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

{"title":"Man with a painful red eye","authors":"Casey Morris MD,&nbsp;Dana Lewis NP,&nbsp;Wesley Eilbert MD","doi":"10.1002/emp2.13325","DOIUrl":"https://doi.org/10.1002/emp2.13325","url":null,"abstract":"<p>A 38-year-old man presented to the emergency department (ED) with a 1-week history of left eye pain and redness (Figures 1-3). The eye pain radiated to his left forehead and was temporarily relieved by ibuprofen. He denied any associated change in his vision. On examination, his eye was diffusely injected, most prominently on the superior and lateral aspects. Instillation of 2.5% phenylephrine eye drops did not significantly change the injection.</p><p>Scleritis is a rare, vision-threatening inflammation of the sclera. It occurs most commonly in the middle-aged, with women more commonly affected.<span>¹</span> Up to 50% of cases of scleritis occur in the setting of systemic autoimmune disease, most commonly rheumatoid arthritis.<span>²</span> Scleritis may be due to infectious causes, medication-induced, or occurring after intraocular surgery, and many cases are idiopathic.<span>²</span></p><p>Patients with scleritis present with an injected, painful eye. The eye pain may radiate to the jaw, forehead or scalp, and is typically worse at night.<span>³</span> The involved eye is usually diffusely injected, though the injection may be localized and nodular in appearance.<span>⁴</span> As with this case, installation of topical vasoconstrictor agents such as phenylephrine will not cause a blanching of the injected vessels with scleritis, as it would with conjunctivitis and episcleritis. Further evaluation and treatment of scleritis in the ED should ideally be discussed with an ophthalmologist and may include investigations for rheumatologic and infectious etiologies. Oral nonsteroidal anti-inflammatory drugs and topical corticosteroids are considered first-line therapy for cases of noninfectious scleritis such as this.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13325","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142447665","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 left-sided flank pain","authors":"Yu-Xuan Jiang MD,&nbsp;Chun-Gu Cheng MD,&nbsp;Yen-Yue Lin MD","doi":"10.1002/emp2.13326","DOIUrl":"https://doi.org/10.1002/emp2.13326","url":null,"abstract":"<p>A 35-year-old man with alcohol abuse presented to the emergency department with a 7-day history of cough and left-sided flank pain. His temperature, pulse rate, and blood pressure were 38.1°C, 104 beats/min, and 134/92 mmHg, respectively. Based on physical examination, his breath sounds were smooth without crackles; whereas, the left flank region was tender to palpation. His white blood cell count, platelet count, and C-reactive protein were 17,740/µL, 1101 × 10³ mm, and 18.5 mg/dL, respectively. An emergency physician performed ultrasonography revealing heterogeneous echoic lesions in the spleen (Figure 1), and the diagnosis was confirmed by computed tomography (Figure 2).</p><p>The patient received antibiotic treatment (moxifloxacin), laparoscopic splenectomy, and pus drainage by a surgeon (Figure 3). The tissue culture of the spleen grew <i>Streptococcus constellatus</i>.</p><p>Splenic abscess is an uncommon life-threatening disease, with incidence ranging from 0.14% to 0.7%. However, the patients are at high risk of mortality if appropriate treatment is not administered. The clinical presentation of fever, left upper quadrant tenderness, and leukocytosis is not usually present. It potentially causes misdiagnosis in patients presenting with nonspecific symptoms, such as cough, abdominal pain, back pain, and malaise.<span>¹</span> Splenectomy is the gold standard treatment for splenic abscess. Percutaneous drainage can be an alternative therapy in patients with high surgical risk.<span>²</span></p><p>The authors declare 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":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142447662","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":"Foreign body complication","authors":"Marcos Adriano Garcia Campos MD,&nbsp;Jadson Oliveira Aguiar MD,&nbsp;Raphael Oliveira Lima Silva MD,&nbsp;Pedro Manuel Barros de Sousa MD,&nbsp;Gyl Eanes Barros Silva MD, PhD","doi":"10.1002/emp2.13288","DOIUrl":"https://doi.org/10.1002/emp2.13288","url":null,"abstract":"<p>A 50-year-old man presented at the emergency department (ED) with pain in the right iliac fossa (RIF) for 10 days associated with nausea, vomiting, fever, and dysuria. On admission examination, he was afebrile, anicteric, with negative Giordano's sign, and there was severe tenderness on deep palpation of the RIF. His vital signs were normal. Blood tests revealed elevated leukocytosis, no anemia, normal kidney function, amylase, and lipase level. A computed tomography (CT) scan of the abdomen was performed showing the presence of a foreign body (FB), a fishbone, inside cecal appendix, with the formation of an abscess (Figure 1). An open appendectomy was performed, with signs of perforation. The patient was discharged 5 days after surgery.