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

{"title":"Evaluating the current breadth of randomized control trials on cardiac arrest: A scoping review","authors":"Jake Toy DO, MS,&nbsp;Lauren Friend MD,&nbsp;Kelsey Wilhelm MD,&nbsp;Michael Kim MD,&nbsp;Claire Gahm MD,&nbsp;Ashish R. Panchal MD, PhD,&nbsp;David Dillon MD, PhD,&nbsp;Joelle Donofrio-Odmann DO,&nbsp;Juan Carlos Montroy MD, PhD,&nbsp;Marianne Gausche-Hill MD,&nbsp;Nichole Bosson MD, MPH,&nbsp;Ryan Coute DO,&nbsp;Shira Schlesinger MD, MPH,&nbsp;James Menegazzi PhD, MS","doi":"10.1002/emp2.13334","DOIUrl":"https://doi.org/10.1002/emp2.13334","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Despite the significant disease burden due to cardiac arrest, there is a relative paucity of randomized controlled trials (RCTs) to inform definitive management. We aimed to evaluate the current scope of cardiac arrest RCTs published between 2015 and 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a search in October 2023 of MEDLINE, Embase, and Web of Science for cardiac arrest RCTs. We included trials published between 2015 and 2022 enrolling human subjects suffering from non-traumatic cardiac arrest. Descriptive statistics were reported and the Mann Kendall test was used to evaluate for temporal trends in the number of trials published annually.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 1764 unique publications, 87 RCTs were included after title/abstract and full-text review. We found no significant increase in trials published annually (eight in 2015 and 16 in 2022, <i>p</i> = 1.0). Geographic analysis of study centers found 31 countries represented; Denmark (<i>n</i> = 13, 15%) and the United States (<i>n</i> = 9, 10%) conducted the majority of trials. Nearly all trials included adults (<i>n</i> = 84, 97%) and few included children (<i>n</i> = 9, 10%). The majority of trials focused on out-of-hospital cardiac arrest (<i>n</i> = 62, 71%). Thirty-eight (44%) trials used an intervention characterized as a <i>process improvement</i>; 28 (32%) interventions were characterized as a <i>drug</i> and 20 (23%) as a <i>device</i>. Interventions were implemented with similar frequency in the prehospital (33%) and intensive care unit (38%) setting, as well as similarly between the intra-arrest (53%) and post-arrest (46%) periods. Twenty (27%) trials selected a primary outcome of survival at ≥ 28 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Publication of cardiac arrest RCTs remained constant between 2015 and 2022. We identified significant gaps including a lack of trials examining in-hospital cardiac arrest and pediatric patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"5 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13334","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451259","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":"Impact of California's naloxone co-prescription law on emergency department visits, 30-day mortality, and prescription patterns","authors":"Ali Ghobadi MD,&nbsp;Michael Hanna MD,&nbsp;Stephanie Tovar MS,&nbsp;Duy H. Do PhD,&nbsp;Lewei Duan PhD,&nbsp;Ming-Sum Lee MD, PhD,&nbsp;Elizabeth A. Samuels MD, MPH,&nbsp;Corey S. Davis JD, MSPH,&nbsp;Adam L. Sharp MD, MSc","doi":"10.1002/emp2.13236","DOIUrl":"https://doi.org/10.1002/emp2.13236","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Opioid overdose is a public health epidemic adversely impacting individuals and communities. To combat this, California passed a law mandating that prescribers offer a naloxone prescription in certain circumstances. Our objective was to evaluate associations with California's naloxone prescription mandate and emergency department (ED) overdose visits/hospitalizations, opioid and naloxone prescribing, and 30-day mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included data from January 1, 2018, to December 31, 2019, and included all Kaiser Permanente Southern California (KPSC) members aged &gt;10 years across 15 KPSC EDs. Exposure was defined as presentation to the ED within the study period. The primary outcome was ED visits for opioid overdose pre- and post-implementation of California's naloxone prescription mandate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1.1 million ED visits (534K pre/576K post) were included in the study population. ED opioid overdose visits were 344 (6.4/10,000) pre-policy and 351 (6.1/10,000) post-policy implementation, while non-opioid overdose visits were 309 (5.8/10,000) pre-implementation and 411 (7.1/10,000) post-implementation. The unadjusted rate of visits with opioid prescriptions decreased significantly (14.9% pre to 13.5% post) after implementation. ED naloxone prescriptions increased substantially (104 pre vs. 6031 post). Primary adjusted interrupted time series analysis found no statistical difference between monthly opioid overdose visits pre versus post (odds ratio 1.02, 95% confidence interval [CI] 0.98‒1.07). Difference-in-differences analysis revealed no significant changes in hospitalization (coefficient [CE] = ‒0.05, 95% CI = ‒0.11 to 0.02) or 30-day mortality (CE = ‒0.01, 95% CI = ‒0.03 to 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study revealed that the implementation of California's naloxone prescription mandate was associated with significantly increased naloxone prescribing and decreased opioid prescribing, but no significant change in ED opioid overdose visits, hospitalizations, or 30-day mortality. This indicates that increasing naloxone prescribing alone may not be sufficient to lower opioid overdose rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"5 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13236","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449051","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 flank pain","authors":"Da Xian Pang MMed,&nbsp;Wei Feng Lee MMed","doi":"10.1002/emp2.13295","DOIUrl":"https://doi.org/10.1002/emp2.13295","url":null,"abstract":"<p>A 48-year-old male with no known past medical history presented to the emergency department with left flank pain of 3 days duration. A urinalysis performed revealed trace blood, which was equivocal for the diagnosis of ureteric colic. A bedside ultrasound performed during assessment revealed a cystic structure within the left renal pelvis (Figure 1A) initially thought to be a renal cyst. Given its unusual location, Doppler ultrasound was utilized with detection of a pulsatile flow (Figure 1B) in the lesion. Computed tomography (CT) urography revealed a ruptured large left renal artery aneurysm (RAA) (Figure 2). The patient subsequently underwent a successful angioembolization of the aneurysm by interventional radiology.