Pub Date : 2023-11-18DOI: 10.1016/j.jemrpt.2023.100057
Jamie L. Holland, Danny G. Thomas
Background
Nasal foreign body removal is a common procedure performed in the emergency department. However, the removal of magnetic nasal foreign bodies presents a unique challenge, and traditional removal techniques are often unsuccessful. These patients frequently warrant otolaryngology consultation (OC) and foreign body removal under general anesthesia.
Discussion
This case report describes an innovative technique for removal of two magnetic foreign bodies across the nasal septum in a pediatric patient presenting to the emergency department by utilizing equipment commonly on hand, including a small Magill forceps and the plastic handle of an 11-blade scalpel. The tapered/wedge shaped handle of the 11-blade scalpel was directed towards and glided between the nasal septum and the magnetic foreign body, thus separating them. The magnets were then drawn to the metal forceps by magnetic attraction.
Conclusion
The use of the technique described here can result in successful magnetic foreign body removal in the emergency department, reduce the likelihood of tissue trauma, and avoid the need for OC and removal under general anesthesia.
{"title":"How to pull off nasal magnetic foreign body removal in the emergency department","authors":"Jamie L. Holland, Danny G. Thomas","doi":"10.1016/j.jemrpt.2023.100057","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100057","url":null,"abstract":"<div><h3>Background</h3><p>Nasal foreign body removal is a common procedure performed in the emergency department. However, the removal of magnetic nasal foreign bodies presents a unique challenge, and traditional removal techniques are often unsuccessful. These patients frequently warrant otolaryngology consultation (OC) and foreign body removal under general anesthesia.</p></div><div><h3>Discussion</h3><p>This case report describes an innovative technique for removal of two magnetic foreign bodies across the nasal septum in a pediatric patient presenting to the emergency department by utilizing equipment commonly on hand, including a small Magill forceps and the plastic handle of an 11-blade scalpel. The tapered/wedge shaped handle of the 11-blade scalpel was directed towards and glided between the nasal septum and the magnetic foreign body, thus separating them. The magnets were then drawn to the metal forceps by magnetic attraction.</p></div><div><h3>Conclusion</h3><p>The use of the technique described here can result in successful magnetic foreign body removal in the emergency department, reduce the likelihood of tissue trauma, and avoid the need for OC and removal under general anesthesia.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232023000536/pdfft?md5=df7f8fa86d2168580ec36ac3e29056d9&pid=1-s2.0-S2773232023000536-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138412673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.jemrpt.2023.100043
Yuji Okazaki , Toshihisa Ichiba , Yuho Maki
Background
Extralobar pulmonary sequestration (EPS) is often diagnosed in neonates due to accompanying congenital anomalies. However, even in adulthood, this condition can, in rare cases, be complicated with torsion and may present with pleuritic chest pain at an emergency department in an undiagnosed state. We describe a case with torsion of ELS in a healthy adult female.
Case report
A 21-year-old woman presented with acute-onset back pain and pleuritic chest pain at our emergency department and was initially diagnosed with pleurisy based on normal results of investigations. However, she revisited our department due to flare-ups of pain, and a subsequent CT scan revealed an expanding homogeneous opacity in the left lower lobe of the lung. Magnetic resonance imaging (MRI) confirmed the presence of an encapsulated mass with a hypointense signal on T2-weighted imaging and a feeding artery from the aorta to the mass, leading to a preoperative diagnosis of EPS with hemorrhagic infarction. Video-assisted thoracoscopic surgery was performed, and the cause of hemorrhagic infarction was found to be a torsion. The diagnosis was confirmed histologically.
Why should an emergency physician be aware of this?
This case highlights the importance of recognizing torsion of EPS as an unusual cause of pleuritic chest pain and emphasizes the need for early diagnosis in order to perform surgery as soon as possible. Changes in CT findings of torsion of EPS over time can help physicians understand this rare condition. MRI may also be useful for the perioperative diagnosis.
