JEM reports最新文献_第4页

Managing acute coccydynia in the ED: A case report of a successful blind sacrococcygeal nerve block 急诊治疗急性尾骨痛：一例成功的盲骶尾骨神经阻滞

JEM reports

Pub Date : 2025-06-21 DOI: 10.1016/j.jemrpt.2025.100178

Aakash A. Setty MD , Stevin M. Bienfait MD , Jessica C. Oswald MD

Background

Acute traumatic coccydynia typically results from direct trauma and is an often overlooked but significant cause of discomfort that can present acutely in the emergency department (ED). First-line treatment including NSAIDs and acetaminophen aims to provide relief but can be insufficient. The sacrococcygeal nerve block, though underutilized in the ED, is a simple intervention using existing skills to provide pain relief. To our knowledge, this is its first documented use in the ED for coccydynia.

Case report

A 20-year-old female presented to the ED with severe coccygeal pain (10/10) following a fall five days prior. Conservative management of NSAIDs, acetaminophen and activity modifications from a prior ED visit failed to improve her symptoms, leaving her requiring significant daily bedrest. In the present ED visit, after failed opioid pain reduction, a sacrococcygeal nerve block was performed using dexamethasone and bupivacaine, resulting in complete pain resolution (0/10) within 15 minutes. The patient experienced 5 h of total relief, a 30 % reduction in pain by 18 hours, and 70 % reduction by week three. She resumed work within a week and reported satisfaction with the procedure.

Why Should an Emergency Physician Be Aware of This?

The sacrococcygeal nerve block is a time-efficient intervention for acute coccydynia that aligns well with the skillset and demands of the ED, although further research is required on its effectiveness in the ED setting prior to wide use. It can possibly provide immediate pain relief, reduce opioid requirements, and minimize repeat visits as discussed in this report.

背景：急性外伤性尾骨痛通常由直接创伤引起，是一种经常被忽视但重要的不适原因，可在急诊科（ED）急性出现。包括非甾体抗炎药和对乙酰氨基酚在内的一线治疗旨在提供缓解，但可能不够。骶尾椎神经阻滞术虽然在急诊科中未被充分利用，但它是一种利用现有技术缓解疼痛的简单干预方法。据我们所知，这是第一次记录使用在ED尾骨痛。病例报告：一名20岁女性，5天前跌倒后出现严重尾骨疼痛（10/10）。保守治疗非甾体抗炎药、对乙酰氨基酚和既往急诊科就诊的活动改变未能改善患者的症状，使其需要大量的每日卧床休息。在本次急诊科就诊中，阿片类镇痛失败后，使用地塞米松和布比卡因进行骶尾椎神经阻滞，15分钟内疼痛完全缓解（0/10）。患者经历了5小时的完全缓解，疼痛减轻30% 18小时，到第三周减轻70%。她在一周内恢复了工作，并对手术过程表示满意。急诊医生为什么要意识到这一点？骶尾椎神经阻滞是治疗急性尾骨痛的一种有效的干预方法，符合急诊科的技能和要求，但在广泛应用之前，还需要进一步研究其在急诊科的有效性。如本报告所述，它可以立即缓解疼痛，减少阿片类药物的需求，并尽量减少重复就诊。

{"title":"Managing acute coccydynia in the ED: A case report of a successful blind sacrococcygeal nerve block","authors":"Aakash A. Setty MD , Stevin M. Bienfait MD , Jessica C. Oswald MD","doi":"10.1016/j.jemrpt.2025.100178","DOIUrl":"10.1016/j.jemrpt.2025.100178","url":null,"abstract":"<div><h3>Background</h3><div>Acute traumatic coccydynia typically results from direct trauma and is an often overlooked but significant cause of discomfort that can present acutely in the emergency department (ED). First-line treatment including NSAIDs and acetaminophen aims to provide relief but can be insufficient. The sacrococcygeal nerve block, though underutilized in the ED, is a simple intervention using existing skills to provide pain relief. To our knowledge, this is its first documented use in the ED for coccydynia.</div></div><div><h3>Case report</h3><div>A 20-year-old female presented to the ED with severe coccygeal pain (10/10) following a fall five days prior. Conservative management of NSAIDs, acetaminophen and activity modifications from a prior ED visit failed to improve her symptoms, leaving her requiring significant daily bedrest. In the present ED visit, after failed opioid pain reduction, a sacrococcygeal nerve block was performed using dexamethasone and bupivacaine, resulting in complete pain resolution (0/10) within 15 minutes. The patient experienced 5 h of total relief, a 30 % reduction in pain by 18 hours, and 70 % reduction by week three. She resumed work within a week and reported satisfaction with the procedure.</div><div>Why Should an Emergency Physician Be Aware of This?</div><div>The sacrococcygeal nerve block is a time-efficient intervention for acute coccydynia that aligns well with the skillset and demands of the ED, although further research is required on its effectiveness in the ED setting prior to wide use. It can possibly provide immediate pain relief, reduce opioid requirements, and minimize repeat visits as discussed in this report.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100178"},"PeriodicalIF":0.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hidden in plain sight: Recognizing TTP in the emergency department 隐藏在视线之中：识别急诊科的TTP

JEM reports

Pub Date : 2025-06-21 DOI: 10.1016/j.jemrpt.2025.100179

Heather Silverstein, Christopher Freeman

Background

Thrombotic thrombocytopenic purpura (TTP) is a rare but life-threatening thrombotic microangiopathy characterized by thrombocytopenia, microangiopathic hemolytic anemia, neurologic symptoms, renal dysfunction, and fever. Often patients present with only a subset of these abnormalities, many of which are present in other conditions, posing difficulty in the diagnosis. This diagnostic difficulty is compounded in the elderly and those with comorbidities who have varying clinical presentations. Early recognition and diagnosis are imperative as early treatment with plasmapheresis significantly improves outcomes.

