JEM reports最新文献_第9页

A woman with right upper extremity paralysis 一名右上肢瘫痪的妇女

JEM reports Pub Date : 2023-12-10 DOI: 10.1016/j.jemrpt.2023.100070

T Andrew Windsor , Jade J. Wong-You-Cheong , Daniel B. Gingold , J David Gatz

引用次数: 0

Reconsidering conservative treatment of primary spontaneous pneumothoraces: A case report 重新考虑原发性自发性气胸的保守治疗：病例报告

JEM reports Pub Date : 2023-12-02 DOI: 10.1016/j.jemrpt.2023.100063

Khalid Zahalka , Tabea Haas-Heger , Ben Balogun-Ojuri

{"title":"Reconsidering conservative treatment of primary spontaneous pneumothoraces: A case report","authors":"Khalid Zahalka , Tabea Haas-Heger , Ben Balogun-Ojuri","doi":"10.1016/j.jemrpt.2023.100063","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100063","url":null,"abstract":"<div><h3>Background</h3><p>Interventional management for primary spontaneous pneumothoraces (PSPs) appears to have become the norm, with conservative management having been pushed into the background over the past few decades. In the UK, management of PSPs is guided by the British Thoracic Society (BTS) Guidelines. While original guidance, dating back to 2011, favoured interventional management, the newly released updated BTS algorithm has given the conservative approach greater visibility.</p></div><div><h3>Case report</h3><p>A teenager presented to the Emergency Department after having developed sudden onset chest discomfort. A chest x-ray confirmed a PSP. He was admitted and initially treated conservatively. After 24 hours of observation, a chest drain was inserted on the basis of a lack of radiologic improvement. On discharge after chest drain removal, he was found to have a recurrence of his pneumothorax when reviewed at the outpatient respiratory clinic. He was again managed conservatively, this time successfully.</p></div><div><h3>Why should the emergency physician be aware of this?</h3><p>This case raised several questions regarding the management of stable patients presenting with PSP. The body of evidence supporting conservative management as a safe and feasible option has been growing. It is therefore important for physicians to reconsider its role and value. While the newly released BTS guidelines are a step in the right direction, there are a number of important questions to address in order to both effectively guide emergency physicians and for conservative management to be used in a more standardised and routine way.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 1","pages":"Article 100063"},"PeriodicalIF":0.0,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232023000597/pdfft?md5=39a3406a5f86d44353fd9a0aa90c8f29&pid=1-s2.0-S2773232023000597-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138549202","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

Sternomanubrial septic arthritis following minor chest trauma 胸骨管脓毒性关节炎继发于轻微的胸部创伤

JEM reports Pub Date : 2023-11-27 DOI: 10.1016/j.jemrpt.2023.100055

Ami Schattner , Ina Dubin , Livnat Uliel

引用次数: 0

Ultrasound-guided fascia iliaca nerve block gelatin model 超声引导髂筋膜神经阻滞明胶模型

JEM reports Pub Date : 2023-11-27 DOI: 10.1016/j.jemrpt.2023.100066

Mary Rometti, Ashley Keifer, Grant Wei, Christopher Bryczkowski

{"title":"Ultrasound-guided fascia iliaca nerve block gelatin model","authors":"Mary Rometti, Ashley Keifer, Grant Wei, Christopher Bryczkowski","doi":"10.1016/j.jemrpt.2023.100066","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100066","url":null,"abstract":"<div><h3>Background</h3><p>Patients with hip fractures frequently present to the emergency department (ED). Traditional methods of pain control often include the use of opioid pain medication. Fascia iliaca nerve blocks offer an alternative method to acute pain management in the ED for hip fractures. At the time of this publication, there are no readily available, cost-effective gelatin models of the surrounding fascia iliaca anatomy.</p></div><div><h3>Objectives</h3><p>The objective was to design an accurate and cost-effective model to simulate fascia iliaca nerve block models for training emergency medicine clinicians.</p></div><div><h3>Discussion</h3><p>A gelatin model was created to simulate the anatomy of the inguinal region in order to perform a fascia iliaca block. This fascia iliaca nerve block model aided in training of residents and attendings to become familiar with the anatomy and techniques necessary to perform this nerve block. Clinicians were able to practice ultrasound guided in-plane approach into the fascia iliaca space where they could then hydrodissect and distill anesthetic. Each model could be used several times allowing trainees multiple attempts.</p></div><div><h3>Conclusion</h3><p>A method to create a fascia iliaca nerve block model using readily available supplies was designed to aid training of emergency medicine clinicians. We hope to improve the technique and clinician comfort-level when performing the fascia iliaca nerve block using this model.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 1","pages":"Article 100066"},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232023000627/pdfft?md5=0143e913b9c8ea79a88de83e0e648664&pid=1-s2.0-S2773232023000627-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138472576","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: 2

Aims and Scope 目标及范围

JEM reports Pub Date : 2023-11-27 DOI: 10.1016/S2773-2320(23)00065-2

引用次数: 0

An EM Intern's Misadventure and Lessons in Sleep and Wellness 一名电磁学实习生的不幸遭遇以及睡眠和健康方面的经验教训

