Annals of emergency medicine最新文献

英文中文

Prevalence of Adverse Drug Reactions: Comparing Crotalidae Immune Polyvalent Antivenoms F(ab’)2 and F(ab) in a Galactose-alpha-1,3-galactose (alpha-gal) Endemic Area 药物不良反应的发生率：比较半乳糖- α -1,3-半乳糖（α -gal）流行地区Crotalidae免疫多价抗蛇毒血清F(ab')2和F（ab）

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2026-03-01 Epub Date: 2025-08-16 DOI: 10.1016/j.annemergmed.2025.06.618

Ari B. Filip MD , Lina Mahmood MD , Collette Tilly MD , Howell R. Foster PharmD , Fawn Jackson BA , William Banner MD, PhD , Thomas A.E. Platts-Mills MD, PhD , Jeffrey Wilson MD, PhD , Pamela Schoppee Bortz PhD , Nathan Charlton MD , Joshua L. Kennedy MD

Study objectives

North American pit viper antivenoms, CroFab® and ANAVIP®, contain galactose-

α

-1,3-galactose (α-GAL) oligosaccharide. We compared adverse drug reactions, including presumed anaphylaxis, following administration of these antivenoms and investigated biological plausibility of these antivenoms leading to anaphylaxis in α-GAL-immunoglobulin (Ig) E-sensitized individuals.

Methods

We performed 2 studies. A retrospective chart review from the Arkansas Poison Center (May 2021 to July 2023) identified adverse drug reactions and presumed anaphylaxis in patients treated with crotaline antivenom. Two allergists (JK, LM), blinded to the antivenom used, adjudicated presumed anaphylaxis cases. To assess whether antivenoms could activate basophils from α-GAL-IgE-sensitized individuals, basophil activation tests were performed on blood from 5 α-GAL-IgE-sensitized participants with a history of mammalian meat allergy. Basophil activation was assessed by %CD63 upregulation.

Results

Adverse drug reactions without presumed anaphylaxis occurred in 7 out of 171 (4.1%) Fab recipients versus 8 out of 37 (21.6%) F(ab’)₂ recipients (Δ=17.5%, 95% confidence interval [CI] [4.0 to 31.0]). Presumed anaphylaxis was observed in 3 out of 171 (1.8%) for Fab and 6/37 (16.2%) for F(ab’)₂ (Δ=14.3%, 95% CI 2.5 to 26.2). In the basophil activation tests, the mean EC₅₀ for basophil CD63 activation was 144-fold higher for Fab (mean, [standard deviation]; 647 μg/mL of antivenom [627]) compared to F(ab’)₂ (4.48 μg/mL of antivenom [2.75]).

Conclusion

We demonstrate a substantial incidence of adverse drug reactions and presumed anaphylaxis to crotaline antivenoms in an α-GAL endemic region, with F(ab’)₂ antivenom associated with more reactions than F(ab). Clinicians in α-GAL endemic regions should be cautious in the use of antivenoms, especially for patients with α-GAL allergy.

研究目的北美蝮蛇抗蛇毒血清CroFab®和ANAVIP®含有半乳糖-α-1,3-半乳糖（α-GAL）低聚糖。我们比较了使用这些抗蛇毒血清后的药物不良反应，包括推定的过敏反应，并研究了这些抗蛇毒血清导致α- gal免疫球蛋白（Ig） e敏感个体过敏反应的生物学合理性。方法我们进行了2项研究。来自阿肯色州毒物中心（2021年5月至2023年7月）的回顾性图表审查确定了使用crotaline抗蛇毒血清治疗的患者的不良药物反应和推定的过敏反应。两名过敏症专家（JK， LM），对使用的抗蛇毒血清不知情，裁定推定的过敏反应病例。为了评估抗蛇毒血清是否能激活α- gal - ige致敏个体的嗜碱性粒细胞，我们对5名有哺乳动物肉类过敏史的α- gal - ige致敏参与者的血液进行了嗜碱性粒细胞激活试验。通过%CD63上调来评估嗜碱性粒细胞活化。结果171例Fab受体患者中有7例（4.1%）未发生推定的过敏反应，37例F(ab)2受体患者中有8例（21.6%）发生药物不良反应（Δ=17.5%， 95%可信区间[CI][4.0 ~ 31.0]）。171例Fab患者中有3例（1.8%）出现推定过敏反应，F(ab')2患者中有6/37例（16.2%）出现推定过敏反应（Δ=14.3%, 95% CI 2.5 ~ 26.2）。在嗜碱性粒细胞激活试验中，嗜碱性粒细胞CD63激活的平均EC50比Fab高144倍(平均值，[标准差]；647 μg/mL抗蛇毒血清[627])，而F(ab')2 （4.48 μg/mL抗蛇毒血清[2.75]）。结论：α-GAL流行区存在大量的药物不良反应和对crotaline抗蛇毒血清的推定过敏反应，其中F（ab’）2抗蛇毒血清的不良反应发生率高于F（ab）。α-GAL流行地区的临床医生应谨慎使用抗蛇毒血清，特别是α-GAL过敏患者。

