JEM reports最新文献_第4页

Patient acceptance of emergency department-initiated buprenorphine and reasons for declining 急诊科患者对丁丙诺啡的接受程度及其下降的原因

JEM reports Pub Date : 2025-01-18 DOI: 10.1016/j.jemrpt.2025.100141

Lindsey K. Jennings , Allison Smith , Angela Moreland , Ralph Ward , Sarah Gainey , Suzanne Lane , Olivia Holodnik , Katherine Scarpino , Karen Hartwell , Louise Haynes , Kathleen T. Brady , Kelly Barth

{"title":"Patient acceptance of emergency department-initiated buprenorphine and reasons for declining","authors":"Lindsey K. Jennings , Allison Smith , Angela Moreland , Ralph Ward , Sarah Gainey , Suzanne Lane , Olivia Holodnik , Katherine Scarpino , Karen Hartwell , Louise Haynes , Kathleen T. Brady , Kelly Barth","doi":"10.1016/j.jemrpt.2025.100141","DOIUrl":"10.1016/j.jemrpt.2025.100141","url":null,"abstract":"<div><h3>Background</h3><div>Medication for Opioid Use Disorder (MOUD) reduces morbidity and mortality for patients with opioid use disorder (OUD). Emergency department-initiated buprenorphine (EDIB) doubles retention in treatment at 30 days compared to outpatient referral alone. Little is known about acceptance rates of EDIB and reasons why patients decline this life-saving intervention.</div></div><div><h3>Objectives</h3><div>The aim of this study was to quantify the number of patients who initiate and decline buprenorphine in the ED and determine reasons for declination.</div></div><div><h3>Methods</h3><div>Seven SC EDs implemented EDIB programs that included ED-based peer recovery specialists (PRSs) to provide a brief intervention and assist with referral to outpatient treatment. The PRSs recorded patient interactions in a database including medical eligibility, if EDIB was provided, and the reason(s) why eligible patients declined EDIB. All eligible EDIB patients were entered in the PRS database and included in the study. Reasons for declining buprenorphine in eligible patients were analyzed with both fixed and free-text response options.</div></div><div><h3>Results</h3><div>A total of 2205 patients were eligible for EDIB. Of those, 963 (43.6 %) patients accepted buprenorphine and 1242 (56.3 %) declined. The most common reasons for declination were 1) the “patient preferring non-MOUD treatment” (53.4 %), 2) “Not ready/would like to think about it and/or check with other treatment providers or case workers” (16.7 %).</div></div><div><h3>Conclusions</h3><div>Over half of patients with OUD who were eligible for EDIB declined treatment, with the most common reason being preference for non-MOUD treatment. Given the success of MOUD for treatment of OUD, this topic requires further exploration.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100141"},"PeriodicalIF":0.0,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143156419","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

Ketamine for rapid control of hyperactive delirium with severe agitation. A retrospective comparison study 氯胺酮快速控制严重躁动的多动性谵妄。回顾性比较研究

JEM reports Pub Date : 2025-01-18 DOI: 10.1016/j.jemrpt.2025.100138

Beatrice Borreani , Annalisa Belluti , Francescopaolo D'Adamo , Luca Acquarone , Cristina Cocino , Paolo Canepa , Francesco Quaglia , Martina D'Antoni , Andrea Alienda , Alessandro Riccardi

{"title":"Ketamine for rapid control of hyperactive delirium with severe agitation. A retrospective comparison study","authors":"Beatrice Borreani , Annalisa Belluti , Francescopaolo D'Adamo , Luca Acquarone , Cristina Cocino , Paolo Canepa , Francesco Quaglia , Martina D'Antoni , Andrea Alienda , Alessandro Riccardi","doi":"10.1016/j.jemrpt.2025.100138","DOIUrl":"10.1016/j.jemrpt.2025.100138","url":null,"abstract":"<div><h3>Background</h3><div>The agitated patient represents a very large clinical problem for the work of the emergency department. The therapeutic goal is rapid symptom control while ensuring maximum patient safety. Hyperactive delirium constitutes a true clinical emergency, and some sedatives carry inherent risks. Ketamine has already demonstrated remarkable safety in this setting. OBJECTIVES This study aims to indentify an effective and safe option for the rapid control of severe psychomotor agitation METHODS Our retrospective study analyzes the comparison of ketamine alone, ketamine with droperidol, and midazolam with haloperidol. RESULTS During the period of January 2022 and September 2023 we identified 66 patients with severe psychomotor agitation (13–76 years), and we demonstrated a faster and more effective response in patients treated with ketamine, and a reduction in adverse events in patients treated with ketamine and droperidol. CONCLUSIONS Our data show that patients treated with ketamine exhibit a significantly faster response, with immediate patient control, with greater safety than patients treated with midazolam. The combination with droperidol increases clinical efficacy compared with ketamine alone.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100138"},"PeriodicalIF":0.0,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100750","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

