JEM reports最新文献

{"title":"Modeling the value of an emergency department influenza vaccination program","authors":"Erin L. Simon ,&nbsp;Bethany Crouse ,&nbsp;Thomas Langlois ,&nbsp;Jaideep M. Karamchandani ,&nbsp;Christopher S. Ramos ,&nbsp;McKinsey Muir ,&nbsp;Stephen Sayles III ,&nbsp;Michael P. Phelan","doi":"10.1016/j.jemrpt.2023.100048","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100048","url":null,"abstract":"<div><h3>Background</h3><p>Seasonal influenza continues to present a significant annual burden as the vaccination rate in the United States is 51.8%. Emergency Department (ED) based influenza programs have been successfully implemented and improve vaccine uptake, reduce incidence and costs, and improve outcomes.</p></div><div><h3>Objective</h3><p>To develop a predictive model to assess preventable influenza cases, hospitalizations, fatalities, and incremental cost avoidance based on the unvaccinated population.</p></div><div><h3>Methods</h3><p>A retrospective cohort of ED encounters limited to Medicare and Medicaid populations was performed across 14 tertiary care hospital EDs and six freestanding EDs for 2020. The total number of unvaccinated individuals was identified to determine the potential impact of an ED vaccination campaign. The average cost and loss per inpatient stay was identified from prior industry Medicare benchmark data and was utilized to extrapolate Medicaid losses. Results from published cost-effectiveness studies identified the vaccination thresholds to prevent one additional case of influenza, one additional hospitalization, and one additional fatality.</p></div><div><h3>Results</h3><p>A total of 39,463 unvaccinated individuals were identified, with 14,064 classified as Medicare, and 25,379 classified as Medicaid. Assuming a 95% target outreach, 90% medical eligibility, and 70% acceptance rate, 414 influenza cases would be prevented (266 Medicaid, 148 Medicare), 28 hospitalizations would be prevented (18 Medicaid, 10 Medicare), and eight deaths would be prevented (5 Medicaid, 3 Medicare). Accordingly, a reduction in admissions would prevent $409,360 in total inpatient medical costs and $36,232 in losses to healthcare systems.</p></div><div><h3>Conclusion</h3><p>An ED-based influenza vaccination program would have a measurable impact on patient influenza disease burden and associated medical expenditures.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 3","pages":"Article 100048"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49839746","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":"Ingestion of a saw-edge knife in a patient with mental illness: A unique and uncommon presentation","authors":"Bharath Gopinath ,&nbsp;Prakash Ranjan Mishra ,&nbsp;Nihar Ranjan Dash ,&nbsp;Gaurav Kumar ,&nbsp;Jayapal Rajendran ,&nbsp;Rajesh Panwar","doi":"10.1016/j.jemrpt.2023.100044","DOIUrl":"10.1016/j.jemrpt.2023.100044","url":null,"abstract":"<div><h3>Background</h3><p>Foreign body ingestion leading to complications is rare, and the need for surgery is even rarer. Foreign body ingestion in patients with mental illness poses challenges in diagnosis due to the varied and often delayed presentation and difficulties in history-taking. Symptom-based management in patients with mental illness may sometimes result in incorrect diagnoses and delayed treatment. Detailed history and investigation may uncover unexpected findings.</p></div><div><h3>Case report</h3><p>We present the case of a 28-year-old male patient with a history of depression and suicidal tendencies who admitted to ingesting a knife after repeated probing. Although there were no signs of peritonitis, abdominal imaging revealed a 17 cm saw-edge knife traversing from the duodenum to the adjacent right lobe of the liver. The patient successfully underwent exploratory laparotomy with knife removal, duodenotomy repair, and feeding jejunostomy.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>A high index of suspicion is required to diagnose complications of foreign body ingestion, especially in patients with mental illness. In many high-volume emergency departments, these patients receive symptomatic management and are discharged with advice for outpatient follow-up. Emergency physicians should be aware that meticulous history-taking and a detailed examination are necessary in patients with mental illness. This approach facilitates a comprehensive diagnosis, timely management, and improved outcomes.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 3","pages":"Article 100044"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48376978","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":"Rare case of SVC perforation secondary to PICC line","authors":"Trung V. Ho ,&nbsp;Thomas L. Schumann ,&nbsp;Eric J. Schmieler","doi":"10.1016/j.jemrpt.2023.100047","DOIUrl":"10.1016/j.jemrpt.2023.100047","url":null,"abstract":"<div><h3>Background</h3><p>While relatively rare, complications from peripherally inserted central catheter (PICC) lines can carry serious morbidity and mortality. PICC lines are known to be associated with infection and thromboembolism, though literature discussing vessel perforation from PICC lines is limited, and to our knowledge there are no reports describing specifically the superior vena cava (SVC) being perforated from a PICC line.