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引用次数: 0

Neonate With Scalp Swelling 新生儿头皮肿胀。

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2026-03-01 Epub Date: 2026-02-19 DOI: 10.1016/j.annemergmed.2025.09.002

Chih-Hao Wang MD, Po-Chih Lin MD

引用次数: 0

Learning Curves and Laryngoscopes: The Influence of Experience on Airway Management 学习曲线与喉镜：经验对气道管理的影响。

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2026-03-01 Epub Date: 2025-10-07 DOI: 10.1016/j.annemergmed.2025.09.008

Michael Gottlieb MD , Stephanie C. DeMasi MD

引用次数: 0

Weak Evidence, Rare Eligibility, and Complex Care Coordination Limit Application of Structured Surveillance for Subsegmental Pulmonary Embolism 证据薄弱、资格罕见和复杂的护理协调限制了结构监测在亚节段性肺栓塞中的应用。

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2026-03-01 Epub Date: 2026-02-19 DOI: 10.1016/j.annemergmed.2025.09.040

David R. Vinson MD, Samuel G. Rouleau MD, Maheswari J. Balasubramanian MD, Nareg H. Roubinian MD, MPH, Ashok P. Pai MD

引用次数: 0

Epinephrine Is the Preferred Vasopressor After Return of Spontaneous Circulation Following Cardiac Arrest 肾上腺素是心脏骤停后自然循环恢复后首选的血管加压素。

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2026-03-01 Epub Date: 2026-02-19 DOI: 10.1016/j.annemergmed.2025.12.023

Ruben Santiago PharmD, Kari Tornes PharmD

引用次数: 0

Time to Vasopressor Initiation Is Not Associated With Increased Mortality in Patients With Septic Shock 感染性休克患者开始使用血管加压素的时间与死亡率增加无关。

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2026-03-01 Epub Date: 2025-11-04 DOI: 10.1016/j.annemergmed.2025.09.024

Lauren Page Black MD, MPH , Charlotte Hopson MS , Michael A. Puskarich MD, MS , François Modave PhD , Danielle M. McCarthy MD, MS , Elizabeth DeVos MD, MPH , Cynthia Garvan PhD , Rosemarie Fernandez MD , Faheem W. Guirgis MD

Study objective

The optimal timing of vasopressor initiation in septic shock remains unclear. Our objective was to evaluate the association between time to vasopressor initiation and mortality.

Methods

This was a retrospective cohort study of patients with septic shock in the OneFlorida Data Trust, a statewide repository of health care data. We included patients if they received vasopressors during hospitalization after at least 1 episode of hypotension (systolic blood pressure ≤100 mmHg) and had either (1) an International Classification of Disease 9 or 10 code for sepsis, or (2) an International Classification of Disease code for infection and received IV antibiotics. The primary outcome was 90-day mortality. The secondary outcome was vasopressor-free days. We used multiple logistic regression with Least Absolute Shrinkage and Selection Operator for variable selection to assess associations with 90-day mortality.

Results

There were 4,699 patients with septic shock between 2012 and 2018 included. The primary outcome, 90-day mortality, was present in 34% (n=1,610). Time to vasopressor initiation was not found to be associated with 90-day mortality (odds ratio [OR] 1.01; 95% confidence interval [CI] 1.00 to 1.02). Independent predictors included age (OR 1.04; 95% CI 1.04 to 1.05), mechanical ventilation (OR 2.98; 95% CI 2.56 to 3.48), laboratory components of the Sequential Organ Failure Assessment score (OR 1.18; 95% CI 1.14 to 1.23), lactate level (OR 1.10; 95% CI 1.08 to 1.13), chronic hypertension (OR 0.60; 95% CI 0.52 to 0.70), and liver disease (OR 1.54; 95% CI 1.30 to 1.82). Time to vasopressor initiation was not found to be an independent predictor of vasopressor-free days.

Conclusion

Time from first hypotensive episode to vasopressor initiation was not found to be associated with 90-day mortality or vasopressor-free days in this large cohort of septic shock patients.

