Journal of the American College of Emergency Physicians open最新文献

{"title":"An unknown (and unexpected) cause of septic shock","authors":"Augustine Kang PhD,&nbsp;Pranjal Gupta MD,&nbsp;Sunnie Wong MD, PhD,&nbsp;Jamie Tung MD,&nbsp;Moises Gallegos MD","doi":"10.1002/emp2.13248","DOIUrl":"10.1002/emp2.13248","url":null,"abstract":"<p>An 80-year-old woman with end-stage renal disease on peritoneal dialysis presented with an episode of syncope. On arrival, the patient was hypotensive, tachycardic, tachypneic, and febrile to 100.2°F. The patient was alert and oriented to person only. There was no abdominal tenderness and her peritoneal catheter site was clean, dry, and intact. A computed tomography scan of her abdomen and pelvis was conducted to rule out peritonitis (Figure 1).</p><p>Murky drainage was later noted to be present at the site of the patient's peritoneal dialysis catheter. A decision was made in consultation with surgery to perform an exploratory laparotomy. Murky and bilious fluid was found in the pelvis, and a pinhole defect with bilious leakage was identified in the proximal ileum in the left lower quadrant. A jellybean-like, non-obstructive nodule (later confirmed by pathology to be an indolent schwannoma) was also found 8 cm distal to the site of the perforation. A 4 cm fishbone was extracted from the small bowel, and 15 cm of the small bowel was resected to include the defect and the nodule (Figure 2).</p><p>Few cases of septic shock from bowel perforation from ingested fish bones have been reported.<span>^{1, 2}</span> The presented case of a fish bone perforation of the ileum as a cause of septic shock underscores the importance of considering multiple etiologies in the setting of undifferentiated shock.</p><p>The authors declare they have no conflicts of interest.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11284238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794195","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 workplace violence prevention program targeting high-risk patients in emergency departments","authors":"Son Chae Kim PhD, RN,&nbsp;Jennifer Kaiser PhD, RN,&nbsp;Tracy Hosford MSN, RN,&nbsp;Carol Sadate-Akhavi MSN, RN,&nbsp;Ashleigh Nurski MSN, RN,&nbsp;Thomas Bos BS,&nbsp;Chelsea Ciampa MSN, RN","doi":"10.1002/emp2.13206","DOIUrl":"10.1002/emp2.13206","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Patient violence in emergency departments (EDs) may be prevented with proactive mitigation measures targeting potentially violent patients. We aimed to evaluate the effects of two interventions guided by a validated risk-assessment tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective interventional study was conducted among patients ≥10 years who visited two EDs in Michigan, USA, from October 2022 to August 2023. During triage, the ED nurses completed the Aggressive Behavior Risk Assessment Tool for EDs (ABRAT-ED) to identify high-risk patients. Following the baseline observational period, interventions were implemented stepwise for the high-risk patients: phase 1 period with signage posting and phase 2 period with a proactive Behavioral Emergency Response Team (BERT) huddle added to the signage posting. Before ED disposition, any violent events and their severities were documented. The data were retrieved retrospectively after the study was completed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 77,424 evaluable patients, 546 had ≥1 violent event. The violent event rates were 0.93%, 0.68%, and 0.62% for baseline, phase 1, and phase 2, respectively. The relative risk of violent events for phase 1 compared to the baseline was 0.73 (95% confidence interval [CI]: 0.59‒0.90; <i>p </i>= 0.003). The relative risk for phase 2 compared to phase 1 was 0.92 (95% CI: 0.76‒1.12; <i>p </i>= 0.418).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The use of signage posting as a persistent visual cue for high-risk patients identified by ABRAT-ED appears to be effective in reducing the overall violent event rates. However, adding proactive BERT huddle to signage posting showed no significant reduction in the violent event rates compared to signage posting alone.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11269763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763122","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":"From concept to reality: A comprehensive exploration into the development and evolution of a virtual emergency department","authors":"Jason Talevski PhD,&nbsp;Adam I. Semciw PhD,&nbsp;James H. Boyd PhD,&nbsp;Rebecca L. Jessup PhD,&nbsp;Suzanne M. Miller MD,&nbsp;Jennie Hutton MBChB, MPH,&nbsp;Joanna Lawrence MBChB, MPH,&nbsp;Loren Sher MBBCh","doi":"10.1002/emp2.13231","DOIUrl":"10.1002/emp2.13231","url":null,"abstract":"<p>Emergency department (ED) overcrowding remains a persistent challenge in global public health, leading to detrimental outcomes for patients and healthcare professionals. Traditional approaches to improve this issue have been insufficient, prompting exploration of novel strategies such as virtual care interventions. Our team developed the first comprehensive statewide virtual ED in Australia, the Victorian Virtual Emergency Department, offering an alternative to in-person care for non-life-threatening emergencies. Here, we present the development and ongoing refinement of this pioneering virtual care service, aiming to provide insights for hospital administrators and policymakers seeking to implement patient-centric care solutions worldwide. By sharing our model of care, we hope to guide further work toward addressing the global problem of over crowded EDs.