</p><p>Renal cysts are common incidental findings on imaging. However, they are typically found in the peripheries of the kidney. Parapelvic cysts (PPC) are uncommon, accounting for 1%–2% of all renal cysts.<span>¹</span> This case exemplified the need to consider differential diagnosis such as RAA when encountering PPC, especially when there is pain involved. The additional utilization of doppler ultrasound can help to differentiate these two entities, of which the latter is a common and rather benign diagnosis while the former is a rare but potentially dangerous diagnosis to miss.</p><p>RAA is known to also mimic other diagnoses on ultrasound. Case reports have described them mimicking renal cell carcinoma and even nephrolithiasis.<span>^{2, 3}</span> Once again, the use of doppler may potentially help to differentiate these diagnoses.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"5 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13295","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449181","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":"Paramedic educational programs maintain entry level competency throughout the COVID-19 pandemic","authors":"Shea L. van den Bergh MPH,&nbsp;Lakeshia T. Logan DMSc, PA-C,&nbsp;Jonathan R. Powell MPA, NRP,&nbsp;Christopher B. Gage MHS, NRP,&nbsp;Kathryn R. Crawford MS,&nbsp;Lisa Collard AS,&nbsp;Michael G. Miller EdD, RN,&nbsp;Ashish R. Panchal MD, PhD","doi":"10.1002/emp2.13316","DOIUrl":"https://doi.org/10.1002/emp2.13316","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The COVID-19 pandemic required unprecedented changes to emergency medical services (EMS) educational frameworks in the United States. It is unclear if pandemic-related changes impacted paramedic educational outcomes. We aimed to evaluate curricular and performance changes resulting from the initial COVID-19 pandemic on paramedic educational programs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective cross-sectional evaluation of paramedic educational programs in 2019 and 2020 using the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions annual reports. These reports contain detailed program components and measures of program success. We included programs reporting at least one graduate in the study period. Descriptive statistics (proportions [%], median [interquartile range, IQR]) were calculated for paramedic program characteristics in 2019 and 2020, as well as pandemic specific curriculum changes. Wilcoxon rank-sum and Fisher's exact tests were used to evaluate differences in characteristics by year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The number of paramedic educational programs in our population decreased from 640 programs in 2019 to 612 in 2020, with a statistically significant decrease in clinical hours (2019: 219 [IQR 168‒272]; 2020: 200.5 [IQR 157‒261]). There was no difference in first or third-attempt certification examination success between years. Temporary shutdown was experienced in 34% of programs (duration: 3 weeks [2‒7]) and 72% of required curricular changes. Curricular changes commonly included decreased in-person education (86%), traditional classroom lectures (78%), number of clinical sites (78%), and increased online didactic education (92%). Only 20% of programs decreased laboratory simulation or total training hours.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>During the pandemic, paramedic educational programs changed educational delivery with no observed differences on overall program performance. Identifying key curricular changes and best practices for implementation may be necessary to better optimize future educational delivery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"5 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13316","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449050","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":"Bradycardia in a woman","authors":"Fang-Yu Lin MD,&nbsp;Chan-Han Wu MD,&nbsp;Chi-Wei Chen MD, MS","doi":"10.1002/emp2.13336","DOIUrl":"https://doi.org/10.1002/emp2.13336","url":null,"abstract":"<p>A 75-year-old woman with a history of coronary artery disease, diabetes mellitus, and a previous stroke was found to have dyspnea and hypotension at a nursing home. She was brought to the emergency department in her baseline comatose state. Her vital signs were as follows: blood pressure 78/61 mmHg, heart rate 53 beats/min, respiratory rate 30 breaths/min, body temperature 36.7°C, and oxygen saturation of 100% while receiving oxygen via a non-rebreather mask.</p><p>An initial electrocardiogram (ECG) revealed mild ST-segment elevation in the inferior leads with reciprocal changes, suggestive of an acute ischemic event. However, the rhythm was inconclusive due to atypical T wave morphology (Figure 1). The emergency physician performed point-of-care ultrasonography (POCUS) to assess the relationship between atrial and ventricular contractions (Video 1).