JEM reports最新文献_第9页

Lemierre's syndrome diagnosed using bedside ultrasound in the emergency department 在急诊科使用床边超声诊断莱米尔综合征

JEM reports Pub Date : 2025-03-01 Epub Date: 2024-12-19 DOI: 10.1016/j.jemrpt.2024.100135

Anis Adnani , Wesley Eilbert

{"title":"Lemierre's syndrome diagnosed using bedside ultrasound in the emergency department","authors":"Anis Adnani , Wesley Eilbert","doi":"10.1016/j.jemrpt.2024.100135","DOIUrl":"10.1016/j.jemrpt.2024.100135","url":null,"abstract":"<div><h3>Background</h3><div>Lemierre's syndrome (LS) is a rare disease, typically occurring after a recent oropharyngeal infection. It is characterized by septic thrombophlebitis of the internal jugular (IJ) vein and bacteremia with metastatic septic emboli. Computed tomography (CT) of the neck with intravenous contrast is the imaging study of choice to diagnose the IJ vein thrombosis present with LS.</div></div><div><h3>Case report</h3><div>We present the case of an 18-year-old male who presented to the emergency department (ED) with right sided neck pain and shortness of breath. He had been seen in the ED two days earlier complaining of sore throat and was diagnosed with a viral infection. CT examinations of the neck and chest with intravenous contrast found multifocal bilateral nodular pulmonary densities with some soft tissue stranding adjacent to the right carotid sheath. No intraluminal filling defects of the right IJ vein were noted. A bedside ultrasound revealed a non-compressible hyperechoic thrombus in the right IJ vein, confirming the diagnosis of LS. To our knowledge, this is only the second reported case of LS diagnosed using bedside ultrasound that was initially missed on CT.</div><div><em>Why should an emergency physician be aware of this?</em> Rapid recognition of LS, a potentially fatal illness, is paramount to optimize outcome. Bedside ultrasound is a useful tool available to emergency physicians to diagnose this disease and initiate prompt treatment.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100135"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143157423","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

Ketamine for rapid control of hyperactive delirium with severe agitation. A retrospective comparison study 氯胺酮快速控制严重躁动的多动性谵妄。回顾性比较研究

JEM reports Pub Date : 2025-03-01 Epub Date: 2025-01-18 DOI: 10.1016/j.jemrpt.2025.100138

Beatrice Borreani , Annalisa Belluti , Francescopaolo D'Adamo , Luca Acquarone , Cristina Cocino , Paolo Canepa , Francesco Quaglia , Martina D'Antoni , Andrea Alienda , Alessandro Riccardi

{"title":"Ketamine for rapid control of hyperactive delirium with severe agitation. A retrospective comparison study","authors":"Beatrice Borreani , Annalisa Belluti , Francescopaolo D'Adamo , Luca Acquarone , Cristina Cocino , Paolo Canepa , Francesco Quaglia , Martina D'Antoni , Andrea Alienda , Alessandro Riccardi","doi":"10.1016/j.jemrpt.2025.100138","DOIUrl":"10.1016/j.jemrpt.2025.100138","url":null,"abstract":"<div><h3>Background</h3><div>The agitated patient represents a very large clinical problem for the work of the emergency department. The therapeutic goal is rapid symptom control while ensuring maximum patient safety. Hyperactive delirium constitutes a true clinical emergency, and some sedatives carry inherent risks. Ketamine has already demonstrated remarkable safety in this setting. OBJECTIVES This study aims to indentify an effective and safe option for the rapid control of severe psychomotor agitation METHODS Our retrospective study analyzes the comparison of ketamine alone, ketamine with droperidol, and midazolam with haloperidol. RESULTS During the period of January 2022 and September 2023 we identified 66 patients with severe psychomotor agitation (13–76 years), and we demonstrated a faster and more effective response in patients treated with ketamine, and a reduction in adverse events in patients treated with ketamine and droperidol. CONCLUSIONS Our data show that patients treated with ketamine exhibit a significantly faster response, with immediate patient control, with greater safety than patients treated with midazolam. The combination with droperidol increases clinical efficacy compared with ketamine alone.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100138"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100750","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

Bilateral true vocal fold avulsion following trampoline accident: A case report 蹦床事故致双侧真声带撕脱1例

JEM reports Pub Date : 2025-03-01 Epub Date: 2025-01-27 DOI: 10.1016/j.jemrpt.2025.100146

