JEM reports最新文献

{"title":"Aims and Scope","authors":"","doi":"10.1016/S2773-2320(24)00011-7","DOIUrl":"https://doi.org/10.1016/S2773-2320(24)00011-7","url":null,"abstract":"","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 1","pages":"Article 100081"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232024000117/pdfft?md5=ae9c56a993db293d0710d80d4d761cd6&pid=1-s2.0-S2773232024000117-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139999080","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":"Treatment of post-traumatic occipital neuralgia with ultrasound-guided greater occipital nerve hydrodissection in the emergency department","authors":"Gabriel Rose","doi":"10.1016/j.jemrpt.2024.100078","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2024.100078","url":null,"abstract":"<div><h3>Background</h3><p>Nerve hydrodissection (HD) has previously been described as a treatment for carpal tunnel syndrome and other musculoskeletal disorders; however, its use in the treatment of occipital neuralgia (ON) has rarely been reported. This is the first report of HD used to treat ON in the emergency department (ED).</p></div><div><h3>Case report</h3><p>A 34-year-old male presented to the ED with a 3-month history of posterior neck and scalp pain consistent with ON. He failed multiple outpatient therapies including oral medication and trigger point injections. An ultrasound (US)-guided HD of the greater occipital nerve (GON) was performed successfully. A 25 g needle was inserted in-plane and a solution of 9 mL normal saline and 1 mL 1 ​% lidocaine was injected within the fascial plane containing the GON until muscle layer separation was achieved.</p><p>Why should an emergency physician be aware of this? A case of refractory ON failing conventional therapy was successfully treated in the ED using US-guided nerve HD.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 1","pages":"Article 100078"},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232024000087/pdfft?md5=dd5c501f8b7db494b6aafeb5f5977bef&pid=1-s2.0-S2773232024000087-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139719565","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":"An unusual cause of right upper quadrant pain: Gastric perforation from a foreign body diagnosed with point-of-care ultrasound (PoCUS) in the emergency department: A case report","authors":"Osama Muhtaseb ,&nbsp;Jordan Chenkin","doi":"10.1016/j.jemrpt.2024.100079","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2024.100079","url":null,"abstract":"<div><h3>Background</h3><p>Foreign body (FB) ingestion is a common presentation in the emergency department (ED). Point-of-care ultrasound (PoCUS) is useful for detecting ingested foreign bodies in pediatrics. However, its utility for diagnosing FB ingestions in adult patients has not been well described.</p></div><div><h3>Case report</h3><p>We present a case of a 52-year-old female patient who presented to our ED with right upper abdominal pain. A PoCUS revealed a long echogenic structure between the gastric pylorus and the gallbladder wall. The appearance raised suspicion for a foreign body perforating through the gastric wall. A CT scan confirmed the diagnosis of a fishbone perforating through the gastric wall. The patient underwent exploratory laparoscopic surgery that confirmed the perforation. The fishbone was removed endoscopically, and the patient made an unremarkable recovery.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>Foreign body ingestion is an important cause of abdominal pain in the ED and can lead to significant morbidity if there is a delay in diagnosis. Some patients may not be aware that they ingested a foreign body. Identification of an abnormal echogenic structure in the abdomen at the site of tenderness should prompt further investigation and consultation.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 1","pages":"Article 100079"},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232024000099/pdfft?md5=c109d589698c57a509fe4308390a3c95&pid=1-s2.0-S2773232024000099-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139719566","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":"An atypical case of purulent pericarditis and cardiac tamponade found on bedside echocardiography","authors":"Daniel Brownstein ,&nbsp;Elaine Yu ,&nbsp;Jessica Amalraj ,&nbsp;Rachna Subramony ,&nbsp;Rahul Nene","doi":"10.1016/j.jemrpt.2024.100077","DOIUrl":"10.1016/j.jemrpt.2024.100077","url":null,"abstract":"<div><h3>Background</h3><p>Bacterial pericarditis is a rare cause of pericardial disease, with purulent pericarditis making up less than 1 ​% of bacterial cases worldwide.</p></div><div><h3>Case report</h3><p>We report the case of a 52-year-old male with diabetes and end-stage renal disease on dialysis who presented for chest pain with an electrocardiogram concerning for myocardial ischemia. He was found to have a large pericardial effusion with heterogenous material and signs of sonographic tamponade on bedside ultrasound. His vital signs did not have any fever, tachycardia, or hypotension. His physical examination was negative for diminished heart sounds or jugular venous distension. He underwent a pericardiocentesis that grew staphylococcus aureus and was found to have a mediastinal abscess that required excision.</p></div><div><h3>“Why should an emergency physician be aware of this?”</h3><p>Bedside point-of-care transthoracic echocardiography can diagnose purulent pericarditis in the absence of clinical examination findings, electrocardiogram changes, or vital sign abnormalities.