JEM reports最新文献

{"title":"Right atrial compression secondary to diaphragmatic rupture and liver displacement: A case report","authors":"Carlos Rodriguez,&nbsp;Elizabeth Reynolds,&nbsp;Brian Chang","doi":"10.1016/j.jemrpt.2025.100190","DOIUrl":"10.1016/j.jemrpt.2025.100190","url":null,"abstract":"<div><h3>Background</h3><div>Diaphragmatic rupture, a rare condition, can be categorized as traumatic or nontraumatic in origin. Traumatic diaphragmatic rupture (TDR) occurs in 0.8–5 % (Rossetti et al., 2005) of cases involving high-impact blunt or penetrating trauma to the chest or abdomen. Nontraumatic etiologies include congenital defects, acute elevations in intra-abdominal pressure, endometriosis, diaphragmatic abscess, or diaphragmatic eventration. Early recognition and management are critical due to its potential complications, including obstructive shock and organ herniation (Rossetti et al., 2005; Keyes et al., 2024).</div></div><div><h3>Case report</h3><div>We report a case of a 70-year-old woman presenting to the emergency department (ED) following cardiac arrest. Imaging revealed a diaphragmatic rupture with herniation of the liver into the thoracic cavity, causing right atrial compression and obstructive shock. Definitive management required transfer to a center with specialized cardiothoracic services for potential surgical repair after hemodynamic stabilization.</div></div><div><h3>Why should an emergency physician be aware of this</h3><div>Diaphragmatic rupture is an uncommon diagnosis that can mimic other conditions, delaying lifesaving treatment. Prompt imaging with CT is essential for accurate diagnosis, as chest radiography has low sensitivity. Emergency physicians must maintain a high index of suspicion in cases of undifferentiated shock to avoid fatal outcomes.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100190"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144841734","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":"2025-09-01","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":"All choked up; male with foreign body sensation","authors":"Harrison Barnhart,&nbsp;Gordon Tse,&nbsp;Norman Ng,&nbsp;Amin Mohamadi,&nbsp;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":"2025-09-01","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":"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":"Creation of prediction tool to guide further workup of febrile children in the emergency department under consideration for Multisystem Inflammatory Syndrome in children","authors":"Lauren Chavanne ,&nbsp;Arthur Chang ,&nbsp;Shawnice Kraeber ,&nbsp;Michelle Penque ,&nbsp;Mark D. Hicar","doi":"10.1016/j.jemrpt.2025.100153","DOIUrl":"10.1016/j.jemrpt.2025.100153","url":null,"abstract":"<div><h3>Background</h3><div>Multisystem Inflammatory Syndrome in Children (MIS-C) is a post-infectious complication of COVID-19 in children. Its workup often necessitates extensive laboratory investigations.</div></div><div><h3>Objectives</h3><div>This project sought to provide pediatric acute care providers with a data-based tool to guide further decision-making during initial workups for children under consideration for MIS-C.</div></div><div><h3>Methods</h3><div>We compared documented physical findings and laboratory data (complete blood counts, inflammatory markers, and electrolytes) from MIS-C cases (n = 46) to control data extracted from a pre-pandemic database of febrile children (n = 70). Significant findings on Fisher's exact test and independent t-tests were used to develop a scoring model. Receiver operating characteristic (ROC) curve analysis was performed to assess this scoring system using two different cohorts of MIS-C.</div></div><div><h3>Results</h3><div>From initial comparative analysis, a score (≥3) utilizing levels of CRP, lymphocytes, platelets, and total white blood cells was developed. ROC curve analysis demonstrated excellent parameters, with overall sensitivity of 97.83 %. In children &lt;9 years old, the score had a sensitivity of 96.15 % and in ≥9 years old, the score demonstrated a sensitivity of 100.00 %. We validated the score on a geographically disparate cohort by showing a sensitivity of 88.37 % of all children and 94.74 % in children ≥2 years of age.</div></div><div><h3>Conclusion</h3><div>Use of this scoring system based on readily available laboratory values can eliminate many febrile children from consideration of MIS-C allowing front-line providers to focus more extensive laboratory evaluations and extended observation on fewer children with a higher likelihood of having MIS-C.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100153"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143471566","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}

{"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":"2025-06-01","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":"2025-06-01","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}