Allison Epstein , Alexandra Welschmeyer , Temitope Adeyeni , Jamil Hayden , Matthew Gropler , Jay Shah , Nelson Scott Howard

{"title":"Bilateral true vocal fold avulsion following trampoline accident: A case report","authors":"Allison Epstein , Alexandra Welschmeyer , Temitope Adeyeni , Jamil Hayden , Matthew Gropler , Jay Shah , Nelson Scott Howard","doi":"10.1016/j.jemrpt.2025.100146","DOIUrl":"10.1016/j.jemrpt.2025.100146","url":null,"abstract":"<div><h3>Background</h3><div>Vocal cord avulsion is a rare and potentially devastating injury which may result from blunt laryngotracheal trauma. While there are cases of unilateral vocal cord avulsion, we present a pediatric patient with bilateral vocal cord avulsion from blunt trauma to the anterior neck following a trampoline accident.</div></div><div><h3>Case report</h3><div>This 10-year-old female presented with dysphonia and dysphagia and was found to have bilateral vocal cord avulsion effecting the superior vocal fold with a noticeable height mismatch and exposed cartilage seen only on diagnostic direct laryngoscopy, corresponding to a Schaeffer Grade 3 laryngeal injury. Distal chip laryngoscopy was not as useful in providing a comprehensive examination of the patient due to muscle tension with arytenoid prolapse. Primary endoscopic repair was performed with subsequent improved vocal cord position, voice quality, and tolerance of oral intake.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Laryngeal trauma in children is rare, and early detection is critical to optimize long term outcomes. To date, no universal protocol for diagnosis and management of these injuries in the pediatric population exists. A low index of suspicion of endolaryngeal injury must be maintained for children with these injuries given their smaller airway diameter and increased propensity to develop acute airway compromise in the absence of obvious warning signs or symptoms. We highlight our endoscopic repair technique and excellent postoperative course with improvements in voice, swallow, and overall quality of life.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100146"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143156626","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

High dose intravenous ascorbic acid masking hypoglycemia in a patient presenting with stroke-like symptoms: A case report 高剂量静脉注射抗坏血酸掩盖出现卒中样症状患者的低血糖：1例报告

JEM reports Pub Date : 2025-03-01 Epub Date: 2024-12-26 DOI: 10.1016/j.jemrpt.2024.100136

John Seaser , Brooke Sherman

{"title":"High dose intravenous ascorbic acid masking hypoglycemia in a patient presenting with stroke-like symptoms: A case report","authors":"John Seaser , Brooke Sherman","doi":"10.1016/j.jemrpt.2024.100136","DOIUrl":"10.1016/j.jemrpt.2024.100136","url":null,"abstract":"<div><h3>Background</h3><div>Point of care glucometers are commonly used in the emergency setting on patients presenting with stroke-like symptoms to rule out abnormal glucose levels as a cause. High doses of intravenous (IV) ascorbic acid have been shown to interfere with the accuracy of point of care glucose readings and some continuous glucose monitors (CGM). This interaction can cause falsely elevated point of care glucose readings which can mask true hypoglycemia.</div></div><div><h3>Case report</h3><div>A 65-year-old female with a past medical history of leukemia and type 1 diabetes mellitus on an insulin pump presented with stroke-like symptoms after receiving an IV infusion of high dose ascorbic acid as an adjunctive cancer treatment. Point of care glucose upon emergency department arrival was 127 mg/dL, however, serum glucose resulted as 36 mg/dL. The serum glucose was thought to be an error when a repeated point of care glucose was 128 mg/dL. The patient was considered for thrombolytic therapy, but it was ultimately held. A repeat serum glucose was again critically low at 37 mg/dL, and around this time the drug-device interaction was discovered. The patient was given IV dextrose with immediate resolution of her symptoms.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Symptoms of hypoglycemia can mimic stroke, and not recognizing hypoglycemia could result in inappropriate thrombolytic administration or delayed correction of glucose. As outpatient vitamin and hydration clinics are becoming more prevalent, providers should be aware of the drug-device interaction between IV ascorbic acid and glucose meters that could negatively impact care.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100136"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143157425","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

Unveiling Wunderlich syndrome: Diagnosis and management of a rare spontaneous renal hematoma 揭示Wunderlich综合征：罕见自发性肾血肿的诊断和治疗

