Altered mental status and seizure are chief complaints frequently seen in pediatric emergency departments. A multitude of disease processes can cause pediatric patients to present with these chief complaints, so it is important to consider broad differential diagnoses. Here, we present the case of a 3-year old patient with acute-onset mental status change and new-onset seizures who we diagnosed with a disorder not commonly seen in children, but one that requires prompt initiation of therapy.
{"title":"Altered mental status and seizures in a 3-year old with suspected anemia","authors":"Ayhan Atmanli MD, PhD , Nilesh K. Desai MD , Jeny Nirappil MD","doi":"10.1016/j.ajem.2025.07.064","DOIUrl":"10.1016/j.ajem.2025.07.064","url":null,"abstract":"<div><div>Altered mental status and seizure are chief complaints frequently seen in pediatric emergency departments. A multitude of disease processes can cause pediatric patients to present with these chief complaints, so it is important to consider broad differential diagnoses. Here, we present the case of a 3-year old patient with acute-onset mental status change and new-onset seizures who we diagnosed with a disorder not commonly seen in children, but one that requires prompt initiation of therapy.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 401-404"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812705","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}
Blunt renal trauma in children is typically managed nonoperatively, but rare delayed vascular complications such as pseudoaneurysm rupture can be life-threatening. A 3-year-old girl sustained grade III right renal injury after a fall. Initial contrast-enhanced computed tomography (CECT) revealed a renal laceration without urinary extravasation but a large perirenal hematoma. The patient was treated conservatively and discharged on day 15 with no evidence of pseudoaneurysm on day 7 CECT. On post-injury day 22, the patient represented with gross hematuria and flank pain. CECT revealed rupture of a lower branch renal artery pseudoaneurysm. Emergency transcatheter arterial embolization with N-butyl-2-cyanoacrylate achieved complete hemostasis. Follow-up at 4 months confirmed no recurrence. This is the first reported case of traumatic renal artery pseudoaneurysm rupture in a child under 5 years. It illustrates that rupture can occur after early negative imaging during hematoma resorption. Vigilant follow up, preferably with ultrasonography, is warranted in pediatric renal trauma with large perirenal hematomas.
{"title":"Delayed rupture of a renal artery pseudoaneurysm following blunt renal trauma in a 3-year-old child","authors":"Yoshitaka Ishiguro , Te-Hsiung Wang , Masahiro Koh , Hiroaki Fukuzawa , Akihiko Hirakawa","doi":"10.1016/j.ajem.2025.08.033","DOIUrl":"10.1016/j.ajem.2025.08.033","url":null,"abstract":"<div><div>Blunt renal trauma in children is typically managed nonoperatively, but rare delayed vascular complications such as pseudoaneurysm rupture can be life-threatening. A 3-year-old girl sustained grade III right renal injury after a fall. Initial contrast-enhanced computed tomography (CECT) revealed a renal laceration without urinary extravasation but a large perirenal hematoma. The patient was treated conservatively and discharged on day 15 with no evidence of pseudoaneurysm on day 7 CECT. On post-injury day 22, the patient represented with gross hematuria and flank pain. CECT revealed rupture of a lower branch renal artery pseudoaneurysm. Emergency transcatheter arterial embolization with N-butyl-2-cyanoacrylate achieved complete hemostasis. Follow-up at 4 months confirmed no recurrence. This is the first reported case of traumatic renal artery pseudoaneurysm rupture in a child under 5 years. It illustrates that rupture can occur after early negative imaging during hematoma resorption. Vigilant follow up, preferably with ultrasonography, is warranted in pediatric renal trauma with large perirenal hematomas.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 413-415"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979774","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.2025.09.006
Maroun M. Sfeir
{"title":"Reader comment regarding “risk factors for enterococcal urinary tract infection in emergency department patients: A sub-analysis of the UNTRIED study”","authors":"Maroun M. Sfeir","doi":"10.1016/j.ajem.2025.09.006","DOIUrl":"10.1016/j.ajem.2025.09.006","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 367-368"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058771","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.2025.07.016
Huan Xiao PhD , Ying Qiu MD , Yong Li PhD, Wei Wang PhD, Chao-qian Li PhD
Currently, clinical studies on lightning injuries are mostly limited to single-patient cases, and there is still limited understanding of the mechanisms and clinical features of injuries that occur simultaneously among multiple individuals in a localized area. This article reports the environmental conditions, injuries, and treatment of six patients who suffered from arc explosion injuries caused by lightning within a 200-m radius. The incident occurred in late June on a rainy day at a coastal location (approximately 680 m elevation). Six patients were simultaneously injured by a lightning-induced electric arc explosion and were thrown several meters away from their original positions, resulting in a brief loss of consciousness and transient memory impairment. All six patients developed pulmonary contusion and hypokalemia, with elevated levels of inflammatory markers (e.g., hs-CRP) and leukocytosis with neutrophilia, as well as abnormal electrocardiogram (ECG) findings. Four patients had skin burns and tympanic-membrane perforations; the other two, who were wearing raincoats, did not have these injuries. The treatment regimens primarily included antibiotic therapy, hyperbaric oxygen, wound care, and other symptomatic supportive treatments. All patients improved and were discharged within eight days. This case series illustrates the environmental factors, injury mechanisms, and complex, multi-system clinical features of arc explosion injuries caused by lightning, emphasizing the importance of lightning protection measures.
