Pub Date : 2025-02-11DOI: 10.1016/j.ajem.2025.02.013
Oluwafemi P Owodunni, Elizabeth Jones, Loren Mead, Paulina Sergot, Remle Crowe, Christian M Garcia, Ryan Huebinger
{"title":"Above-guideline ketamine dosing: Saving lives or complicating care?","authors":"Oluwafemi P Owodunni, Elizabeth Jones, Loren Mead, Paulina Sergot, Remle Crowe, Christian M Garcia, Ryan Huebinger","doi":"10.1016/j.ajem.2025.02.013","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.02.013","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477268","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 : 2025-02-10DOI: 10.1016/j.ajem.2025.02.008
Tomoyuki Kawada
{"title":"Effectiveness of route selection in patients with out-of-hospital cardiac arrest.","authors":"Tomoyuki Kawada","doi":"10.1016/j.ajem.2025.02.008","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.02.008","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426708","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 : 2025-02-07DOI: 10.1016/j.ajem.2025.02.011
Romain Jouffroy, Benoît Vivien
{"title":"Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: do signs of life should overpass initial cardiac rhythm?","authors":"Romain Jouffroy, Benoît Vivien","doi":"10.1016/j.ajem.2025.02.011","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.02.011","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426710","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 : 2025-02-05DOI: 10.1016/j.ajem.2025.02.004
Yalcin Golcuk
{"title":"Refining mortality prediction in the transfer of sepsis patients: Biomarkers and frailty assessment.","authors":"Yalcin Golcuk","doi":"10.1016/j.ajem.2025.02.004","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.02.004","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426712","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 : 2025-02-05DOI: 10.1016/j.ajem.2025.01.081
Daniela Usuga, Scott C Everett, Michael Shalaby
Introduction: Acute otitis externa (OE) is a prevalent infectious condition of the external ear canal, often presenting with painful inflammation and purulent drainage. Sensory innervation of the external ear and canal involves several nerves, including the auriculotemporal, lesser occipital, great auricular, and auricular branch of the vagus nerve. This case series explores the efficacy of the auricular nerve block as a targeted pain management technique in patients presenting with OE in the emergency department (ED).
Case reports: Three patients with AOE underwent auricular nerve blocks with bupivacaine 0.5 %. All three patients reported immediate pain relief from nerve block. Two out of the three patients were lost to follow up.
Discussion: The auricular nerve block is safe and involves injection sites distant from major vascular structures, utilizes a small amount of anesthetic, is easy to perform by a landmark-based technique, and does not require the use of ultrasound.
Conclusion: Auricular nerve blocks may provide a safe, efficient, and localized alternative for OE pain relief. Further research, including larger case series or randomized trials, is recommended to establish its efficacy and refine its application.
{"title":"Auricular nerve block for otitis externa: A case series.","authors":"Daniela Usuga, Scott C Everett, Michael Shalaby","doi":"10.1016/j.ajem.2025.01.081","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.01.081","url":null,"abstract":"<p><strong>Introduction: </strong>Acute otitis externa (OE) is a prevalent infectious condition of the external ear canal, often presenting with painful inflammation and purulent drainage. Sensory innervation of the external ear and canal involves several nerves, including the auriculotemporal, lesser occipital, great auricular, and auricular branch of the vagus nerve. This case series explores the efficacy of the auricular nerve block as a targeted pain management technique in patients presenting with OE in the emergency department (ED).</p><p><strong>Case reports: </strong>Three patients with AOE underwent auricular nerve blocks with bupivacaine 0.5 %. All three patients reported immediate pain relief from nerve block. Two out of the three patients were lost to follow up.</p><p><strong>Discussion: </strong>The auricular nerve block is safe and involves injection sites distant from major vascular structures, utilizes a small amount of anesthetic, is easy to perform by a landmark-based technique, and does not require the use of ultrasound.</p><p><strong>Conclusion: </strong>Auricular nerve blocks may provide a safe, efficient, and localized alternative for OE pain relief. Further research, including larger case series or randomized trials, is recommended to establish its efficacy and refine its application.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426706","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 : 2025-02-04DOI: 10.1016/j.ajem.2025.02.006
Sriram Ramgopal MD , Caleb E. Ward MB BChir, MPH , Alexander Rogers MD , Seth D. Goldstein MD , Julie C. Leonard MD MPH , Christian Martin-Gill MD MPH
Objective
Improved data on spinal motion restriction (SMR) use can improve pediatric prehospital guidelines and inform the appropriate use of this procedure. We sought to evaluate the prevalence and factors associated with SMR among injured children in the prehospital setting.
Methods
We performed a retrospective analysis using retrospective data using the 2022–2023 National Emergency Medical Services Information System datasets, including injured pediatric (<18 years) ground encounters at the scene transported to the hospital. We identified the percentage of encounters for which SMR was applied. We identified demographic and clinical associations with SMR application using a linear mixed effects model.