Case report

We present the case of a 58-year-old female with a history of recent cerebrovascular accident (CVA), diabetes, hypertension, and psychiatric illness, who presented with acute change in mental status. Her confusion was attributed to a urinary tract infection and her chronic neuropsychiatric conditions. Further laboratory evaluation revealed severe thrombocytopenia, elevated lactate dehydrogenase, low haptoglobin, and schistocytes on peripheral smear, raising concern for TTP. The patient was initiated on plasmapheresis, and the diagnosis of TTP was subsequently confirmed via ADAMTS13 testing.

Why should an emergency physician be aware of this?

This case highlights the diagnostic challenge of a patient with overlapping comorbidities that may contribute to a change in mental status, masking the underlying diagnosis of TTP. The rapid identification and early initiation of plasmapheresis prevented further organ damage, improved prognosis, and provided a favorable outcome. This underscores the importance of maintaining a broad differential for patients presenting with altered mental status and remaining conscious of bias and anchoring in these patients with comorbid conditions when alternative explanations exist.

背景：血栓性血小板减少性紫癜（TTP）是一种罕见但危及生命的血栓性微血管疾病，其特征是血小板减少、微血管致病性溶血性贫血、神经系统症状、肾功能障碍和发烧。通常患者只表现出这些异常的一个子集，其中许多在其他情况下也存在，给诊断带来困难。这种诊断困难在老年人和具有不同临床表现的合并症患者中更为复杂。早期识别和诊断是必要的，因为早期治疗血浆置换可显著改善预后。病例报告我们报告一例58岁女性，近期有脑血管意外（CVA）、糖尿病、高血压和精神疾病史，并表现为精神状态的急性改变。她的精神错乱归因于尿路感染和慢性神经精神疾病。进一步的实验室评估显示严重的血小板减少，乳酸脱氢酶升高，接触珠蛋白低，外周涂片上有血吸虫细胞，增加了对TTP的关注。患者开始进行血浆置换，随后通过ADAMTS13检测确认TTP的诊断。急诊医生为什么要意识到这一点？这个病例强调了一个重叠的合并症患者的诊断挑战，这些合并症可能导致精神状态的改变，掩盖了TTP的潜在诊断。血浆置换的快速识别和早期启动防止了进一步的器官损害，改善了预后，并提供了良好的结果。这强调了对出现精神状态改变的患者保持广泛区分的重要性，当存在其他解释时，对这些有合并症的患者保持偏见意识和锚定。

{"title":"Hidden in plain sight: Recognizing TTP in the emergency department","authors":"Heather Silverstein, Christopher Freeman","doi":"10.1016/j.jemrpt.2025.100179","DOIUrl":"10.1016/j.jemrpt.2025.100179","url":null,"abstract":"<div><h3>Background</h3><div>Thrombotic thrombocytopenic purpura (TTP) is a rare but life-threatening thrombotic microangiopathy characterized by thrombocytopenia, microangiopathic hemolytic anemia, neurologic symptoms, renal dysfunction, and fever. Often patients present with only a subset of these abnormalities, many of which are present in other conditions, posing difficulty in the diagnosis. This diagnostic difficulty is compounded in the elderly and those with comorbidities who have varying clinical presentations. Early recognition and diagnosis are imperative as early treatment with plasmapheresis significantly improves outcomes.</div></div><div><h3>Case report</h3><div>We present the case of a 58-year-old female with a history of recent cerebrovascular accident (CVA), diabetes, hypertension, and psychiatric illness, who presented with acute change in mental status. Her confusion was attributed to a urinary tract infection and her chronic neuropsychiatric conditions. Further laboratory evaluation revealed severe thrombocytopenia, elevated lactate dehydrogenase, low haptoglobin, and schistocytes on peripheral smear, raising concern for TTP. The patient was initiated on plasmapheresis, and the diagnosis of TTP was subsequently confirmed via ADAMTS13 testing.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>This case highlights the diagnostic challenge of a patient with overlapping comorbidities that may contribute to a change in mental status, masking the underlying diagnosis of TTP. The rapid identification and early initiation of plasmapheresis prevented further organ damage, improved prognosis, and provided a favorable outcome. This underscores the importance of maintaining a broad differential for patients presenting with altered mental status and remaining conscious of bias and anchoring in these patients with comorbid conditions when alternative explanations exist.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100179"},"PeriodicalIF":0.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Stroke in adolescent patient requiring mechanical thrombectomy: A case report 需要机械取栓的青少年中风患者一例报告

JEM reports

Pub Date : 2025-06-01 DOI: 10.1016/j.jemrpt.2025.100175

Alyssa M. Gill , Carina Grain , Christine Dharshika , Todd Chassee

Background

Strokes are rare in pediatric patients, however approximately 80% have an identifiable cause. Risk factors for pediatric stroke include the typical atherosclerotic risk factors for adults, but also unique pediatric conditions such as congenital heart diseases, hematological diseases, vasculitis, inflammatory conditions, and trauma. Treatment for pediatric stroke is also much less researched and often extrapolated from adults. Here we present a case of a large vessel stroke in a pediatric patient, with no identifiable cause, treated successfully with mechanical thrombectomy.