{"title":"Unusual cause of sudden-onset pleuritic chest pain: Torsion of extralobar pulmonary sequestration","authors":"Yuji Okazaki , Toshihisa Ichiba , Yuho Maki","doi":"10.1016/j.jemrpt.2023.100043","DOIUrl":"10.1016/j.jemrpt.2023.100043","url":null,"abstract":"<div><h3>Background</h3><p>Extralobar pulmonary sequestration (EPS) is often diagnosed in neonates due to accompanying congenital anomalies. However, even in adulthood, this condition can, in rare cases, be complicated with torsion and may present with pleuritic chest pain at an emergency department in an undiagnosed state. We describe a case with torsion of ELS in a healthy adult female.</p></div><div><h3>Case report</h3><p>A 21-year-old woman presented with acute-onset back pain and pleuritic chest pain at our emergency department and was initially diagnosed with pleurisy based on normal results of investigations. However, she revisited our department due to flare-ups of pain, and a subsequent CT scan revealed an expanding homogeneous opacity in the left lower lobe of the lung. Magnetic resonance imaging (MRI) confirmed the presence of an encapsulated mass with a hypointense signal on T2-weighted imaging and a feeding artery from the aorta to the mass, leading to a preoperative diagnosis of EPS with hemorrhagic infarction. Video-assisted thoracoscopic surgery was performed, and the cause of hemorrhagic infarction was found to be a torsion. The diagnosis was confirmed histologically.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>This case highlights the importance of recognizing torsion of EPS as an unusual cause of pleuritic chest pain and emphasizes the need for early diagnosis in order to perform surgery as soon as possible. Changes in CT findings of torsion of EPS over time can help physicians understand this rare condition. MRI may also be useful for the perioperative diagnosis.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48021399","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}
Pub Date : 2023-09-01DOI: 10.1016/j.jemrpt.2023.100033
Brenda Sokup , Michael Cydylo , Ivan Ivanov , Adam Rhodes
{"title":"Expanding the differential of adolescent hip pain to include arteriovenous malformations","authors":"Brenda Sokup , Michael Cydylo , Ivan Ivanov , Adam Rhodes","doi":"10.1016/j.jemrpt.2023.100033","DOIUrl":"10.1016/j.jemrpt.2023.100033","url":null,"abstract":"","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44349620","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}
Pub Date : 2023-09-01DOI: 10.1016/S2773-2320(23)00047-0
{"title":"Aims and Scope","authors":"","doi":"10.1016/S2773-2320(23)00047-0","DOIUrl":"https://doi.org/10.1016/S2773-2320(23)00047-0","url":null,"abstract":"","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49839678","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}
Pub Date : 2023-09-01DOI: 10.1016/j.jemrpt.2023.100049
Zahra Al Haloob , George Braitberg , Anthony Tu Tran , Joe Anthony Rotella , Anselm Wong
Background
Little is known on the frequency and nature of re-presentations to emergency departments post initial COVID admission.
Objectives
The aim of the study was to determine the characteristics and outcomes of patients with subsequent presentations to an Emergency Department (ED) following positive COVID-19 PCR diagnosis.
Methods
A retrospective chart review of patients admitted to Austin Health ED who had a confirmed positive COVID-19 PCR, for the period July 2020–August 2020 and October 2021 was undertaken. All patients who had a re-presentation 6 months post initial hospital discharge were included. The primary outcomes were number of subsequent presentations, diagnoses and symptoms.
Results
Among the 254 patients who met the inclusion criteria, 127 tested positive during the 2020 period, and 126 tested positive during the 2021 period. During the 2020 period, 17 of 127 (13%) patients had subsequent presentations to ED. During October 2021, 23 of 126 (18%) patients had subsequent presentations to ED. There were often multiple re-presentations to ED (range 2–9). During both periods, the most common representing symptom was shortness of breath (2020: 60% vs 2021: 59%). The most common re-presentation diagnosis was Post COVID syndrome (12% in 2020 vs 10% in 2021).
Conclusion
There was a high proportion of ED re-presentations post initial COVID admission, with patients often having multiple re-presentations. Post COVID syndrome was the commonest re-presentation diagnosis. This and other complications have the potential to become more frequently diagnosed in the coming years contributing to the increasing demand on emergency departments.