JEM reports Pub Date : 2025-03-01 Epub Date: 2025-01-27 DOI: 10.1016/j.jemrpt.2025.100144

Rebecca Merrill , Pete Jordanides , Jessica Krizo , Erin L. Simon

{"title":"Unveiling Wunderlich syndrome: Diagnosis and management of a rare spontaneous renal hematoma","authors":"Rebecca Merrill , Pete Jordanides , Jessica Krizo , Erin L. Simon","doi":"10.1016/j.jemrpt.2025.100144","DOIUrl":"10.1016/j.jemrpt.2025.100144","url":null,"abstract":"<div><h3>Background</h3><div>Wunderlich syndrome (WS) is a rare condition that is described as an atraumatic, spontaneous renal hemorrhage in the perirenal space. Symptoms typically present as nondescript flank pain, but a flank mass and hypovolemic shock are also possible. Computed tomography (CT) imaging with intravenous contrast should be the modality of choice to diagnose WS, with recent studies highlighting the efficacy of transcatheter arterial embolization (TAE) as the preferred treatment over surgery. WS is often secondary to conditions such as renal neoplasms, vascular diseases, and infections, necessitating adequate follow up to determine the etiology.</div></div><div><h3>Case report</h3><div>We present the case of a 79-year-old woman presenting to the emergency department (ED) with left flank pain. Computed tomography with angiography revealed a large left renal subcapsular hematoma with perinephric and retroperitoneal extension with active extravasation, characteristic of Wunderlich syndrome. The patient was treated emergently with transcatheter arterial embolization of the lower polar branch of her left renal artery. In the ED, WS can present with a variety of non-specific symptoms, making the diagnosis challenging for emergency physicians.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Wunderlich syndrome is a rare, sudden, and life-threatening emergency that requires prompt diagnosis, as the hematoma can spread to the perinephric space leading to massive internal hemorrhage. Causes and presenting symptoms are variable, with flank pain being a common symptom. CT or MRI imaging is necessary for diagnosis, and embolization is often the treatment of choice to avoid further complications.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100144"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100752","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

Acute pancreatitis and euglycemic non-diabetic ketoacidosis caused by an intentional semaglutide overdose 故意过量服用西马鲁肽引起的急性胰腺炎和血糖正常的非糖尿病酮症酸中毒

JEM reports Pub Date : 2025-03-01 Epub Date: 2025-01-17 DOI: 10.1016/j.jemrpt.2025.100139

Anthony Acosta , Ashley Fanco , Hataitaya Rohan , Zane Elfessi

{"title":"Acute pancreatitis and euglycemic non-diabetic ketoacidosis caused by an intentional semaglutide overdose","authors":"Anthony Acosta , Ashley Fanco , Hataitaya Rohan , Zane Elfessi","doi":"10.1016/j.jemrpt.2025.100139","DOIUrl":"10.1016/j.jemrpt.2025.100139","url":null,"abstract":"<div><h3>Background</h3><div>Glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, have been approved for weight loss and have gained popularity for its efficacy and a once-weekly administration. The FDA approved max dose of 2.4 mg per week resulted in a 10 % reduction in weight over a 6-month period. GLP receptors are expressed in islet and exocrine duct cells of the pancreas. Case reports of pancreatitis and diabetic ketoacidosis have been reported in patients who have hypertriglyceridemia or carry a diagnosis of diabetes.</div></div><div><h3>Case report</h3><div>We report a first-of-its kind case of an intentional overdose of semaglutide leading to pancreatitis and ultimately euglycemic non-diabetic ketoacidosis (EnDKA). Overstimulation by GLP-1 agonists, like semaglutide, can lead to hyperplasia and resulting pancreatitis. Acute pancreatitis can induce a systemic inflammatory response and may be responsible for dysfunction of beta cells and subsequent insulin deficiency, resulting in diabetic ketoacidosis.</div><div>Why should an EM Physician be aware of this?</div><div>Acute pancreatitis and euglycemic non-diabetic ketoacidosis are both life threatening emergencies. As the use of weight-management drugs become increasingly popular, the incidence of these emergencies may be on the rise as well.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100139"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100754","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

Curious case of a frozen pupil – Orbital apex syndrome 奇怪的瞳孔冻结病例-眶尖综合征

JEM reports Pub Date : 2025-03-01 Epub Date: 2025-01-13 DOI: 10.1016/j.jemrpt.2025.100140