Case Report

This case report describes a 12-year-old female who had an ischemic stroke of an unknown etiology. Her case demonstrates a classic stroke presentation and intervention, presenting with acute onset of hemiparesis, facial asymmetry, and dysarthria. Code stroke was promptly activated in the Emergency Department and CTA showed a middle cerebral artery thrombus. She underwent mechanical thrombectomy with Interventional Radiology 4 h after her last known well. Although 78% of pediatric patients have long-standing neurological deficits following ischemic stroke, this patient made a full recovery without long-term neurological deficits. Despite a thorough workup with Pediatric Cardiology, Hematology, and Neurology, the cause of her stroke was never identified.

Why should an emergency physician be aware of this?

The case of idiopathic ischemic stroke in an adolescent patient is an unusual occurrence. Being able to identify these patients presenting to the Emergency Department and ensuring protocols are in place is critical for generating successful outcomes, as evidenced by this case. The complete resolution of her symptoms also demonstrates the potential role of neuroplasticity in pediatric brain recovery.

背景：中风在儿科患者中很少见，但大约80%的患者有明确的病因。儿童中风的危险因素包括成人典型的动脉粥样硬化危险因素，但也有独特的儿童疾病，如先天性心脏病、血液病、血管炎、炎症和创伤。儿童中风的治疗研究也少得多，而且往往是从成年人身上推断出来的。在这里，我们提出一个病例的大血管卒中的儿童患者，没有明确的原因，治疗成功的机械血栓切除术。病例报告：本病例报告描述了一名12岁的女性，她患有病因不明的缺血性中风。她的病例表现为典型的中风表现和干预，表现为急性偏瘫，面部不对称和构音障碍。急诊科立即启动脑卒中，CTA显示大脑中动脉血栓。她在最后一次出院后4小时接受了介入放射学的机械取栓术。尽管78%的儿童患者在缺血性卒中后存在长期的神经功能缺损，但该患者完全康复，没有长期的神经功能缺损。尽管经过儿科心脏病学、血液学和神经学的彻底检查，她中风的原因始终没有确定。急诊医生为什么要意识到这一点？特发性缺血性脑卒中的情况下，青少年患者是一个不寻常的发生。正如本病例所证明的那样，能够识别这些到急诊科就诊的患者并确保协议到位对于产生成功的结果至关重要。她的症状的完全解决也证明了神经可塑性在儿童大脑恢复中的潜在作用。

{"title":"Stroke in adolescent patient requiring mechanical thrombectomy: A case report","authors":"Alyssa M. Gill , Carina Grain , Christine Dharshika , Todd Chassee","doi":"10.1016/j.jemrpt.2025.100175","DOIUrl":"10.1016/j.jemrpt.2025.100175","url":null,"abstract":"<div><h3>Background</h3><div>Strokes are rare in pediatric patients, however approximately 80% have an identifiable cause. Risk factors for pediatric stroke include the typical atherosclerotic risk factors for adults, but also unique pediatric conditions such as congenital heart diseases, hematological diseases, vasculitis, inflammatory conditions, and trauma. Treatment for pediatric stroke is also much less researched and often extrapolated from adults. Here we present a case of a large vessel stroke in a pediatric patient, with no identifiable cause, treated successfully with mechanical thrombectomy.</div></div><div><h3>Case Report</h3><div>This case report describes a 12-year-old female who had an ischemic stroke of an unknown etiology. Her case demonstrates a classic stroke presentation and intervention, presenting with acute onset of hemiparesis, facial asymmetry, and dysarthria. Code stroke was promptly activated in the Emergency Department and CTA showed a middle cerebral artery thrombus. She underwent mechanical thrombectomy with Interventional Radiology 4 h after her last known well. Although 78% of pediatric patients have long-standing neurological deficits following ischemic stroke, this patient made a full recovery without long-term neurological deficits. Despite a thorough workup with Pediatric Cardiology, Hematology, and Neurology, the cause of her stroke was never identified.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>The case of idiopathic ischemic stroke in an adolescent patient is an unusual occurrence. Being able to identify these patients presenting to the Emergency Department and ensuring protocols are in place is critical for generating successful outcomes, as evidenced by this case. The complete resolution of her symptoms also demonstrates the potential role of neuroplasticity in pediatric brain recovery.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100175"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144203484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Severe pentobarbital poisoning treated after two sessions of intermittent hemodialysis: A case report 间歇性血液透析治疗重度戊巴比妥中毒1例

JEM reports

Pub Date : 2025-05-09 DOI: 10.1016/j.jemrpt.2025.100174

Sohma Miyamoto , Shutaro Isokawa , Norio Otani , Masatoshi Miyamoto , Yoshito Kamijo

Background

Pentobarbital is a short-acting barbiturate that can cause life-threatening central nervous system, respiratory, and cardiovascular depression if massively overdosed.

Case report

This case report describes a 38-year-old female who entered a deep coma after ingesting 2.45 g of pentobarbital. She had severe respiratory depression and hypotension refractory to fluid administration. The patient was intubated, placed under mechanical ventilation, and given continuous intravenous administration of norepinephrine. She then underwent 2 sessions of intermittent hemodialysis (IHD) lasting 4 h each, after which her clinical condition rapidly improved. The serum pentobarbital concentration determined using liquid chromatography-tandem mass spectrometry (LD/MS/MS) decreased rapidly from 60.61 to 23.75 μg/ml after the first session and from 26.16 to 9.34 μg/ml after the second session. The half-lives of pentobarbital were estimated to be 3.8 and 4.1 h during the first and second sessions, respectively, 157.5 h between the two sessions, and 20.4 h after the second session. The case highlights the potential benefit of IHD in managing pentobarbital toxicity, where enhanced drug clearance may shorten intubation and intensive care unit stay.

Why should an emergency physician should be aware of this?