背景对首次新冠肺炎入院后向急诊科再次报告的频率和性质知之甚少。目的本研究的目的是确定新冠肺炎PCR诊断呈阳性后随后在急诊科（ED）就诊的患者的特征和结果。方法对2020年7月至2020年8月和2021年10月期间入住Austin Health ED的新冠肺炎PCR确诊阳性患者进行回顾性图表审查。所有在初次出院6个月后再次就诊的患者都包括在内。主要结果是随后的表现、诊断和症状的数量。结果在符合纳入标准的254名患者中，127人在2020年期间检测呈阳性，126人在2021年期间检测阳性。在2020年期间，127名患者中有17名（13%）随后出现ED。在2021年10月期间，126名患者中的23名（18%）随后出现了ED。经常有多次再次出现ED（范围为2-9）。在这两个时期，最常见的代表性症状是呼吸急促（2020年：60%，2021年：59%）。最常见的再表现诊断是新冠肺炎后综合征（2020年为12%，2021年为10%）。结论首次新冠肺炎入院后ED再表现的比例很高，患者经常有多次再表现。新冠肺炎后综合征是最常见的再诊断。这种并发症和其他并发症有可能在未来几年更频繁地被诊断出来，这导致了对急诊部门的需求不断增加。
{"title":"Re-presentations to the emergency department post COVID-19 admission in Australia","authors":"Zahra Al Haloob , George Braitberg , Anthony Tu Tran , Joe Anthony Rotella , Anselm Wong","doi":"10.1016/j.jemrpt.2023.100049","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100049","url":null,"abstract":"<div><h3>Background</h3><p>Little is known on the frequency and nature of re-presentations to emergency departments post initial COVID admission.</p></div><div><h3>Objectives</h3><p>The aim of the study was to determine the characteristics and outcomes of patients with subsequent presentations to an Emergency Department (ED) following positive COVID-19 PCR diagnosis.</p></div><div><h3>Methods</h3><p>A retrospective chart review of patients admitted to Austin Health ED who had a confirmed positive COVID-19 PCR, for the period July 2020–August 2020 and October 2021 was undertaken. All patients who had a re-presentation 6 months post initial hospital discharge were included. The primary outcomes were number of subsequent presentations, diagnoses and symptoms.</p></div><div><h3>Results</h3><p>Among the 254 patients who met the inclusion criteria, 127 tested positive during the 2020 period, and 126 tested positive during the 2021 period. During the 2020 period, 17 of 127 (13%) patients had subsequent presentations to ED. During October 2021, 23 of 126 (18%) patients had subsequent presentations to ED. There were often multiple re-presentations to ED (range 2–9). During both periods, the most common representing symptom was shortness of breath (2020: 60% vs 2021: 59%). The most common re-presentation diagnosis was Post COVID syndrome (12% in 2020 vs 10% in 2021).</p></div><div><h3>Conclusion</h3><p>There was a high proportion of ED re-presentations post initial COVID admission, with patients often having multiple re-presentations. Post COVID syndrome was the commonest re-presentation diagnosis. This and other complications have the potential to become more frequently diagnosed in the coming years contributing to the increasing demand on emergency departments.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49839747","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}
Pub Date : 2023-09-01DOI: 10.1016/j.jemrpt.2023.100032
Daniel R. Martin , Kenneth V. Iserson , John C. Moskop
Background
The doctor-patient relationship has always been at the core of health care, and this relationship remains of paramount importance, regardless of treatment location or the patient's condition. The hospital emergency department (ED) plays a major role in this relationship by providing access to board-certified, residency-trained emergency physicians capable of rapid diagnosis and treatment of urgent, emergent, and life-threatening conditions. U.S. EDs also serve as the nation's safety net for the care of uninsured and underinsured patients.
Discussion
As the ED has become a major profit center in the multi-trillion-dollar health care industry, business-centric pressures on ED care pose major threats to the doctor-patient relationship. This article describes and evaluates business-imposed practices that can undermine this relationship in the ED.
Conclusions
Health systems should strive to enhance relationships between emergency physicians and their patients and to avoid business practices that undermine them.
{"title":"Business-centric healthcare's effects on the doctor-patient relationship in the emergency department","authors":"Daniel R. Martin , Kenneth V. Iserson , John C. Moskop","doi":"10.1016/j.jemrpt.2023.100032","DOIUrl":"10.1016/j.jemrpt.2023.100032","url":null,"abstract":"<div><h3>Background</h3><p>The doctor-patient relationship has always been at the core of health care, and this relationship remains of paramount importance, regardless of treatment location or the patient's condition. The hospital emergency department (ED) plays a major role in this relationship by providing access to board-certified, residency-trained emergency physicians capable of rapid diagnosis and treatment of urgent, emergent, and life-threatening conditions. U.S. EDs also serve as the nation's safety net for the care of uninsured and underinsured patients.</p></div><div><h3>Discussion</h3><p>As the ED has become a major profit center in the multi-trillion-dollar health care industry, business-centric pressures on ED care pose major threats to the doctor-patient relationship. This article describes and evaluates business-imposed practices that can undermine this relationship in the ED.</p></div><div><h3>Conclusions</h3><p>Health systems should strive to enhance relationships between emergency physicians and their patients and to avoid business practices that undermine them.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45553639","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}
Pub Date : 2023-09-01DOI: 10.1016/j.jemrpt.2023.100042
Zachary Boivin , Chandler Ford , Andrew Franco
Background
Craniopharyngioma is a rare condition which can present with a multitude of symptoms from increased intracranial pressure, endocrine disorder, visual deficits, and hypothalamic dysfunction, making it difficult to diagnose. In this case, our patient presented with symptoms concerning for a stroke, creating diagnostic uncertainty.
