Journal of the American College of Emergency Physicians open最新文献

A 22-year-old man with past medical history of type 1 diabetes, intravenous polysubstance use, bacterial endocarditis, and frequent urinary tract infections presented to the emergency department with left-sided flank pain and dysuria. The pain had been worsening over the last 3–4 days and associated with dysuria, foul smelling urine, and urine “clumps.” He was noted to be ill-appearing with left costovertebral angle tenderness. Vital signs were heart rate of 114 bpm, blood pressure of 122/66, temperature of 37.5°C, respiratory rate of 18 breaths per minute, and pulse oximetry of 97% on room air. Labs were notable for blood glucose 431 mg/dL, beta hydroxybutyrate 2.83 mmol/L, leukocytosis of 13.2 K/µL, creatinine 1.15 mg/dL, and normal lactate. Urinalysis was consistent with infection. Ultrasound showed a hyperechoic area in the renal pelvis with heterogenous appearing posterior acoustic shadowing (Figure 1, Video 1).

M Prats has received payments from Butterfly Network, Inc. for consulting on educational materials. Advertising payments were made to M Prats' businesses Exo Imaging, Inc. and Echonous Inc.

Reisdorff EJ, Johnston MM, Kraus CK, Keim SM, Santen SA. Association between the american board of emergency medicine oral certifying examination and future state medical board disciplinary actions. JACEP Open. 2024; 5:e13119. 10.1002/emp2.13119

For the article titled “Association between the American Board of Emergency Medicine Oral Certifying Examination and Future State Medical Board Disciplinary Actions” published in the Journal of the American College of Emergency Physicians Open (2024):

In Section 2.2 Data Sources, the statement “The NPDB is managed by the Federal government through the U.S. Department of Health and Human Services” is incomplete.

This statement should have read “Data utilized in this study were obtained from the National Practitioner Data Bank, which is managed by the Health Resources and Services Administration (HRSA), an agency of the U.S. Government. HRSA does not endorse any specific products, services, or conclusions described in this manuscript. The views and opinions expressed are solely those of the authors and do not necessarily reflect the official policy or position of HRSA or the U.S. Government.”

We apologize for this error.

A 53-year-old male presented with acute neck pain radiating to the occiput for 2 days. He had been playing golf daily before symptom onset. There was no history of recent upper respiratory infection. Examination revealed an axillary temperature of 37.4°C, with other vital signs normal. The patient was alert with no meningeal signs, and neck pain worsened with rotation. Neurological examination was normal, with no palpable lymphadenopathy, and the pharyngeal examination was normal. Computed tomography (CT) confirmed the diagnosis (Figure 1).

The authors declare no conflicts of interest.

A 57-year-old female was admitted to the intensive care unit (ICU) following brain surgery. The process of deep venipuncture was challenging, as indicated by her lung computed tomography (CT) scans (Figures 1-3). Previously, she had a catheter in her left internal jugular vein, which was not functioning properly and was subsequently removed, leaving a retrosternal air leak shadow, as indicated by the red arrow in Figure 1. An attempt to puncture the right subclavian vein failed, resulting in residual gas trapped between the muscle layers (Figure 2) with a radius of 2 mm and an area of 13.21 mm². Eventually, catheterization of the right internal jugular vein was successful after two failed attempts (Figure 3); some gas was observed near the catheter, with a maximum area of approximately 32 mm × 10 mm.

The patient's vital signs remained stable during and after the procedure. A follow-up lung CT performed 4 days later showed that all gas had been absorbed. However, deep venipuncture failures are common in clinical settings and can lead to complications,¹ such as mediastinal emphysema, peripheral nerve injury,² and pneumothorax, which in turn can result in economic burdens, prolonged hospitalization, and even fatalities—fortunately, this patient did not experience significant complications. However, the CT scan revealed past injuries, serving as a reminder for clinicians to exercise caution and rigor during invasive procedures.

The authors declare no conflict of interest.

The patient is a 52-year-old male with a 30-year history of human immunodeficiency virus (HIV), not compliant with antiretroviral therapy (although his last viral load was undetectable 1 year prior), presenting with 3 months of worsening left facial mass (Figures 1-5), generalized weakness, and a 30-pound weight loss. He came into the emergency department (ED) because the mass started causing changes in his speech.

The authors declare no conflicts of interest.

A 42-year-old female presented to the emergency department (ED) with a headache of 2 days’ duration. She reported a low mechanism headstrike without loss of consciousness 2 days prior, as well as a history of idiopathic intracranial hypertension (IIH). She endorsed blurred vision but denied nausea, vomiting, fever, or use of anticoagulation. Point-of-care ultrasound revealed elevated optic discs with crescent signs bilaterally (Figure 1).

A computed tomography scan of the brain was negative for intracranial hemorrhage or mass, but did show sequelae of IIH, including prominent optic nerve sheaths and an empty sella, which had been previously demonstrated on neuroimaging in the medical record. She was offered therapeutic lumbar puncture and neurology evaluation but declined as she was scheduled for ventriculoperitoneal shunt placement with neurosurgery for management.

Ocular ultrasound is an accessible and noninvasive tool for measuring intracranial pressure (ICP) in the ED, and has been shown to be 90% sensitive in detection of papilledema.¹ The optic nerve sheath is contiguous with the subarachnoid space and therefore the optic nerve sheath diameter fluctuates with changes in ICP.^2-4 Crescent sign on point-of-care ultrasound is a hypoechoic ring of subarachnoid fluid surrounding the optic nerve and the presence of a crescent sign has been found to be 92% sensitive for papilledema.^{5, 6} When present, the crescent sign is highly indicative of elevated ICP and warrants neuroimaging and specialty consult to rule out space-occupying lesions or other emergent etiologies of elevated ICP Video 1

The authors declare no conflicts of interest.

This is a non-funded study, with no compensation or honoraria for conducting the study.