In severe pentobarbital poisoning, hemodialysis may be effective to enhance drug clearance.

戊巴比妥是一种短效巴比妥类药物，如果大量过量，可导致危及生命的中枢神经系统、呼吸系统和心血管抑制。病例报告：本病例报告描述了一位38岁女性在摄入2.45 g戊巴比妥后进入深度昏迷。她有严重的呼吸抑制和低血压，输液难治性。患者插管，机械通气，并给予持续静脉给药去甲肾上腺素。随后进行了2次间歇血液透析（IHD），每次持续4小时，临床状况迅速改善。液相色谱-串联质谱（LD/MS/MS）测定血清戊巴比妥浓度在第一次治疗后从60.61降至23.75 μg/ml，在第二次治疗后从26.16降至9.34 μg/ml。戊巴比妥的半衰期在第一次和第二次治疗期间分别为3.8和4.1小时，两次治疗之间为157.5小时，第二次治疗后为20.4小时。该病例强调了IHD在控制戊巴比妥毒性方面的潜在益处，其中增强的药物清除可能缩短插管和重症监护病房的时间。为什么急诊医生应该意识到这一点？对于严重戊巴比妥中毒患者，血液透析可有效提高药物清除率。

{"title":"Severe pentobarbital poisoning treated after two sessions of intermittent hemodialysis: A case report","authors":"Sohma Miyamoto , Shutaro Isokawa , Norio Otani , Masatoshi Miyamoto , Yoshito Kamijo","doi":"10.1016/j.jemrpt.2025.100174","DOIUrl":"10.1016/j.jemrpt.2025.100174","url":null,"abstract":"<div><h3>Background</h3><div>Pentobarbital is a short-acting barbiturate that can cause life-threatening central nervous system, respiratory, and cardiovascular depression if massively overdosed.</div></div><div><h3>Case report</h3><div>This case report describes a 38-year-old female who entered a deep coma after ingesting 2.45 g of pentobarbital. She had severe respiratory depression and hypotension refractory to fluid administration. The patient was intubated, placed under mechanical ventilation, and given continuous intravenous administration of norepinephrine. She then underwent 2 sessions of intermittent hemodialysis (IHD) lasting 4 h each, after which her clinical condition rapidly improved. The serum pentobarbital concentration determined using liquid chromatography-tandem mass spectrometry (LD/MS/MS) decreased rapidly from 60.61 to 23.75 μg/ml after the first session and from 26.16 to 9.34 μg/ml after the second session. The half-lives of pentobarbital were estimated to be 3.8 and 4.1 h during the first and second sessions, respectively, 157.5 h between the two sessions, and 20.4 h after the second session. The case highlights the potential benefit of IHD in managing pentobarbital toxicity, where enhanced drug clearance may shorten intubation and intensive care unit stay.</div></div><div><h3>Why should an emergency physician should be aware of this?</h3><div>In severe pentobarbital poisoning, hemodialysis may be effective to enhance drug clearance.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100174"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

From the emergency department to veno-venous ECMO- a case of refractory hypoxia 从急诊科到静脉-静脉ECMO-一例难治性缺氧

JEM reports

Pub Date : 2025-05-08 DOI: 10.1016/j.jemrpt.2025.100173

Joshua Fuller, Cameron Harrison

Background

A known rare side effect of naloxone administration is non-cardiac pulmonary edema. There have been multiple proposed mechanisms for this, the most accepted one being a catecholamine surge causing physiologic changes favoring the development of pulmonary edema. The literature is sparse on this clinical entity, mostly consisting of case reports and a case series.

Case report

Here we present a case of a young male who presents with refractory hypoxia and shock requiring emergent Extracorporeal Membrane Oxygenation (ECMO) consultation and cannulation for veno-venous ECMO(VV-ECMO) from the emergency department. The patient responded well and was decannulated and extubated within 50 hours and ultimately discharged on hospital day 6.

Why should an emergency physician be aware of this

This would be a rare publication of VV-ECMO being used emergently for hypoxic respiratory failure secondary to naloxone-induced pulmonary edema compounded by subsequent aspiration in the Emergency Department.

纳洛酮的一个罕见副作用是非心源性肺水肿。对此有多种机制，最被接受的一种是儿茶酚胺激增导致有利于肺水肿发展的生理变化。关于这种临床实体的文献很少，主要由病例报告和病例系列组成。病例报告：我们报告了一例年轻男性，他表现出难治性缺氧和休克，需要紧急体外膜氧合（ECMO）咨询和静脉-静脉ECMO（VV-ECMO）插管，从急诊科。患者反应良好，在50小时内停用导管并拔管，最终在住院第6天出院。急诊医生为什么要意识到这一点？这将是一篇罕见的关于VV-ECMO在急诊科用于纳洛酮引起的肺水肿并发误吸的低氧性呼吸衰竭的急诊报道。

引用次数: 0

Case report:Acute hepatic and renal failure caused by alcohol and acetaminophen poisoning 病例报告：酒精和对乙酰氨基酚中毒致急性肝肾衰竭

JEM reports

Pub Date : 2025-04-26 DOI: 10.1016/j.jemrpt.2025.100171

Liu Yiyang, He Xinhua

Background

Acetaminophen, a commonly used antipyretic and analgesic in clinical practice, is widely applied due to its effectiveness in relieving pain and reducing fever, as well as its low gastrointestinal irritation. However, taking large doses or using it long - term, taking it while drinking alcohol, or taking two or more drugs containing acetaminophen can lead to severe drug - induced liver damage, and in rare cases, kidney function damage and even death.

