JEM reports最新文献

Diagnosing Neurocysticercosis after a traumatic fall 创伤性跌倒后的神经囊虫病诊断

JEM reports

Pub Date : 2026-01-22 DOI: 10.1016/j.jemrpt.2026.100209

Priya Shil, Michelle Fowler, Scott Gutovitz

Background

Neurocysticercosis (NCC) is an infection of the central nervous system caused by the tapeworm, Taenia solium, acquired from the ingestion of contaminated food or water. Larvae travel to various tissues of the human body and form cysts, leading to cysticercosis. NCC is a leading cause of acquired epilepsy worldwide. Immigrants from endemic areas are disproportionately affected by the disease which contributes to healthcare disparities.

Case report

This case report discusses a 28-year-old predominantly Spanish speaking male who presented as a trauma activation secondary from a fall off a ladder. He was born in Guatemala and has been working in the United States for six years. His family member noted he was experiencing seizure-like activity and syncopal episodes over the last 3 years, but he did not seek medical evaluation. The initial concern was syncope or seizure causing the fall. CT imaging revealed an indeterminate right frontal lobe hypoattenuating mass, but no traumatic findings. Follow-up MRI showed a cyst with subtle marginal enhancement concerning for NCC. He was treated with levetiracetam, dexamethasone and albendazole for 14 days.

Why should an emergency physician be aware of this

This case elucidates the importance of surveillance for NCC, as its exact prevalence is underreported in the United States. NCC should be included in the differential diagnosis of neurological symptoms, especially in populations at risk. This preventable disease when undiagnosed will increase healthcare cost and disease morbidity. The incidence of NCC in the United States is likely to increase due to immigration, international travel, and globalization.

神经囊虫病（NCC）是一种由绦虫（猪带绦虫）引起的中枢神经系统感染，通过摄入受污染的食物或水而获得。幼虫游走于人体的各个组织，形成囊肿，导致囊虫病。NCC是世界范围内获得性癫痫的主要原因。来自流行地区的移民不成比例地受到这种疾病的影响，这造成了保健方面的差距。这个病例报告讨论了一个28岁的主要讲西班牙语的男性，他表现为从梯子上摔下来的创伤激活。他出生在危地马拉，在美国工作了六年。他的家人注意到他在过去3年中有癫痫样活动和晕厥发作，但他没有寻求医学评估。最初的担心是晕厥或癫痫引起的。CT影像显示一不确定的右额叶低衰减肿块，但未见外伤性发现。后续MRI显示囊肿边缘有轻微强化，可能为NCC。左乙拉西坦、地塞米松、阿苯达唑治疗14天。为什么急诊医生应该意识到这一点？这个病例说明了监测非传染性细胞癌的重要性，因为在美国，它的确切患病率被低估了。神经系统症状的鉴别诊断应包括非细胞癌，特别是在高危人群中。这种可预防的疾病如果未得到诊断，将增加医疗费用和疾病发病率。由于移民、国际旅行和全球化，NCC在美国的发病率可能会增加。

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引用次数: 0

Diabetic ketoacidosis induced by Alpelisib: A case report on a rare complication requiring emergency management Alpelisib致糖尿病酮症酸中毒：一例罕见并发症急诊处理报告

JEM reports

Pub Date : 2026-01-16 DOI: 10.1016/j.jemrpt.2026.100207

Gizem Candemir , Gulcan Candemir Ergene , Cansu Alyesil Ozturan , Ayse Dilara Oztermeli , Huseyin Cahit Halhalli

Background

Alpelisib is a PI3K inhibitor used for the treatment of hormone receptor-positive (HR+), HER2-negative advanced breast cancer with a PIK3CA mutation. Hyperglycemia is its most common adverse effect, which can rarely lead to life-threatening complications such as diabetic ketoacidosis (DKA). This complication can develop even in patients with no prior history of diabetes and requires rapid intervention in the emergency department (ED).

Case presentation

A 62-year-old female patient presented to the ED with complaints of reduced oral intake, fatigue, and oral sores 15 days after initiating alpelisib therapy. Laboratory investigations revealed severe hyperglycemia (593.9 mg/dL), metabolic acidosis (pH 7.159, HCO₃⁻ 6.8 mmol/L), positive urinary ketones, and an HbA1c level of 9.4 %, suggesting previously undiagnosed diabetes. A prompt diagnosis was made of alpelisib-induced DKA in a patient with previously undiagnosed diabetes mellitus. Her acidosis resolved on the second day of admission.