Case report
A 71-year-old male developed decreased grip strength in his right hand and word finding difficulties over a period of several hours, and upon arrival to the emergency department was triaged as a potential stroke. On initial imaging he appeared to have a hemorrhage in the area of the sella turcica. Subsequently, multidisciplinary input resulted in a preliminary diagnosis of craniopharyngioma. The patient's laboratory results raised concern for adrenal insufficiency, and the patient's vital sign abnormalities of bradycardia, hypotension, and hypothermia resolved with corticosteroids. The patient was discharged home after a brief hospital stay, and neurosurgery recommended outpatient follow up to excise the mass.
Why should an emergency physician be aware of this
We could find no literature describing craniopharyngioma as a stroke mimic, and given the patient's initial presentation with right hand weakness and word finding difficulty, there was high concern for stroke. The patient's imaging showed what appeared to be an intracranial hemorrhage, further confounding the clinical picture. The patient's subsequent development of vital signs and laboratory results consistent with adrenal crisis helped us arrive at the final diagnosis. Emergency physicians should avoid anchoring bias in the treatment of patients with stroke-like symptoms and be familiar with the complex presentations of craniopharyngioma.
{"title":"Craniopharyngioma presenting as a stroke mimic, a case report","authors":"Zachary Boivin , Chandler Ford , Andrew Franco","doi":"10.1016/j.jemrpt.2023.100042","DOIUrl":"10.1016/j.jemrpt.2023.100042","url":null,"abstract":"<div><h3>Background</h3><p>Craniopharyngioma is a rare condition which can present with a multitude of symptoms from increased intracranial pressure, endocrine disorder, visual deficits, and hypothalamic dysfunction, making it difficult to diagnose. In this case, our patient presented with symptoms concerning for a stroke, creating diagnostic uncertainty.</p></div><div><h3>Case report</h3><p>A 71-year-old male developed decreased grip strength in his right hand and word finding difficulties over a period of several hours, and upon arrival to the emergency department was triaged as a potential stroke. On initial imaging he appeared to have a hemorrhage in the area of the sella turcica. Subsequently, multidisciplinary input resulted in a preliminary diagnosis of craniopharyngioma. The patient's laboratory results raised concern for adrenal insufficiency, and the patient's vital sign abnormalities of bradycardia, hypotension, and hypothermia resolved with corticosteroids. The patient was discharged home after a brief hospital stay, and neurosurgery recommended outpatient follow up to excise the mass.</p></div><div><h3>Why should an emergency physician be aware of this</h3><p>We could find no literature describing craniopharyngioma as a stroke mimic, and given the patient's initial presentation with right hand weakness and word finding difficulty, there was high concern for stroke. The patient's imaging showed what appeared to be an intracranial hemorrhage, further confounding the clinical picture. The patient's subsequent development of vital signs and laboratory results consistent with adrenal crisis helped us arrive at the final diagnosis. Emergency physicians should avoid anchoring bias in the treatment of patients with stroke-like symptoms and be familiar with the complex presentations of craniopharyngioma.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46566340","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}
Pub Date : 2023-09-01DOI: 10.1016/j.jemrpt.2023.100048
Erin L. Simon , Bethany Crouse , Thomas Langlois , Jaideep M. Karamchandani , Christopher S. Ramos , McKinsey Muir , Stephen Sayles III , Michael P. Phelan
Background
Seasonal influenza continues to present a significant annual burden as the vaccination rate in the United States is 51.8%. Emergency Department (ED) based influenza programs have been successfully implemented and improve vaccine uptake, reduce incidence and costs, and improve outcomes.
Objective
To develop a predictive model to assess preventable influenza cases, hospitalizations, fatalities, and incremental cost avoidance based on the unvaccinated population.