</p><p>FB ingestion is a common condition at ED, mainly among children (80% cases).<span>^{1, 2}</span> In appendix, the FB can cause acute appendicitis, perforations, periappendiceal abscess, and peritonitis.<span>³</span> Although fishbone is one of the most ingested FB, it rarely causes perforation of the appendix.<span>⁴</span> Ingested fishbone can get impacted in any part of the digestive tract and cause serious complications (perforation, abscess, and tract obstruction). Due to poor peristaltic movement, the appendix is unable to expel the FB back to the cecum, leading progressively to inflammation with a high risk of appendix perforation.<span>⁵</span> CT scan has high sensitivity and specificity to detect fishbone showing as a linear calcified object surrounded by inflammation.<span>⁶</span> Surgical treatment is the best management in the case of fishbone-induced appendicitis.<span>⁷</span></p><p>The authors declare 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":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13288","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443536","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 man with hip pain post-trauma","authors":"Haley Sinatro MD, MBA,&nbsp;C. Reece Brockman II MD","doi":"10.1002/emp2.13328","DOIUrl":"https://doi.org/10.1002/emp2.13328","url":null,"abstract":"<p>A 22-year-old man presented to the emergency department with new left hip pain and chronic firmness after a fall. He has a history of multiple traumatic injuries and quadriplegia secondary to a motor vehicle accident 8 months prior. Examination reveals a firm, irregularly shaped left thigh with mild tenderness to the hip and thigh.</p><p>X-ray of the left hip shows extensive bulky heterotopic ossifications, and a computed tomography scan shows myositis ossificans about the left iliopsoas bursa (Figures 1 and 2). Prior to discharge, the patient was counseled on the importance of continuing physical therapy, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for symptomatic management, and the importance for a follow-up outpatient x-ray.</p><p>Heterotopic ossificans refers to bone deposition within soft tissue, with myositis ossificans specifically referring to muscle. This can occur in up to half of spinal cord injury patients, most commonly 12 weeks after injury.<span>¹</span> Plain radiographs are of low utility early on, as calcification may take months to appear. Early ultrasound<span>²</span> or triple phase bone scan has high reliability as a diagnostic method. Treatment modalities include range of motion exercises to support joint mobility and NSAIDs. More recently, bisphosphonates have shown utility in halted progression of ossification.<span>³</span> Surgery remains an option for refractory cases, but recurrence is common.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13328","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443579","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":"Implementation of an EMS-based naloxone distribution program: A qualitative evaluation","authors":"Emily E. Ager MD, MPH,&nbsp;Ella K. Purington MD,&nbsp;Megan H. Purdy MD,&nbsp;Brian Benenati MD,&nbsp;Jessica E. Baker BS,&nbsp;Christine Jane Schellack MD,&nbsp;Graham C. Smith MD,&nbsp;Nathaniel R. Hunt MD,&nbsp;Eve D. Losman MD, MHSA","doi":"10.1002/emp2.13300","DOIUrl":"https://doi.org/10.1002/emp2.13300","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We evaluated a novel leave-behind naloxone (LBN) program that allows Emergency Medical Services (EMS) personnel to distribute naloxone after an opioid overdose. Our objective was to explore EMS engagement and experiences with the program, as well as interest in education on addiction and harm reduction. We also assessed the acceptability of LBN programs among people who use drugs (PWUD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted telephone interviews with EMS personnel and residents of substance use recovery housing between February and September 2023. EMS personnel described their direct experiences with the LBN program and perceived facilitating factors and barriers to naloxone distribution. First responder interactions and support for LBN were explored with PWUD. A rapid assessment method was used to analyze the interview data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighteen of the 23 EMS