{"title":"Ultrasound for Pupillary Assessment - A Systematic Review","authors":"Gunaseelan Rajendran ,&nbsp;Sasikumar Mahalingam ,&nbsp;Anitha Ramkumar ,&nbsp;Yuvaraj Krishnamoorthy ,&nbsp;P.T. Kumaresh ,&nbsp;Vijayanthi Vijayan ,&nbsp;Rajkumar Elanjaeran ,&nbsp;Rahini Kannan ,&nbsp;Sathya Prakasam ,&nbsp;Anas Salih","doi":"10.1016/j.jemrpt.2025.100158","DOIUrl":"10.1016/j.jemrpt.2025.100158","url":null,"abstract":"<div><h3>Background</h3><div>The conventional clinical assessment of pupils &amp; pupillometers has shown very poor interrater reliability. As a promising alternative, bedside ultrasound has emerged for pupillary assessment.</div></div><div><h3>Objectives</h3><div>Thus, we conducted a systematic review to assess ultrasound's utility and comparative effectiveness in pupillary assessment.</div></div><div><h3>Methods</h3><div>This systematic review involved searching three major databases—PubMed, Embase, and Scopus—from inception to April 2024, using predefined search terms. Inclusion criteria comprised adult patients over 18 years undergoing ultrasound for pupillary assessment, with comparison against standard methods such as pupillometry or clinical examination. Screening and data extraction were independently conducted by two investigators (GR, SM), with data appraisal utilizing the QUADAS-2 Risk of Bias assessment tool (CRD42024540402).</div></div><div><h3>Results</h3><div>Among 556 identified studies, seven met inclusion criteria, encompassing 865 patients and 1141 ultrasonographic pupillary assessments. Six of these studies reported a favourable correlation or association between ultrasound and pupillometer or clinical examination. Significant findings included a substantial correlation between ultrasound and infrared video pupillometry by Farina et al. (R = 0.831, p &lt; 0.01), by Fu et al. (Bland-Altman agreement −0.069) &amp; Modi et al. (Interclass Correlation Coefficient = 0.93). Diagnostic accuracy for identifying Relative Afferent Pupillary Defect (RAPD) had high sensitivity and specificity reported by Ramamoorthy et al. and Schmidt et al.</div></div><div><h3>Conclusion</h3><div>Our systematic review demonstrates a significant correlation/association between ultrasound and pupillometer or clinical examination for pupillary assessment. However, current evidence remains limited, and further high-quality research is needed before recommending routine use or claiming superiority over pupillometry or standard clinical assessments.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100158"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551552","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}

{"title":"Multiple cranial nerve palsies as a rare manifestation of Lyme disease: A case report","authors":"Spencer Prete ,&nbsp;Calvin S. Jackson ,&nbsp;Erin L. Simon","doi":"10.1016/j.jemrpt.2025.100155","DOIUrl":"10.1016/j.jemrpt.2025.100155","url":null,"abstract":"<div><h3>Background</h3><div>Lyme disease is a common illness transmitted by ticks and caused by <em>Borrelia</em> bacteria. It can lead to a range of neurological symptoms known collectively as neuroborreliosis. Facial nerve palsy (CN VII) is the most common cranial nerve deficit in Lyme disease, and involvement of multiple cranial nerves is rare.</div></div><div><h3>Case report</h3><div>A 74-year-old male with no significant past medical history presented to the emergency department (ED) with symptoms of nausea, vomiting, headache, right-sided facial droop, and diplopia. The patient denied fever, rash, neck rigidity, or extremity deficits. On examination, he exhibited right-sided facial paralysis involving the nasolabial fold, lip, eyebrow, forehead, and eyelid, alongside abducens nerve palsy (CN VI). A CT scan of the head and neck did not reveal any acute processes. The patient's differential diagnosis included posterior fossa lesion, vertebral artery dissection, stroke, multiple sclerosis, and Guillain-Barré syndrome. Given the lack a of clear etiology and the patient's presentation in an endemic area, a Lyme disease panel was ordered, which returned positive. The patient was diagnosed with neuroborreliosis and treated with intravenous ceftriaxone.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>An emergency physician should consider Lyme disease in their differential diagnosis for patients presenting with cranial nerve palsies after normal imaging studies. Ordering Lyme laboratory testing and initiating treatment in the ED can decrease morbidity and mortality. It is essential to distinguish between Lyme disease and Bell's palsy in patients presenting with a facial cranial nerve palsy as treatment for Lyme disease facial palsies includes antibiotics and avoidance of steroids.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100155"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529251","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}

{"title":"Dermal filler for penile augmentation Masquerading as abscesses on ultrasound: A case report","authors":"Mary E. Velagapudi,&nbsp;Adrienne Malik,&nbsp;Bradley S. Jackson","doi":"10.1016/j.jemrpt.2025.100160","DOIUrl":"10.1016/j.jemrpt.2025.100160","url":null,"abstract":"<div><h3>Introduction</h3><div>Dermal fillers have gained popularity over the years for cosmetic procedures including penile augmentation. With the increasing use of cosmetic enhancement dermal fillers, it is important to understand how they appear when imaged with ultrasound.</div></div><div><h3>Case report</h3><div>A 32-year-old male presented for penile pain, swelling, and erythema with a fever and leukocytosis after receiving a polymethyl-methacrylate (PMMA) filler 10 days prior in Mexico. Soft tissue point of care ultrasound was concerning for cellulitis versus abscess.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Penile dermal fillers can present with post-procedure complications including infections such as cellulitis or abscess. However, we found that particulate debris and coarse-grain heterogenous echogenicity of PMMA fillers are an abscess mimic.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100160"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529252","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}