Journal of Emergency Medicine最新文献

英文中文

A Case Report of Headache and Weakness Diagnosed as Functional Neurological Disorder 头痛无力诊断为功能性神经障碍1例。

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.jemermed.2025.04.012

Drew Castleberry MD , Michael P. Wilson MD, PhD , Kimberly Nordstrom MD, JD

Background

Cerebral venous sinus thrombosis (CVST) is a rare diagnosis and is estimated at 1.32-1.57 per 100,000 cases. Patients with CVST often present with headache, seizures, focal motor deficits, encephalopathy, or aphasia, and can be fatal in 3%-15% of cases. Newer diagnostic criteria indicate functional neurological disorder (previously known as conversion disorder) as a “rule in” diagnosis that should be given only if patients meet strict criteria.

Case Report

A 26-year-old woman with a past medical history of depression during pregnancy, anxiety, and migraines, presented to a large emergency department in the United States with headache, unilateral weakness, spastic movement, numbness, and “feeling off.” At the time of presentation, she had a Glasgow Coma Scale score of 14 and was approximately 7 weeks postpartum and had resumed oral contraceptives 11 days prior. After a normal head computed tomography scan, she was discharged with a diagnosis of anxiety reaction and headache, with question of possible conversion disorder. The patient returned the next morning with worsening weakness and inability to walk. Given that she was only intermittently following commands, she was admitted for seizure monitoring, with particular concern for psychogenic nonepileptic seizures. A magnetic resonance imaging scan ordered by the admitting hospitalist indicated left thalamic infarct secondary to cerebral venous thrombosis.

Why Should an Emergency Physician Be Aware of This?

CVST should be considered on the differential for premenopausal women presenting with headache, altered mental status, and focal neurological deficits. The diagnosis of functional neurological disorder was previously thought of as a diagnosis of exclusion, however, it is now a diagnosis of inclusion using specific positive findings.

背景：脑静脉窦血栓形成（CVST）是一种罕见的诊断，估计为1.32-1.57 / 10万例。CVST患者通常表现为头痛、癫痫发作、局灶性运动缺陷、脑病或失语，3%-15%的病例可致死性。较新的诊断标准表明，功能性神经障碍（以前称为转换障碍）是一种“常规”诊断，只有在患者符合严格标准的情况下才应给予诊断。病例报告：一名26岁的女性，在怀孕期间有抑郁、焦虑和偏头痛的病史，因头痛、单侧无力、痉挛运动、麻木和“感觉不舒服”而在美国的一家大型急诊室就诊。在就诊时，她的格拉斯哥昏迷评分为14分，产后约7周，并在11天前恢复口服避孕药。在进行了正常的头部计算机断层扫描后，她出院了，诊断为焦虑反应和头痛，并可能存在转换障碍。病人第二天早上回来时，虚弱和无法行走的症状越来越严重。考虑到她只是间歇性地服从命令，她被送进医院接受癫痫监测，特别关注心因性非癫痫性发作。入院医生安排的磁共振成像扫描显示，左丘脑梗死继发于脑静脉血栓形成。急诊医生为什么要意识到这一点？对于出现头痛、精神状态改变和局灶性神经功能障碍的绝经前妇女，应考虑CVST。功能性神经障碍的诊断以前被认为是一种排除诊断，然而，现在它是一种诊断，包括使用特定的阳性结果。

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引用次数: 0

Clarity on: Regional Anesthesia Techniques for the Shoulder 明确：肩部区域麻醉技术。

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.jemermed.2025.07.056

Raghuraman M․ Sethuraman M.D.

引用次数: 0

Comment on “Adenosine versus Fixed-Dose Intravenous Bolus Diltiazem on Reversing Supraventricular Tachycardia in the Emergency Department: A Multi-Center Cohort Study” 对“腺苷与固定剂量静脉滴注地尔硫卓在急诊科逆转室上性心动过速：一项多中心队列研究”的评论。

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.jemermed.2025.08.042

Parth Aphale , Shashank Dokania , Himanshu Shekhar

引用次数: 0

Investigation of the Relationship Between Shock Index, Scores in Patients with Upper Gastrointestinal Bleeding 上消化道出血患者休克指数与评分关系的探讨

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.jemermed.2025.10.043

Bahadir Taslidere, Julide Gurbuz, Elif Betul Balci, Emre Kalkan, Basar Cander

Background

Upper gastrointestinal bleeding (UGIB) is a common and life-threatening emergency with a mortality rate of 2–8%. Although prognostic assessment often relies on the Glasgow-Blatchford Score (GBS) and Rockall Score (RS), their inclusion of multiple parameters limits use in acute settings. The shock index (SI), derived from heart rate and systolic blood pressure, provides a simple and rapid alternative. This study investigates the relationship between the SI and established risk scores (GBS and RS) in patients with UGIB.