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 1","pages":"Article 100077"},"PeriodicalIF":0.0,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232024000075/pdfft?md5=45a5e8bbfd140882665acaeb2f3d96de&pid=1-s2.0-S2773232024000075-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139637475","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":"Catalytic converter theft: An emerging risk factor for carbon monoxide poisoning","authors":"Ahna H. Weeks ,&nbsp;Suzan Mazor ,&nbsp;Anita A. Thomas","doi":"10.1016/j.jemrpt.2024.100076","DOIUrl":"10.1016/j.jemrpt.2024.100076","url":null,"abstract":"<div><h3>Background</h3><p>Carbon monoxide (CO) poisoning is associated with high morbidity and mortality. Diagnosis can be challenging for the encountering physician due to vague and nonspecific presenting signs and symptoms. Confirmatory testing is typically prompted by historical information identifying a key exposure or risk factor.</p></div><div><h3>Case report</h3><p>A patient presented to the emergency department after having a seizure. The patient was diagnosed with CO poisoning, with a carboxyhemoglobin level of &gt;20.9 ​%, caused by unintentional exposure to motor vehicle exhaust while idling in his car after his catalytic converter was stolen. The patient was transferred to a hospital with the capacity for treatment with hyperbaric oxygen.</p><p>Why should an emergency physician be aware of this? Increasing prevalence of catalytic converter theft puts people at risk for CO poisoning. Emergency physicians should consider CO poisoning broadly, especially in urban environments with high rates of petty crime.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 1","pages":"Article 100076"},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232024000063/pdfft?md5=931178fab86411fb713b0c91270dec76&pid=1-s2.0-S2773232024000063-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139631731","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":"Crosswise approach to the popliteal sciatic nerve block","authors":"Joseph R. Brown ,&nbsp;Andrew J. Goldsmith ,&nbsp;Jonathan Brewer ,&nbsp;Arun Nagdev","doi":"10.1016/j.jemrpt.2024.100072","DOIUrl":"10.1016/j.jemrpt.2024.100072","url":null,"abstract":"<div><h3>Background</h3><p>The ultrasound guided popliteal sciatic block is a nerve block commonly used for pain control in the setting of distal tibia and/or fibular fractures, ankle reductions, Achilles tendon ruptures, and injuries to the lateral/posterior calf (burns, abscesses, or lacerations. In the Emergency Department, this block is classically performed by positioning the patient in a lateral or prone position. Unfortunately, in the acute setting, patient repositioning is often not possible secondary to pain, limiting the use of this block. In this case series, we describe a novel approach to the popliteal sciatic nerve block that allows the patient to remain in the supine position and enter from a crosswise approach.</p></div><div><h3>Case report</h3><p>This paper describes three cases, all which have painful complaints in the distribution of the popliteal sciatic nerve. In the first case, the patient has a bimalleolar ankle fracture. In the second, the patient has second degree burns that get contaminated and need decontamination. In the third, the patient has an unstable ankle fracture but will not accept opiates. In each, the presentation limits the provider’s ability to reposition the patient therefore this novel, crosswise approach to the popliteal sciatic nerve block allows optimal care without painful repositioning.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>While further research is still needed on the crosswise approach to the popliteal sciatic nerve block, it offers a novel approach to this classic block without the need for patient repositioning.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 1","pages":"Article 100072"},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232024000026/pdfft?md5=6e7aa8cdcfdc79b1a966195f9bc36454&pid=1-s2.0-S2773232024000026-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139633189","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":"Atrioventricular block, supraventricular tachycardia and grossly ischemic ST-T wave changes; what is the culprit?","authors":"Mazen M. Kawji","doi":"10.1016/j.jemrpt.2024.100073","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2024.100073","url":null,"abstract":"<div><h3>Background</h3><p>Hypokalemia is a common problem encountered in the emergency department. Severe cases of hypokalemia are associated with increased morbidity and mortality. ECG is an immediately-available test that can clinch the diagnosis, leading to immediate intervention. The trick is to differentiate ECG changes of severe hypokalemia from severe ischemia.</p></div><div><h3>Case report</h3><p>We here present a case of a middle-aged woman whose ECG showed sinus tachycardia with atrioventricular block, then supraventricular tachycardia with marked ischemic changes due to severe hypokalemia. Potassium level was 1.1 mEq/L. The ECG could have been mistaken for a high-risk, acute myocardial infarction due to severe left main and/or multi-vessel coronary artery disease. After initial potassium replenishment, classic text-book findings of hypokalemia became apparent. Troponin was mildly positive, however clinical presentation, the absence of chest pain, and confirmatory laboratory results led to the accurate decision not to activate a “Code STEMI” An echocardiogram done later showed no wall motion abnormalities. Supraventricular tachycardia terminated spontaneously. An ECG done after correction of hypokalemia was normal. No Q waves were noted.