Pub Date : 2025-12-01DOI: 10.1016/j.ajem.2025.08.046
Hirotaka Ata MD PhD
Prolonged febrile illness (PFI) in adults poses a diagnostic challenge in an Emergency Department (ED). The ED workup for PFI should target specific patient factors. Here, we report a case of mitral valve infective endocarditis in a 64-year-old male with no medical comorbidities, presenting with several weeks of fever. 1 out of 3 peripheral blood cultures obtained in the ED was positive for Haemophilus haemolyticus. Patient required mitral valve replacement during his hospitalization, and was discharged on a 4-week course of oral ciprofloxacin.
{"title":"Prolonged febrile illness: Infective endocarditis in adult without risk factors","authors":"Hirotaka Ata MD PhD","doi":"10.1016/j.ajem.2025.08.046","DOIUrl":"10.1016/j.ajem.2025.08.046","url":null,"abstract":"<div><div>Prolonged febrile illness (PFI) in adults poses a diagnostic challenge in an Emergency Department (ED). The ED workup for PFI should target specific patient factors. Here, we report a case of mitral valve infective endocarditis in a 64-year-old male with no medical comorbidities, presenting with several weeks of fever. 1 out of 3 peripheral blood cultures obtained in the ED was positive for <em>Haemophilus haemolyticus</em>. Patient required mitral valve replacement during his hospitalization, and was discharged on a 4-week course of oral ciprofloxacin.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 419-422"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.ajem.2025.08.051
Myungwook Bae DO, Nicholas Spoerk MD
Current understanding of multiple sclerosis includes likely genetic predispositions with superimposed environmental risk factors. A few population-based epidemiological studies suggest a correlation between multiple sclerosis and high-altitude exposure but reports of individual cases that might demonstrate a temporal relationship are lacking. We are reporting a case of multiple sclerosis onset after multiple exposures to high-altitude environments through recreational mountaineering.
{"title":"A new onset of multiple sclerosis in a young woman after multiple recreational high-altitude exposures","authors":"Myungwook Bae DO, Nicholas Spoerk MD","doi":"10.1016/j.ajem.2025.08.051","DOIUrl":"10.1016/j.ajem.2025.08.051","url":null,"abstract":"<div><div>Current understanding of multiple sclerosis includes likely genetic predispositions with superimposed environmental risk factors. A few population-based epidemiological studies suggest a correlation between multiple sclerosis and high-altitude exposure but reports of individual cases that might demonstrate a temporal relationship are lacking. We are reporting a case of multiple sclerosis onset after multiple exposures to high-altitude environments through recreational mountaineering.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 423-425"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.ajem.2025.11.029
Chih-Hsien Chi MD , Chia-Lung Kao MD , Ming-Yuan Hong MD, PhD , Su-Chun Cheng PhD , Jui-Yi Tsou PhD
Background
Specific muscular fitness indicators and their predictive thresholds for high-quality CPR have not been well established. Therefore, a randomized crossover study was designed to investigate the relationship between muscular fitness and CPR performance under continuous chest compressions and 30:2 strategies, and to identify fitness-based thresholds for predicting effective chest compressions.
Methods
Fifty-seven participants certified to perform CPR completed three muscular fitness assessments: handgrip strength, push-up, and curl-up tests. Participants performed 6 min of CPR using both continuous chest compressions and 30:2 protocols. Compression depth, force, and rate were recorded using a pressure mat and skill-reporting system. Correlation and receiver operating characteristic (ROC) analyses were conducted to determine associations between muscular fitness and CPR quality and to identify the predictive threshold of effective performance.
Results
Among all muscular fitness indicators, handgrip strength showed the strongest correlation with both compression force (r = 0.59–0.68) and depth (r = 0.77–0.81) across all time intervals and CPR strategies. ROC analysis identified handgrip strength thresholds of 82.5 kg for high-quality CPR during the first 2 min, and 93.85 kg for sustained performance over 6 min (AUC = 0.85–0.94, p < 0.001). The 30:2 CPR consistently produced higher compression force and depth compared to continuous chest compressions, with increasing differences over time.
Conclusions
Handgrip strength is a robust predictor of high-quality CPR performance. The identified thresholds may inform evidence-based training, provider rotation strategies, and screening for CPR readiness, particularly in individuals at risk of fatigue-related performance decline.