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11269764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763123","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":"Alleviating stressfeeding in the emergency department: Elucidating the tensions induced by workplace lactation space issues","authors":"Kimberly L. Moulton MD,&nbsp;Samantha A. Izuno MD,&nbsp;Nicole Prendergast MD,&nbsp;Nicole Battaglioli MD,&nbsp;Stefanie S. Sebok-Syer PhD","doi":"10.1002/emp2.13226","DOIUrl":"10.1002/emp2.13226","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Women remain underrepresented in the emergency medicine (EM) workforce, academic EM, and institutional leadership. In order to support women physicians in EM, we must explore factors that contribute to attrition and workplace satisfaction. For example, tensions between workplace and familial roles are important to consider as women navigate careers in EM. The logistics and stressors of workplace lactation pose a particular challenge during an already stressful time for a new mother returning to work in a busy emergency department (ED), but limited empirical data exist regarding this experience. We aimed to explore the stressors associated with workplace lactation spaces in order to better inform the creation of lactation spaces for individuals working in EDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Our team used an exploratory qualitative design to investigate lactation-specific stressors and understand their relationship to individuals’ needs when lactating in EM workplace environments. A total of 40 individuals were interviewed, highlighting post-pregnancy return-to-work (RTW) experiences of medical students, residents, advanced practice professionals, nurses, fellows, and faculty. Interviews were coded and analyzed using thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified both tangible and intangible characteristics of lactation spaces that contribute to stress for lactating individuals. Additionally, we discovered that participants frequently noted a desire to work simultaneously while pumping in order to feel they were self-actualizing in their dual roles of parent and clinician. Among tangible items, access to a computer within lactation space was a key driver of ability to fulfill dual roles. Among intangible characteristics, we identified three distinct, yet interrelated, subthemes, including the need for lactation spaces to be respectful of individuals’ time, privacy, and general health and well-being.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study suggests that meeting basic lactation needs with thoughtfully designed lactation spaces can empower individuals in their roles both as a lactating parent and a clinician. EM leadership can evaluate existing lactation spaces to ensure they meet the tangible and intangible needs of lactating physicians, trainees, advanced practice professionals, and nurses.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11264252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753475","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":"Understanding uptake of information about innovations among emergency department clinicians during the COVID-19 pandemic","authors":"Nabeel Qureshi MPH, MPhil,&nbsp;Shreya S. Huilgol BA,&nbsp;Carl T. Berdahl MD, MS,&nbsp;Catherine C. Cohen PhD, RN,&nbsp;Peter Mendel PhD,&nbsp;Shira H. Fischer MD, PhD","doi":"10.1002/emp2.13243","DOIUrl":"https://doi.org/10.1002/emp2.13243","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Early in the COVID-19 pandemic, little was known about managing sick patients, but emergency department (ED) clinicians had to decide which treatments and care processes to adopt. Our objective was to describe how ED clinicians learned about innovations and how they assessed them for credibility during the pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We purposively sampled clinicians from hospital-based EDs to conduct focus groups with ED clinicians and staff. We used both inductive and deductive approaches to conduct thematic analysis of transcripts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We conducted focus groups with clinicians from eight EDs across the United States. We found that ED clinicians in our sample relied on friends and colleagues or departmental and institutional leadership for information on innovations. They used social media sources when they came from credible accounts but did not directly seek information from professional societies. Clinicians reported a range of challenges to obtain credible information during the pandemic, including a fractured and changing information environment, policies misaligned across clinical sites or that conflicted with clinical knowledge, high patient volume, fear of harming patients, and untimely information. Facilitators included access to experienced and trusted colleagues and leaders and practicing at multiple EDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Participants cited anecdotal evidence, institutional practice, and word-of-mouth—rather than peer-reviewed evidence and professional society communications—as their primary sources of information about care innovations during the early phases of the pandemic. These results underscore the importance of developing trusted local mechanisms and wider networks to identify and vet information for frontline clinicians during rapidly emerging public health emergencies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13243","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141732535","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":"Epidemiology and risk stratification of young infants presenting to the emergency department with hypothermia","authors":"Michelle L. Wang BA,&nbsp;Indi Trehan