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>Emergency department physicians, cardiologists, and internists, among other physicians should be aware of the recently-described pattern of diffuse ST segment depression and ST segment elevation due to severe hypokalemia. This will lead to accurate measuring decisions by treating hypokalemia and avoiding activating the catheterization laboratory, performing an unnecessary intervention.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 1","pages":"Article 100073"},"PeriodicalIF":0.0,"publicationDate":"2024-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232024000038/pdfft?md5=527e74ce509a2636d00a3c6d4c15226f&pid=1-s2.0-S2773232024000038-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139503482","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":"Pulmonary embolism: Thrombus-in-transit","authors":"Natalie T. Truong ,&nbsp;Patrick B. Hinfey","doi":"10.1016/j.jemrpt.2024.100071","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2024.100071","url":null,"abstract":"<div><h3>Background</h3><p>Point-of-care transthoracic echocardiography can be useful in diagnosing a pulmonary embolism in patients with hemodynamic instability and facilitate with their management in the emergency department.</p></div><div><h3>Case report</h3><p>A 64 year-old man presented to the ED with several days of worsening exertional dyspnea associated with left-sided chest pain who was hemodynamically unstable. Point-of-care ultrasound revealed a clot in the right atrium, which led to further assessment of the right heart function to detect signs of acute right heart strain when a pulmonary embolism is highly suspected.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>Point-of-care ultrasound (POCUS) was utilized to evaluate characteristic findings that will predict a higher risk of deterioration from a pulmonary embolism. Rarely, a mobile clot can be seen within the right atrium which is highly specific for imminent pulmonary embolism and is associated with higher risk of decompensation. Bedside transthoracic echocardiogram allowed for rapid diagnostic assessment that guided decision making and early management of pulmonary embolism, which can improve the patient's outcome.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 1","pages":"Article 100071"},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232024000014/pdfft?md5=02648de60f441a205d70ebb2abc127a2&pid=1-s2.0-S2773232024000014-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139479953","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":"Association between emergency department computed tomography utilization rate and patient satisfaction: A clinician level analysis across a regional healthcare system","authors":"Katherine A. Pollard ,&nbsp;Thomas Lardaro ,&nbsp;Carl Pafford ,&nbsp;Julia Vaizer ,&nbsp;Christian C. Strachan ,&nbsp;Steven K. Roumpf ,&nbsp;Megan R. Crittendon ,&nbsp;Karen N. Crevier ,&nbsp;Benton R. Hunter","doi":"10.1016/j.jemrpt.2024.100075","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2024.100075","url":null,"abstract":"<div><h3>Background</h3><p>Computed Tomography (CT) use is common during emergency department (ED) visits, and ED clinicians may order CTs for myriad reasons, including desire to improve patient satisfaction.</p></div><div><h3>Objectives</h3><p>To determine if greater CT use by ED clinicians is associated with increased average patient satisfaction scores for those providers.</p></div><div><h3>Methods</h3><p>The study took part across 15 non-pediatric hospitals in a regional healthcare system. We compared clinician CT use rate for adult patients discharged from the ED with Net Promotor Score (NPS) for that clinician. NPS is a patient satisfaction metric with a possible range of scores from −100 to +100. We included ED clinicians (physicians and non-physician providers (NPPs)) with at least 500 adult patient encounters resulting in ED discharge from July 2020 through June 2022. We assessed for an association between CT use and clinician NPS using univariate and multivariate regression models.</p></div><div><h3>Results</h3><p>Across the 15 hospitals, 166 physicians and 74 NPPs were included in the study. The median CT rate was 25.7 ​% (range 7.1 ​%–48.9 ​%). In both models, there was a statistical association between CT utilization and NPS such that every absolute increase in CT use by 10 ​% resulted in a 3-point improvement in provider NPS on the 200-point scale. When examined in a sensitivity analysis, none of the hospitals individually showed this same association.</p></div><div><h3>Conclusions</h3><p>We found a 26 ​% rate of CT use by clinicians for adults discharged from the ED, with wide variation in utilization between clinicians. There was a small and inconsistent association between CT utilization and clinician specific NPS scores.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 1","pages":"Article 100075"},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232024000051/pdfft?md5=b8567c1eed03f69a6ebef491073ef86a&pid=1-s2.0-S2773232024000051-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433740","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":"Successful use of haemato-polyvalent anti-venom cross-neutralisation in the clinical management of Rhabdophis subminiatus (Rhabdophis keelback) envenomation","authors":"Abhay Kant, Mingwei Ng, Ming Jing Elizabeth Tan, Ponampalam R","doi":"10.1016/j.jemrpt.2024.100074","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2024.100074","url":null,"abstract":"","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"12 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139540696","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}