Case

This article reports a case of a young female patient who experienced coma after excessive alcohol consumption and overdose of acetaminophen due to emotional breakdown. After rescue, the patient concealed her medication history and left the hospital on her own after regaining consciousness. Six days later, the patient was re - admitted due to coagulation disorders, and it was found that she had severe acute hepatic and renal function damage. After a clear diagnosis through toxicological analysis, the patient received active treatment and recovered.

Why should an emergency physician be aware of this?

Combining with literature reports, this article analyzes the phenomenon of young female patients attempting suicide by taking acetaminophen while drinking heavily in an emotionally out - of - control state, and explores the mechanism of liver and kidney function damage caused by excessive use of acetaminophen, aiming to draw the attention of clinicians and society.

对乙酰氨基酚是临床常用的解热镇痛药，具有止痛退热的作用，且对胃肠道刺激小，应用广泛。然而，服用大剂量或长期使用，饮酒时服用，或同时服用两种或两种以上含有对乙酰氨基酚的药物，可导致严重的药物性肝损害，在极少数情况下，肾功能损害甚至死亡。这篇文章报告了一例年轻的女性患者，她在过度饮酒和过量服用对乙酰氨基酚后因情绪崩溃而昏迷。经抢救，患者隐瞒用药史，苏醒后自行出院。6天后，患者因凝血功能障碍再次入院，发现有严重的急性肝肾功能损害。经毒理学分析明确诊断后，积极治疗，康复。急诊医生为什么要意识到这一点？本文结合文献报道，分析年轻女性患者在情绪失控状态下大量饮酒服用对乙酰氨基酚企图自杀的现象，探讨过度使用对乙酰氨基酚导致肝肾功能损害的机制，旨在引起临床医生和社会的重视。

{"title":"Case report:Acute hepatic and renal failure caused by alcohol and acetaminophen poisoning","authors":"Liu Yiyang, He Xinhua","doi":"10.1016/j.jemrpt.2025.100171","DOIUrl":"10.1016/j.jemrpt.2025.100171","url":null,"abstract":"<div><h3>Background</h3><div>Acetaminophen, a commonly used antipyretic and analgesic in clinical practice, is widely applied due to its effectiveness in relieving pain and reducing fever, as well as its low gastrointestinal irritation. However, taking large doses or using it long - term, taking it while drinking alcohol, or taking two or more drugs containing acetaminophen can lead to severe drug - induced liver damage, and in rare cases, kidney function damage and even death.</div></div><div><h3>Case</h3><div>This article reports a case of a young female patient who experienced coma after excessive alcohol consumption and overdose of acetaminophen due to emotional breakdown. After rescue, the patient concealed her medication history and left the hospital on her own after regaining consciousness. Six days later, the patient was re - admitted due to coagulation disorders, and it was found that she had severe acute hepatic and renal function damage. After a clear diagnosis through toxicological analysis, the patient received active treatment and recovered.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Combining with literature reports, this article analyzes the phenomenon of young female patients attempting suicide by taking acetaminophen while drinking heavily in an emotionally out - of - control state, and explores the mechanism of liver and kidney function damage caused by excessive use of acetaminophen, aiming to draw the attention of clinicians and society.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100171"},"PeriodicalIF":0.0,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143894962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Dystonic reaction to haloperidol causing severe tongue swelling requiring cricothyroidotomy 氟哌啶醇的张力障碍反应引起严重的舌肿，需要环甲状腺切开术

JEM reports

Pub Date : 2025-04-24 DOI: 10.1016/j.jemrpt.2025.100172

Carmen Estrada Huerta, Emily White

Background

Haloperidol is a widely used drug in both the prehospital setting and the emergency department (ED) for agitation. Though rare, haloperidol can lead to severe dystonic reactions that can cause traumatic tongue swelling. Severe tongue swelling can lead to airway compromise.

Case Report

A 31-year-old female was given haloperidol in the pre-hospital setting by EMS for agitation to allow for transport and medical evaluation. She had a delayed dystonic reaction that led to tongue protrusion, jaw clenching, and subsequent traumatic oral swelling. The severe tongue swelling caused airway compromise requiring an emergency cricothyroidotomy. She recovered in the ICU with removal of airway support on day five.

Why should an emergency physician be aware of this?

Agitation in patients needing emergency care is not infrequent. Haloperidol is a common medication to treat agitation in both the pre-hospital and emergency department settings. A key to the safe administration of this drug is awareness of life-threatening adverse reactions such as severe dystonic reactions. It is important for emergency providers to be aware that dystonic reactions can cause tongue protrusion, tongue biting, and resultant traumatic tongue swelling. Anti-cholinergic medications are a critical intervention as the first line treatment of dystonia. It is also essential that emergency providers look for medical bracelets prior to giving medications if the patient is unable to communicate allergies. It was discovered in the ED that the patient had a bracelet noting her prior reactions to haloperidol.

