":"Spontaneous perinephric hematoma in an emergency department patient with flank pain: A case report","authors":"Amna Nawaz , Denise Elizondo , Rebecca G. Theophanous","doi":"10.1016/j.jemrpt.2024.100127","DOIUrl":"10.1016/j.jemrpt.2024.100127","url":null,"abstract":"<div><h3>Background</h3><div>Perinephric hematomas are defined by hemorrhage originating from the kidney parenchyma into the subcapsular and perirenal spaces. Spontaneous perinephric hematomas are rare and usually occur due to an underlying renal mass, vascular abnormality, coagulation disorder, or inflammatory disorder. The classic clinical presentation includes acute flank pain, hemorrhagic shock, and detection of a renal mass. Diagnosis is by computed tomography (CT), ultrasound, or angiography.</div></div><div><h3>Case report</h3><div>A 74-year-old male with coronary artery disease, severe heart failure, and atrial fibrillation/flutter on apixaban presented to the emergency department (ED) with left-sided abdominal and back pain for two weeks. He denied urinary symptoms, fever, or vomiting. The patient was hypotensive with low hemoglobin (8.9g/dL), thus he received blood transfusions and apixaban reversal for hemorrhagic shock. CT scan diagnosed a 10x9 cm perinephric hematoma, and he was transferred to our hospital’s ED. Point-of-care ultrasound demonstrated a left perinephric hematoma and clotted blood in the splenorenal recess. Urology and interventional radiology (IR) were consulted, with emergent transport to IR for angiogram and left coil embolization then intensive care unit admission.</div></div><div><h3>Why should an emergency medicine physician be aware of this</h3><div>This case describes important diagnostic testing and bedside ultrasound utility in expediting care for patients with renal pathology. It describes a case of spontaneous renal hemorrhage and management steps including IR embolization, urology involvement, and evaluation for surgical intervention. Finally, we emphasize potential serious complications including chronic renal failure, pyelonephritis, renal obstruction, and permanent kidney distortion if disease is not recognized and treated early.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100127"},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706881","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

Symptomatic complete heart block: A rare complication of anterior myocardial infarction in a young, fit male: A case report 症状性完全性心脏传导阻滞：体格健壮的年轻男性前心肌梗死的罕见并发症：病例报告

JEM reports Pub Date : 2024-11-19 DOI: 10.1016/j.jemrpt.2024.100129

Huang Huiling , Lee Keyao , Zhang Yuan Helen

{"title":"Symptomatic complete heart block: A rare complication of anterior myocardial infarction in a young, fit male: A case report","authors":"Huang Huiling , Lee Keyao , Zhang Yuan Helen","doi":"10.1016/j.jemrpt.2024.100129","DOIUrl":"10.1016/j.jemrpt.2024.100129","url":null,"abstract":"<div><h3>Background</h3><div>Acute myocardial infarction (AMI) is a major cause of morbidity and mortality, typically affecting older individuals with multiple cardiovascular comorbidities. Complete heart block (CHB) is a rare but serious complication of AMI, requiring prompt intervention. We present a case of AMI involving total occlusion of the proximal left anterior descending (LAD) coronary artery, leading to CHB and alternating bundle branch blocks, requiring temporary pacing. The patient was discharged with good outcomes.</div></div><div><h3>Case report</h3><div>A 41-year-old Indian male with no significant past medical history presented with chest discomfort and abnormal electrocardiogram (ECG) findings. Emergency percutaneous coronary intervention (PCI) revealed critical proximal LAD occlusion and moderate disease in the other coronary arteries. The patient developed trifascicular block and subsequent episodes of alternating right and left bundle branch block, necessitating temporary pacing. Despite the complex arrhythmias resulting from his anterior AMI and the transient need for a temporary pacing wire, the patient showed remarkable improvement post-revascularization, with no requirement for a permanent pacemaker at discharge.</div></div><div><h3>Why should an Emergency Physician be aware of this?</h3><div>This case highlights that CHB can occur with anterior, not just inferior MI. When associated with anterior MI, there is extensive myocardial injury and a high risk of conduction abnormalities, which can potentially be permanent. While AMI can cause a range of complications, CHB tends to be rarer in LAD occlusion based on the anatomy it supplies. Recognizing and promptly treating both the primary lesion and its complications especially in the younger patients, can improve outcomes.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100129"},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706882","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

