JEM reports最新文献_第8页

Angiotensin converting enzyme inhibitor-induced penile angioedema: A case report 血管紧张素转换酶抑制剂诱导阴茎血管性水肿1例

JEM reports Pub Date : 2025-03-01 Epub Date: 2025-01-27 DOI: 10.1016/j.jemrpt.2025.100143

Anthony Acosta , Enas Alamreia , Nimra Afreen , Zane Elfessi

{"title":"Angiotensin converting enzyme inhibitor-induced penile angioedema: A case report","authors":"Anthony Acosta , Enas Alamreia , Nimra Afreen , Zane Elfessi","doi":"10.1016/j.jemrpt.2025.100143","DOIUrl":"10.1016/j.jemrpt.2025.100143","url":null,"abstract":"<div><h3>Background</h3><div>Angioedema is local swelling in the subcutaneous or submucosal layers resulting from bradykinin-mediated capillary leakage allowing fluid to accumulating in the interstitial space. It is estimated to affect up to 1 in 10,000 individuals each year worldwide.</div></div><div><h3>Case report</h3><div>Angioedema typically affects areas such as the face, lips, mouth, and throat, larynx, uvula, and GI tract, but rarely affects the genitals. Causes of angioedema include allergic reactions, drug-induced, hereditary factors, acquired factors, and idiopathic. We report a rare case of penile angioedema due to the angiotensin-converting enzyme (ACE) inhibitor lisinopril.</div><div>Why should an EM Physician be aware of this?</div><div>Penile angioedema is an extremely rare complication of ACE inhibitor use and should be included in the differential diagnosis for genital swelling. In the absence of complications from angioedema, such as paraphimosis, patients can be discharged from the emergency department without the need for pharmacotherapy as the swelling is self-resolving after discontinuation of the offending agent.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100143"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143156420","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

An atypical case of infective endocarditis initially diagnosed as myopericarditis 一例不典型的感染性心内膜炎，最初诊断为心包炎

JEM reports Pub Date : 2025-03-01 Epub Date: 2025-01-27 DOI: 10.1016/j.jemrpt.2025.100145

Negin Ceraolo , Rachel Dietz , Spencer Prete , Erin L Simon

{"title":"An atypical case of infective endocarditis initially diagnosed as myopericarditis","authors":"Negin Ceraolo , Rachel Dietz , Spencer Prete , Erin L Simon","doi":"10.1016/j.jemrpt.2025.100145","DOIUrl":"10.1016/j.jemrpt.2025.100145","url":null,"abstract":"<div><h3>Background</h3><div>Acute myopericarditis is inflammation of the pericardium, or the membrane surrounding the heart, and the myocardium, or the muscular myocardial layer of the heart. Infective endocarditis is an infection of the cardiac endothelium. Diagnosis relies on clinical evaluation, blood cultures to identify the causative organism, and echocardiography to visualize vegetations on heart valves. In the emergency department (ED), distinguishing between myopericarditis and infective endocarditis is crucial to avoid misdiagnosis.</div></div><div><h3>Case report</h3><div>We present the case of a 36-year-old male who was initially hospitalized for myocarditis and discharged on medications with cardiology follow-up planned. Twelve days later, the patient was readmitted with recurring chest pain. A bedside cardiac ultrasound showed mild mitral regurgitation. The patient was found to have bacteremia with Streptococcus anginosus which was concerning for endocarditis. The patient was transferred to a quaternary care hospital, where he underwent successful mitral valve repair.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>In the ED setting, it is crucial to broaden differential diagnoses. Myopericarditis can sometimes result from endocarditis, which can present in various ways. Therefore, endocarditis should be ruled out in acute presentations of chest pain. To avoid missing cases of endocarditis, obtaining blood cultures from patients with myopericarditis symptoms is essential. Additionally, expediting a transesophageal echocardiogram (TEE) can lead to a faster and more accurate diagnosis. Promptly conducting these tests can reduce the number of missed endocarditis cases and prevent patients from returning to the emergency department.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100145"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100755","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