氟哌啶醇是一种广泛用于院前和急诊科（ED）躁动的药物。虽然罕见，氟哌啶醇可导致严重的张力障碍反应，可引起创伤性舌头肿胀。严重的舌头肿胀会导致气道受损。病例报告：一名31岁女性在院前因躁动被EMS给予氟哌啶醇，以便转移和医学评估。她有迟发性张力障碍反应，导致舌头突出，下巴紧咬，随后出现创伤性口腔肿胀。严重的舌肿导致气道受损，需要紧急环甲环切开术。她在重症监护室康复，第五天移除气道支持。急诊医生为什么要意识到这一点？需要紧急护理的病人的躁动并不罕见。氟哌啶醇是院前和急诊科治疗躁动的常用药物。安全使用该药的关键是要意识到危及生命的不良反应，如严重的张力障碍反应。对于急救人员来说，重要的是要意识到张力障碍反应会导致舌头突出、咬舌和由此产生的创伤性舌头肿胀。抗胆碱能药物是肌张力障碍一线治疗的关键干预措施。同样重要的是，如果病人无法沟通过敏，急救人员在给药之前寻找医疗手镯。在急诊科发现病人有一个手镯，上面记录着她以前对氟哌啶醇的反应。

{"title":"Dystonic reaction to haloperidol causing severe tongue swelling requiring cricothyroidotomy","authors":"Carmen Estrada Huerta, Emily White","doi":"10.1016/j.jemrpt.2025.100172","DOIUrl":"10.1016/j.jemrpt.2025.100172","url":null,"abstract":"<div><h3>Background</h3><div>Haloperidol is a widely used drug in both the prehospital setting and the emergency department (ED) for agitation. Though rare, haloperidol can lead to severe dystonic reactions that can cause traumatic tongue swelling. Severe tongue swelling can lead to airway compromise.</div></div><div><h3>Case Report</h3><div>A 31-year-old female was given haloperidol in the pre-hospital setting by EMS for agitation to allow for transport and medical evaluation. She had a delayed dystonic reaction that led to tongue protrusion, jaw clenching, and subsequent traumatic oral swelling. The severe tongue swelling caused airway compromise requiring an emergency cricothyroidotomy. She recovered in the ICU with removal of airway support on day five.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Agitation in patients needing emergency care is not infrequent. Haloperidol is a common medication to treat agitation in both the pre-hospital and emergency department settings. A key to the safe administration of this drug is awareness of life-threatening adverse reactions such as severe dystonic reactions. It is important for emergency providers to be aware that dystonic reactions can cause tongue protrusion, tongue biting, and resultant traumatic tongue swelling. Anti-cholinergic medications are a critical intervention as the first line treatment of dystonia. It is also essential that emergency providers look for medical bracelets prior to giving medications if the patient is unable to communicate allergies. It was discovered in the ED that the patient had a bracelet noting her prior reactions to haloperidol.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100172"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143894938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Adult facial Fractures: A review and guide for emergency medicine clinicians 成人面部骨折：急诊医学临床医生的综述和指南

JEM reports

Pub Date : 2025-04-21 DOI: 10.1016/j.jemrpt.2025.100170

Keenan S. Fine , Caroline C. Bay , Gina Krause , Robert E. George , Camille J. LaLiberte , Daniel Y. Cho , C. Corlin Jewell , Hani I. Kuttab

Background

Facial fractures are common injuries in emergency departments across the United States. These can present various challenges for emergency medicine (EM) physicians and other healthcare providers. Managing these injuries can be complex which may be exacerbated by varying availability of specialist support, particularly in rural or community settings.

Objective of review

This review aims to provide a comprehensive, evidence-based approach to the management of facial fractures for emergency medicine (EM) clinicians. This review highlights key principles in trauma evaluation, imaging, and indications for surgical consultation to improve decision-making and patient care.

Discussion

Facial fracture management begins with systematic trauma evaluation, prioritizing stability, hemorrhage control, and airway patency. Maxillofacial CT without contrast is the preferred imaging modality for most facial fractures with some requiring further imaging. Emergency physicians should recognize high risk features requiring surgical consultation, including displacement, malocclusion, and neurovascular compromise. Orbital and midface fractures may require ophthalmologic consultation if the patient presents with entrapment, globe rupture, or orbital compartment syndrome. In many cases, stable, non-displaced fractures may be managed outpatient with clear return precautions and outpatient surgical follow-up.

Conclusion

This review is designed to be accessible and instructive for EM trainees and clinicians. These multidisciplinary guidelines provided can equip EM providers with the knowledge to safely and effectively triage facial fractures.

背景：面部骨折是美国急诊科常见的损伤。这可能会给急诊医生和其他医疗保健提供者带来各种挑战。处理这些伤害可能很复杂，特别是在农村或社区环境中，专家支持的可用性不同可能会加剧这种情况。本综述旨在为急诊医学（EM）临床医生提供一种全面的、循证的面部骨折治疗方法。这篇综述强调了创伤评估、影像学和外科会诊指征的关键原则，以改善决策和患者护理。面部骨折的处理始于系统的创伤评估，优先考虑稳定性、出血控制和气道通畅。颌面部CT无对比成像是大多数面部骨折的首选成像方式，有些需要进一步成像。急诊医生应认识到需要外科会诊的高风险特征，包括移位、错颌和神经血管损伤。如果患者出现眶内压、眼球破裂或眶间室综合征，眶内和中面部骨折可能需要眼科会诊。在许多情况下，稳定的、非移位的骨折可以在门诊进行治疗，并有明确的复发预防措施和门诊手术随访。结论本综述对急诊培训生和临床医生具有参考价值和指导意义。提供的这些多学科指南可以为EM提供者提供安全有效地分诊面部骨折的知识。