{"title":"Six cases of collective lightning-induced arc explosion injuries: A case report","authors":"Huan Xiao PhD , Ying Qiu MD , Yong Li PhD, Wei Wang PhD, Chao-qian Li PhD","doi":"10.1016/j.ajem.2025.07.016","DOIUrl":"10.1016/j.ajem.2025.07.016","url":null,"abstract":"<div><div><span><span><span>Currently, clinical studies on lightning injuries are mostly limited to single-patient cases, and there is still limited understanding of the mechanisms and clinical features of injuries that occur simultaneously among multiple individuals in a localized area. This article reports the environmental conditions, injuries, and treatment of six patients who suffered from arc explosion injuries caused by lightning within a 200-m radius. The incident occurred in late June on a rainy day at a coastal location (approximately 680 m elevation). Six patients were simultaneously injured by a lightning-induced electric arc explosion and were thrown several meters away from their original positions, resulting in a brief loss of consciousness and transient memory impairment. All six patients developed </span>pulmonary contusion and </span>hypokalemia<span>, with elevated levels of inflammatory markers (e.g., hs-CRP) and leukocytosis<span> with neutrophilia, as well as abnormal electrocardiogram (ECG) findings. Four patients had skin burns and tympanic-membrane perforations; the other two, who were wearing raincoats, did not have these injuries. The treatment regimens primarily included antibiotic therapy, hyperbaric oxygen, wound care, and other symptomatic supportive treatments. All patients improved and were discharged within eight days. This case series illustrates the </span></span></span>environmental factors, injury mechanisms, and complex, multi-system clinical features of arc explosion injuries caused by lightning, emphasizing the importance of lightning protection measures.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 379-383"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627827","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}
Spinal cord hemorrhages are very rare conditions. It can be categorized into four types based on its anatomical location: epidural, subdural, subarachnoid, and intramedullary. The incidence of spinal hematomas remains undetermined due to limited data. Early detection and prompt management are critical for better outcomes in terms of morbidity and mortality.
Case report
A 65-year-old Southeast Asian female with a history of mechanical valve replacement and long-term warfarin use presented with progressive back pain following a mild back pain after riding a speedboat. She later developed sudden bilateral lower limb weakness and urinary retention. Magnetic resonance imaging (MRI) revealed multiple spinal cord hematomas: intramedullary from T4 to the conus medullaris, epidural from T8 to L1, and subdural from T2 to T7. She underwent T10-T12 laminectomy for epidural hematoma evacuation. Anticoagulation therapy with warfarin was resumed under close monitoring of international normalized ratio.
Conclusion
Spinal hemorrhage involving multiple spinal cord layer is a very rare condition. It should be considered in patients with acute back pain and neurological symptoms. MRI is the imaging modality of choice, with early decompression within 12 h of symptom onset improving outcomes. Prompt correction of coagulopathy is crucial to prevent hematoma expansion. Proper warfarin management is essential to prevent the recurrence of bleeding events while ensuring cardiovascular protection.
{"title":"Multilayer spinal hemorrhage in a patient on long-term warfarin: A case report","authors":"Charakrit Pankongngam , Pawaruj Rirermsoonthorn MD , Borwon Wittayachamnankul MD, PhD","doi":"10.1016/j.ajem.2025.07.046","DOIUrl":"10.1016/j.ajem.2025.07.046","url":null,"abstract":"<div><h3>Background</h3><div>Spinal cord hemorrhages are very rare conditions. It can be categorized into four types based on its anatomical location: epidural, subdural, subarachnoid, and intramedullary. The incidence of spinal hematomas remains undetermined due to limited data. Early detection and prompt management are critical for better outcomes in terms of morbidity and mortality.</div></div><div><h3>Case report</h3><div>A 65-year-old Southeast Asian female with a history of mechanical valve replacement and long-term warfarin use presented with progressive back pain following a mild back pain after riding a speedboat. She later developed sudden bilateral lower limb weakness and urinary retention. Magnetic resonance imaging (MRI) revealed multiple spinal cord hematomas: intramedullary from T4 to the conus medullaris, epidural from T8 to L1, and subdural from T2 to T7. She underwent T10-T12 laminectomy for epidural hematoma evacuation. Anticoagulation therapy with warfarin was resumed under close monitoring of international normalized ratio.</div></div><div><h3>Conclusion</h3><div>Spinal hemorrhage involving multiple spinal cord layer is a very rare condition. It should be considered in patients with acute back pain and neurological symptoms. MRI is the imaging modality of choice, with early decompression within 12 h of symptom onset improving outcomes. Prompt correction of coagulopathy is crucial to prevent hematoma expansion. Proper warfarin management is essential to prevent the recurrence of bleeding events while ensuring cardiovascular protection.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 386-389"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735551","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.2025.07.067
Philippe Laitselart, Jean Derely
{"title":"Reader comment regarding “The emergency/trauma regional anesthesia service - A novel concept for provision of regional anesthesia to emergency department and inpatients with acute pain”","authors":"Philippe Laitselart, Jean Derely","doi":"10.1016/j.ajem.2025.07.067","DOIUrl":"10.1016/j.ajem.2025.07.067","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 355-356"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796186","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.2025.10.013
Mehmet Necmeddin Sutaşır MD
{"title":"Reader comment regarding: Discrepancies in patient selection an performance metrics of the APUA-RO2 score","authors":"Mehmet Necmeddin Sutaşır MD","doi":"10.1016/j.ajem.2025.10.013","DOIUrl":"10.1016/j.ajem.2025.10.013","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 374-375"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145294486","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.2025.08.057
Andrea Shehaj BS , Catherine A. Marco MD , Nathan J. Morrison DO, M.Eng , Julia Dunbar MD
{"title":"Antipsychotic agents for treatment of schizophrenia in the emergency department: Comparison of oral and parenteral first- and second-generation agents","authors":"Andrea Shehaj BS , Catherine A. Marco MD , Nathan J. Morrison DO, M.Eng , Julia Dunbar MD","doi":"10.1016/j.ajem.2025.08.057","DOIUrl":"10.1016/j.ajem.2025.08.057","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 361-363"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979754","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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