{"title":"Muscular fitness thresholds for predicting high-quality CPR: A crossover study of two compression strategies","authors":"Chih-Hsien Chi MD , Chia-Lung Kao MD , Ming-Yuan Hong MD, PhD , Su-Chun Cheng PhD , Jui-Yi Tsou PhD","doi":"10.1016/j.ajem.2025.11.029","DOIUrl":"10.1016/j.ajem.2025.11.029","url":null,"abstract":"<div><h3>Background</h3><div>Specific muscular fitness indicators and their predictive thresholds for high-quality CPR have not been well established. Therefore, a randomized crossover study was designed to investigate the relationship between muscular fitness and CPR performance under continuous chest compressions and 30:2 strategies, and to identify fitness-based thresholds for predicting effective chest compressions.</div></div><div><h3>Methods</h3><div>Fifty-seven participants certified to perform CPR completed three muscular fitness assessments: handgrip strength, push-up, and curl-up tests. Participants performed 6 min of CPR using both continuous chest compressions and 30:2 protocols. Compression depth, force, and rate were recorded using a pressure mat and skill-reporting system. Correlation and receiver operating characteristic (ROC) analyses were conducted to determine associations between muscular fitness and CPR quality and to identify the predictive threshold of effective performance.</div></div><div><h3>Results</h3><div>Among all muscular fitness indicators, handgrip strength showed the strongest correlation with both compression force (<em>r</em> = 0.59–0.68) and depth (<em>r</em> = 0.77–0.81) across all time intervals and CPR strategies. ROC analysis identified handgrip strength thresholds of 82.5 kg for high-quality CPR during the first 2 min, and 93.85 kg for sustained performance over 6 min (AUC = 0.85–0.94, <em>p</em> < 0.001). The 30:2 CPR consistently produced higher compression force and depth compared to continuous chest compressions, with increasing differences over time.</div></div><div><h3>Conclusions</h3><div>Handgrip strength is a robust predictor of high-quality CPR performance. The identified thresholds may inform evidence-based training, provider rotation strategies, and screening for CPR readiness, particularly in individuals at risk of fatigue-related performance decline.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"100 ","pages":"Pages 148-153"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.ajem.2025.07.066
Somdattaa Ray DM , Thomas Mathew DM , D. Sai Kanth MD , G.G. Sharath Kumar DM
Spontaneous intracranial hypotension (SIH) is associated with subdural hematoma in the supratentorial convexities. We report a patient with SIH who had presented to us with subdural hematoma in the posterior fossa. A 50 year old lady presented with history of sudden onset of lower back ache of 4 weeks duration and daily headaches and neck pain for past three weeks. The headache exacerbated on activity, on sitting and standing position and relieved on supine position. There was no history of fever or head trauma. Imaging of the brain revealed hematoma of the tentorium cerebelli, hematoma of the bilateral convexities in addition to other signs of spontaneous intracranial hypotension. She was administered epidural patch with there was complete resolution of symptoms.
Subdural hematoma is seen in upto 20 % of patients with SIH. Treatment of the CSF leak is generally sufficient for management of the subdural hematoma and for preventing its recurrence. Decompression craniectomy is reserved for hematomas larger than 10 mm on CT scan or associated impaired consciousness. In these patients, delay in evacuating SDH might be associated with an increased risk of brain herniation. Subdural hematoma in the posterior fossa is rare and has been reported following trauma. It has never been reported in spontaneous intracranial hypotension. This report illustrates SIH as a rare etiology of posterior fossa subdural hematoma. Posterior fossa hematoma in the absence of trauma should raise the suspicion of SIH and one should carefully look for features of CSF leak on imaging.
{"title":"Posterior fossa subdural hematoma in spontaneous intracranial hypotension","authors":"Somdattaa Ray DM , Thomas Mathew DM , D. Sai Kanth MD , G.G. Sharath Kumar DM","doi":"10.1016/j.ajem.2025.07.066","DOIUrl":"10.1016/j.ajem.2025.07.066","url":null,"abstract":"<div><div>Spontaneous intracranial hypotension (SIH) is associated with subdural hematoma in the supratentorial convexities. We report a patient with SIH who had presented to us with subdural hematoma in the posterior fossa. A 50 year old lady presented with history of sudden onset of lower back ache of 4 weeks duration and daily headaches and neck pain for past three weeks. The headache exacerbated on activity, on sitting and standing position and relieved on supine position. There was no history of fever or head trauma. Imaging of the brain revealed hematoma of the tentorium cerebelli, hematoma of the bilateral convexities in addition to other signs of spontaneous intracranial hypotension. She was administered epidural patch with there was complete resolution of symptoms.</div><div>Subdural hematoma is seen in upto 20 % of patients with SIH. Treatment of the CSF leak is generally sufficient for management of the subdural hematoma and for preventing its recurrence. Decompression craniectomy is reserved for hematomas larger than 10 mm on CT scan or associated impaired consciousness. In these patients, delay in evacuating SDH might be associated with an increased risk of brain herniation. Subdural hematoma in the posterior fossa is rare and has been reported following trauma. It has never been reported in spontaneous intracranial hypotension. This report illustrates SIH as a rare etiology of posterior fossa subdural hematoma. Posterior fossa hematoma in the absence of trauma should raise the suspicion of SIH and one should carefully look for features of CSF leak on imaging.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 405-407"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.ajem.2025.09.030
Christine Ramdin PhD , Jamey Lister PhD , Stephanie Shiau PhD , Mara Domider MPH , Lewis S. Nelson MD, MBA
{"title":"Opioid utilization patterns and predictors for emergency department visits related to ankle sprains between 2016 and 2021: A National Analysis Utilizing Neural Networks","authors":"Christine Ramdin PhD , Jamey Lister PhD , Stephanie Shiau PhD , Mara Domider MPH , Lewis S. Nelson MD, MBA","doi":"10.1016/j.ajem.2025.09.030","DOIUrl":"10.1016/j.ajem.2025.09.030","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 371-373"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.ajem.2025.07.027
Kelley Gorsuch DO, Sean M. Bryant MD
Atraumatic first rib fractures are an uncommon diagnosis in the emergency department and case reports are lacking in the Emergency Medicine literature. A 26-year-old man presented to the emergency department with significant right shoulder pain after weightlifting. Plain radiographs showed no fracture or dislocation with a subsequent CT revealing a first rib fracture. Given the uncommon nature of this injury, first rib fractures should be considered in patients with recent weightlifting or similarly explosive activity.