{"title":"Adult facial Fractures: A review and guide for emergency medicine clinicians","authors":"Keenan S. Fine , Caroline C. Bay , Gina Krause , Robert E. George , Camille J. LaLiberte , Daniel Y. Cho , C. Corlin Jewell , Hani I. Kuttab","doi":"10.1016/j.jemrpt.2025.100170","DOIUrl":"10.1016/j.jemrpt.2025.100170","url":null,"abstract":"<div><h3>Background</h3><div>Facial fractures are common injuries in emergency departments across the United States. These can present various challenges for emergency medicine (EM) physicians and other healthcare providers. Managing these injuries can be complex which may be exacerbated by varying availability of specialist support, particularly in rural or community settings.</div></div><div><h3>Objective of review</h3><div>This review aims to provide a comprehensive, evidence-based approach to the management of facial fractures for emergency medicine (EM) clinicians. This review highlights key principles in trauma evaluation, imaging, and indications for surgical consultation to improve decision-making and patient care.</div></div><div><h3>Discussion</h3><div>Facial fracture management begins with systematic trauma evaluation, prioritizing stability, hemorrhage control, and airway patency. Maxillofacial CT without contrast is the preferred imaging modality for most facial fractures with some requiring further imaging. Emergency physicians should recognize high risk features requiring surgical consultation, including displacement, malocclusion, and neurovascular compromise. Orbital and midface fractures may require ophthalmologic consultation if the patient presents with entrapment, globe rupture, or orbital compartment syndrome. In many cases, stable, non-displaced fractures may be managed outpatient with clear return precautions and outpatient surgical follow-up.</div></div><div><h3>Conclusion</h3><div>This review is designed to be accessible and instructive for EM trainees and clinicians. These multidisciplinary guidelines provided can equip EM providers with the knowledge to safely and effectively triage facial fractures.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100170"},"PeriodicalIF":0.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A pilot study on physiological indicators of expertise in pre-hospital emergency medical services (EMS) providers during endotracheal intubation 一项关于院前紧急医疗服务（EMS）提供者在气管插管期间专业知识生理指标的试点研究

JEM reports

Pub Date : 2025-04-16 DOI: 10.1016/j.jemrpt.2025.100169

Gabriel Gazetta , Yaoyu Fu , Kaori Tanaka , Brian M. Clemency , Anirban Dutta , Matthew Hackett , Jack Norfleet , Rahul , Suvranu De , Steven Schwaitzberg , Lora Cavuoto

Background

Prehospital intubation is a high risk, low frequency skill. Manikin intubations, the most common means of evaluating providers’ competency, may be insufficient to predict procedural success.

Objective

The objective of this pilot study was to explore whether physiological measures, including gaze behavior, pupil response, and cortical activation, differed between groups of pre-hospital emergency medical services (EMS) providers during simulated endotracheal intubation.

Methods

Fifteen certified paramedics (expert clinicians) and fifteen Advanced Emergency Medical Technicians (intermediate clinicians) participated in this pilot study. Each participant performed three intubations on a standard airway manikin. During the intubations, pupillometry and gaze data were collected using eye tracking glasses and brain activation using functional near infrared spectroscopy (fNIRS). Groups were compared based on the eye tracking and neuroimaging metrics.

Results

Twenty-seven out of 30 participants successfully intubated the manikin across all repetitions, and expert clinicians finished the task on average 11.6s faster than intermediate clinicians. Experts spent less task time in gaze fixation (39.8 % vs. 55.2 %, p = 0.03). Peaks in pupil diameter during the task most often occurred during the sub-task of inserting the tube in the trachea (76% of the time). Neuroimaging results revealed significant group-level differences in the left supramarginal gyrus.

Conclusion

This study explored physiological responses during simulated intubation by pre-hospital emergency medicine providers. While some group-level differences were observed in gaze behavior and brain activation, these findings were not sufficient to differentiate expertise. Further research is needed to better understand how physiological responses may reflect task demands in clinical settings.

院前插管是一项高风险、低频率的技能。人体插管是评估提供者能力的最常用手段，但可能不足以预测手术的成功。本初步研究的目的是探讨院前急救医疗服务（EMS）提供者在模拟气管插管期间的凝视行为、瞳孔反应和皮层激活等生理指标是否存在差异。方法15名持证护理人员（专家型临床医生）和15名高级急救技术人员（中级临床医生）参与了本研究。每位参与者在标准气道模型上进行三次插管。在插管期间，使用眼动追踪眼镜收集瞳孔测量和凝视数据，并使用功能性近红外光谱（fNIRS）收集脑激活数据。根据眼动追踪和神经成像指标对各组进行比较。结果30名参与者中有27名成功插管，专家临床医生比中级临床医生平均快11.6s完成任务。专家注视的任务时间较少（39.8%比55.2%,p = 0.03）。任务中瞳孔直径的峰值最常出现在将管子插入气管的子任务中（76%的时间）。神经影像学结果显示左边缘上回组间差异显著。结论本研究探讨院前急救医学人员在模拟插管过程中的生理反应。虽然在凝视行为和大脑激活方面观察到一些群体水平的差异，但这些发现不足以区分专业知识。需要进一步的研究来更好地理解生理反应如何反映临床环境中的任务需求。