While hyperglycemia is observed in patients treated with alpelisib, the incidence of Grade 3–4 hyperglycemia is 36.6 %, emerging within the first few weeks of treatment. The incidence of DKA is low (0.7 %) but is a life-threatening condition. The underlying mechanism is attributed to severe insulin resistance and increased hepatic gluconeogenesis due to the inhibition of the PI3K/AKT pathway.

Why should an emergency physician be aware of this

This case report underscores that alpelisib therapy can precipitate DKA, especially in patients with underlying, potentially undiagnosed, diabetes. A multidisciplinary approach, including close glycemic monitoring, assessment of risk factors, and preparedness for hyperglycemic emergencies, is critical for patients starting alpelisib.

背景：dalpelisib是一种PI3K抑制剂，用于治疗激素受体阳性（HR+）、her2阴性、PIK3CA突变的晚期乳腺癌。高血糖是其最常见的副作用，很少会导致危及生命的并发症，如糖尿病酮症酸中毒（DKA）。即使没有糖尿病病史的患者也可能出现这种并发症，需要在急诊科（ED）进行快速干预。病例表现：一名62岁女性患者，在开始alpelisib治疗15天后，以口服摄入量减少、疲劳和口腔溃疡的主诉来到急诊科。实验室检查显示严重高血糖（593.9 mg/dL），代谢性酸中毒（pH 7.159, HCO3−6.8 mmol/L），尿酮阳性，HbA1c水平为9.4%，提示以前未诊断的糖尿病。在一个以前未确诊的糖尿病患者中，及时诊断出alpelisib诱导的DKA。她的酸中毒在入院的第二天消失了。虽然在alpelisib治疗的患者中观察到高血糖，但3-4级高血糖的发生率为36.6%，出现在治疗的前几周。DKA的发病率很低（0.7%），但却是一种危及生命的疾病。其潜在机制归因于PI3K/AKT通路抑制导致的严重胰岛素抵抗和肝脏糖异生增加。急诊医生为什么要注意这一点？本病例报告强调，alpelisib治疗可诱发DKA，特别是对潜在未确诊的糖尿病患者。多学科方法，包括密切血糖监测、风险因素评估和高血糖紧急情况的准备，对开始使用阿派西布的患者至关重要。

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引用次数: 0

Rare complication of active renal arterial hemorrhage after extracorporeal shockwave lithotripsy (ESWL) in a low-risk patient: A case report 低危病人体外冲击波碎石术后活动性肾动脉出血的罕见并发症1例报告

JEM reports

Pub Date : 2026-01-11 DOI: 10.1016/j.jemrpt.2026.100205

Danica Anderson , Pallash A. Desai , Hung Nguyen , Faith C. Quenzer , Steven Groke

Background

Renal calculi commonly present with flank pain or hematuria. Extracorporeal shockwave lithotripsy (ESWL) is a noninvasive treatment for kidney or proximal ureteral stones ≤10 mm, except in cases of obesity, pregnancy, coagulopathy, high stone attenuation on computerized tomography (CT), or abnormal renal anatomy. Rare complications include ureteral obstruction, urinary tract infection, and hemorrhage. This case report reviews a rare complication of active renal arterial hemorrhage after outpatient ESWL, requiring resuscitation and interventional radiology (IR).

Case report

A 44-year-old Caucasian male presented to the emergency department (ED) with mild tachycardia, pallor, and significant right flank pain following an outpatient ESWL hours earlier. A point-of-care ultrasound demonstrated free fluid in the hepatorenal space. The initial non-contrast CT scan of the abdomen and pelvis revealed a large perinephric hematoma but possible extravasation. The CT of the abdomen and pelvis with contrast revealed active intrarenal arterial extravasation with extensive retroperitoneal hemorrhage and perinephric hematoma; his hemoglobin was 8.1 g/dL. The patient underwent emergent IR embolization and received five units of packed red blood cells during his stay in the intensive care unit (ICU). He was discharged on hospital day three.

