Open Access Emergency Medicine

The nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for their analgesic, anti-inflammatory and antipyretic actions. They are commonly taken in overdose in many areas of the world. The majority of patients with acute NSAID overdose will remain asymptomatic or develop minor self-limiting gastrointestinal symptoms. However, serious clinical sequelae have been reported in patients with acute NSAID overdose and these include convulsions, metabolic acidosis, coma and acute renal failure. There appear to be some differences between the NSAIDs in terms of the relative risk of these complications; in particular mefenamic acid is most commonly associated with convulsions. The management of these serious clinical features is largely supportive and there are no specific antidotes for acute NSAID toxicity.

Laura Hunter

David Wood

Dargan

OAEM

The patterns of toxicity and management of acute nonsteroidal anti-inflammatory drug (NSAID) overdose

急性非甾体抗炎药（NSAID）过量中毒模式及处理

Purpose: Mild Traumatic brain injury is classified based on Glasgow Coma Scale (GCS 13– 15), it also involves transient alteration of brain function, which may lead to severe short- and long-term sequelae. When treating a patient with a mild head injury outside the hospital, it is of crucial importance to decide whether to transport him to a center without neurosurgery or to a center equipped with neurosurgery (primary centralization). Recent decades have seen exploration of portable, non-invasive devices for intracranial injury and stroke detection, with microwave frequency electromagnetic field technology showing promising clinical outcomes. This clinical investigation aims to assess the diagnostic accuracy of the TES HT100 medical device, utilizing electromagnetic fields for endocranial lesion screening. Patients and Methods: Patients with mild traumatic brain injury were randomly enrolled according to inclusion criteria. Twenty-three patients recruited from the Intensive Short-Term Observation (ISTO) unit at San Donato Hospital in Arezzo. The sensitivity and specificity of the TES HT were evaluated statistically against cranial computed tomography (CT), the gold standard. Results: A preliminary analysis shows a sensitivity of 100% and a specificity of 100%. Based on these results, there is maximum concordance between the two examinations, and the AUC is 1. No adverse events related to the use of TES HT100 or the examination. Conclusion: The device's ability to differentiate patients with intracranial lesions from those without can streamline the diagnostic and therapeutic process, potentially leading to improved patient outcomes. If Temnography will maintain high standards of sensitivity and specificity with the expansion of the enrolled population, it could be considered as a stable screening tool in the Emergency Room (ER). We could think to apply this technology to reduce the length of stay that patients with mTBI have to spend in ER for observation. Temnography could also be useful in special categories of patients such as pregnant women or the pediatric population. Moreover, another front of future development of this technology could be extending the study to include Territorial Emergency. In this context, Temnography could aid centralized decision-making in patient care. Keywords: temnography, mild traumatic brain injury, mTBI, traumatic brain injury, TBI, emergency medicine, pre-hospital

Sara Montemerani

Cosimo Fabrizi

Cecilia Sacchi

Antoine Belperio

Lorenzo Moriani

Samuele Pacchi

Cinzia Garofalo

Giovanni Sbrana

Duccio Venezia

Maurizio Zanobetti

Simone Nocentini

Reliability Evaluation of Temnography for Early Detection of Intracranial Lesions in Mild Traumatic Brain Injury Patient: A Preliminary Report of a New Portable, Non-Invasive Device

轻度创伤性脑损伤患者颅内病变早期检测的经颅多普勒可靠性评估：一种新型便携式无创设备的初步报告

Background: ST elevation combined with typical chest pain is an indication for acute coronary vascularization and is usually associated with acute myocardial infarction. Herein, we present an unusual case of ST elevation. Case Presentation: A 57-year-old male patient presented to the emergency department with chest pain radiating to both arms and the back. Typical clinical presentation and inferolateral ST elevations were suggestive of ST elevation myocardial infarction. Interestingly, coronary occlusion was excluded by coronary angiography. Despite extensive diagnostic workup, no underlying diagnosis was made. Four days later, the patient returned and reported pain in the right upper abdomen. Clinical presentation, laboratory analysis, and imaging features led to a diagnosis of calculous acute cholecystitis. Laparoscopic cholecystectomy was performed, and the diagnosis was confirmed. Electrocardiographic changes and pain resolved completely. Conclusion: Acute calculous cholecystitis is initiated by gallbladder distension due to biliary duct occlusion caused by gallstones. ST elevations in response to gallbladder distension have been demonstrated in animal models. We hypothesize that the ST elevations observed in this patient with chest pain were linked to stone-mediated distension of the gallbladder, leading to reflex coronary vasoconstriction. Keywords: electrocardiography, ECG, STEMI, cope's sign, chest pain, case report

Helene Meyer

Kristina Fäh

Michael Christ

An Atypical Presentation of Acute Cholecystitis with Left Sided Chest Pain and ST Elevation – A Case Report