研究目的感染性休克开始使用血管加压素的最佳时机尚不清楚。我们的目的是评估血管加压素起始时间与死亡率之间的关系。方法：本研究是一项回顾性队列研究，研究对象为佛罗里达数据信托基金会（OneFlorida Data Trust）的脓毒性休克患者，该基金会是一个全州范围的卫生保健数据存储库。我们纳入了住院期间至少1次低血压发作（收缩压≤100 mmHg）后接受血管加压药物治疗的患者，并且患有(1)败血症的国际疾病分类9或10代码，或(2)感染的国际疾病分类代码并接受静脉注射抗生素的患者。主要终点为90天死亡率。次要终点为无血管加压剂天数。我们使用多元逻辑回归和最小绝对收缩和选择算子进行变量选择来评估与90天死亡率的关联。结果2012 - 2018年共纳入感染性休克患者4699例。主要结局为90天死亡率，占34% （n=1,610）。血管加压素起始时间与90天死亡率无相关性（优势比[OR] 1.01； 95%可信区间[CI] 1.00 ~ 1.02）。独立预测因素包括年龄（OR 1.04; 95% CI 1.04至1.05）、机械通气（OR 2.98; 95% CI 2.56至3.48）、序序器官衰竭评估评分的实验室组成（OR 1.18; 95% CI 1.14至1.23）、乳酸水平（OR 1.10; 95% CI 1.08至1.13）、慢性高血压（OR 0.60; 95% CI 0.52至0.70）和肝脏疾病（OR 1.54; 95% CI 1.30至1.82）。血管加压剂起始时间未被发现是无血管加压剂天数的独立预测因子。结论：在这一大型感染性休克患者队列中，从首次低血压发作到开始使用血管加压剂的时间与90天死亡率或无血管加压剂天数无关。

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引用次数: 0

The Emergency Diaries: Stories From Doctors Inside the ER 《急诊日记：急诊室医生的故事

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2026-03-01 Epub Date: 2026-02-19 DOI: 10.1016/j.annemergmed.2025.09.038

Nikita Joshi MD , Jordana Haber MD

引用次数: 0

Evaluation, Stabilization, and Transfer of Pregnant and Postpartum Patients Presenting to Emergency Departments Without Inpatient Obstetric Services 评估、稳定和转移孕妇和产后患者到急诊科没有住院产科服务。

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2026-03-01 Epub Date: 2025-10-10 DOI: 10.1016/j.annemergmed.2025.09.011

Elisabeth Erekson MD, MPH , Guy Nuki MD, MBA , Nathan Mick MD , Kelley Conroy MD , Maria D. Padin MD , Emily Watson BSN MPH , Regan N. Theiler MD, PhD

More than 50% of rural critical access hospitals in the United States no longer provide inpatient obstetric services. As more hospitals close their hospital-based obstetric services, emergency physicians must still be ready to care for pregnant patients who present emergently for care. Ideally, this will include immediate medical screening examination, stabilization and transfer to a hospital with obstetric services. In other circumstances, it will result in the need to provide basic obstetric emergency care for conditions such as unanticipated delivery, postpartum hemorrhage, eclamptic seizure, and neonatal resuscitation. Emergency physicians working in hospitals without inpatient obstetric services need to have knowledge of both the closest obstetric unit they can transfer a full-term patient for obstetric triage and delivery, and where they can transfer a preterm patient at any gestational age. Level I Obstetrical Units (low-risk units) can typically accept patients with more than 37 weeks gestation. Regional maternal centers (Level III/Level IV) can typically accept any gestational age. It is critical for emergency physicians working in facilities without inpatient obstetrics to be familiar with both resources in their catchment area (eg, nearby low-risk and regional high-risk centers). This article examines the emergency physician’s role in evaluation, stabilization, and transfer of pregnant and postpartum patients seeking emergency medical care at facilities without inpatient obstetric services.

美国超过50%的农村危重医院不再提供住院产科服务。随着越来越多的医院关闭以医院为基础的产科服务，急诊医生仍然必须准备好照顾紧急前来就诊的孕妇。理想情况下，这将包括立即进行医疗检查、稳定病情和转到提供产科服务的医院。在其他情况下，它将导致需要为意外分娩、产后出血、子痫发作和新生儿复苏等情况提供基本的产科急诊护理。在没有住院产科服务的医院工作的急诊医生需要了解最近的产科单位，他们可以将足月病人转到哪里进行产科分诊和分娩，以及他们可以将任何胎龄的早产儿病人转到哪里。一级产科病房（低风险病房）通常可以接受妊娠超过37周的患者。区域产妇中心（三级/四级）通常可以接受任何胎龄。对于在没有住院产科的设施中工作的急诊医生来说，熟悉其集水区（例如，附近的低风险和区域高风险中心）的这两种资源是至关重要的。本文探讨了急诊医生在评估、稳定和转移孕妇和产后患者在没有住院产科服务的设施寻求紧急医疗护理中的作用。

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引用次数: 0

Snake Antivenom Reactions: A New Finding and Continued Controversy 蛇抗蛇毒血清反应：新发现和持续争议。

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2026-03-01 Epub Date: 2025-10-25 DOI: 10.1016/j.annemergmed.2025.09.023

Richard C. Dart MD, PhD

引用次数: 0

Postmenopausal Woman With Sepsis and Lower Abdominal Pain 绝经后妇女脓毒症和下腹痛。

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2026-03-01 Epub Date: 2026-02-19 DOI: 10.1016/j.annemergmed.2025.09.022

Chun Chang MD , Hao-Cho Ou MD

引用次数: 0

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Annals of emergency medicine

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