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The Beginnings of an Emergency Medicine Investigator Pipeline. 急诊医学调查员队伍的开始
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-01-01 DOI: 10.1016/j.annemergmed.2024.11.010
Katie M Lebold, Christopher L Bennett, Caroline Raymond-King
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引用次数: 0
Managing Emergency Endotracheal Intubation Utilizing a Bougie 使用气管插管器进行紧急气管插管。
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-01-01 DOI: 10.1016/j.annemergmed.2024.04.021
Ryan N. Barnicle MD, MSEd , Alexander Bracey MD , Scott D. Weingart MD
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引用次数: 0
Annals Q&A With Dr. Amish Shah 《年鉴》专访Amish Shah博士
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-01-01 DOI: 10.1016/j.annemergmed.2024.11.011
Jeremy S. Faust MD, MS (Special Contributor to Annals News & Perspective)
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引用次数: 0
Tube Thoracostomy Should Remain the Preferred Intervention for Traumatic Hemothorax 管式胸腔造口术仍应是治疗外伤性血胸的首选方法。
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-01-01 DOI: 10.1016/j.annemergmed.2024.07.018
Leydricah S. Saint Louis DO, MS, Eric N. Klein MD, Daniel Jafari MD, MPH
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引用次数: 0
Pregnant Woman With a Thin Fetal Umbilical Artery 胎儿脐带动脉细的孕妇。
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-01-01 DOI: 10.1016/j.annemergmed.2024.07.007
Jian-Fei Zhu MMed , Xian-Jun Chen MMed , Wen-Luo Tu MMed , Ya-Ping Zhao MMed
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引用次数: 0
Remembering Amy Kaji, MD, PhD, 1968–2024 记住Amy Kaji,医学博士,博士,1968-2024。
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-01-01 DOI: 10.1016/j.annemergmed.2024.11.008
Richelle J. Cooper MD, MSHS, David L. Schriger MD, MPH, Lise E. Nigrovic MD, MPH, Steve M. Green MD, Richard C. Dart MD, PhD, Donald M. Yealy MD, Editorial Board of Annals of Emergency Medicine
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引用次数: 0
They Are Dying in the Waiting Room 他们在候诊室里奄奄一息。
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-01-01 DOI: 10.1016/j.annemergmed.2024.07.020
Sophia Görgens MD
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引用次数: 0
Effectiveness and Safety of Pharmacologic Therapies for Migraine in the Emergency Department: A Systematic Review and Bayesian Network Meta-analysis. 急诊科偏头痛药物治疗的有效性和安全性:系统综述和贝叶斯网络荟萃分析。
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-12-13 DOI: 10.1016/j.annemergmed.2024.11.004
Ian S deSouza, Nicole Anthony, Henry Thode, Robert Allen, Jane Belyavskaya, Jessica Koos, Adam Singer

Study objective: We performed a systematic review and Bayesian network meta-analysis to determine which pharmacologic therapies are relatively more effective and safer for migraine in adult patients who present to the emergency department (ED).

Methods: We searched MEDLINE, Embase, and Web of Science from inception to February 9, 2024. Eligible studies were randomized controlled trials that enrolled adult participants presenting to ED with migraine and compared one pharmacologic therapy to another or placebo. Outcomes were as follows: 1) adequate pain relief at 2 hours, 2) change in pain intensity at 1 hour, 3) need for rescue drug at 2 hours, and 4) significant adverse reaction. We extracted data according to PRISMA-network meta-analysis and appraised trials using Cochrane RoB 2. For dichotomous outcomes, we performed Bayesian network meta-analysis to calculate odds ratios with 95% credible intervals; for continuous outcomes, we performed frequentist network meta-analysis to calculate mean differences with 95% confidence intervals. We assessed confidence using Confidence in Network Meta-analysis. We used Surface under the cumulative ranking curve (SUCRA) to rank agents.

Results: Chlorpromazine intravenous (IV)/intramuscular (IM) (SUCRA=87.3%) was most likely to be superior for "adequate pain relief at 2 hours" (24 trials; n=2,361); metoclopramide IV-ibuprofen IV (SUCRA=94.6%) was most likely to be superior for "need for rescue drug" (not needing rescue drug) at 2 hours (27 trials; n=2,942); dexamethasone IV (SUCRA=79.5%) was most likely to be superior for "significant adverse reaction" (not causing adverse reaction) (22 trials; n=2,450). The network for change in pain intensity demonstrated statistically significant incoherence at the overall level. Confidence in network meta-analysis estimates (certainty of evidence) varied and was mostly "low" or "very low," limiting the validity of the probabilistic analyses.