participants had distributed LBN; most agreed EMS agencies should have an LBN program. Barriers included forgetting, patient acuity, patients declining, and perceived liability. Facilitators included having a clear protocol, accessible kits, and minimal documentation burden. The majority expressed interest in harm reduction education. Eight of the 11 PWUD participants reported recent involvement in an opioid overdose. The majority supported LBN and felt comfortable receiving naloxone training from EMS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this qualitative evaluation, we found broad support for EMS-based naloxone distribution among EMS personnel and PWUD. We identified several modifiable barriers to the success of such programs, which should be the subject of future investigation. EMS and harm reduction communities should support the expansion of LBN programs across the United States.</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":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13300","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443537","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 abdominal pain following blunt trauma","authors":"Katarina Trajkovic MD,&nbsp;Sanela Hasanagic MD,&nbsp;Dragan Vasin MD","doi":"10.1002/emp2.13335","DOIUrl":"https://doi.org/10.1002/emp2.13335","url":null,"abstract":"<p>A 73-year-old patient presented to the emergency department after a fall from a 3-m height, complaining of headache and light pain in the abdomen. Upon examination his vital signs were stable, his abdomen tender, and a small hematoma was observed in the left hemiabdomen. Laboratory results showed a normal bleeding profile and leukocytosis. Ultrasound examination demonstrated hyperechoic mesenteric fat. Head computed tomography (CT) showed no signs of trauma. Contrast-enhanced CT of the abdomen revealed the Janus sign (Figure 1), the complete cutoff sign (Figures 2 and 3), free fluid, and small gas particles.</p><p>The patient underwent immediate surgery: jejunal resection and sigmoid resection with terminal colostomy were performed. He recovered well and was discharged in good condition. Closing of the colostomy is planned for the end of the year.</p><p>Bowel injury is rare in blunt abdominal trauma, often presenting with few signs and symptoms.<span>¹</span> CT is the primary imaging modality for evaluating these patients.<span>²</span> Bowel transection is the most severe form of bowel trauma, and the findings include the Janus sign—specific for small bowel transection, representing a hyper enhancing loop continuous with a loop that shows no or decreased enhancement, as well as the complete cutoff sign—the circular disruption of the bowel wall, specific of both small and large bowel transection.<span>³</span> Knowledge and prompt observance of these signs, as well as of nonspecific findings, such as pneumoperitoneum or free fluid, is the key to the correct diagnosis and timely surgical treatment.</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":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13335","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443583","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":"Emergency physicians spend more time caring for patients who prefer a language other than English which may not be accounted for in reimbursement structures","authors":"Martin A. Reznek MD, MBA,&nbsp;Jennifer Edwards MD, MBA,&nbsp;Sean S. Michael MD, MBA,&nbsp;Jacqueline Furbacher MD, MS,&nbsp;Alexandra Sanseverino MD, MBA,&nbsp;Payal K. Modi MD, MPH,&nbsp;Kevin A. Kotkowski MD, MBA,&nbsp;Celine Larkin PhD","doi":"10.1002/emp2.13332","DOIUrl":"https://doi.org/10.1002/emp2.13332","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Emergency departments increasingly serve patients who prefer a language other than English. Honoring patients’ language preferences is crucial for quality and cultural appropriateness of care. We sought to assess whether time spent in caring for patients who preferred a language other than English differed from patients whose language preference was English. Secondarily, we sought to assess professional reimbursement across the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed an existing dataset from a time-in-motion study that included direct observation measurements of emergency physicians’ time spent during patient encounters. Our primary outcome was physician time spent conducting patient care, comparing patients who preferred a language other than English to patients who preferred English. Secondarily, we sought to assess if relative value unit (RVU)-based compensation differed across the two groups. We calculated descriptive statistics and performed multivariable regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Across 218 patient encounters, physicians spent 18.6% longer on encounters with patients whose preferred a language other than English (median = 18.5 min, interquartile range [IQR] 14.8–27.9 min) than for those who preferred English (median = 15.6 min, IQR 11.5–22.9 min; <i>p</i> = 0.04). After controlling for other factors, patients’ preferred language was not associated with increased RVUs (<i>β</i> = −0.12, <i>t</i> = −1.94, <i>p</i> = 0.055).