Why should an emergency medicine physician be aware of this?

Less than 1 % of cases report major vascular bleeding following an ESWL. Early recognition by the emergency medicine physician can help significantly decrease morbidity and mortality by initiating early multidisciplinary response through urology, IR, and intensive care.

背景：肾结石通常表现为腹部疼痛或血尿。体外冲击波碎石术（ESWL）是一种无创治疗肾或输尿管近端≤10毫米结石的方法，但肥胖、怀孕、凝血功能障碍、计算机断层扫描（CT）上结石衰减高或肾脏解剖异常的情况除外。罕见的并发症包括输尿管梗阻、尿路感染和出血。这个病例报告回顾了一个罕见的并发症活动性肾动脉出血后，门诊ESWL，需要复苏和介入放射学（IR）。病例报告：一名44岁的白人男性在几小时前进行了门诊ESWL后，以轻度心动过速、苍白和明显的右侧疼痛来到急诊室。即时超声显示肝肾间隙有游离液体。最初的腹部和骨盆非对比CT扫描显示一个大的肾周血肿，但可能有外渗。腹部及骨盆CT示活动性肾内动脉外渗伴广泛腹膜后出血及肾周血肿；血红蛋白8.1 g/dL。患者在重症监护病房（ICU）住院期间接受了紧急IR栓塞治疗，并注射了5个单位的填充红细胞。他在住院的第三天出院了。急诊医生为什么要意识到这一点？不到1%的病例报告ESWL后出现大血管出血。急诊医师的早期识别可以通过泌尿外科、IR和重症监护等早期多学科反应来帮助显著降低发病率和死亡率。

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引用次数: 0

Thyroid storm in an adolescent presenting with acute sinus tachycardia triggered by Streptococcal and Influenza co-infection 甲状腺风暴在一个青少年表现为急性窦性心动过速由链球菌和流感合并感染

JEM reports

Pub Date : 2026-01-09 DOI: 10.1016/j.jemrpt.2026.100206

Bradford Huff

Background

Thyroid storm is a rare but life-threatening complication of thyrotoxicosis. It is particularly uncommon in pediatric populations with an incidence of approximately 1–2 % among patients with overt hyperthyroidism (Karger and Fuhrer, 2008) [1]. Thyrotoxicosis has a reported annual incidence of 0.9 per 100,000 in post pubertal children and a prevalence in the US of 1.2 % (Bahn et al., 2011) [2], (Williamson and Greene, 2010) [3]. Symptoms of thyroid storm include hypertension, fever, gastrointestinal symptoms, tachycardia, and altered mental status. These signs and symptoms easily mimic common emergency medicine patient presentations such as sepsis, dysrhythmia, viral infections, pneumonia, or recreational drug use, making diagnosis difficult. Delayed recognition of thyroid storm significantly increases morbidity and mortality, making prompt recognition and treatment critical in the emergency medicine setting.

Case report

We present the case of a 14-year-old adolescent who arrived to the emergency department with fever, rapid heart rate, anxiety, and sore throat. The constellation of physical exam findings led to suspicion for thyroid storm. Treatment including IV fluids, beta-blockade, antithyroid therapy, corticosteroids, and iodine therapy were initiated. Laboratory testing later confirmed the diagnosis of thyroid storm. Testing for Streptococcal pharyngitis and Influenza B also resulted positive, likely representing the triggers. The patient improved with the treatment administered in the emergency department and subsequently transferred to the pediatric ICU.

Why should an emergency physician be aware of this?

Although rare in pediatric patients, thyroid storm carries a mortality rate of 10–30 % (De Groot and Abalovich, 2022) [4], (Karger and Fuhrer, 2008) [1]. Early diagnosis is essential, yet the clinical presentation can be mistaken for more common emergencies such as sepsis, dysrhythmia, myocarditis, endocarditis, pneumonia, or recreational drug use. Emergency physicians must maintain a high index of suspicion for thyroid storm in patients presenting with unexplained tachycardia, fever, and hypertension, even in the absence of known thyroid disease. Emergency physicians play a critical role in stabilizing these patients and initiating time-sensitive treatment that significantly improves outcomes.