Conclusions: According to Bayesian network meta-analysis, ibuprofen IV is definitely among the least effective for adequate pain relief; chlorpromazine IV/IM is definitely among the most effective; valproate IV is definitely among the least effective, and ketorolac IV/IM is possibly among the least effective as single agents. The relative safety of the pharmacologic therapies cannot be determined with sufficient certainty.

研究目的我们进行了一项系统综述和贝叶斯网络荟萃分析,以确定哪些药物疗法对急诊科(ED)就诊的成年偏头痛患者相对更有效、更安全:我们检索了从开始到 2024 年 2 月 9 日的 MEDLINE、Embase 和 Web of Science。符合条件的研究均为随机对照试验,这些试验招募了因偏头痛而到急诊科就诊的成年患者,并对一种药物疗法与另一种药物疗法或安慰剂进行了比较。研究结果如下1)2 小时内疼痛得到充分缓解;2)1 小时内疼痛强度发生变化;3)2 小时内需要使用抢救药物;4)出现明显不良反应。我们根据 PRISMA 网络荟萃分析法提取数据,并使用 Cochrane RoB 2 对试验进行评估。对于二分结果,我们采用贝叶斯网络荟萃分析法计算几率比,并得出 95% 的可信区间;对于连续结果,我们采用频数网络荟萃分析法计算平均差,并得出 95% 的可信区间。我们使用网络荟萃分析中的置信度来评估置信度。我们使用累积排序曲线下表面(SUCRA)对药物进行排序:氯丙嗪静脉注射(IV)/肌肉注射(IM)(SUCRA=87.3%)最有可能在 "2小时内充分缓解疼痛 "方面更具优势(24项试验;n=2,361);甲氧氯普胺静脉注射-布洛芬静脉注射(SUCRA=94.地塞米松静脉注射(SUCRA=79.5%)在 "明显不良反应"(未引起不良反应)方面最可能具有优势(22 项试验;n=2,450)。疼痛强度变化网络在总体水平上显示出统计学意义上的不一致性。网络荟萃分析估计值的置信度(证据的确定性)各不相同,大多为 "低 "或 "非常低",限制了概率分析的有效性:根据贝叶斯网络荟萃分析,布洛芬静脉滴注对充分止痛的效果肯定是最差的;氯丙嗪静脉滴注/IM肯定是最有效的;丙戊酸钠静脉滴注肯定是效果最差的,而酮咯酸静脉滴注/IM作为单一药物可能是效果最差的。药物疗法的相对安全性还不能完全确定。
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引用次数: 0
Trends in Firearm Injuries Treated in Emergency Departments by Individual- and County-Level Characteristics, 2019 to 2023. 2019年至2023年急诊部门枪支伤害的个体和县级特征趋势
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-12-12 DOI: 10.1016/j.annemergmed.2024.11.003
Marissa L Zwald, Kristin M Holland, Steven A Sumner, Michael Sheppard, Yushiuan Chen, Anika Wallace, Norah W Friar, Thomas R Simon

Study objective: To understand trends in nonfatal firearm injuries by examining rates of firearm injury emergency department (ED) visits stratified by individual- and county-level characteristics.

Methods: Data from participating EDs within 10 jurisdictions in the United States funded through the Centers for Disease Control and Prevention's Firearm Injury Surveillance Through Emergency Rooms program, including the District of Columbia, Florida, Georgia, New Mexico, North Carolina, Oregon, Utah, Virginia, Washington, and West Virginia, were analyzed. We examined trends in firearm injury ED visits by sex, age group, jurisdiction, county-level urbanicity, and county-level social vulnerability from January 2019 to August 2023. Mean weekly rates of firearm injury ED visits and visit ratios (or the proportion of firearm injury-related ED visits of all visits during the surveillance periods with the same period in 2019) were calculated.

Results: Compared with 2019, the proportion of ED visits for firearm injury was elevated each year during 2020 to 2023 overall, with the largest observed increase in 2020 (visit ratio=1.59). All 10 Firearm Injury Surveillance Through Emergency Rooms jurisdictions experienced an increase in the proportion of firearm injury ED visits in 2020 (visit ratios ranging from 1.26 in West Virginia and 2.31 in Washington, DC) when compared with 2019. By county-level social vulnerability, the mean weekly rate of firearm injury ED visits was highest in counties with the highest social vulnerability over the entire study period.

Conclusion: Results highlight the continued burden of firearm injuries in communities with higher social vulnerability. Timely ED data by community social vulnerability can inform public health interventions and resource allocation at local, state, and national levels.