Sophia Aguirre, Rahul Nene

引用次数: 0

Hydrogen peroxide toxicity of a lower lip piercing: A case report 过氧化氢对下唇穿孔的毒性：1例报告

JEM reports Pub Date : 2025-03-01 Epub Date: 2025-01-11 DOI: 10.1016/j.jemrpt.2025.100137

Monique Graf , Craig Reece Brockman II , Kara Pretzlaff

{"title":"Hydrogen peroxide toxicity of a lower lip piercing: A case report","authors":"Monique Graf , Craig Reece Brockman II , Kara Pretzlaff","doi":"10.1016/j.jemrpt.2025.100137","DOIUrl":"10.1016/j.jemrpt.2025.100137","url":null,"abstract":"<div><h3>Background</h3><div>Hydrogen peroxide, a well-known cleaning product, is responsible for a large number of emergency department visits each year. The current literature contains only few case reports of these exposures, and our case report provides an example of what can happen from direct hydrogen exposure and how it is managed from the emergency department.</div></div><div><h3>Case report</h3><div>A 26-year-old female presented to the emergency department with lower lip swelling and overlying skin changes. Vital signs were within normal limits and the remainder of her exam was within normal limits. It was elicited with further questioning that the patient had irrigated her lip piercing the night before with hydrogen peroxide. With this information, the correct diagnosis of hydrogen peroxide toxicity was made and with the help of oral and maxillofacial surgery, the patient was treated appropriately for this condition.</div></div><div><h3>Why should emergency medicine physicians be aware of this</h3><div>Toxic exposures, whether via direct contact, inhalation, or ingestion, are commonly seen in the emergency department and require expeditious diagnosis and treatment. Based on physical exam alone, lip swelling suggests a variety of diagnoses. In this case, as in many others, accurate history taking is crucial in making the correct diagnoses.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100137"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143157426","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

Implementing artificial intelligence for electrocardiogram interpretation: A case study 在心电图判读中应用人工智能：一个案例研究

JEM reports Pub Date : 2025-03-01 Epub Date: 2024-12-07 DOI: 10.1016/j.jemrpt.2024.100132

Jace C. Bradshaw , Emily Nagourney , McKenzie Warshel , P Logan Weygandt

{"title":"Implementing artificial intelligence for electrocardiogram interpretation: A case study","authors":"Jace C. Bradshaw , Emily Nagourney , McKenzie Warshel , P Logan Weygandt","doi":"10.1016/j.jemrpt.2024.100132","DOIUrl":"10.1016/j.jemrpt.2024.100132","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) is expected to have a growing role in medical diagnostic interpretation and existing programs should be challenged with difficult cases in clinical practice senerios. An isolated posterior myocardial infarction (MI) is suggested by ST segment depression in the anteroseptal leads on a standard 12-lead electrocardiogram (ECG) and confirmed by the presence of 0.5mm ST segment elevation in any of the posterior leads (V7-V9). Isolated posterior MI is rare (potentially <4 % of all MIs).</div></div><div><h3>Case report</h3><div>We present a case of a 79-year-old man who presented with intermittent chest pain and subtle ECG changes concerning for a posterior MI. His catheterization images confirm a completely occluded LCx artery. We also present the AI analysis of the ECG's crucial for making the diagnosis in this case.</div><div>Why should an Emergency Physician be aware of this?</div><div>Given the diagnostic challenge of posterior wall MIs with a standard 12-lead ECG, clinical suspicion for a posterior MI should remain high with any degree of ST segment depression in the anterior leads and prompt the emergency physician to obtain a posterior ECG. AI-based ECG interpretation was able to determine that this patient was having an occlusive myocardial infarction. We discuss how to utilize the third-party AI for diagnostic aid.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100132"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100248","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

A case report: Point-of-care ultrasound revealing cystolithiasis in a bladder diverticulum as the cause of sepsis and encephalopathy 病例报告：点护理超声显示膀胱憩室膀胱结石作为败血症和脑病的原因

JEM reports Pub Date : 2025-03-01 Epub Date: 2024-12-12 DOI: 10.1016/j.jemrpt.2024.100133

Kahra Nix , Alexandra Parson , Nicholas DiMeo , Jeffery Baker

引用次数: 0