Methods

This retrospective study included patients over 18 years of age who presented to the emergency department between January 1 and December 31, 2021. Of the 246 patients who underwent endoscopy, 106 were excluded due to variceal bleeding, pregnancy, incomplete or missing data, loss to follow-up, referral, or trauma. Clinical and laboratory information, including endoscopic findings, laboratory results, treatment details, and clinical follow-up, were collected. GBS, RS, and SI were calculated for each patient to evaluate the effectiveness of the SI in UGIB by examining its relationship with the GBS and RS.

Result

We enrolled 140 patients (62.9% male, n = 88; 37.1% female, n = 52). The mean age was comparable between the low and high SI groups (57.08 ± 20.20 vs. 54.75 ± 18.67 years, p = 0.482). Female patients had a significantly higher mean age than males (p < 0.001). The high SI group demonstrated significantly higher GBS scores compared with the low SI group (9.26 ± 3.50 vs. 6.29 ± 3.47, p < 0.001). The mean RS was significantly higher in the high SI group compared with the low SI group (4.42 ± 2.11 vs. 3.30 ± 2.20, p = 0.003).

Conclusions

In our study, both GBS and RS were significantly higher in patients with elevated SI, indicating that the Shock Index closely reflects bleeding severity and hemodynamic instability. Given that SI can be calculated rapidly, at no cost, and without the need for laboratory data, it may provide an early estimate of bleeding severity and prognosis before more comprehensive scoring systems such as GBS or RS are determined in the emergency department.

背景：十二指肠出血（UGIB）是一种常见的危及生命的急症，死亡率为2-8%。尽管预后评估通常依赖于格拉斯哥-布拉奇福德评分（GBS）和罗克尔评分（RS），但它们包含的多个参数限制了在急性情况下的使用。由心率和收缩压得出的休克指数（SI）提供了一个简单而快速的替代方法。本研究探讨了UGIB患者SI与既定风险评分（GBS和RS）之间的关系。方法本回顾性研究纳入了2021年1月1日至12月31日在急诊科就诊的18岁以上患者。在246例接受内窥镜检查的患者中，106例因静脉曲张出血、妊娠、数据不完整或缺失、随访缺失、转诊或创伤而被排除在外。收集临床和实验室信息，包括内镜检查结果、实验室结果、治疗细节和临床随访。计算每位患者的GBS、RS和SI，通过检查其与GBS和RS的关系来评估SI在UGIB中的有效性。结果纳入140例患者，其中男性62.9%,n = 88；女性37.1%,n = 52)。低SI组和高SI组的平均年龄具有可比性（57.08±20.20∶54.75±18.67岁，p = 0.482）。女性患者的平均年龄明显高于男性（p < 0.001）。高SI组的GBS评分明显高于低SI组（9.26±3.50比6.29±3.47,p < 0.001）。高SI组的平均RS显著高于低SI组（4.42±2.11∶3.30±2.20,p = 0.003）。结论在我们的研究中，SI升高的患者GBS和RS均明显升高，表明休克指数密切反映出血严重程度和血流动力学不稳定。考虑到SI可以快速计算，不需要成本，不需要实验室数据，它可以在急诊科确定更全面的评分系统（如GBS或RS）之前提供出血严重程度和预后的早期估计。

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引用次数: 0

Comment on the “Pericapsular Nerve Group (PENG) Block-Augmented Analgesia VS. Conventional Opioid Analgesia for Hip Fracture Patients in the Emergency Department” 对“急诊科髋部骨折患者囊包神经组（PENG）阻滞增强镇痛与常规阿片类镇痛”的评论。

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.jemermed.2025.09.034

Chitta Ranjan Mohanty MD , Amiya Kumar Barik DM , Anju Gupta MD , Rakesh Vadakkethil Radhakrishnan MSN , Amlan Kusum Rout

引用次数: 0

American Academy of Emergency Medicine 美国急诊医学学会

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2025-12-01 DOI: 10.1016/S0736-4679(25)00448-2

引用次数: 0

Response to Letter to the Editor on “Pericapsular Nerve Group (PENG) Block-Augmented Analgesia vs. Conventional Opioid Analgesia for Hip Fracture Patients in the Emergency Department: A Comparative Effectiveness Study” 对《急诊科髋部骨折患者囊包神经组（PENG）阻滞增强镇痛与常规阿片类镇痛：疗效比较研究》致编辑的回复。