Results
We identified 623,785 encounters for injured children (median age 13 years, IQR 6–15; 55.5 % for boys). Among these, 67,551 (10.8 %) had SMR applied in the prehospital setting. In multivariable analysis, SMR use was positively associated (odds ratio, 95 % confidence interval) with older age (1.05, 1.05–1.05), longer transport times (1.23, 1.20–1.25), altered consciousness (increasing odds ratios from 3.12 to 4.54 with worsening AVPU scores), high reported pain scores (1.24, 1.21–1.27 relative to low/medium pain), advanced life support transports (1.81, 1.74–1.88), tachycardia (1.11, 1.06–1.16), tachypnea (1.45, 1.37–1.52), bradypnea (1.15, 1.05–1.26). Hypotension was negatively associated with SMR (0.59, 0.54–0.65). Pedestrian and non-traffic MVCs were positively associated with SMR; mechanisms of falls, penetration with sharp objects, and environmental injuries were negatively associated with SMR.
Conclusions
We identified multiple factors associated with SMR use. These findings provide an opportunity to evaluate practices, track changes, and assess the impact of updated SMR guidelines in pediatric EMS.
{"title":"Application of cervical spinal motion restriction to injured children in the prehospital setting","authors":"Sriram Ramgopal MD , Caleb E. Ward MB BChir, MPH , Alexander Rogers MD , Seth D. Goldstein MD , Julie C. Leonard MD MPH , Christian Martin-Gill MD MPH","doi":"10.1016/j.ajem.2025.02.006","DOIUrl":"10.1016/j.ajem.2025.02.006","url":null,"abstract":"<div><h3>Objective</h3><div>Improved data on spinal motion restriction (SMR) use can improve pediatric prehospital guidelines and inform the appropriate use of this procedure. We sought to evaluate the prevalence and factors associated with SMR among injured children in the prehospital setting.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis using retrospective data using the 2022–2023 National Emergency Medical Services Information System datasets, including injured pediatric (<18 years) ground encounters at the scene transported to the hospital. We identified the percentage of encounters for which SMR was applied. We identified demographic and clinical associations with SMR application using a linear mixed effects model.</div></div><div><h3>Results</h3><div>We identified 623,785 encounters for injured children (median age 13 years, IQR 6–15; 55.5 % for boys). Among these, 67,551 (10.8 %) had SMR applied in the prehospital setting. In multivariable analysis, SMR use was positively associated (odds ratio, 95 % confidence interval) with older age (1.05, 1.05–1.05), longer transport times (1.23, 1.20–1.25), altered consciousness (increasing odds ratios from 3.12 to 4.54 with worsening AVPU scores), high reported pain scores (1.24, 1.21–1.27 relative to low/medium pain), advanced life support transports (1.81, 1.74–1.88), tachycardia (1.11, 1.06–1.16), tachypnea (1.45, 1.37–1.52), bradypnea (1.15, 1.05–1.26). Hypotension was negatively associated with SMR (0.59, 0.54–0.65). Pedestrian and non-traffic MVCs were positively associated with SMR; mechanisms of falls, penetration with sharp objects, and environmental injuries were negatively associated with SMR.</div></div><div><h3>Conclusions</h3><div>We identified multiple factors associated with SMR use. These findings provide an opportunity to evaluate practices, track changes, and assess the impact of updated SMR guidelines in pediatric EMS.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"90 ","pages":"Pages 214-218"},"PeriodicalIF":2.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386848","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}
A hiatal herniation, which is a common disease worldwide, is associated with various complications. However, hiatal herniation has rarely been reported to cause life-threatening complications in emergency settings. We report a rare case of a patient in shock with collapsed jugular veins and an overdistended inferior vena cava upon transabdominal ultrasonography. The patient was ultimately diagnosed with obstructive shock with inferior vena cava compression attributed to hiatal herniation upon imaging. Clinicians should consider the possibility that hiatal herniation can cause obstructive shock with inferior vena cava compression and take immediate steps to stabilize the vital signs.
{"title":"Shock vitals with collapsed jugular vein and overdistended inferior vena cava due to hiatal herniation: A case report.","authors":"Ryunosuke Hashikawa, Manabu Takamatsu, Makoto Sasaki, Shiho Hiraizumi, Tadashi Echigo","doi":"10.1016/j.ajem.2025.02.002","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.02.002","url":null,"abstract":"<p><p>A hiatal herniation, which is a common disease worldwide, is associated with various complications. However, hiatal herniation has rarely been reported to cause life-threatening complications in emergency settings. We report a rare case of a patient in shock with collapsed jugular veins and an overdistended inferior vena cava upon transabdominal ultrasonography. The patient was ultimately diagnosed with obstructive shock with inferior vena cava compression attributed to hiatal herniation upon imaging. Clinicians should consider the possibility that hiatal herniation can cause obstructive shock with inferior vena cava compression and take immediate steps to stabilize the vital signs.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400870","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 : 2025-02-03DOI: 10.1016/j.ajem.2025.02.001
Mevlüt Ozmen, Faisal Al Ali, Ismael Shaukat, Ozge Ozpolat Bulut, Fatih Bagcier
{"title":"Unexplained abdominal pain: Could it be rectus Abdominis' trigger point.","authors":"Mevlüt Ozmen, Faisal Al Ali, Ismael Shaukat, Ozge Ozpolat Bulut, Fatih Bagcier","doi":"10.1016/j.ajem.2025.02.001","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.02.001","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374599","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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