Re-presentations to the emergency department initial presentation with COVID-19: Insights from the omicron wave 向急诊科重新介绍COVID-19的初步介绍：来自欧米波的见解

JEM reports Pub Date : 2025-03-01 Epub Date: 2025-01-31 DOI: 10.1016/j.jemrpt.2025.100147

Daniella Audish , George Braitberg , Anselm Wong

{"title":"Re-presentations to the emergency department initial presentation with COVID-19: Insights from the omicron wave","authors":"Daniella Audish , George Braitberg , Anselm Wong","doi":"10.1016/j.jemrpt.2025.100147","DOIUrl":"10.1016/j.jemrpt.2025.100147","url":null,"abstract":"<div><h3>Background</h3><div>Relapsing symptoms post-SARS-CoV-2 (COVID) infection, particularly with variants like Omicron, remain poorly understood and cumulative mortality rates are in the millions worldwide. Re-presentation rates to emergency departments (ED) post initial presentation are poorly defined.</div></div><div><h3>Objectives</h3><div>To identify the frequency and characteristics of ED re-presentations during the six months post initial COVID-19 admission.</div></div><div><h3>Methodology</h3><div>A retrospective chart review of patients with a positive COVID-19 PCR result <em>and</em> initial ED presentation at the Austin hospital in Victoria, Australia during January–February 2022 (wave one) and March–April 2022 (wave two). Subsequent ED re-presentations up to six months from initial admission were analyzed, concentrating on symptoms, diagnoses and mortalities.</div></div><div><h3>Results</h3><div>Of 926 wave one patients meeting the inclusion criteria, 162 (18 %) had subsequent ED presentations. For wave two, out of 556 patients, 129 (23 %) had re-presentations. The highest number of re-presentations for an individual were 24 and 11 for waves one and two respectively. Shortness of breath was the most common symptom for re-presentation during both waves (21 % and 19 % respectively), followed by cough. Additionally, 79 % of wave one patients and 29 % of wave two patients had respiratory-related comorbidities. Twelve percent of patients died within six months of the initial COVID-19 related presentation in wave one compared to 7 % in wave two.</div></div><div><h3>Conclusion</h3><div>Re-presentation rates were similar to previous COVID waves with the alpha and delta variants. Respiratory symptoms and related diagnoses were common. Strengthening public health strategies is vital to curb transmission, alleviate strain on hospitals, and prevent further morbidity and mortality.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100147"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349610","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

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 : 2025-03-01 Epub 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":"2025-03-01","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 : 2025-03-01 Epub 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":"2025-03-01","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

Early-stage balanitis xerotica obliterans in an 11-year-old boy 11岁男童早期完全性干性龟头炎

JEM reports Pub Date : 2025-03-01 Epub Date: 2025-01-28 DOI: 10.1016/j.jemrpt.2025.100148

Shaili Patel , Ee Tein Tay

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 : 2025-03-01 Epub 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":"2025-03-01","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

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 : 2025-03-01 Epub 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":"2025-03-01","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

The importance of source control in the treatment of infections in elderly patients aged 80 and above 源头控制在80岁及以上老年患者感染治疗中的重要性

JEM reports Pub Date : 2025-03-01 Epub Date: 2025-02-14 DOI: 10.1016/j.jemrpt.2025.100151