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Emergency physicians appear to spend more time caring for patients who prefer a language other than English. This additional effort during the care of this potentially vulnerable population may not be reflected in past and current reimbursement structures. Additional research is prudent as we seek to better address social determinants of health in care delivery and reimbursement systems.</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":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13332","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443584","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":"Emergency physicians perspectives of state continuing medical education requirements for medical licensure","authors":"Marianne Gausche-Hill MD,&nbsp;Yachana Bhakta MPH,&nbsp;Michael C. Bond MD,&nbsp;Sandra M. Schneider MD,&nbsp;Jeffrey Druck MD,&nbsp;Colleen E. Livingston BS,&nbsp;Lisa Moreno-Walton MD,&nbsp;Jonathan S. Jones MD,&nbsp;Melissa A. Barton MD","doi":"10.1002/emp2.13314","DOIUrl":"10.1002/emp2.13314","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aims to better understand the perspectives of emergency medicine physicians’ on the role that state-mandated, topic-specific continuing medical education (CME) plays in addressing knowledge gaps, its relevance to current emergency practice, its reported burden and costs of CME activities to emergency physicians, and its perceived improvement in patient care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional survey was designed by the Coalition of Board-Certified Emergency Physicians (COBCEP) and distributed in February 2023 to all American Board of Emergency Medicine (ABEM)-certified physicians. Statistical tests of significance (Pearson's chi-square and Fisher's exact test) assessed the cost and time spent on CME as well as the perceived value placed on CME by ABEM-certified physicians to improve patient care. Data were summarized using descriptive statistics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 5562 (13.0%) responses from the 43656 physicians who received the survey—5506 responses were included for analysis. Over half of the physicians (53.0%) had more than 15 years of post-residency practice experience. Most physicians (57.3%) spent less than $5,000 per year on obtaining CME. Most physicians practicing in states with state-mandated, topic-specific CME requirements believed that participation in ABEM continuing certification could be used to reduce the need for state-mandated, topic-specific CME requirements (83.6%) and state-mandated, topic-specific requirements were believed to be unlikely to improve patient care (70.8%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although well-intended, state CME requirements may lack relevancy and can, at times, place an undue burden on emergency physicians. Tailoring CME requirements to increase relevance to their patient populations and reduce barriers to completing CME could enhance knowledge translation and improve patient outcomes.</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":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395757","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":"Total body weight estimation by 3D camera systems: Potential high-tech solutions for emergency medicine applications? A scoping review","authors":"Mike Wells MBBCh, PhD,&nbsp;Lara Nicole Goldstein MD, PhD,&nbsp;Terran Wells,&nbsp;Niloufar Ghazi MD,&nbsp;Abhijit Pandya PhD,&nbsp;Borifoje Furht PhD,&nbsp;Gabriella Engstrom PhD,&nbsp;Muhammad Tanveer Jan PhD,&nbsp;Richard Shih MD","doi":"10.1002/emp2.13320","DOIUrl":"10.1002/emp2.13320","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Weight estimation is required in adult patients when weight-based medication must be administered during emergency care, as measuring weight is often not possible. Inaccurate estimations may lead to inaccurate drug dosing, which may cause patient harm. High-tech 3D camera systems driven by artificial intelligence might be the solution to this problem. The aim of this review was to describe and evaluate the published literature on 3D camera weight estimation methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic literature search was