JEM reports最新文献

{"title":"Technique description: Extraction of engulfed ear-piercing backing – The fast and atraumatic technique","authors":"Dmitry Beylin","doi":"10.1016/j.jemrpt.2024.100091","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2024.100091","url":null,"abstract":"<div><h3>Background</h3><p>Ear piercings are a common practice for body modification and self-expression, but they can lead to various complications, including embedded jewelry, infections, and difficulty removing earring backings. Traditional techniques for removing stuck backings involve forceful manipulation, resulting in pain, scarring, and suboptimal cosmetic outcomes.</p></div><div><h3>Discussion</h3><p>In this technique description, we present an alternative atraumatic technique for the removal of stuck ear-piercing backings. The technique involves injecting a mixture of local anesthetic and a vasoconstrictor, around the backing to create a fluid pocket that loosens the earring post. A special maneuver is then applied using a needle driver allowing for easy gentle removal. If the backing remains embedded, gentle pressure on the earlobe reveals a loop that can be threaded with a syringe needle to propel the backing out.</p></div><div><h3>Conclusions</h3><p>The proposed atraumatic technique for removing stuck ear-piercing backings offers a satisfactory and less stressful experience for pediatric patients while reducing the need for emergency department referrals. Given the lack of consensus on extraction methods, this technique provides a valuable alternative in the absence of a widely agreed-upon approach. Further research is needed to establish standardized protocols. Nevertheless, adopting this technique has the potential to enhance patient satisfaction and improve outcomes.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 2","pages":"Article 100091"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S277323202400021X/pdfft?md5=c09da96c1cc33eddfa73b391fa97d56f&pid=1-s2.0-S277323202400021X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140820148","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":"Jersey fracture: Avulsion-fracture injury of the flexor digitorum profundus","authors":"Maikel Falcon ,&nbsp;Gary M. Vilke","doi":"10.1016/j.jemrpt.2024.100089","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2024.100089","url":null,"abstract":"<div><p>Closed avulsion injuries of the flexor digitorum profundus (FDP) from the insertion at the base of the distal phalanx are not a very common lesion but when they occur, tend to be related to sport injuries. Though the diagnosis is made clinically, radiographs need be performed. Prompt surgical treatment within 7 to 14 days is the first line option to assure good outcomes.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 2","pages":"Article 100089"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232024000191/pdfft?md5=a8a1619e2873432c2f57c91438167bf5&pid=1-s2.0-S2773232024000191-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140650037","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":"Abdominal compartment syndrome from sigmoid volvulus presenting as acute respiratory failure","authors":"Emily M. Sze ,&nbsp;Jennifer Williams ,&nbsp;Nilesh B. Shukla ,&nbsp;Robert C. Lee ,&nbsp;Daniel B. Frank ,&nbsp;Edward Yamin ,&nbsp;Richard Nierenberg","doi":"10.1016/j.jemrpt.2024.100088","DOIUrl":"10.1016/j.jemrpt.2024.100088","url":null,"abstract":"<div><p>Background: Volvulus of the large intestine is a relatively uncommon cause of bowel obstruction. A rare complication is abdominal compartment syndrome, which can manifest as multisystem organ failure. Case Report: We present a case of a 62-year-old hemiparetic man who presented intubated for respiratory distress, and later became unstable, with profound hypotension and hypoxia. He was found to have a large sigmoid volvulus causing acute abdominal compartment syndrome with compression of bilateral lower lungs and mediastinal structures, and ultimately survived to undergo an exploratory laparotomy with sigmoidectomy. Why should an emergency physician be aware of this? Respiratory distress and abdominal pain are some of the most common chief complaints presenting to the ED. Emergency physicians must be aware of the potential sequelae of bowel obstruction, and recall that not all respiratory failure is caused by a primary cardiopulmonary process.