</p></div><div><h3>Case report</h3><p>In this report, we describe a case of a 48-year-old female who presented with chest pain in the setting of having a PICC line for chronic medical conditions. A computed tomography with angiography (CTA) was obtained and revealed perforation of the SVC and subsequent mediastinitis from her PICC line. Her PICC line was immediately secured, broad spectrum antibiotics were given, and cardiothoracic surgery was consulted. She subsequently had her PICC removed under ultrasound guidance with plans for immediate operative intervention if that failed. The patient did well and was ultimately discharged with a new PICC line.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>Although large vessel perforation from PICC lines is relatively rare, it can be associated with significant morbidity and needs immediate treatment. It is important for the emergency physician to have knowledge of this complication to make the diagnosis and initiate timely specialist intervention.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 3","pages":"Article 100047"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49590128","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":"A mimicker of serious neck pain - Acute calcific tendinitis of the longus colli","authors":"David Peng ,&nbsp;Christina Seow ,&nbsp;Alison Toczek ,&nbsp;Ian Ferguson ,&nbsp;David Massasso","doi":"10.1016/j.jemrpt.2023.100040","DOIUrl":"10.1016/j.jemrpt.2023.100040","url":null,"abstract":"","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 3","pages":"Article 100040"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41482632","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":"Re-presentations to the emergency department post COVID-19 admission in Australia","authors":"Zahra Al Haloob, G. Braitberg, Anthony Tu Tran, J. Rotella, Anselm Wong","doi":"10.1016/j.jemrpt.2023.100049","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100049","url":null,"abstract":"","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54779879","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":"Obstructive pyelonephritis caused by the accidental malpositioning of a urethral catheter into the ureter: A case report","authors":"Hiroshi Ito,&nbsp;Toshiya Nakashima,&nbsp;Jura Oshida,&nbsp;Taisuke Kodama,&nbsp;Sayato Fukui,&nbsp;Daiki Kobayashi","doi":"10.1016/j.jemrpt.2023.100041","DOIUrl":"10.1016/j.jemrpt.2023.100041","url":null,"abstract":"<div><h3>Background</h3><p>Indwelling urethral catheters can sometimes be accidently inserted into the ureter, which impedes urine flow.</p></div><div><h3>Case report</h3><p>We report a 74-year-old Japanese woman with neurogenic bladder who visited to our hospital due to fever. She was diagnosed as pyelonephritis based on her symptoms and laboratory findings, including pyuria. Abdominal computed tomographic scan showed an indwelling urethral catheter accidently malpositioned into a right ureter, caused ureteral dilatation, and hydronephrosis. Her urethral catheter was replaced, and she was successfully treated with piperacillin-tazobactam and cefotiam.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>Urethral catheter malpositioning into the ureter may be asymptomatic and overlooked in patients with neurogenic bladder, which can result in obstructive pyelonephritis. Prompt urethral catheter replacement is essential in treating such conditions.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 2","pages":"Article 100041"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44532380","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":"Chewing gum bezoar in a pediatric patient","authors":"Chizite Iheonunekwu ,&nbsp;Calvin Jackson ,&nbsp;Kara Weichler ,&nbsp;Oscar N. Emihe ,&nbsp;Erin L. Simon","doi":"10.1016/j.jemrpt.2023.100036","DOIUrl":"10.1016/j.jemrpt.2023.100036","url":null,"abstract":"<div><h3>Background</h3><p>A bezoar is a collection of indigestible material found in the gastrointestinal (GI) tract that has become large enough not to progress through the rest of the intestinal system. Bezoars are caused by both food and non-food materials. Symptoms resemble other forms of GI obstructions with post-prandial fullness, abdominal pain, nausea, vomiting, and weight loss.</p></div><div><h3>Case report</h3><p>A five-year-old male presented to the emergency department (ED) complaining of abdominal pain and diarrhea. He reportedly swallowed a large quantity of chewing gum a day before his presentation. A computed tomography (CT) of the abdomen and pelvis revealed a gastric bezoar due to chewing gum. The patient was successfully treated with several passes of an esophagoduodenoscopy (EGD) to remove the chewing gum mass.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>Gastric bezoars are rare and can vary in their presentations. ED physicians must consider bezoars in their differential diagnosis for pediatric patients presenting with postprandial fullness, abdominal pain, nausea, vomiting, or weight loss. Complications of bezoars include ischemia and perforation. A thorough history can help delineate the material causing the bezoar. Treatment of bezoars varies and can include treatment with carbonated beverages, endoscopy, and surgery.