急性胆囊炎非典型表现伴左侧胸痛及ST段抬高——一例报告

Objective: To investigate the clinical utility of administering patiromer as an adjunct to insulin for potassium reduction in patients presenting to the emergency department (ED) with hyperkalemia. Methods: This retrospective cohort study used electronic health record data to identify adults treated with at least one intravenous dose of regular insulin for hyperkalemia within the ED. Patients who were administered patiromer within one hour before or after their insulin dose were categorized as the intervention group. Matching was performed at a 1:1 ratio. The primary outcome, mean change in potassium from baseline to the latest value within the 4– 12 hour interval, was compared. Secondary outcomes included net clinical benefit, defined as the mean difference in the number of potassium-lowering interventions minus the change in potassium. Results: The final analysis included 133 patients treated with patiromer plus insulin and 133 patients treated with insulin alone. Participants had a mean age of 71 years; 43% were female, 31% self-identified as Black, and 38% self-identified as Latinx. No significant changes were observed in potassium from baseline (mean levels 6.2 mEq/L in each group) to the 4– 12 hour time frame (patiromer: − 0.90 mEq/L, n=78 vs insulin-only: − 0.98 mEq/L, n=81; p = 0.51). The calculated net clinical benefit of potassium reduction was − 0.25 in favor of the patiromer plus insulin group; however, this difference did not reach statistical significance. In the subgroup of eGFR > 30 mL/min, patiromer group received numerically less potassium-lowering interventions (0.63 vs 1.12, p = 0.057). Conclusion: In this study of patients with acute hyperkalemia in the ED setting, concurrent administration of patiromer did not result in more sustained potassium reduction compared to insulin alone in the overall cohort. The trend in favor of adjunct patiromer in the subgroup with adequate renal function warrants further investigation. Keywords: patiromer, hyperkalemia, emergency department, insulin, renal impairment

Pavel Goriacko

Ladan Golestaneh

Katherine Di Palo

A Retrospective Study of Patiromer as Adjunct to Insulin Therapy for Acute Hyperkalemia in the Emergency Department

帕西罗莫尔作为急诊科急性高钾血症胰岛素治疗的辅助药物的回顾性研究

Abdullahi Ahmed Ahmed

Abdinasir Elmi

Ismail Ibrahim

Mohamed Farah Yusuf Mohamud

Diagnostic Challenges and Management Strategies for Superior Sagittal Sinus Thrombosis Induced by Snake Bite Envenomation: A Case Report from Somalia

蛇咬伤致上矢状窦血栓形成的诊断挑战与管理策略：来自索马里的病例报告

Quincy Chopra

Vincent Peyko

Jessica Lee

Leo Puhalla

David Gemmel

Todd Bolotin

Droperidol Plus Diphenhydramine for Symptom Improvement in Suspected Cannabinoid Hyperemesis Syndrome: A Prospective Cohort Study

氟哌利多联合苯海拉明治疗疑似大麻素诱导的恶心呕吐综合征症状改善的前瞻性队列研究

Abbreviation	OAEM
Journal Impact	1.38
Quartiles(Global)	EMERGENCY MEDICINE(Q3)

ISSN	1179-1500
h-index	23

Publication Information	Publisher: Dove Medical Press Ltd，Publishing cycle: ，Journal Type: journal，Open Access Journals: Yes
Basic data	Year of publication: 2010，Proportion of original research papers: 84.38%，Self Citation Rate:6.70%， Gold OA Rate: 98.37%
Journal Fees	$2990Details
Average review cycle	网友分享经验：16 Weeks

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The patterns of toxicity and management of acute nonsteroidal anti-inflammatory drug (NSAID) overdose

Reliability Evaluation of Temnography for Early Detection of Intracranial Lesions in Mild Traumatic Brain Injury Patient: A Preliminary Report of a New Portable, Non-Invasive Device

An Atypical Presentation of Acute Cholecystitis with Left Sided Chest Pain and ST Elevation – A Case Report

A Retrospective Study of Patiromer as Adjunct to Insulin Therapy for Acute Hyperkalemia in the Emergency Department

Diagnostic Challenges and Management Strategies for Superior Sagittal Sinus Thrombosis Induced by Snake Bite Envenomation: A Case Report from Somalia

Reliability Evaluation of Temnography for Early Detection of Intracranial Lesions in Mild Traumatic Brain Injury Patient: A Preliminary Report of a New Portable, Non-Invasive Device

An Atypical Presentation of Acute Cholecystitis with Left Sided Chest Pain and ST Elevation – A Case Report

A Retrospective Study of Patiromer as Adjunct to Insulin Therapy for Acute Hyperkalemia in the Emergency Department

Diagnostic Challenges and Management Strategies for Superior Sagittal Sinus Thrombosis Induced by Snake Bite Envenomation: A Case Report from Somalia

Droperidol Plus Diphenhydramine for Symptom Improvement in Suspected Cannabinoid Hyperemesis Syndrome: A Prospective Cohort Study