Acute pancreatitis and euglycemic non-diabetic ketoacidosis caused by an intentional semaglutide overdose 故意过量服用西马鲁肽引起的急性胰腺炎和血糖正常的非糖尿病酮症酸中毒

JEM reports Pub Date : 2025-01-17 DOI: 10.1016/j.jemrpt.2025.100139

Anthony Acosta , Ashley Fanco , Hataitaya Rohan , Zane Elfessi

{"title":"Acute pancreatitis and euglycemic non-diabetic ketoacidosis caused by an intentional semaglutide overdose","authors":"Anthony Acosta , Ashley Fanco , Hataitaya Rohan , Zane Elfessi","doi":"10.1016/j.jemrpt.2025.100139","DOIUrl":"10.1016/j.jemrpt.2025.100139","url":null,"abstract":"<div><h3>Background</h3><div>Glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, have been approved for weight loss and have gained popularity for its efficacy and a once-weekly administration. The FDA approved max dose of 2.4 mg per week resulted in a 10 % reduction in weight over a 6-month period. GLP receptors are expressed in islet and exocrine duct cells of the pancreas. Case reports of pancreatitis and diabetic ketoacidosis have been reported in patients who have hypertriglyceridemia or carry a diagnosis of diabetes.</div></div><div><h3>Case report</h3><div>We report a first-of-its kind case of an intentional overdose of semaglutide leading to pancreatitis and ultimately euglycemic non-diabetic ketoacidosis (EnDKA). Overstimulation by GLP-1 agonists, like semaglutide, can lead to hyperplasia and resulting pancreatitis. Acute pancreatitis can induce a systemic inflammatory response and may be responsible for dysfunction of beta cells and subsequent insulin deficiency, resulting in diabetic ketoacidosis.</div><div>Why should an EM Physician be aware of this?</div><div>Acute pancreatitis and euglycemic non-diabetic ketoacidosis are both life threatening emergencies. As the use of weight-management drugs become increasingly popular, the incidence of these emergencies may be on the rise as well.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100139"},"PeriodicalIF":0.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100754","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

Curious case of a frozen pupil – Orbital apex syndrome 奇怪的瞳孔冻结病例-眶尖综合征

JEM reports Pub Date : 2025-01-13 DOI: 10.1016/j.jemrpt.2025.100140

Sophia Aguirre, Rahul Nene

引用次数: 0

Hydrogen peroxide toxicity of a lower lip piercing: A case report 过氧化氢对下唇穿孔的毒性：1例报告

JEM reports Pub Date : 2025-01-11 DOI: 10.1016/j.jemrpt.2025.100137

Monique Graf , Craig Reece Brockman II , Kara Pretzlaff

{"title":"Hydrogen peroxide toxicity of a lower lip piercing: A case report","authors":"Monique Graf , Craig Reece Brockman II , Kara Pretzlaff","doi":"10.1016/j.jemrpt.2025.100137","DOIUrl":"10.1016/j.jemrpt.2025.100137","url":null,"abstract":"<div><h3>Background</h3><div>Hydrogen peroxide, a well-known cleaning product, is responsible for a large number of emergency department visits each year. The current literature contains only few case reports of these exposures, and our case report provides an example of what can happen from direct hydrogen exposure and how it is managed from the emergency department.</div></div><div><h3>Case report</h3><div>A 26-year-old female presented to the emergency department with lower lip swelling and overlying skin changes. Vital signs were within normal limits and the remainder of her exam was within normal limits. It was elicited with further questioning that the patient had irrigated her lip piercing the night before with hydrogen peroxide. With this information, the correct diagnosis of hydrogen peroxide toxicity was made and with the help of oral and maxillofacial surgery, the patient was treated appropriately for this condition.</div></div><div><h3>Why should emergency medicine physicians be aware of this</h3><div>Toxic exposures, whether via direct contact, inhalation, or ingestion, are commonly seen in the emergency department and require expeditious diagnosis and treatment. Based on physical exam alone, lip swelling suggests a variety of diagnoses. In this case, as in many others, accurate history taking is crucial in making the correct diagnoses.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100137"},"PeriodicalIF":0.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143157426","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

High dose intravenous ascorbic acid masking hypoglycemia in a patient presenting with stroke-like symptoms: A case report 高剂量静脉注射抗坏血酸掩盖出现卒中样症状患者的低血糖：1例报告