JEM reports Pub Date : 2023-11-26 DOI: 10.1016/j.jemrpt.2023.100059

Rebekah Riordan

{"title":"An EM Intern's Misadventure and Lessons in Sleep and Wellness","authors":"Rebekah Riordan","doi":"10.1016/j.jemrpt.2023.100059","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100059","url":null,"abstract":"<div><h3>Background</h3><p>Burnout, mental health issues, and sleep disorders continue to be a problem among emergency medicine physicians, affecting patient care, personal well-being, and retention of the specialty.</p></div><div><h3>Case report</h3><p>A 35-year-old female emergency medicine intern is brought in by her assistant program directors for altered mental status and ataxia, concerning for alcohol or drug intoxication. It was noted that she was confused, oriented only to self, and seemed to be experiencing auditory hallucinations. Also noted was she was tremulous and exhibited an ataxic gait. However, lab testing was inconsistent with drug or alcohol intoxication. During her hospital admission, it was discovered she had been awake over 80 hours after gaining collateral from friends and family. With the administration of a large amount of trazodone, she eventually fell asleep and was later diagnosed with four different sleep disorders and successfully treated by sleep specialists. This case is discussed here to bring more awareness to the poor state of wellness in the emergency medicine specialty and to suggest practical ways to address these multifactorial issues.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 1","pages":"Article 100059"},"PeriodicalIF":0.0,"publicationDate":"2023-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S277323202300055X/pdfft?md5=e4d85a70420d4defb8ed1039ffe27c11&pid=1-s2.0-S277323202300055X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138656560","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

Pasteurella multocida epiglottitis: A case report 多杀性巴氏杆菌会厌炎1例

JEM reports Pub Date : 2023-11-25 DOI: 10.1016/j.jemrpt.2023.100058

Laura Sofoulis , Blake Dawson , Tuan Pham

{"title":"Pasteurella multocida epiglottitis: A case report","authors":"Laura Sofoulis , Blake Dawson , Tuan Pham","doi":"10.1016/j.jemrpt.2023.100058","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100058","url":null,"abstract":"<div><h3>Background</h3><p>Acute epiglottitis is a life-threatening condition usually caused by streptococcal or staphylococcal species. It is rarely caused by <em>Pasteurella multocida</em>, which is an oropharyngeal commensal in cats and dogs, and is usually responsible for human skin infections following inoculation by bite or scratch.</p></div><div><h3>Case report</h3><p>We report a case of a 50-year-old female who presented to the emergency department with acute epiglottitis due to <em>Pasteurella multocida</em>. The patient suffered rapid deterioration and subsequent hypoxic cardiac arrest requiring advanced life support measures and intubation. She recovered well following a course of penicillin-based intravenous antibiotics and airway support in the intensive care unit. Infection was likely acquired after close contact with her pet dog.</p></div><div><h3>Why an emergency physician should be aware of this</h3><p><em>Pasteurella multocida</em> can cause a variety of atypical infections, including acute epiglottitis, and should be considered a possible causal organism in those with a history of animal exposure. While it is important to take a careful exposure history, the nature of a patient's presentation may necessitate a reliance on collateral history when there is unexpected and rapid patient deterioration. As is demonstrated in this case, the diagnosis, management, and treatment of adult-onset epiglottitis is multidisciplinary in nature and reliant on careful patient assessment that correlates pertinent historical findings with relevant laboratory results.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 1","pages":"Article 100058"},"PeriodicalIF":0.0,"publicationDate":"2023-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232023000548/pdfft?md5=f1a97ed40c037ea28f3e47b0ab0a1c89&pid=1-s2.0-S2773232023000548-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138474526","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 law of unintended consequences: An unusual case of posterior reversible encephalopathy syndrome during lithium therapy and hypernatremia 意想不到的后果规律:锂治疗和高钠血症期间后可逆脑病综合征的不寻常病例

JEM reports Pub Date : 2023-11-24 DOI: 10.1016/j.jemrpt.2023.100067

Giuseppe Trainito , Lorenzo Pelagatti , Heifa Ounalli , Cecilia Lanzi , Francesco Gambassi , Alessandra Ieri , Francesca Innocenti

{"title":"The law of unintended consequences: An unusual case of posterior reversible encephalopathy syndrome during lithium therapy and hypernatremia","authors":"Giuseppe Trainito , Lorenzo Pelagatti , Heifa Ounalli , Cecilia Lanzi , Francesco Gambassi , Alessandra Ieri , Francesca Innocenti","doi":"10.1016/j.jemrpt.2023.100067","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100067","url":null,"abstract":"<div><h3>Background</h3><p>We present the case of a 70-year-old woman who experienced an episode of posterior reversible encephalopathy syndrome (PRES) triggered by hyperlithiemia and hypernatremia.</p></div><div><h3>Case repor</h3><p>t: This case report describes a 70-year-old woman with bipolar disorder who presented at the Emergency Department (ED) with posterior reversible encephalopathy syndrome (PRES) triggered by hyperlithiemia and hypernatremia. Although lithium treatment is commonly prescribed for bipolar disorder, the exact mechanisms underlying lithium-induced PRES are still under investigation. The patient's altered consciousness prompted toxicological consultation, leading to a diagnosis of PRES associated with lithium toxicity. The patient required intensive care and received hydration therapy, resulting in a gradual reduction of sodium and lithium levels. After a period of rehabilitation, she was discharged with minimal neurological deficits.</p></div><div><h3>\"Why should an emergency physician be aware of this?\"</h3><p>Hyperlithiemia is an extremely rare cause of PRES (Posterior Reversible Encephalopathy Syndrome), which, if unrecognized, can have serious consequences and long-term effects on the patient.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 1","pages":"Article 100067"},"PeriodicalIF":0.0,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232023000639/pdfft?md5=55847e2549c9635692be6e36170457ac&pid=1-s2.0-S2773232023000639-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138466479","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