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 2","pages":"Article 100088"},"PeriodicalIF":0.0,"publicationDate":"2024-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S277323202400018X/pdfft?md5=a0febe8e2148b8aa1fe3524729fb56ba&pid=1-s2.0-S277323202400018X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140278644","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":"A novel 2-in-1 ultrasound-guided hydrodissection for the treatment of upper back pain in the emergency department: A case series","authors":"Joshua Fuchs,&nbsp;Carlos Gonzalez-Cobos,&nbsp;Dasia Esener,&nbsp;Gabriel Rose","doi":"10.1016/j.jemrpt.2024.100087","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2024.100087","url":null,"abstract":"<div><h3>Background</h3><p>Upper back pain is a common occurrence with a lifetime prevalence of up to 19%. Patients with refractory upper back pain can pose a unique challenge to the emergency physician. The use of ultrasound-guided regional anesthesia is an important component of multi-modal analgesia in the emergency department. Ultrasound-guided peripheral nerve hydrodissection has been shown to be an effective treatment of various nerve entrapment syndromes in the outpatient setting.</p></div><div><h3>Case report</h3><p>We present 2 cases of patients who presented to the emergency department with refractory upper back pain failing standard therapy who were treated successfully using an ultrasound-guided combined 2–in-1 hydrodissection of the spinal accessory nerve and dorsal scapular nerve.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>This technique may offer a safe, rapid, and effective approach to treating patients with refractory upper back pain. Further studies would be required to assess its utility on a broader scale.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 2","pages":"Article 100087"},"PeriodicalIF":0.0,"publicationDate":"2024-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232024000178/pdfft?md5=082753008af5f63cb62a3dc3832fbaa0&pid=1-s2.0-S2773232024000178-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140187857","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":"Accelerated diagnostic protocols using high-sensitivity troponin assays to rule in or out myocardial infarction: A systematic review","authors":"Jonie J. Hsiao ,&nbsp;Manuel A. Celedon ,&nbsp;James L. Rudolph ,&nbsp;Kristin J. Konnyu ,&nbsp;Sebhat A. Erqou ,&nbsp;Muhammad Baig ,&nbsp;Thomas A. Trikalinos ,&nbsp;Kyari Sumayin Ngamdu ,&nbsp;Ghid Kanaan ,&nbsp;Sunny Cui ,&nbsp;Thien Phuc Tran ,&nbsp;Taylor Rickard ,&nbsp;Ethan M. Balk ,&nbsp;Eric Jutkowitz","doi":"10.1016/j.jemrpt.2024.100086","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2024.100086","url":null,"abstract":"<div><h3>Background</h3><p>Accelerated diagnostic protocols (ADPs) that incorporate high-sensitivity cardiac troponin (hs-cTn) can help emergency department (ED) providers quickly rule in or out acute myocardial infarction (AMI).</p></div><div><h3>Objectives</h3><p>This systematic review evaluated the effectiveness and comparative effectiveness of clinically applied ADPs that use hs-cTn on clinical and health service use outcomes.</p></div><div><h3>Methods</h3><p>Medline, Embase, <span>ClinicalTrials.gov</span><svg><path></path></svg>, and the Cochrane Database of Systematic Reviews were searched through May 2022. Standard systematic review methods were followed.</p></div><div><h3>Results</h3><p>We found 17 eligible primary studies (reporting on 23 ADPs), including 2 randomized controlled trials (N ​= ​32,050), 5 nonrandomized comparative studies (N ​= ​18,377) and 10 single-group studies (N ​= ​44,016). One study compared an ADP with hs-cTn to hs-cTn alone, finding that the ADP increased discharges from the ED to the community and is not associated with worse clinical outcomes. Among 6 studies, ADPs with shorter compared to longer hs-cTn timing and ADPs that incorporated the HEART score compared to the TIMI score reduced ED length of stay and increased discharges to the community without resulting in worse clinical outcomes. Across studies, ADPs that measured hs-cTn for up to 12 ​h had longer ED lengths of stay than ADPs with ≤6 ​h of measurements.</p></div><div><h3>Conclusions</h3><p>ADPs with shorter compared to longer hs-cTn timing reduce ED length of stay, increase discharges, and are not associated with changes in 30-day major adverse cardiovascular event, AMI, or mortality. Among ADPs that reduce ED length of stay, there is no obvious best choice, and any ADP should be tailored to local context.