Methods
A retrospective cohort of ED encounters limited to Medicare and Medicaid populations was performed across 14 tertiary care hospital EDs and six freestanding EDs for 2020. The total number of unvaccinated individuals was identified to determine the potential impact of an ED vaccination campaign. The average cost and loss per inpatient stay was identified from prior industry Medicare benchmark data and was utilized to extrapolate Medicaid losses. Results from published cost-effectiveness studies identified the vaccination thresholds to prevent one additional case of influenza, one additional hospitalization, and one additional fatality.
Results
A total of 39,463 unvaccinated individuals were identified, with 14,064 classified as Medicare, and 25,379 classified as Medicaid. Assuming a 95% target outreach, 90% medical eligibility, and 70% acceptance rate, 414 influenza cases would be prevented (266 Medicaid, 148 Medicare), 28 hospitalizations would be prevented (18 Medicaid, 10 Medicare), and eight deaths would be prevented (5 Medicaid, 3 Medicare). Accordingly, a reduction in admissions would prevent $409,360 in total inpatient medical costs and $36,232 in losses to healthcare systems.
Conclusion
An ED-based influenza vaccination program would have a measurable impact on patient influenza disease burden and associated medical expenditures.
{"title":"Modeling the value of an emergency department influenza vaccination program","authors":"Erin L. Simon , Bethany Crouse , Thomas Langlois , Jaideep M. Karamchandani , Christopher S. Ramos , McKinsey Muir , Stephen Sayles III , Michael P. Phelan","doi":"10.1016/j.jemrpt.2023.100048","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100048","url":null,"abstract":"<div><h3>Background</h3><p>Seasonal influenza continues to present a significant annual burden as the vaccination rate in the United States is 51.8%. Emergency Department (ED) based influenza programs have been successfully implemented and improve vaccine uptake, reduce incidence and costs, and improve outcomes.</p></div><div><h3>Objective</h3><p>To develop a predictive model to assess preventable influenza cases, hospitalizations, fatalities, and incremental cost avoidance based on the unvaccinated population.</p></div><div><h3>Methods</h3><p>A retrospective cohort of ED encounters limited to Medicare and Medicaid populations was performed across 14 tertiary care hospital EDs and six freestanding EDs for 2020. The total number of unvaccinated individuals was identified to determine the potential impact of an ED vaccination campaign. The average cost and loss per inpatient stay was identified from prior industry Medicare benchmark data and was utilized to extrapolate Medicaid losses. Results from published cost-effectiveness studies identified the vaccination thresholds to prevent one additional case of influenza, one additional hospitalization, and one additional fatality.</p></div><div><h3>Results</h3><p>A total of 39,463 unvaccinated individuals were identified, with 14,064 classified as Medicare, and 25,379 classified as Medicaid. Assuming a 95% target outreach, 90% medical eligibility, and 70% acceptance rate, 414 influenza cases would be prevented (266 Medicaid, 148 Medicare), 28 hospitalizations would be prevented (18 Medicaid, 10 Medicare), and eight deaths would be prevented (5 Medicaid, 3 Medicare). Accordingly, a reduction in admissions would prevent $409,360 in total inpatient medical costs and $36,232 in losses to healthcare systems.</p></div><div><h3>Conclusion</h3><p>An ED-based influenza vaccination program would have a measurable impact on patient influenza disease burden and associated medical expenditures.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49839746","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}
Foreign body ingestion leading to complications is rare, and the need for surgery is even rarer. Foreign body ingestion in patients with mental illness poses challenges in diagnosis due to the varied and often delayed presentation and difficulties in history-taking. Symptom-based management in patients with mental illness may sometimes result in incorrect diagnoses and delayed treatment. Detailed history and investigation may uncover unexpected findings.
Case report
We present the case of a 28-year-old male patient with a history of depression and suicidal tendencies who admitted to ingesting a knife after repeated probing. Although there were no signs of peritonitis, abdominal imaging revealed a 17 cm saw-edge knife traversing from the duodenum to the adjacent right lobe of the liver. The patient successfully underwent exploratory laparotomy with knife removal, duodenotomy repair, and feeding jejunostomy.
Why should an emergency physician be aware of this?
A high index of suspicion is required to diagnose complications of foreign body ingestion, especially in patients with mental illness. In many high-volume emergency departments, these patients receive symptomatic management and are discharged with advice for outpatient follow-up. Emergency physicians should be aware that meticulous history-taking and a detailed examination are necessary in patients with mental illness. This approach facilitates a comprehensive diagnosis, timely management, and improved outcomes.