</p><p>POCUS identified two atrial contractions for every ventricular contraction, indicating a 2:1 second-degree atrioventricular (AV) block. ECG interpretation can be difficult when waveforms are obscured by overlapping or multifocal signals, complicating arrhythmia classification.<span>¹</span> In cases of bradycardia, timely identification of AV blocks is crucial. When ECG findings are inconclusive, POCUS serves as an effective tool to assess AV conduction, enhancing diagnostic accuracy and guiding immediate clinical decisions.<span>²</span></p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"5 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13336","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449171","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":"Etiology of septic arthritis in children of Qatar","authors":"Abdullah Khan MD,&nbsp;Abdelmoneem Mohammed Elsheikh MD,&nbsp;Khalid Alansari MD","doi":"10.1002/emp2.13313","DOIUrl":"https://doi.org/10.1002/emp2.13313","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Septic arthritis is an orthopedic emergency and if not evaluated and treated appropriately, it can lead to poor clinical outcomes. Previously several studies have been performed to identify the etiology of septic arthritis in the pediatric population in developed countries. The main objective of our study was to identify the etiology of septic arthritis in children in Qatar in previously healthy and fully vaccinated children.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed retrospective chart analysis of children presenting to our emergency department between July 2018 and June 2024, who were diagnosed and treated with septic arthritis. The study was conducted at a level 1 pediatric trauma center and the only children's hospital in the country. We used ICD 9 and ICD 10 codes to identify such cases. After using predefined exclusion criteria, children with positive blood cultures, blood titers for Brucella and/or synovial cultures were included in the analysis. Clinical symptoms and signs, ultrasound findings, and culture results were tabulated using descriptive statistics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 45 patients were included. The median age of children was 5 years (interquartile range [IQR] 2–10 years). Majority (60%) were male. The most common clinical findings were limping/limitation of joint movement (100%), fever (80%), and swelling of joints (58%). The median C-reactive protein and erythrocyte sedimentation rate were 94 mg/L and 47 mm/h. The knee and hip were the most common joints affected. The most common causative organisms were <i>Staphylococcus aureus</i> (56%), <i>Streptococcus pyogenes</i> (13%), and Brucella (11%). Pre-intervention imaging, such as ultrasound and/or magnetic resonance imaging, was performed in 95% of patients. All patients recovered without any complications. One of the limitations of our study is that cases of <i>Kingella kingae</i> septic arthritis may be underreported as polymerase chain reaction (PCR) analysis of synovial fluid was not performed on all patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Gram-positive cocci, especially <i>S. aureus</i>, remains the most common cause of septic arthritis in vaccinated children. We also identified Gram-negative bacilli as causative organisms in our study. We suggest including empiric coverage for both Gram- and Gram-negative bacilli when treating children with suspected septic arthritis till culture results are available.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"5 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13313","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449180","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":"Rash in a slaughterhouse worker","authors":"Michael B. Murphy DO, MS,&nbsp;Brian F. Kelly DO","doi":"10.1002/emp2.13286","DOIUrl":"https://doi.org/10.1002/emp2.13286","url":null,"abstract":"<p>A 32-year-old man presented to the emergency department with a new rash on his left hand that has a clear discharge. He was employed at a livestock slaughterhouse and did not wear gloves when handling animals. The most common animals he was in contact with were sheep and goats. The rash was only in one location, between his third and fourth digit on his left hand (Figures 1 and 2) and worsened over the previous 4 days. The blister is approximately 1 cm × 1 cm × 1 cm and tender to touch. He denied any fevers, chills, or additional rashes. Due to the uniqueness of the patient's profession, dermatology was consulted and a shave biopsy was performed.</p><p>The patient was ultimately diagnosed with Orf virus based on clinical presentation alone. Tissue biopsy showed epidermal hyperplasia with vacuolated cytoplasm and eosinophilic inclusion bodies in upper epidermal keratinocytes, ulceration, and mixed inflammatory infiltrate, which aligned with the clinical diagnosis of Orf. Orf is caused by the <i>Parapoxvirus</i> and is often self-limiting, lasting around 4–6 weeks. It is found in people who have direct contact with animals, most commonly farms. Treatment is mainly supportive, cleaning the wound with soap and water, and keeping the wound dry and covered with a bandage. It is important to keep zoonotic diseases on the differential of rash.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"5 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13286","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142447603","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 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":"5 5","pages":""},"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":"5 5","pages":""},"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":"5 5","pages":""},"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}