背景：甲状腺风暴是一种罕见但危及生命的甲状腺毒症并发症。这在儿科人群中尤其罕见，在明显甲状腺功能亢进的患者中发病率约为1 - 2% （Karger和Fuhrer， 2008）。据报道，青春期后儿童甲状腺毒症的年发病率为10万分之0.9，在美国的患病率为1.2% (Bahn et al., 2011), （Williamson and Greene, 2010）。甲状腺风暴的症状包括高血压、发热、胃肠道症状、心动过速和精神状态改变。这些体征和症状很容易模仿常见的急诊患者表现，如败血症、心律失常、病毒感染、肺炎或娱乐性药物使用，使诊断变得困难。甲状腺风暴的延迟识别显着增加发病率和死亡率，使及时识别和治疗在急诊医学环境中至关重要。病例报告我们报告一名14岁青少年的病例，他以发烧、心率加快、焦虑和喉咙痛来到急诊科。一系列的体检结果引起了对甲状腺风暴的怀疑。治疗包括静脉输液、β -阻断剂、抗甲状腺治疗、皮质类固醇和碘治疗。后来的实验室检查证实了甲状腺风暴的诊断。链球菌性咽炎和乙型流感的检测结果也呈阳性，可能代表了触发因素。患者在急诊科接受治疗后病情有所好转，随后转至儿科重症监护病房。急诊医生为什么要意识到这一点？虽然在儿科患者中罕见，但甲状腺风暴的死亡率为10 - 30% (De Groot and Abalovich, 2022), （Karger and Fuhrer, 2008）。早期诊断至关重要，但临床表现可能被误认为是更常见的紧急情况，如败血症、心律失常、心肌炎、心内膜炎、肺炎或娱乐性药物使用。急诊医生必须对出现不明原因的心动过速、发热和高血压的患者甲状腺风暴保持高度的怀疑，即使在没有已知甲状腺疾病的情况下。急诊医生在稳定这些患者和启动时间敏感的治疗方面发挥着关键作用，显著改善了结果。

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引用次数: 0

Cancer pain in the emergency department: A narrative review 急诊科的癌症疼痛：叙述性回顾

JEM reports

Pub Date : 2026-01-09 DOI: 10.1016/j.jemrpt.2026.100208

Nam T. Nguyen , Jace Nguyen , Rayan Jouny , Rebecca A. Shatsky , Christopher J. Coyne

Background

Cancer-related pain accounts for up to 62 % of emergency department (ED) visits among patients with malignancy, yet one in three receives inadequate analgesia. Persistent disparities in cancer pain management based on race, age, and insurance status, further exacerbate this issue. To date, there are no reviews evaluating the existing literature on cancer pain management in the emergency department, or strategies to optimize care for this prevalent condition.

Objective

To review and synthesize recent evidence (2015–2025) on the burden of cancer-related pain in the ED, focusing on incidence, clinical features, treatment shortcomings, and emerging strategies to improve care.

Discussion

Twenty-seven studies were included in the review. Pain recurred or persisted in 40–62 % of encounters, with musculoskeletal and abdominal pain responding poorly. Median time to opioid administration exceeded 1 h; while escalation occurred in only 11 % of undertreated cases. Black patients were nearly twice as likely as White patients to present in severe pain but were less likely to receive opioids. Younger adults, Medicaid/Medicare recipients, and patients with chronic pain or bone metastases also faced higher pain scores and admission rates. Promising interventions, including electronic best-practice advisories, alternative-to-opioid protocols, nerve blocks, and oncology-specific observation units were linked to lower pain scores, reduced opioid use, and fewer revisits or admissions. These strategies are based on single-center studies, with limited validation and sparse data on long-term, patient-centered outcomes. Although there are novel modalities explored, the primary pain management intervention for patients with cancer is opioids.

Conclusion

Cancer pain remains a leading, inequitable driver of ED use, highlighting the need for scalable, validated interventions that integrate timely analgesia and address structural disparities.