研究目的通过研究按个人和县级特征分层的枪支伤害急诊科(ED)就诊率,了解非致命性枪支伤害的趋势:我们分析了由美国疾病控制与预防中心 "通过急诊室进行枪支伤害监测 "项目资助的美国 10 个辖区内参与项目的急诊室提供的数据,这些辖区包括哥伦比亚特区、佛罗里达州、佐治亚州、新墨西哥州、北卡罗来纳州、俄勒冈州、犹他州、弗吉尼亚州、华盛顿州和西弗吉尼亚州。我们研究了 2019 年 1 月至 2023 年 8 月期间按性别、年龄组、辖区、县级城市化程度和县级社会脆弱性分列的枪支伤害急诊室就诊趋势。我们计算了枪支伤害 ED 就诊的每周平均比率和就诊比率(或监测期间与 2019 年同期所有就诊中与枪支伤害相关的 ED 就诊比例):与 2019 年相比,在 2020 年至 2023 年期间,因枪支伤害而就诊的急诊室就诊人数比例每年都在上升,其中 2020 年的增幅最大(就诊率=1.59)。与 2019 年相比,所有 10 个通过急诊室进行火器伤害监测的辖区在 2020 年的火器伤害急诊室就诊比例都有所上升(就诊比从西弗吉尼亚州的 1.26 到华盛顿特区的 2.31 不等)。从县级社会脆弱性来看,在整个研究期间,社会脆弱性最高的县的火器伤害急诊室平均每周就诊率最高:研究结果突出表明,在社会脆弱性较高的社区,枪支伤害造成的负担仍然很重。按社区社会脆弱性划分的及时急诊室数据可为地方、州和国家层面的公共卫生干预措施和资源分配提供信息。
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引用次数: 0
Midazolam and Ketamine for Convulsive Status Epilepticus in the Out-of-Hospital Setting. 咪达唑仑和氯胺酮治疗院外惊厥癫痫持续状态
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-12-12 DOI: 10.1016/j.annemergmed.2024.11.002
Tony Zitek, Kenneth A Scheppke, Peter Antevy, Charles Coyle, Sebastian Garay, Eric Scheppke, David A Farcy

Study objective: To determine if ketamine, when added to midazolam for the treatment of out-of-hospital seizures, is associated with an increase in the rate of cessation of convulsions prior to hospital arrival.

Methods: We performed a retrospective cohort study of out-of-hospital patients with an active convulsive seizure being transported to a hospital by a large emergency medical services system in Florida, using data from August 1, 2015 and August 5, 2024. Per protocol, patients received midazolam first for their seizure. Starting in June 2017, a new protocol was developed in which patients who continued to convulse after midazolam received ketamine. We used propensity score matching and multivariable logistic regression to determine if patients who received ketamine were more likely to stop convulsing prior to hospital arrival than those who received midazolam alone.

Results: Overall, 479 (80.1%) of 598 actively convulsing patients who received 2 doses of midazolam (without subsequent ketamine) had resolution of their convulsions prior to hospital arrival compared with 85 (94.4%) of 90 who received ketamine after midazolam, an absolute difference between groups of 14.3% (95% CI 8.6% to 20.1%). After propensity matching, 82.0% of those in the midazolam only group had resolution of convulsions compared to 94.4% in the ketamine group, a difference of 12.4% (95% CI 3.1% to 21.7%).

Conclusion: In this retrospective study of out-of-hospital patients with active convulsive seizures, patients who received ketamine were more likely to have stopped convulsing prior to hospital arrival than those who received midazolam alone.

研究目的确定在治疗院外癫痫发作时将氯胺酮添加到咪达唑仑中是否会增加患者在到达医院前停止抽搐的比率:我们利用 2015 年 8 月 1 日至 2024 年 8 月 5 日的数据,对佛罗里达州一家大型急救医疗服务系统送往医院的院外活动性惊厥发作患者进行了一项回顾性队列研究。根据协议,患者发作时首先接受咪达唑仑治疗。从 2017 年 6 月开始,我们制定了一项新方案,让服用咪达唑仑后继续抽搐的患者接受氯胺酮治疗。我们使用倾向得分匹配和多变量逻辑回归来确定接受氯胺酮治疗的患者是否比仅接受咪达唑仑治疗的患者更有可能在到达医院前停止抽搐:总体而言,在 598 名接受 2 次咪达唑仑治疗(未随后使用氯胺酮)的活跃抽搐患者中,有 479 人(80.1%)在到达医院前停止了抽搐,而在接受咪达唑仑治疗后接受氯胺酮治疗的 90 人中,有 85 人(94.4%)停止了抽搐,组间绝对差异为 14.3%(95% CI 为 8.6% 至 20.1%)。经过倾向匹配后,仅接受咪达唑仑治疗组中有82.0%的患者惊厥得到缓解,而接受氯胺酮治疗组中有94.4%的患者惊厥得到缓解,两组之间的差异为12.4%(95% CI为3.1%至21.7%):在这项针对院外活动性惊厥发作患者的回顾性研究中,与仅接受咪达唑仑治疗的患者相比,接受氯胺酮治疗的患者更有可能在入院前停止抽搐。
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Annals of emergency medicine
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