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 2","pages":"Article 100086"},"PeriodicalIF":0.0,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232024000166/pdfft?md5=00e66697b7f0bfb081f25f187b9069e9&pid=1-s2.0-S2773232024000166-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140180087","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":"The use of a psychiatric overflow unit in a large urban community hospital to improve process outcomes","authors":"Bahareh Aslani-Amoli ,&nbsp;Alex Marwaha ,&nbsp;Maria Stepanova ,&nbsp;Sarah Rhine ,&nbsp;Samir Nader ,&nbsp;Linda Henry ,&nbsp;John Howell ,&nbsp;Tanveer Gaibi","doi":"10.1016/j.jemrpt.2024.100083","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2024.100083","url":null,"abstract":"<div><h3>Background</h3><p>The United States is experiencing a mental health (MH) crisis with limited resources to meet demands. We established a 5-bed psychiatric overflow unit (POU) within the emergency department (ED) as a care alternative.</p></div><div><h3>Objective</h3><p>Determine the clinical utility and safety of a POU in care delivery to patients in a MH crisis compared to the main ED (controls).</p></div><div><h3>Methods</h3><p>Retrospective study using data from electronic health record/chart review [October 1, 2021–May 31, 2022 (POU established January 2022)] for all ED patients ≥12 years admitted with MH crisis. Per triage nurse, patients for potential hospital admission were POU admitted when medically cleared. Clinical utility definition: ED length of stay (LOS); patient safety definition: return to ED within 72 ​h for same complaint.</p></div><div><h3>Results</h3><p>Patients (n ​= ​919; POU ​= ​302, main ED ​= ​617) were 61.4% male, mean age 39.7 ​± ​15.6 years, 84.2% ESI 2, 61.7% admitted/transferred, average ED LOS was 932.3 ​± ​804.7 ​min and no returns within 72 ​h. POU had longer ED LOS (1058.7 ​± ​736.5 vs 884.6 ​± ​824.6, P ​&lt; ​0.0001) but no differences among admitted/transferred patients comparing POU vs controls (P ​&gt; ​0.05); Among discharged patients POU compared to main ED had a longer mean ED LOS (819.9 ​± ​779.8 vs 486.4 ​± ​577.3, P ​&lt; ​0.0001); Removal of police escort patients did not change POU ED LOS (P ​&lt; ​0.05).</p></div><div><h3>Conclusions</h3><p>An ED POU, staffed with behavioral health nurses, had equivocal safety and clinical utility as the main ED potentially providing an alternative care-delivery option when ED space and MH resources are limited.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 2","pages":"Article 100083"},"PeriodicalIF":0.0,"publicationDate":"2024-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232024000130/pdfft?md5=6aa69ea634d3a02718d5174c2742bcdf&pid=1-s2.0-S2773232024000130-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140122048","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":"Prostate abscess causing obstruction in an emergency department patient with constipation","authors":"Daniel Mercader,&nbsp;Rebecca G. Theophanous","doi":"10.1016/j.jemrpt.2024.100084","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2024.100084","url":null,"abstract":"<div><h3>Background</h3><p>Prostate abscess differs from prostatitis as a complicated infection requiring appropriate early treatment. It typically presents with urinary symptoms plus rectal or pelvic pain in middle-aged or older men. Diabetic, immunosuppressed, or patients with urological procedures are at higher risk for serious infection. If untreated, prostate abscess can progress to critical illness including sepsis and death, thus early diagnosis and treatment is key.</p></div><div><h3>Case report</h3><p>A middle-aged male with diabetes, hypertension, emphysema, and hypothyroidism presented with severe constipation for one week but no urinary symptoms, fever, or vomiting. On examination, he had mild abdominal distension without tenderness, decreased bowel sounds, and a normal external rectal exam. Computed tomography scan demonstrated prostatomegaly and a large 5.2cm prostate abscess with multiple lobulations causing mass effect on the distal colon, thus blood cultures were sent, intravenous antibiotics started, and urology consulted. The patient was admitted for continued antibiotic treatment and underwent surgical transurethral resection with urology the next day. A foley catheter was maintained for seven days, with improvement until hospital discharge 3 days later, with oral antibiotics and close urology clinic follow up.</p></div><div><h3>Why should an emergency medicine physician be aware of this?</h3><p>Prostate abscess is difficult to diagnose clinically and can lead to severe illness without early recognition and treatment. Patients may present with pelvic or rectal pain plus fever or urinary symptoms. Urgent antibiotic therapy is key, and many patients require urology consultation for surgical or procedural management.