Tatsuro Sakai , Youichi Yanagawa , Hiroshi Ito

{"title":"The importance of source control in the treatment of infections in elderly patients aged 80 and above","authors":"Tatsuro Sakai , Youichi Yanagawa , Hiroshi Ito","doi":"10.1016/j.jemrpt.2025.100151","DOIUrl":"10.1016/j.jemrpt.2025.100151","url":null,"abstract":"<div><h3>Background</h3><div>There is currently no research in super-elderly patients with source of infections that require invasive treatment</div></div><div><h3>Objectives</h3><div>We retrospectively examined the impact on outcomes of performing or not performing such procedures in super-elderly patients with infection sources</div></div><div><h3>Methods</h3><div>The subjects were patients aged 80 years or older who were transported by ambulance to Numazu City Hospital and diagnosed with \"infections requiring source control\" in the emergency department during the six-year period. Infections requiring source control were generally defined as infections for which procedures such as drainage, debridement, or surgical resection to physically reduce the bacterial load at the source were necessary</div></div><div><h3>Results</h3><div>There were 201 patients were enrolled. The average age was 87.0 years. There were 175 cases where procedures were performed, and 24 cases (11.9 %) resulted in death. Hepatobiliary diseases were the most common, accounting for 153 cases, followed by renal infections with 25 cases. Compared to the surviving group, the fatal group had a statistically significantly lower rate of source control, shorter hospital stays, and higher Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores. Among them, only source control was identified as an independent factor related to survival by multivariate analysis</div></div><div><h3>Conclusion</h3><div>This study suggests that performing source control in patients, even those aged 80 years and older, might increase survival rates</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100151"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143436319","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

Rescuing the heart: HIET in undifferentiated shock from beta-blocker and dapagliflozin overdose in acute coronary syndrome 抢救心脏：急性冠状动脉综合征患者过量服用β受体阻滞剂和达格列净导致的未分化性休克中的HIET

JEM reports Pub Date : 2025-03-01 Epub Date: 2025-02-14 DOI: 10.1016/j.jemrpt.2025.100152

Arihant Jain , Swetha Ramesh , Shruti Singh , Anas Mohammed Muthanikkatt , N. Balamurugan

{"title":"Rescuing the heart: HIET in undifferentiated shock from beta-blocker and dapagliflozin overdose in acute coronary syndrome","authors":"Arihant Jain , Swetha Ramesh , Shruti Singh , Anas Mohammed Muthanikkatt , N. Balamurugan","doi":"10.1016/j.jemrpt.2025.100152","DOIUrl":"10.1016/j.jemrpt.2025.100152","url":null,"abstract":"<div><h3>Background</h3><div>A 60-year-old female with ischemic dilated cardiomyopathy and diabetes mellitus presented with acute coronary syndrome (ACS) complicated by severe ventricular tachyarrhythmia after ingesting an excessive dose of metoprolol (250 mg) and dapagliflozin (100 mg). Despite metoprolol's dose being below traditional toxic thresholds, chronic beta-blocker therapy likely amplified its negative inotropic effects, leading to refractory hypotension overdose of metoprolol was not the cause of V tach, rather it was because of underlying ACS. Initial resuscitation with synchronized cardioversion and noradrenaline infusion failed to stabilize her blood pressure. High-Dose Insulin Euglycemia Therapy (HIET) was initiated as a salvage measure, resulting in significant hemodynamic improvement within 2–3 hours, increased left ventricular ejection fraction (LVEF) on repeat echocardiography, and blood pressure stabilization.</div></div><div><h3>Case-report</h3><div>The patient presented with severe ventricular tachyarrhythmia and persistent hypotension following an overdose of metoprolol and dapagliflozin. Despite initial treatments, her condition did not improve. HIET was initiated and led to rapid hemodynamic stabilization and improved LVEF within a few hours. Lidocaine infusion was added to manage the prolonged QT interval and suppress further arrhythmias. Her condition gradually improved over the following days, with resolution of hypotension and arrhythmias. She was discharged after four days of inpatient care.</div></div><div><h3>Why should an emergency physician be aware of this ?</h3><div>This case highlights that chronic beta-blocker use can lead to refractory hypotension even at non-toxic overdose levels and demonstrates the efficacy of HIET as a critical, lifesaving intervention for shock and cardiac recovery in overdose of B- blocker.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100152"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143463568","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