MD, MPH","doi":"10.1002/emp2.13241","DOIUrl":"https://doi.org/10.1002/emp2.13241","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Hypothermic infants are presumed to be at high risk for a serious bacterial infection (SBI) or herpes simplex virus (HSV) infection. In contrast to febrile infants, the emergency department (ED) management of hypothermic infants is variable in the absence of consensus guidelines, potentially resulting in low-value care and missed diagnoses. We investigated the diagnostic workup conducted for hypothermic infants in our academic pediatric ED, the incidence of SBI and HSV infection, and risk factors associated with infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a single-center retrospective study of infants ≤90 days of age with a rectal temperature ≤36.5°C in the ED between 2013 and 2022. From their medical records, we abstracted the type(s) of testing each infant received in the ED and the diagnosis of SBI and HSV, analyzing characteristics associated with each.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1095 hypothermic infants identified, 402 (37%) underwent testing for SBI or HSV. Among these, 34/402 (8.5%) had an SBI or HSV. A minimum temperature below 36°C and hospital admission were characteristics associated with higher rates of infectious testing. Infants aged 29‒90 days, compared to 0‒28 days, were more likely to have a urinary tract infection (odds ratio 3.28, 95% confidence interval 1.47‒7.32).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Hypothermic infants have slightly lower rates of SBI or HSV than febrile infants, for whom infectious studies are widely recommended, but still high enough to warrant an infectious workup in most cases. Further research is required to risk stratify hypothermic infants in the ED to standardize care and improve outcomes while optimizing resource utilization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13241","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730178","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":"Change from semi-rigid to soft collars for prehospital management of trauma patients: An observational study","authors":"Biswadev Mitra MBBS, PhD,&nbsp;Stephen Bernard MBBS, MD,&nbsp;Cassandra Yankoff CCRN,&nbsp;Abha Somesh CCRN,&nbsp;Cara Stewart CCRN,&nbsp;Christine Koolstra CCRN,&nbsp;Carly Talarico MPH, MHA,&nbsp;Ziad Nehme PhD,&nbsp;Mark C. Fitzgerald MBBS, MD,&nbsp;Peter A. Cameron MBBS, MD","doi":"10.1002/emp2.13239","DOIUrl":"https://doi.org/10.1002/emp2.13239","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Protection of the cervical spine is recommended following multisystem injury. In 2021, Ambulance Victoria changed clinical practice guidelines to apply soft collars instead of semi-rigid collars for suspected cervical spine injury. The aim of this study was to describe associated changes in imaging practices and diagnoses of pressure sores, hospital acquired pneumonia, and spinal cord injury.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective pre- and postintervention study was conducted including all consecutive patients that presented to an adult major trauma center in Melbourne, Australia with a cervical collar placed by emergency medical services over two 3-month periods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 1762 patients included. A computed tomography (CT) of the cervical spine was performed in 795 (88.4%) patients in the semi-rigid collar period and 810 (93.8%) in the soft collar period (<i>p</i> = 0.001). Soft collars were associated with higher rates of clearance of the cervical spine in the emergency department (ED) (odds ratio [OR] 4.14; 95% confidence interval [CI]: 3.36–5.09). There were no differences in diagnosis of pressure sores (0.11% vs. 0.23%, <i>p</i> = 0.97) or hospital acquired pneumonia (2.0% vs. 2.7%; <i>p</i> = 0.44) or cervical spinal cord injury (0.45% vs. 0.81%; <i>p</i> = 0.50).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Following a change from prehospital semi-rigid collars to soft collars, more patients were investigated with a CT scan and more frequent clearance of the cervical spine occurred in the ED. There were no differences in the rates of spinal cord injuries, pressure sores or hospital acquired pneumonia, but the study was underpowered to detect significant differences. The practice of soft collars for prehospital care of patients with suspected neck injury requires ongoing surveillance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13239","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141639511","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":"Hidden hemorrhage: A case of idiopathic omental hemorrhage causing spontaneous hemoperitoneum","authors":"Emily McDowell MD,&nbsp;Kirsten Hughes MD,&nbsp;Max Jones,&nbsp;Candace Kimpson MD,&nbsp;Michael J. Twiner MD, PhD,&nbsp;Sean McCormick MD","doi":"10.1002/emp2.13242","DOIUrl":"https://doi.org/10.1002/emp2.13242","url":null,"abstract":"<p>Idiopathic omental hemorrhage (IOH) is a rare and underexplored entity in current medical literature. Most patients are male, aged 20–65 years, presenting with abdominal pain. Like most presentations of active intra-abdominal bleeding, recognition, stabilization, and definitive management are key. Expedited diagnosis and treatment of this condition is imperative as mortality rates can exceed 30% in cases due to delays of care. Presented here is a case of a young male with abdominal pain and recurrent emesis, ultimately diagnosed with bleeding from the greater omentum. He had been discharged from the emergency department the previous day. This patient's presentation highlights the importance of having high clinical suspicion for IOH in patients with recurrent or intractable nausea and emesis with persistent abdominal pain and utilizing advanced imaging for unexplained symptoms.