背景：恶性肿瘤患者中，与癌症相关的疼痛占急诊科（ED）就诊人数的62%，但三分之一的患者接受的镇痛不足。基于种族、年龄和保险状况的癌症疼痛管理的持续差异进一步加剧了这一问题。到目前为止，还没有对现有的关于急诊科癌症疼痛管理的文献进行评估，也没有针对这种普遍情况优化护理的策略。目的回顾和综合最近（2015-2025）关于急诊科癌症相关疼痛负担的证据，重点关注发病率、临床特征、治疗缺陷和改善护理的新策略。讨论本综述纳入了27项研究。40 - 62%的患者复发或持续疼痛，肌肉骨骼和腹部疼痛反应较差。阿片类药物给药的中位时间超过1小时；而在治疗不足的病例中，只有11%发生了病情升级。黑人患者出现严重疼痛的可能性几乎是白人患者的两倍，但接受阿片类药物治疗的可能性较低。年轻人、医疗补助/医疗保险接受者、慢性疼痛或骨转移患者也面临更高的疼痛评分和入院率。有前景的干预措施，包括电子最佳实践咨询、阿片类药物替代方案、神经阻滞和肿瘤特异性观察单元，与降低疼痛评分、减少阿片类药物使用、减少复诊或入院次数有关。这些策略基于单中心研究，验证有限，且以患者为中心的长期结果数据稀少。虽然有新的模式探索，主要的疼痛管理干预癌症患者是阿片类药物。结论：癌症疼痛仍然是ED使用的主要不公平驱动因素，强调需要可扩展的、有效的干预措施，包括及时镇痛和解决结构差异。

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引用次数: 0

ED point-of-care ultrasound evaluation of acute splenic sequestration in sickle cell disease 镰状细胞病急性脾隔离的急诊超声评价

JEM reports

Pub Date : 2025-12-31 DOI: 10.1016/j.jemrpt.2025.100202

James W. Tsung , Sarah McCuskee , Jeffrey A. Glassberg

Background

Acute splenic sequestration is a life-threatening complication of sickle cell disease. While traditionally considered a clinical diagnosis not requiring imaging, the increasing availability of point-of-care ultrasound (PoCUS) in the emergency department (ED) presents an opportunity to re-evaluate its role in expediting diagnosis and management.

Case report

This case series reports the use of PoCUS in the ED evaluation of pediatric patients with sickle cell disease presenting with suspected acute splenic sequestration. We describe key sonographic findings, including splenomegaly and altered splenic echogenicity. We present two cases of acute splenic sequestration where PoCUS rapidly identified splenomegaly and increased splenic echogenicity relative to the adjacent left kidney. In one case, these sonographic findings, prompted by left upper quadrant abdominal pain, preceded the characteristic drop in hemoglobin. Serial ultrasound measurements demonstrated a progressive increase in spleen size, correlating with the clinical course. In contrast, an asymptomatic control patient with a remote history of sequestration had normal spleen size and isoechoic parenchyma. These findings suggest that PoCUS may provide objective, real-time data that may be more reliable than physical examination for splenomegaly and can track the progression of sequestration.

Why should an emergency physician be aware of this?

PoCUS may be a simple, rapid, and feasible tool for evaluating suspected acute splenic sequestration in the ED. Measuring spleen size and assessing for increased splenic echogenicity can aid in early diagnosis and inform timely management, potentially improving outcomes for patients with sickle cell disease.

背景：急性脾隔离是镰状细胞病危及生命的并发症。虽然传统上认为临床诊断不需要成像，但急诊部（ED）越来越多的即时超声（PoCUS）提供了重新评估其在加速诊断和管理中的作用的机会。病例报告：本系列病例报告使用PoCUS对疑似急性脾隔离的镰状细胞病患儿进行ED评估。我们描述了主要的超声表现，包括脾肿大和脾回声改变。我们报告了两例急性脾隔离病例，其中PoCUS快速识别脾肿大，相对于邻近的左肾脾回声增强。在一个病例中，这些超声结果是由左上腹腹痛引起的，先于血红蛋白的特征性下降。连续超声测量显示脾脏体积进行性增大，与临床病程相关。相比之下，无症状的对照组患者有长期的隔离史，其脾大小和等回声实质正常。这些发现表明PoCUS可以提供客观、实时的数据，可能比体格检查更可靠，并且可以跟踪脾肿大的进展。急诊医生为什么要意识到这一点？PoCUS可能是一种简单、快速、可行的工具，用于评估ED中可疑的急性脾隔离。测量脾脏大小和评估脾脏回声增强有助于早期诊断和及时处理，可能改善镰状细胞病患者的预后。