{"title":"Ingestion of a saw-edge knife in a patient with mental illness: A unique and uncommon presentation","authors":"Bharath Gopinath , Prakash Ranjan Mishra , Nihar Ranjan Dash , Gaurav Kumar , Jayapal Rajendran , Rajesh Panwar","doi":"10.1016/j.jemrpt.2023.100044","DOIUrl":"10.1016/j.jemrpt.2023.100044","url":null,"abstract":"<div><h3>Background</h3><p>Foreign body ingestion leading to complications is rare, and the need for surgery is even rarer. Foreign body ingestion in patients with mental illness poses challenges in diagnosis due to the varied and often delayed presentation and difficulties in history-taking. Symptom-based management in patients with mental illness may sometimes result in incorrect diagnoses and delayed treatment. Detailed history and investigation may uncover unexpected findings.</p></div><div><h3>Case report</h3><p>We present the case of a 28-year-old male patient with a history of depression and suicidal tendencies who admitted to ingesting a knife after repeated probing. Although there were no signs of peritonitis, abdominal imaging revealed a 17 cm saw-edge knife traversing from the duodenum to the adjacent right lobe of the liver. The patient successfully underwent exploratory laparotomy with knife removal, duodenotomy repair, and feeding jejunostomy.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>A high index of suspicion is required to diagnose complications of foreign body ingestion, especially in patients with mental illness. In many high-volume emergency departments, these patients receive symptomatic management and are discharged with advice for outpatient follow-up. Emergency physicians should be aware that meticulous history-taking and a detailed examination are necessary in patients with mental illness. This approach facilitates a comprehensive diagnosis, timely management, and improved outcomes.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48376978","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}
Pub Date : 2023-09-01DOI: 10.1016/j.jemrpt.2023.100047
Trung V. Ho , Thomas L. Schumann , Eric J. Schmieler
Background
While relatively rare, complications from peripherally inserted central catheter (PICC) lines can carry serious morbidity and mortality. PICC lines are known to be associated with infection and thromboembolism, though literature discussing vessel perforation from PICC lines is limited, and to our knowledge there are no reports describing specifically the superior vena cava (SVC) being perforated from a PICC line.
Case report
In this report, we describe a case of a 48-year-old female who presented with chest pain in the setting of having a PICC line for chronic medical conditions. A computed tomography with angiography (CTA) was obtained and revealed perforation of the SVC and subsequent mediastinitis from her PICC line. Her PICC line was immediately secured, broad spectrum antibiotics were given, and cardiothoracic surgery was consulted. She subsequently had her PICC removed under ultrasound guidance with plans for immediate operative intervention if that failed. The patient did well and was ultimately discharged with a new PICC line.
Why should an emergency physician be aware of this?
Although large vessel perforation from PICC lines is relatively rare, it can be associated with significant morbidity and needs immediate treatment. It is important for the emergency physician to have knowledge of this complication to make the diagnosis and initiate timely specialist intervention.
{"title":"Rare case of SVC perforation secondary to PICC line","authors":"Trung V. Ho , Thomas L. Schumann , Eric J. Schmieler","doi":"10.1016/j.jemrpt.2023.100047","DOIUrl":"10.1016/j.jemrpt.2023.100047","url":null,"abstract":"<div><h3>Background</h3><p>While relatively rare, complications from peripherally inserted central catheter (PICC) lines can carry serious morbidity and mortality. PICC lines are known to be associated with infection and thromboembolism, though literature discussing vessel perforation from PICC lines is limited, and to our knowledge there are no reports describing specifically the superior vena cava (SVC) being perforated from a PICC line.</p></div><div><h3>Case report</h3><p>In this report, we describe a case of a 48-year-old female who presented with chest pain in the setting of having a PICC line for chronic medical conditions. A computed tomography with angiography (CTA) was obtained and revealed perforation of the SVC and subsequent mediastinitis from her PICC line. Her PICC line was immediately secured, broad spectrum antibiotics were given, and cardiothoracic surgery was consulted. She subsequently had her PICC removed under ultrasound guidance with plans for immediate operative intervention if that failed. The patient did well and was ultimately discharged with a new PICC line.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>Although large vessel perforation from PICC lines is relatively rare, it can be associated with significant morbidity and needs immediate treatment. It is important for the emergency physician to have knowledge of this complication to make the diagnosis and initiate timely specialist intervention.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49590128","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}
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