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13242","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141639513","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":"Utility of D-dimer in predicting pulmonary embolism in patients with COVID-19 presenting to the emergency department","authors":"Natalie M. Lemon MD,&nbsp;Luke K. Taylor MS,&nbsp;Megan A. Rech PharmD, MS,&nbsp;Quang Nguyen MS,&nbsp;Gregory J. Matthews PhD,&nbsp;George Lew MD, PhD,&nbsp;Shannon Lovett MD","doi":"10.1002/emp2.13237","DOIUrl":"https://doi.org/10.1002/emp2.13237","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>While our understanding of coronavirus disease 2019 (COVID-19) has evolved, uncertainty remains regarding utility of previously established pulmonary embolism (PE) screening guidelines in patients with COVID-19. Many studies have investigated the efficacy of D-dimer (DD) screenings for patients with COVID-19 admitted to inpatient services, but few have evaluated patients in the emergency department (ED). The purpose of this study was to investigate utility of DD threshold for PE screening in patients with COVID-19 presenting to the ED.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective, multicenter cohort including patients presenting to three EDs between March 1, 2020 and February 1, 2021 who tested positive for COVID-19 during ED visit or in 60 days prior to presentation and had DD ordered in ED. Patients were grouped by those who underwent computed tomography pulmonary angiogram (CTPA) to evaluate for PE and those who did not, and descriptive statistics were performed. Those who underwent CTPA were further divided into PE-positive and PE-negative groups. The discriminative ability of DD in predicting PE in patients with COVID-19 was analyzed using the receiver operating characteristic (ROC) curve.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 570 patients with COVID-19 were included in the study, of which 107 underwent CTPA to evaluate for PE. History of diabetes, elevated glucose, elevated lactate dehydrogenase, elevated white blood cell count, elevated platelets, elevated respiratory rate, and lower temperature were associated with increased risk for PE. Compared to those without PE, patients with PE were significantly more likely to be hospitalized (100% vs. 82%, <i>p</i> = 0.020) and admitted to the ICU (64% vs. 24%, <i>p</i> = 0.002). Those with PE had a significantly higher median DD value (21,177 ng/mL) compared to PE-negative group (952 ng/mL, <i>p</i> &lt; 0.001). The ROC curve for DD in predicting PE had an area under the curve of 0.91 (95% confidence interval [0.84, 0.98]). In our study population, the optimal DD threshold for predicting PE was 1815 ng/mL (sensitivity 93% and specificity 80%). A conservative threshold of 1089 ng/mL could be used with sensitivity 100% and specificity 58%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>DD is often elevated in patients with COVID-19, regardless of PE. While the classically used DD cutoff is 500 ng/mL, our study demonstrated a threshold of 1089 ng/mL safely predicted PE in patients with COVID-19 .</p>\u0000 ","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13237","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141639456","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":"Man with hypertension and abdominal pain","authors":"Morgan Pooler MD,&nbsp;Andrew T. Reiter MD,&nbsp;Joseph S. Colla MD","doi":"10.1002/emp2.13230","DOIUrl":"https://doi.org/10.1002/emp2.13230","url":null,"abstract":"<p>A 61-year-old with history of hypertension and atrial flutter on rivaroxaban presented to the emergency department from a cardiology clinic for uncontrolled hypertension. The patient reported intermittent, nonexertional, left-sided chest, and epigastric pressure. On examination, the patient had elevated blood pressure: left arm 240/131 and right arm 217/109. Vital signs were otherwise normal and physical examination was unremarkable. The patient's electrocardiogram showed no acute ischemic changes. Point-of-care ultrasound (Video 1 and Figure 1) and computed tomography angiography (CTA) (Figure 2) of the patient's aorta were obtained.</p><p>Spontaneous isolated celiac artery dissection (SICAD) is a rare visceral arterial dissection, the second leading type after superior mesenteric artery dissection. Symptoms can range from an asymptomatic incidental finding to severe epigastric, back, or flank pain in middle-aged adults.<span>^{1, 2}</span> The most prevalent risk factors include male sex, smoking, and hypertension.<span>^{3, 4}</span> CTA is the primary modality used to diagnose SICAD worldwide. Findings include an intimal flap, which is pathognomonic, or a mural thrombus in the celiac lumen. Complications include organ ischemia, aneurysm formation, and rupture.<span>⁵</span> First-line treatment for SICAD is conservative management including strict blood pressure control, antithrombotic therapy, and surveillance. Surgical and endovascular intervention are reserved for patients who have failed conservative treatment.<span>⁶</span></p><p>Our patient was admitted to the cardiac intensive care unit on a labetalol drip to treat hypertensive emergency. Vascular surgery was consulted and recommended addition of a daily aspirin and atorvastatin to his home medications and smoking cessation. The patient was discharged home in stable condition on hospital day 2.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13230","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141639512","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}