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.jemermed.2025.10.022

William Murk MD, PhD, MPH , Ariella Gartenberg MD , Jonathan Maik DO , Michelle A. Montenegro MD , Sarika Antora MD , Aamir Bandagi DO , Michael Boulay MS , Julie Clemmensen DO , Trevor Dixon MD , Michael Jones MD , Kaushal Khambhati MD , Nicole Leonard-Shiu MD , Anna Liveris MD , Philip O’Donnell MD , Anthony Scoccimarro MD , Jeremy Sperling MD , Dean Wiseman MD , Anirudh Ramachandran DO , Michael Halperin MD, MPH

引用次数: 0

“Associations Between Prenotification and Time to Management in Acute Stroke Patients Transported by Emergency Medical Services”: A Broader Perspective “紧急医疗服务运送的急性脑卒中患者的预通知与管理时间之间的关系”：一个更广泛的视角。

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.jemermed.2025.09.001

Engin Ozakin MD

引用次数: 0

The possibility of extracorporeal membrane oxygenation in cardiac arrest (both In Hospital Cardiac Arrest and Out of Hospital Cardiac Arrest) 心脏骤停（院内心脏骤停和院外心脏骤停）时体外膜氧合的可能性

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.jemermed.2025.10.044

Péter Lukács , Andrea Székely , András Szabó , Krisztina Józsa , Béla Merkely

Background

The place of extracorporeal membrane oxygenation (ECMO) in resuscitational guidelines has become unquestionable, but the exact time to start the treatment and appropriate patient selection remains unclear. The aim of this study is to find correlations between pre-ECMO parameters and subsequent survival indicators of patients requiring ECMO treatment, which could help intra-/prehospital providers to more easily identify potential ECMO candidates among their patients.

Methods

This research is a single-center retrospective observational study. The subjects of the research are patients who required ECMO support between January 2019 and November 2024. A total of 101 patients were included in the research (n=101).

Results

The median age was 49 years (IQR 37.5-62.5). 65.6% were male and 36.4% were female (65 vs. 36). The median duration of ECMO support was 6 days (IQR 6.5-8.5). Overall survival was 29.3% (101 vs. 29). Out of the 101 patients, 63 underwent cardiopulmonary resuscitation (CPR) before starting ECMO, 25 cases were out of hospital cardiac arrest (OHCA) and 38 were in hospital cardiac arrest (IHCA). Return of spontaneous circulation (ROSC) occurred in 18 cases. Cannulation was performed during continuous CPR in 44 cases, with a median low-flow time of 30 minutes (IQR 20-60). No CPR was performed in 39 cases. The group of patients who underwent ECMO with previous continuous CPR had a significantly better survival in the IHCA group (p <.001). An achieved ROSC during CPR was not associated with significantly better survival in comparison with the group that underwent full CPR (p = 0.066), but survival was significantly higher compared to the group of patients who were cannulated during continuous CPR (p = 0.01).

Conclusion

The key point of ECMO treatment is the selection of the right patients and the initiation of treatment at the right time. The inclusion/exclusion criterias of current guidelines can provide adequate assistance in this matter.

体外膜氧合（ECMO）在复苏指南中的地位已成为毋庸置疑的，但确切的开始治疗时间和适当的患者选择仍不清楚。本研究的目的是发现ECMO前参数与需要ECMO治疗的患者的后续生存指标之间的相关性，这可以帮助院内/院前提供者更容易地在患者中识别潜在的ECMO候选者。方法本研究为单中心回顾性观察研究。该研究的对象是2019年1月至2024年11月期间需要ECMO支持的患者。研究共纳入101例患者（n=101）。结果中位年龄49岁（IQR 37.5 ~ 62.5）。男性65.6%，女性36.4%（65对36）。ECMO支持的中位持续时间为6天（IQR 6.5-8.5）。总生存率为29.3%（101比29）。101例患者中，63例在开始ECMO前接受了心肺复苏（CPR）， 25例院外心脏骤停（OHCA）， 38例院内心脏骤停（IHCA）。自发循环恢复（ROSC） 18例。44例患者在持续CPR过程中插管，中位低流量时间为30分钟（IQR 20-60）。未行心肺复苏术39例。在IHCA组中，接受ECMO且既往持续CPR的患者生存率显著提高（p <.001）。与完全心肺复苏术组相比，在心肺复苏术中达到ROSC与更好的生存率没有显著相关（p = 0.066），但与在持续心肺复苏术中插管的患者组相比，生存率明显更高（p = 0.01）。结论选择合适的患者，在合适的时间开始治疗是ECMO治疗的关键。现行准则的纳入/排除标准可以在这方面提供充分的协助。

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引用次数: 0

Response to “Clarity on: Regional Anesthesia Techniques for the Shoulder” 对“澄清：肩部区域麻醉技术”的回应。

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.jemermed.2025.08.005

Vincent W. Klokman MD, MSc , Titus J.A. Schönberger MD

引用次数: 0

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Journal of Emergency Medicine

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