JEM reports Pub Date : 2024-12-26 DOI: 10.1016/j.jemrpt.2024.100136

John Seaser , Brooke Sherman

{"title":"High dose intravenous ascorbic acid masking hypoglycemia in a patient presenting with stroke-like symptoms: A case report","authors":"John Seaser , Brooke Sherman","doi":"10.1016/j.jemrpt.2024.100136","DOIUrl":"10.1016/j.jemrpt.2024.100136","url":null,"abstract":"<div><h3>Background</h3><div>Point of care glucometers are commonly used in the emergency setting on patients presenting with stroke-like symptoms to rule out abnormal glucose levels as a cause. High doses of intravenous (IV) ascorbic acid have been shown to interfere with the accuracy of point of care glucose readings and some continuous glucose monitors (CGM). This interaction can cause falsely elevated point of care glucose readings which can mask true hypoglycemia.</div></div><div><h3>Case report</h3><div>A 65-year-old female with a past medical history of leukemia and type 1 diabetes mellitus on an insulin pump presented with stroke-like symptoms after receiving an IV infusion of high dose ascorbic acid as an adjunctive cancer treatment. Point of care glucose upon emergency department arrival was 127 mg/dL, however, serum glucose resulted as 36 mg/dL. The serum glucose was thought to be an error when a repeated point of care glucose was 128 mg/dL. The patient was considered for thrombolytic therapy, but it was ultimately held. A repeat serum glucose was again critically low at 37 mg/dL, and around this time the drug-device interaction was discovered. The patient was given IV dextrose with immediate resolution of her symptoms.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Symptoms of hypoglycemia can mimic stroke, and not recognizing hypoglycemia could result in inappropriate thrombolytic administration or delayed correction of glucose. As outpatient vitamin and hydration clinics are becoming more prevalent, providers should be aware of the drug-device interaction between IV ascorbic acid and glucose meters that could negatively impact care.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100136"},"PeriodicalIF":0.0,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143157425","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

Procedural pain management in an academic emergency department, a pilot study 一个学术急诊科的程序性疼痛管理，一项试点研究

JEM reports Pub Date : 2024-12-19 DOI: 10.1016/j.jemrpt.2024.100134

Irvan J. Bubic , Sidra L. Speaker , Christopher J. Coyne , Jessica C. Oswald

{"title":"Procedural pain management in an academic emergency department, a pilot study","authors":"Irvan J. Bubic , Sidra L. Speaker , Christopher J. Coyne , Jessica C. Oswald","doi":"10.1016/j.jemrpt.2024.100134","DOIUrl":"10.1016/j.jemrpt.2024.100134","url":null,"abstract":"<div><h3>Background</h3><div>Pain is the leading cause of Emergency Department (ED) visits and untreated acute pain can frequently transition to chronic pain. (1,2) A 2020 pilot study showed that an ED-physician-led procedural pain management program reduced pain. (3)</div></div><div><h3>Objectives</h3><div>Our objective was to determine the feasibility and usefulness of a Mobile ED (MED) Pain Management program led by a dual-trained Pain Management and Emergency physician.</div></div><div><h3>Methods</h3><div>We included adult patients who visited the ED at a large academic hospital between October 26th and November 17th, 2020. Patients had a variety of types of pain and were treated with bedside nerve blocks. We recorded procedure indication, demographic data, and pre-and-post Visual Analog Scale (VAS) pain scores. We also captured patient and provider satisfaction, and billing data.</div></div><div><h3>Results</h3><div>The MED team was available for a total of 30 h and performed 14 procedures on 12 patients and 4 consults without procedures on 4 additional patients. VAS 30-min score reductions ranged from 20 % (intercostal nerve blocks) to 100 % erector spinae plane block (ESPB). The average VAS pain reduction was 58 %. The most common procedure performed was the ESPB with mean VAS pain reduction of 74 %. The procedures and consults produced 50.13 RVUs total and work Relative Value Units (wRVUs) of 29.4. Average RVU was 3.13 (1.84 wRVU) per patient and 1.67 RVU (0.98 wRVU) per hour.</div></div><div><h3>Conclusions</h3><div>These preliminary data suggest that although implementation of a dedicated ED pain could potentially lead to improved pain relief, it may not be financially feasible in this setting.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100134"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100753","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

Lemierre's syndrome diagnosed using bedside ultrasound in the emergency department 在急诊科使用床边超声诊断莱米尔综合征

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 病例报告：点护理超声显示膀胱憩室膀胱结石作为败血症和脑病的原因

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 中午前零号候诊室：一项具有下游效应的急诊科质量改进倡议

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