{"title":"A pilot study on physiological indicators of expertise in pre-hospital emergency medical services (EMS) providers during endotracheal intubation","authors":"Gabriel Gazetta , Yaoyu Fu , Kaori Tanaka , Brian M. Clemency , Anirban Dutta , Matthew Hackett , Jack Norfleet , Rahul , Suvranu De , Steven Schwaitzberg , Lora Cavuoto","doi":"10.1016/j.jemrpt.2025.100169","DOIUrl":"10.1016/j.jemrpt.2025.100169","url":null,"abstract":"<div><h3>Background</h3><div>Prehospital intubation is a high risk, low frequency skill. Manikin intubations, the most common means of evaluating providers’ competency, may be insufficient to predict procedural success.</div></div><div><h3>Objective</h3><div>The objective of this pilot study was to explore whether physiological measures, including gaze behavior, pupil response, and cortical activation, differed between groups of pre-hospital emergency medical services (EMS) providers during simulated endotracheal intubation.</div></div><div><h3>Methods</h3><div>Fifteen certified paramedics (expert clinicians) and fifteen Advanced Emergency Medical Technicians (intermediate clinicians) participated in this pilot study. Each participant performed three intubations on a standard airway manikin. During the intubations, pupillometry and gaze data were collected using eye tracking glasses and brain activation using functional near infrared spectroscopy (fNIRS). Groups were compared based on the eye tracking and neuroimaging metrics.</div></div><div><h3>Results</h3><div>Twenty-seven out of 30 participants successfully intubated the manikin across all repetitions, and expert clinicians finished the task on average 11.6s faster than intermediate clinicians. Experts spent less task time in gaze fixation (39.8 % vs. 55.2 %, <em>p</em> = 0.03). Peaks in pupil diameter during the task most often occurred during the sub-task of inserting the tube in the trachea (76% of the time). Neuroimaging results revealed significant group-level differences in the left supramarginal gyrus.</div></div><div><h3>Conclusion</h3><div>This study explored physiological responses during simulated intubation by pre-hospital emergency medicine providers. While some group-level differences were observed in gaze behavior and brain activation, these findings were not sufficient to differentiate expertise. Further research is needed to better understand how physiological responses may reflect task demands in clinical settings.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100169"},"PeriodicalIF":0.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143847997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Thyrotoxicosis misdiagnosed as anaphylaxis following NSAID use in an adolescent 青少年使用非甾体抗炎药后甲状腺毒症误诊为过敏反应

JEM reports

Pub Date : 2025-04-15 DOI: 10.1016/j.jemrpt.2025.100168

Eytan Mendelow, Andrew Weinberger, Crista Cerrone

Background

Emergency physicians often encounter patients presenting with symptoms suggestive of common conditions, such as anaphylaxis. However, when clinical findings deviate from the expected course, maintaining a broad differential is critical.

Case report

A 17-year-old female presented to the emergency department with flushing, and tachycardia following ibuprofen ingestion.The patient had administered intramuscular epinephrine at home prior to arrival. In the emergency department, she was treated with antihistamines for a presumed anaphylactic reaction. While what was perceived as her facial swelling and hives improved, she remained persistently tachycardic and hypertensive. Further evaluation revealed suppressed TSH and elevated free T4 levels, leading to a diagnosis of thyrotoxicosis. Endocrinology consultation confirmed the findings. The patient was treated with atenolol for symptomatic relief and methimazole to address the underlying thyroid dysfunction.

Why Should an Emergency Physician Be Aware of This?: This case underscores the importance of re-evaluating initial impressions when a patient's response to treatment is incomplete or atypical. Persistent tachycardia and hypertension after apparent anaphylaxis should prompt consideration of alternative diagnoses, including thyrotoxicosis. Emergency physicians must remain vigilant for less common presentations of thyroid dysfunction, especially when triggered by medications or other stressors, to ensure timely diagnosis and management.

背景急诊医师经常会遇到一些表现出常见症状的病人，如过敏反应。然而，当临床表现偏离预期病程时，保持广泛的鉴别是至关重要的。病例报告：一名17岁女性在摄入布洛芬后出现潮红和心动过速。患者在入院前在家接受肌肉注射肾上腺素。在急诊科，她接受了抗组胺药治疗，推测是过敏反应。虽然她的面部肿胀和荨麻疹有所改善，但她仍然持续心动过速和高血压。进一步的评估显示TSH抑制和游离T4水平升高，导致甲状腺毒症的诊断。内分泌学咨询证实了这一发现。患者给予阿替洛尔缓解症状和甲巯咪唑治疗潜在的甲状腺功能障碍。急诊医生为什么要意识到这一点？当病人对治疗的反应不完全或不典型时，这个病例强调了重新评估最初印象的重要性。明显过敏反应后持续的心动过速和高血压应提示考虑其他诊断，包括甲状腺毒症。急诊医生必须对不常见的甲状腺功能障碍表现保持警惕，特别是当药物或其他压力源引发时，以确保及时诊断和管理。

{"title":"Thyrotoxicosis misdiagnosed as anaphylaxis following NSAID use in an adolescent","authors":"Eytan Mendelow, Andrew Weinberger, Crista Cerrone","doi":"10.1016/j.jemrpt.2025.100168","DOIUrl":"10.1016/j.jemrpt.2025.100168","url":null,"abstract":"<div><h3>Background</h3><div>Emergency physicians often encounter patients presenting with symptoms suggestive of common conditions, such as anaphylaxis. However, when clinical findings deviate from the expected course, maintaining a broad differential is critical.</div></div><div><h3>Case report</h3><div>A 17-year-old female presented to the emergency department with flushing, and tachycardia following ibuprofen ingestion.The patient had administered intramuscular epinephrine at home prior to arrival. In the emergency department, she was treated with antihistamines for a presumed anaphylactic reaction. While what was perceived as her facial swelling and hives improved, she remained persistently tachycardic and hypertensive. Further evaluation revealed suppressed TSH and elevated free T4 levels, leading to a diagnosis of thyrotoxicosis. Endocrinology consultation confirmed the findings. The patient was treated with atenolol for symptomatic relief and methimazole to address the underlying thyroid dysfunction.</div><div>Why Should an Emergency Physician Be Aware of This?: This case underscores the importance of re-evaluating initial impressions when a patient's response to treatment is incomplete or atypical. Persistent tachycardia and hypertension after apparent anaphylaxis should prompt consideration of alternative diagnoses, including thyrotoxicosis. Emergency physicians must remain vigilant for less common presentations of thyroid dysfunction, especially when triggered by medications or other stressors, to ensure timely diagnosis and management.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100168"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0