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引用次数: 0

Point-of-care ultrasound for the detection of sigmoid colon foreign body: A case report 即时超声检查乙状结肠异物1例

JEM reports

Pub Date : 2025-12-30 DOI: 10.1016/j.jemrpt.2025.100204

Brooke Johnson , Camille Mulcahy , Nathan Roberts , Nigel Bowe , Ahmed Naseem , Christopher Clark

Background

Emergency department (ED) visits for colorectal foreign bodies are not uncommon across the United States, with increasing incidence over recent years. Plain abdominal radiographs (XR) are the standard initial imaging modality of choice in cases of retained colorectal foreign bodies; however, they are limited in their ability to detect radiolucent objects. The use of point-of-care ultrasound (POCUS) in identification of radiolucent colorectal foreign bodies remains poorly studied and may even be underutilized. Case Report: This case report examines the use of POCUS in the ED for a patient presenting with a retained sigmoid colon foreign body. Why Should An Emergency Physician Be Aware Of This? Our findings highlight the potential role of POCUS as a valuable adjunct to traditional imaging in the assessment and management of colorectal foreign bodies.

背景：在美国，因结直肠异物到急诊科就诊并不罕见，近年来发病率不断上升。腹部x线平片（XR）是结肠直肠异物残留的标准初始成像方式；然而，它们在探测透光物体的能力上是有限的。使用即时超声（POCUS）识别放射性结直肠异物的研究仍然很少，甚至可能未充分利用。病例报告：本病例报告探讨了在急诊科使用POCUS治疗乙状结肠异物。急诊医生为什么要意识到这一点？我们的研究结果强调了POCUS作为传统影像学评估和处理结直肠异物的辅助手段的潜在作用。

引用次数: 0

Varices everywhere: Stomal bleeding due to undiagnosed portal hypertension 到处静脉曲张：未确诊的门静脉高压引起的口出血

JEM reports

Pub Date : 2025-12-30 DOI: 10.1016/j.jemrpt.2025.100203

Anastasia Crenshaw , Kaitlynn Borik , Joshua Julian , Tina H. Chen

Background

Patients with stomas commonly experience bleeding at the stoma site, often due to local mucosal trauma. However, more serious underlying causes should be considered.

Case report

We discuss the case of a 77-year-old man with a past medical history of colostomy who presented to the emergency department (ED) after an episode of acute stomal bleeding. He had experienced increasingly worsening episodes of superficial stomal bleeding for three years prior to presentation. Computed tomography (CT) revealed an unexpected finding of an ectopic parastomal varix within the stoma, associated with newly discovered cirrhosis and infiltrated hepatocellular carcinoma.

Why should an emergency physician be aware of this?

Stomal bleeding is usually due to a range of superficial causes. However, parastomal variceal bleeding can be severe and life-threatening. Emergency physicians should consider this diagnosis when encountering a patient with stomal bleeding, especially if the patient has risk factors for portal hypertension.

研究背景：造口患者通常会在造口部位出血，通常是由于局部粘膜损伤。然而，应该考虑更严重的潜在原因。病例报告我们讨论的情况下，77岁的男子与过去的医疗历史的结肠造口后出现急性口出血急诊科（ED）。在就诊前三年，他经历了越来越严重的浅表造口出血。计算机断层扫描（CT）显示一个意想不到的发现，异位造口旁静脉曲张在瘘内，与新发现的肝硬化和浸润性肝细胞癌相关。急诊医生为什么要意识到这一点？口出血通常是由一系列表面原因引起的。然而，造口旁静脉曲张出血可能很严重并危及生命。急诊医生在遇到有口出血的病人时应考虑这个诊断，特别是当病人有门静脉高压的危险因素时。

引用次数: 0

Ultrasound-guided interscalene block for shoulder avascular necrosis pain in the emergency department: A case report 超声引导下斜角肌间阻滞治疗急诊科肩关节缺血性坏死疼痛1例

JEM reports

Pub Date : 2025-11-24 DOI: 10.1016/j.jemrpt.2025.100201

Jennifer X. Hong , Richard J. Gawel , Jeffrey A. Kramer

Background

Avascular necrosis (AVN) of the humeral head may cause severe pain requiring ED management, particularly in patients awaiting surgical treatment.