Pitfalls of overreliance on capnography and disregard of visual evidence of tracheal tube placement: A pediatric case series 过度依赖气管造影和忽视气管管放置的视觉证据的陷阱:一个儿科病例系列

JEM reports Pub Date : 2023-11-24 DOI: 10.1016/j.jemrpt.2023.100061

Daniel H. Lee , Brian E. Driver , Robert F. Reardon

{"title":"Pitfalls of overreliance on capnography and disregard of visual evidence of tracheal tube placement: A pediatric case series","authors":"Daniel H. Lee , Brian E. Driver , Robert F. Reardon","doi":"10.1016/j.jemrpt.2023.100061","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100061","url":null,"abstract":"<div><h3>Background</h3><p>Confirming the placement of an endotracheal tube in a pediatric patient is a critically important step in resuscitation, and no single method of confirmation has been proven to be completely reliable. Capnography has become the standard-of-care in confirming endotracheal tube placement in many institutions and guidelines. However, it has inherent limitations in critically ill patients.</p></div><div><h3>Case report</h3><p>Two pediatric patients presented with acute hypoxemic respiratory failure in the emergency department and both underwent endotracheal intubation with video laryngoscopy. Post-intubation capnography showed no evidence of end-tidal carbon dioxide production. The clinicians assumed a misplaced endotracheal tube for both patients despite multiple emergency physicians simultaneously visualizing the endotracheal tube being placed through the vocal cords on the video laryngoscopy monitor. Both patients subsequently underwent multiple repeated intubations for over 30 minutes without any change in capnography findings. In one case, the reason for the lack of capnography findings was incorrectly connected capnography tubing; for the other, a positive capnography finding was only visualized after surfactant administration allowed adequate ventilation.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>Capnography, though a valuable tool, is not an infallible method of endotracheal tube placement confirmation. Sole reliance on one method of confirmation, particularly in light of other compelling evidence—eg, clear visualization of tube passage through the vocal cords by multiple experienced physicians—should be avoided.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 1","pages":"Article 100061"},"PeriodicalIF":0.0,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232023000573/pdfft?md5=662c1af32980149a9b9ba9fefff9b4a3&pid=1-s2.0-S2773232023000573-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138466480","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

Hyponatremia after intravenous zoledronic acid administration: A case report 静脉注射唑来膦酸后低钠血症1例

JEM reports Pub Date : 2023-11-22 DOI: 10.1016/j.jemrpt.2023.100054

Nafis Vural , Murat Duyan

{"title":"Hyponatremia after intravenous zoledronic acid administration: A case report","authors":"Nafis Vural , Murat Duyan","doi":"10.1016/j.jemrpt.2023.100054","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100054","url":null,"abstract":"<div><h3>Background</h3><p>Bisphosphonates are an antiresorptive agent approved to treat numerous skeletal disorders, including osteoporosis (postmenopausal and steroid-induced), malignancy-associated bone disease, and Paget's bone disease. The three most commonly used intravenous (IV) bisphosphonates for these treatments are zoledronate, ibandronate, and pamidronate. IV bisphosphonates for PMO have the advantage of better adherence to treatment compared to daily oral therapy.</p></div><div><h3>Case report</h3><p>A 77-year-old female patient presented to the emergency department (ED) with complaints of nausea and vomiting for one day. In the patient's history, it was learned that she had been using 4 mg zoledronic acid IV every four weeks for three months. Symptomatic hyponatremia was detected according to the patient's laboratory results and clinic. Since the patient had symptomatic hyponatremia, 150ml 3 % sodium chloride infusion was given. In addition, hydration was continued as she had metabolic alkalosis due to vomiting. The patient, whose symptoms decreased, was hospitalized for follow-up and treatment.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>ED physicians and other clinicians should be aware that gastrointestinal symptoms such as nausea and vomiting may occur after intravenous administration of zoledronate and that symptoms may be the cause or result of hyponatremia. In these cases, laboratory examinations, appropriate treatments, and hospitalization should be performed for the necessary patients.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 4","pages":"Article 100054"},"PeriodicalIF":0.0,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232023000500/pdfft?md5=dd6725f20a578f4b59489902e07cb946&pid=1-s2.0-S2773232023000500-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138430727","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