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 2","pages":"Article 100036"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46882674","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":"Emergent pharmacological management of ulnar artery thrombosis","authors":"Henry Zou ,&nbsp;Bethany Beard MD","doi":"10.1016/j.jemrpt.2023.100019","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100019","url":null,"abstract":"<div><h3>Background</h3><p>Ulnar artery thrombosis (UAT) refers to occlusion of the ulnar artery due to a blood clot and is a subcategory of hypothenar hammer syndrome (HHS). We present a case of right ulnar artery thrombosis that was pharmacologically managed in the Emergency Department (ED) and inpatient ward.</p></div><div><h3>Case report</h3><p>A 52-year-old male with a history of anemia and elevated ferritin presented to the ED with a 5-day history of skin discoloration, numbness, and tingling of his right 5th finger. CT angiogram showed a focal 1.5 cm-long thrombotic ulnar artery occlusion at the palmar bifurcation and embolic occlusion of the 5th digital arteries in the finger. Following consultation with vascular surgery, he was given intravenous heparin, transitioned to apixaban for lifelong anticoagulation therapy, and discharged following the placement of a Zio^Ⓡ patch.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>The patient's career involving manual labor, elevated ferritin, and smoking history may have been risk factors for UAT development. Our case illustrates the value of interdisciplinary collaboration and conservative management in low-acuity cases of UAT.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 2","pages":"Article 100019"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49775060","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":"Traumatic hypopharyngeal perforation and pneumomediastinum from a toothbrush","authors":"Rahul V. Nene ,&nbsp;Mena Said ,&nbsp;Philip A. Weissbrod ,&nbsp;Christanne H. Coffey ,&nbsp;Peter J. Witucki","doi":"10.1016/j.jemrpt.2023.100017","DOIUrl":"10.1016/j.jemrpt.2023.100017","url":null,"abstract":"<div><h3>Background</h3><p>Hypopharyngeal injuries are infrequently described, and management is extrapolated from the literature on esophageal perforations. Cases may present with associated pneumomediastinum and are associated with high morbidity and mortality, particularly if there is a delay in diagnosis.</p></div><div><h3>Case Report</h3><p>A 52-year-old man presented with dyspnea and neck swelling after inserting a toothbrush into his throat when he thought he was developing an allergic reaction to sushi. He had extensive neck and chest crepitus, with pneumomediastinum identified on chest x-ray. Flexible laryngoscopy was used to directly identify a posterior pharyngeal perforation. The patient was hemodynamically stable without signs of sepsis, and the otolaryngology consultant deferred surgical intervention. He was successfully treated with conservative medical management and made a full recovery.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>Hypopharyngeal perforation is a rare diagnosis with high morbidity and mortality. Early diagnosis, broad-spectrum antibiotics, and early surgical consultation are essential to minimize complications of this rare presentation.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 2","pages":"Article 100017"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43140065","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":"Cotton fever: A case report and review of the literature","authors":"Natasha Tobarran ,&nbsp;John Huchison ,&nbsp;Emily Kershner ,&nbsp;Andrew Chambers ,&nbsp;Kirk L. Cumpston ,&nbsp;Brandon K. Wills","doi":"10.1016/j.jemrpt.2023.100030","DOIUrl":"10.1016/j.jemrpt.2023.100030","url":null,"abstract":"<div><h3>Background</h3><p>The term “cotton fever” describes a benign, self-limited febrile response within minutes following cotton filter use with intravenous (IV) drug injection. We present a case of <em>Pantoea</em> species (previously <em>Enterobacter agglomerans</em>) bacteremia related to injection of solubilized oxycodone.</p></div><div><h3>Case report</h3><p>A 33-year-old male solubilized half of an oxycodone 5 mg tablet in tap water, filtered it with cotton and injected it intravenously. He immediately felt unwell. Initial vital signs included a temperature of 40.5 ​°C, blood pressure 150/107 ​mmHg, heart rate 170 bpm, respiratory rate 28 bpm, and SpO2 of 98% on room air. His physical exam was notable only for rigors. Initial laboratory studies demonstrated a serum lactate of 2.7 mmol/L without leukocytosis. He was treated with vancomycin and piperacillin/tazobactam for two days with resolution of fever. Blood cultures were positive for <em>Pantoea</em> species resistant to ampicillin and cefazolin. He continued piperacillin/tazobactam for three additional days then transitioned to oral levofloxacin for seven days upon discharge.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>Cotton fever describes an acute, febrile response following IV injection using cotton as a filter. The initial febrile reaction could be due to pyrogens or preformed endotoxins. Bacteremia from <em>Enterobacter agglomerans</em> (now <em>Pantoea</em> species) is possible and is frequently resistant to amoxicillin and first- and second-generation cephalosporins.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 2","pages":"Article 100030"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42325167","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}