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 2","pages":"Article 100084"},"PeriodicalIF":0.0,"publicationDate":"2024-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232024000142/pdfft?md5=f4c756d89c9dba69acecf9af1f9c366d&pid=1-s2.0-S2773232024000142-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140122047","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":"Recurring eczema herpeticum complicated by herpetic meningitis and staphylococcal bacteremia","authors":"Morgan C. Lain ,&nbsp;John R. Bales ,&nbsp;Mahmoud D. Al-Fadhl ,&nbsp;Anthony V. Thomas ,&nbsp;Hamid D. Al-Fadhl ,&nbsp;Uzma Rizvi ,&nbsp;Joseph B. Miller ,&nbsp;Bruce D. Harley ,&nbsp;Mark M. Walsh","doi":"10.1016/j.jemrpt.2024.100085","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2024.100085","url":null,"abstract":"<div><h3>Background</h3><p>Eczema Herpeticum (EH) is a dermatological emergency that may progress to viral meningitis in patients not treated urgently. We present a case of recurrent EH in a young, immunocompetent patient complicated by progressing herpetic meningitis and staphylococcal bacteremia.</p></div><div><h3>Case report</h3><p>Our patient was a 20-year-old male intercollegiate athlete with a past medical history of atopic dermatitis (AD) who presented with photophobia, purulence in the medial left eye, and a painful rapidly worsening acute rash for two days. Polymerase chain reaction was performed on the cerebrospinal fluid and vesicular drainage. Both tested positive for herpes simplex virus type 1 (HSV-1), confirming the suspected diagnosis of EH. Blood culture returned positive for <em>Staphylococcus aureus</em> believed to be contracted through the breaks in his skin. He received intravenous normal saline, ceftriaxone, and acyclovir. He was hospitalized for 9 days before being discharged with oral acyclovir. Our patient returned to the emergency department one month later with a milder case of EH. Intravenous acyclovir was started, and the patient was discharged the next day with 1 g oral valacyclovir twice daily.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>It is crucial to establish a previous history of HSV-1 infection and recognize cutaneous presentations of EH in order to initiate early empiric antiviral therapy. The emergency physician must be hypervigilant and aggressively pursue diagnosis and treatment of suspected HSV-1 and -2 infections when confronted with an inexplicably worsening vesicular rash in a patient with AD. Delay in treatment can significantly worsen prognosis and lead to mortality.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 2","pages":"Article 100085"},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232024000154/pdfft?md5=2764be6df845f00a200a558a1d58f4f4&pid=1-s2.0-S2773232024000154-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140062489","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":"Massive spontaneous hemothorax in a young ESRD patient","authors":"Siu Fai Li,&nbsp;Nicole Lulevitch,&nbsp;Rachel S. Mirsky,&nbsp;Kayla M. Jaime,&nbsp;Tesfa X. Young","doi":"10.1016/j.jemrpt.2024.100082","DOIUrl":"10.1016/j.jemrpt.2024.100082","url":null,"abstract":"<div><h3>Background</h3><p>Pleural effusions are common problems for the emergency medicine physician and may require emergent therapeutic thoracentesis to prevent respiratory failure. Rarely, a pleural fluid collection may in fact be a spontaneous hemothorax.</p></div><div><h3>Case report</h3><p>A 22-year-old man presented to the emergency department with chest pain. He had a history of end-stage renal disease (ESRD) as a result of minimal change disease. The patient was in visible respiratory distress with absent breath sounds in the right chest. A chest x-ray revealed a large pleural effusion with mediastinal shift. Emergent thoracentesis relieved the patient’s symptoms, but the pleural fluid was grossly bloody. The patient’s cell counts and PT/PTT were normal. His thromboelastography (TEG) was borderline abnormal. The patient required video-assisted thoracoscopic surgery (VATS) for debulking and removal of the hemothorax. Otherwise, he had an unremarkable recovery. There was no obvious cause of the hemothorax. Clinicians must be wary that in patients with ESRD on hemodialysis, a pleural effusion may be in fact a spontaneous hemothorax. <em>Why should an emergency medicine physician be aware of this?</em> Patients with ESRD may present with massive spontaneous hemothorax that requires emergent thoracostomy and operative management. Emergency medicine physicians should be knowledgeable about the causes and work-up of patients with spontaneous hemothorax.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 2","pages":"Article 100082"},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232024000129/pdfft?md5=442852c06261d25a2f47f3f288a70f48&pid=1-s2.0-S2773232024000129-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140088634","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":"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}