JACEP Open

New in JACEP Open: Man with a swollen neck A 46-year-old male with neck swelling, erythema, and edema extending from the mandible to the suprasternal notch was diagnosed with necrotizing fasciitis (NF) of the neck with associated mediastinitis. Hypoxia improved with oxygen, and imaging confirmed the diagnosis, prompting emergent surgical intervention and broad-spectrum antibiotics. NF, a life-threatening soft tissue infection, requires early recognition and urgent surgical debridement to reduce high morbidity and mortality. Article Link: https://buff.ly/3PO2Ibp

New in JACEP Open: Facial pain after choking A 60-year-old male presented with facial pain following a choking episode on chicken wings, leading to persistent nasal drainage and sinus tenderness. CT imaging revealed a chicken bone impacted in the ethmoid air cells, prompting ENT referral for endoscopic removal. Prompt foreign body removal from the paranasal sinuses is essential to avoid severe complications, such as infections, cerebrospinal fluid fistulas, or optic nerve compression. Article Link: https://buff.ly/3Cm1kJS

New in JACEP Open: Pragmatism and feasibility: A qualitative study of experiences implementing and upgrading care in geriatric emergency departments Implementing geriatric care processes for Geriatric Emergency Department Accreditation (GEDA) requires balancing patient care improvements with resource constraints. Key factors include financial support, integrating guidelines into clinical practice, addressing staff motivation, and using electronic health records for geriatric screenings. Long-term success depends on sustained staff education and commitment despite challenges like turnover and competing priorities. Article link in the comments ⬇️ Article Link: https://buff.ly/3PPZofL

New in JACEP Open: Woman with growing scalp mass A 77-year-old woman presented with a rapidly enlarging scalp mass, initially thought benign, now tender and fluctuant. PoCUS and CT revealed a mixed echogenic mass eroding through the skull and compressing brain parenchyma. Biopsy confirmed diffuse large B-cell lymphoma (DLBCL), highlighting PoCUS's role in identifying overlooked lesions and prompting advanced imaging for timely diagnosis. Article Link: https://buff.ly/3Eb5Xac

New in JACEP Open: The relationship between intraosseous catheter tip placement, flow rates, and infusion pressures in a high bone density cadaveric swine (Sus scrofa) model IO infusion requires high flow rates at safe pressures, influenced by catheter tip placement. In a swine cadaveric model, zone 1 (medullary space) and zone 2 (trabecular bone) placements showed similar flow rates and pressures, while zone 3 (cortical bone) placements had lower flow rates and higher pressures. Accurate placement avoiding dense cortical bone is critical for optimal IO infusion performance. Article Link: https://buff.ly/40yW1Pm

New in JACEP Open: Delta troponin does not distinguish acute coronary syndrome in emergency department patients with renal impairment and an initial positive troponin In ED patients with renal impairment and positive initial troponin levels, about one-third developed ACS events within 6 weeks. A delta troponin threshold of 20% showed limited utility in predicting or excluding ACS events, with event rates of 32%–47% for cTnT and 24%–61% for hsTnT. These findings highlight challenges in using delta troponin for ACS evaluation in this population. Article Link: https://buff.ly/4aAi7W3

New in JACEP Open: Quality improvement in the era of boarding and burnout: A postpandemic blueprint The COVID-19 pandemic exacerbated barriers to quality improvement in emergency departments, such as burnout and staff turnover. Using a blueprint emphasizing psychological safety, egalitarian conversations, and frontline staff engagement, a team achieved a 4% reduction in "leave without being seen" rates (9% to 5%, p < 0.001) and high staff satisfaction. This approach highlights the importance of inclusive strategies in overcoming postpandemic challenges. Article Link: https://buff.ly/4geDZra

New in JACEP Open: Great expectations: A multisite, randomized controlled open‐label trial of a novel patient expectations communication tool A novel questionnaire was tested in emergency medicine to help clinicians understand patient expectations. In a randomized trial of 308 participants, patients using the tool had 2.1 times greater odds of feeling their expectations were understood (OR 2.1, 95% CI: 1.2–3.7, p=0.01). While satisfaction metrics did not differ significantly, results suggest potential for improving patient-centered care. Article Link: https://buff.ly/4jHETjc

New in JACEP Open: Diagnosing aortic dissection: A review of this elusive, lethal diagnosis Aortic dissection (AD) is a rare but life-threatening condition that remains challenging to diagnose, even with advancements in computed tomography angiography. No single history or physical exam feature reliably raises suspicion, but severe, unexplained chest pain should prompt consideration of AD. Atypical presentations, including neurologic deficits or hypotension, complicate diagnosis, underscoring the need for heightened clinical awareness and judicious imaging use. Article Link: https://buff.ly/40qxL1I

New in JACEP Open: Hidden hemorrhage: A case of idiopathic omental hemorrhage causing spontaneous hemoperitoneum Idiopathic omental hemorrhage (IOH) is a rare condition, often presenting with abdominal pain and intractable nausea or emesis, predominantly in males aged 20–65. Delayed recognition can lead to mortality rates exceeding 30%, emphasizing the need for high clinical suspicion and prompt advanced imaging. This case underscores the importance of early diagnosis and timely intervention in patients with persistent abdominal symptoms. Article link: https://buff.ly/4h9o3rL