Case report

A 38-year-old woman presented with severe left shoulder AVN pain refractory to oral and intravenous opioids. She received an ultrasound-guided interscalene brachial plexus block (ISB) with complete relief. She was discharged without the need for any subsequent analgesics in the ED.

Why should an emergency physician be aware of this?

This case highlights the novel use of an emergency physician-performed ISB for AVN-related shoulder pain and supports the potential role of ultrasound-guided regional anesthesia as an opioid-sparing intervention for AVN-related pain in the ED.

背景：肱骨头的血管坏死（AVN）可能引起严重的疼痛，需要ED治疗，特别是等待手术治疗的患者。病例报告：一名38岁女性，出现严重左肩AVN疼痛，口服和静脉注射阿片类药物难治。她接受了超声引导的斜角肌间臂丛阻滞（ISB），完全缓解。她出院时不需要在急诊科使用任何镇痛药，为什么急诊医生应该意识到这一点？本病例强调了急诊医师实施ISB治疗avn相关肩痛的新应用，并支持超声引导下区域麻醉作为一种不使用阿片类药物干预急诊科avn相关疼痛的潜在作用。

引用次数: 0

Balancing bleeding and thrombosis in chronic liver disease: ROTEM-guided management of life-threatening lower GI bleed 平衡慢性肝病的出血和血栓形成：rotem指导下危及生命的下消化道出血的管理

JEM reports

Pub Date : 2025-11-21 DOI: 10.1016/j.jemrpt.2025.100200

Mayuri Bhanwar, Naazia Siddiqua, Jamshed Nayer

Background

Chronic liver disease (CLD) often presents with unique coagulation challenges that complicate management of gastrointestinal bleeding. Conventional laboratory tests (PT, aPTT, INR) are often unreliable in predicting the true balance between bleeding and thrombotic risk in CLD. Also, the occurrence of meckel's diverticulum-related bleeding in adults is an uncommon phenomenon.

Case report

A 28-year-old male with chronic liver disease presented with life-threatening gastrointestinal bleeding and hemorrhagic shock. Rotational thromboelastometry (ROTEM) used as a point-of-care test, revealed factor deficiency with preserved platelet function. ROTEM-guided transfusion strategy included fresh frozen plasma and PRBCs. Contrast enhanced computed tomography (CECT) abdomen demonstrated small bowel obstruction with intraluminal bleeding. Emergency exploratory laparotomy revealed a bleeding Meckel's diverticulum, which is rare in adults. Segmental resection, including the diverticulum, was performed with creation of double-barrel ileostomy.

Why should an emergency physician be aware of this?

Managing bleeding in chronic liver disease is challenging, as it requires controlling bleeding while carefully avoiding an increased risk of thrombosis. ROTEM-by offering a dynamic, whole-blood picture of coagulation, allows for tailored transfusion strategies, avoiding unnecessary correction and associated thrombotic risk while at the same time, facilitating a definitive surgery for bleeding Meckel's diverticulum.

背景：慢性肝病（CLD）往往表现出独特的凝血挑战，使胃肠道出血的治疗复杂化。常规实验室检测（PT、aPTT、INR）在预测CLD出血和血栓风险之间的真实平衡时往往不可靠。此外，成人发生梅克尔憩室相关出血是一种罕见的现象。病例报告：一名28岁男性慢性肝病患者表现为危及生命的胃肠道出血和失血性休克。旋转血栓弹性测定（ROTEM）作为一个点护理试验，揭示因子缺乏与保留血小板功能。rotem指导的输血策略包括新鲜冷冻血浆和红细胞。腹部增强计算机断层扫描（CECT）显示小肠梗阻伴腔内出血。急诊剖腹探查发现梅克尔憩室出血，这在成人中很少见。节段性切除，包括憩室，进行双管回肠造口术。急诊医生为什么要意识到这一点？慢性肝病的出血管理具有挑战性，因为它需要控制出血，同时小心避免血栓形成的风险增加。rotem -通过提供动态的全血凝血图像，允许量身定制的输血策略，避免不必要的纠正和相关的血栓形成风险，同时，促进出血的梅克尔憩室的最终手术。

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引用次数: 0