Case of monocular visual impairment 单眼视力障碍病例

JEM reports Pub Date : 2024-11-17 DOI: 10.1016/j.jemrpt.2024.100128

Lev Libet, Edward McCrink, Lawrence Liu

引用次数: 0

Upper gastrointestinal bleeding: A rare presenting sign of pediatric hypothyroidism 上消化道出血：小儿甲状腺功能减退症的罕见症状

JEM reports Pub Date : 2024-11-10 DOI: 10.1016/j.jemrpt.2024.100126

Nicholas Aldredge , Sara A. DiVall , Yongtian T. Tan

{"title":"Upper gastrointestinal bleeding: A rare presenting sign of pediatric hypothyroidism","authors":"Nicholas Aldredge , Sara A. DiVall , Yongtian T. Tan","doi":"10.1016/j.jemrpt.2024.100126","DOIUrl":"10.1016/j.jemrpt.2024.100126","url":null,"abstract":"<div><h3>Background</h3><div>Severe pediatric hypothyroidism is a relatively rare endocrine disorder characterized by inadequate thyroid hormone production or action in children. It can have significant effects on various organ systems, including the gastrointestinal (GI) tract, and cause upper GI bleeding (UGIB). It can be challenging to diagnose as the cause in the emergency department (ED).</div></div><div><h3>Case report</h3><div>We present the case of a 13-year-old previously healthy male presenting with hematemesis as the chief complaint to the pediatric emergency department, who was subsequently found to have severe hypothyroidism based on a constellation of vital sign abnormalities in the absence of other likely etiologies. This case illustrates the importance of considering endocrinopathies as part of the overall differential diagnoses for a pediatric patient presenting with isolated hematemesis, especially if there is a disparity between vital signs and other clinical signs.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Recognizing pediatric hypothyroidism as a potential cause of UGIB presents a particular diagnostic challenge for emergency physicians. Symptoms of pediatric hypothyroidism can be varied, and UGIB in this setting is a rare and poorly understood clinical entity. Timely diagnosis and treatment of hypothyroidism are crucial to prevent further complications and optimize the child's growth and development.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 4","pages":"Article 100126"},"PeriodicalIF":0.0,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142654320","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

Tamsulosin-induced priapism: A case report 坦索罗辛诱发的前列腺增生症：病例报告

JEM reports Pub Date : 2024-11-07 DOI: 10.1016/j.jemrpt.2024.100125

Julie Martino , Zane Elfessi , Heather Webster

{"title":"Tamsulosin-induced priapism: A case report","authors":"Julie Martino , Zane Elfessi , Heather Webster","doi":"10.1016/j.jemrpt.2024.100125","DOIUrl":"10.1016/j.jemrpt.2024.100125","url":null,"abstract":"<div><h3>Background</h3><div>Priapism is a persistent erection generally lasting more than 4 h. Types of priapism include recurrent, ischemic, and non-ischemic and are generally classified based on penile arterial blood flow. Priapism can be induced by hematologic disorders (i.e. sickle cell anemia), infections, recreational drug use, and medication use. Tamsulosin is an α<sub>1A</sub> receptor antagonist commonly used in the treatment of LUTS and benign prostatic hyperplasia (BPH).</div></div><div><h3>Case report</h3><div>We report a case of priapism lasting 48 hours due to tamsulosin. Aspiration and irrigation of the corpus cavernosa and intracavernosal injection of phenylephrine were performed without success. A penile blood gas revealed a pH of 6.92, pCO2 of 108 mmHg, pO2 of 40 mmHg, and HCO3 of 22.2 mmol/L—indicating ischemic priapism. A T-shunt was performed through the glans with moderate detumescence—the penis was able to bend at least 60° in all directions and 90° ventrally. The patient had a computed tomographic angiography (CTA) of the pelvis and a magnetic resonance angiography (MRA) 1 and 3 months later, respectively, which indicated proper flow and the absence of arteriovenous malformations.</div><div>Why should an EM Physician be aware of this?</div><div>Despite its attractive nature for the treatment of LUTS or BPH, because of α<sub>1A</sub> receptor selectivity, tamsulosin should be recognized as a culprit of priapism. Because of the high affinity for the α<sub>1A</sub> receptor, patients on tamsulosin may not respond to traditional medical therapies for priapism and therefore may require surgical intervention.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 4","pages":"Article 100125"},"PeriodicalIF":0.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142654197","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