performed for articles that studied the use of 3D camera systems for weight estimation in adults. Data on the study characteristics, the quality of the studies, the 3D camera methods evaluated, and the accuracy of the systems were extracted and evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 14 studies were included, published from 2012 to 2024. Most studies used Microsoft Kinect cameras, with various analytical approaches to weight estimation. The 3D camera systems often achieved a P10 of 90% (90% of estimates within 10% of actual weight), with all systems exceeding a P10 of 78%. The studies highlighted a significant potential for 3D camera systems to be suitable for use in emergency care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The 3D camera systems offer a promising method for weight estimation in emergency settings, potentially improving drug dosing accuracy and patient safety. Weight estimates were satisfactorily accurate, often exceeding the reported accuracy of existing weight estimation methods. Importantly, 3D camera systems possess characteristics that could make them very appropriate for use during emergency care. Future research should focus on developing and validating this methodology in larger studies with true external and clinical validation.</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":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11452255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382677","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 characteristics of coral snake bites reported to the National Poison Data System (2006‒2022)","authors":"Mary E. Velagapudi DO,&nbsp;Juliana J. Navarro MD, MPH,&nbsp;Alexander E. Hill MD,&nbsp;Michael A. Darracq MD, MPH,&nbsp;Stephen L. Thornton MD","doi":"10.1002/emp2.13296","DOIUrl":"10.1002/emp2.13296","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;North American coral snake envenomations can result in life-threatening neurotoxicity. Their bites are relatively rare, making large studies difficult. Using the National Poison Data System (NPDS), we sought to investigate the epidemiological trends and clinical outcomes associated with North American coral snake bites over a 17-year period.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;NPDS cases involving coral snakes from January 1, 2006, to December 31, 2022, were analyzed. Data collected included patient age, date, geographic location, clinical effects, treatments administered, and medical outcomes including incidence of “dry bites” (non-envenomation) and death.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;During the 17-year period, a total of 1374 cases were reported and analyzed. Cases included adults (≥ 20 years), accounting for 80% (&lt;i&gt;n&lt;/i&gt; = 1107), and pediatric patients (≤19 years), accounting for 20% (&lt;i&gt;n&lt;/i&gt; = 267) of total cases. Out of 50 US states and District of Columbia, 20 states reported cases. Florida and Texas accounted for 90.5% of all bites (&lt;i&gt;n&lt;/i&gt; = 1243) with April being the month with the most reported cases (&lt;i&gt;n&lt;/i&gt; = 184). The most bites (&lt;i&gt;n&lt;/i&gt; = 96) were reported in 2008 and the fewest (&lt;i&gt;n&lt;/i&gt; = 69) in 2016. Male patients predominated for both pediatric (75.7%, &lt;i&gt;n&lt;/i&gt; = 202) and adult cases (75.3%, &lt;i&gt;n&lt;/i&gt; = 834). Moderate to major clinical outcomes were documented in approximately 30% of total cases; with no reported deaths. Moderate effect is defined as the patient exhibited symptoms as a result of the exposure that were more pronounced, more prolonged, or more of a systemic nature than minor symptoms. Major effect was defined as the patient exhibited symptoms as a result of the exposure that were life threatening or resulted in significant residual disability or disfigurement. The three most reported clinical effects were wound/sting, dermal irritation/pain, and edema. Antivenom was administered in 21% (&lt;i&gt;n&lt;/i&gt; = 286) of total cases and 37% (&lt;i&gt;n&lt;/i&gt; = 511) of patients were admitted to a critical care unit. Dry bites occurred in 7% (&lt;i&gt;n&lt;/i&gt; = 100) of total cases.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Coral snake bites were rare, but consistently reported. While bites were associated with significant morbidity in adult and pediatric patients, there were no deaths reported. Antivenom use declined over the study period but was not associated with an increase in morbidity. An increased incidence of intubations was seen in association with decreased antiv","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11449674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382676","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}