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

A 57-year-old male transit passenger from an 8-hour flight presented to the emergency department with severe left posterior thigh pain. He had experienced a traumatic event a few weeks prior, resulting in fractures of the left hip and left lower ribs. Upon examination, he exhibited severe tenderness, warmth, and fluctuation in the left posterior thigh with minimal swelling. He had a low-grade fever (37.8°C), was markedly tachycardic (heart rate: 125 beats/min), and appeared clinically dehydrated. Blood investigations revealed raised inflammatory markers, elevated creatinine, and high lactate levels (Table 1). Given his clinical presentation and recent surgery combined with the long flight, initial differential diagnoses included deep venous thrombosis (DVT) and sepsis. Point-of-care ultrasound (POCUS) ruled out DVT but revealed subcutaneous edema with fluid collection in the hamstring muscles (Figure 1, Video 1).

A 77-year-old female presented to our community-based emergency department complaining of clitoral swelling and pain (Figure 1). She reported a 2-week history of gradually increasing enlargement and discomfort of the area. One month prior to the onset of these symptoms, she had undergone a urethral bulking agent injection by a urogynecologist at a different health system to treat urinary stress incontinence with polyacrylamide hydrogel (Bulkamid).¹

She was awaiting a follow-up appointment with her urogynecologist but decided to seek care in the emergency department instead once she felt the pain was no longer tolerable. In the emergency department, point-of-care ultrasound was performed showing a localized collection of heterogeneous nonvascular debris consistent with abscess formation, as opposed to solid or cystic mass (Figure 2 and video file supplemental data).²

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.