{"title":"Atraumatic first rib fracture after weightlifting","authors":"Kelley Gorsuch DO, Sean M. Bryant MD","doi":"10.1016/j.ajem.2025.07.027","DOIUrl":"10.1016/j.ajem.2025.07.027","url":null,"abstract":"<div><div>Atraumatic first rib fractures are an uncommon diagnosis in the emergency department and case reports are lacking in the Emergency Medicine literature. A 26-year-old man presented to the emergency department with significant right shoulder pain after weightlifting. Plain radiographs showed no fracture or dislocation with a subsequent CT revealing a first rib fracture. Given the uncommon nature of this injury, first rib fractures should be considered in patients with recent weightlifting or similarly explosive activity.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 384-385"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.ajem.2025.07.047
Chunxiang Chen , Lili Shan , Mingfeng He, Yan Han
Hearing loss caused by stroke must be taken seriously, as it is a treatable condition that highly depends on timely intervention. This case report presents a rare case of a 75-year-old female with a history of hypertension who visited the Emergency Department of Otolaryngology due to sudden left-sided deafness accompanied by vertigo and vomiting, and magnetic resonance imaging (MRI) demonstrated acute posterior circulation cerebral infarction.In the Emergency Department setting, for middle-aged and elderly patients with vascular risk factors, hearing loss may serve as an early warning sign of vertebrobasilar artery ischemic stroke. Immediate stroke screening should always be prioritized, as acute antithrombotic and acute revascularization treatments may be necessary.
{"title":"Posterior circulation infarction with sudden deafness as a clinical manifestation","authors":"Chunxiang Chen , Lili Shan , Mingfeng He, Yan Han","doi":"10.1016/j.ajem.2025.07.047","DOIUrl":"10.1016/j.ajem.2025.07.047","url":null,"abstract":"<div><div>Hearing loss caused by stroke must be taken seriously, as it is a treatable condition that highly depends on timely intervention. This case report presents a rare case of a 75-year-old female with a history of hypertension who visited the Emergency Department of Otolaryngology due to sudden left-sided deafness accompanied by vertigo and vomiting, and magnetic resonance imaging (MRI) demonstrated acute posterior circulation cerebral infarction.In the Emergency Department setting, for middle-aged and elderly patients with vascular risk factors, hearing loss may serve as an early warning sign of vertebrobasilar artery ischemic stroke. Immediate stroke screening should always be prioritized, as acute antithrombotic and acute revascularization treatments may be necessary.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 390-392"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.ajem.2025.07.058
Lucas Nelson MD , Bernard Weigel MD , Ayoolamide N. Gazal MD , Chadrick R. Evans MD
Rectal foreign body insertion is a well-described phenomenon in the emergency department (ED). Here, we present a case of a 64-year-old male who presented to a community ED after rectal insertion of a two-part expanding polyurethane foam sealant. The sealant had hardened and adhered to the colonic mucosa, necessitating surgical intervention and colostomy creation. This case highlights the dual risks—both chemical and structural—posed by polyurethane foam sealant and illustrates the importance of early imaging and multidisciplinary evaluation.
{"title":"Rectal insertion of expanding polyurethane foam requiring sigmoid colectomy: A case report with surgical and toxicologic implications","authors":"Lucas Nelson MD , Bernard Weigel MD , Ayoolamide N. Gazal MD , Chadrick R. Evans MD","doi":"10.1016/j.ajem.2025.07.058","DOIUrl":"10.1016/j.ajem.2025.07.058","url":null,"abstract":"<div><div>Rectal foreign body insertion is a well-described phenomenon in the emergency department (ED). Here, we present a case of a 64-year-old male who presented to a community ED after rectal insertion of a two-part expanding polyurethane foam sealant. The sealant had hardened and adhered to the colonic mucosa, necessitating surgical intervention and colostomy creation. This case highlights the dual risks—both chemical and structural—posed by polyurethane foam sealant and illustrates the importance of early imaging and multidisciplinary evaluation.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 393-394"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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