Sandy L. Dong, Karen D. Kelly, Ryan C. Oland, Brian R. Holroyd, Brian H. Rowe
DOI: http://dx.doi.org/10.1053/ajem.2001.28330
Published in issue: November 2001
xCellulitis is a common problem presenting to the emergency department (ED). This study examines the epidemiology of cellulitis in 5 Canadian urban EDs and determines the practice variation in this management among sites. From computerized provincial ED diagnosis information, 10% of cellulitis charts from April 1, 1997 to March 31, 1998 were randomly selected for review. All 5 EDs in one urban region were sampled; physicians were unaware of the study when seeing patients. A standardized audit form was used to collect information pertaining to visits for the incident infection case.
Ishak A. Mansi, Ira S. Nash
DOI: http://dx.doi.org/10.1053/ajem.2001.28326
Published in issue: November 2001
xDeviation of the ST segment of the electrocardiogram (ECG) may signify infarction or ischemia. Prior studies suggest that normal ECG patterns may differ among ethnic groups. We retrospectively reviewed the first thousand medical files of a multiethnic community, where all individuals shared similar living conditions. Only healthy adults, aged 15 to 60 years, were included. Along with age, the most common causes for exclusion were diabetes, hypertension, and ischemic heart disease. A total of 597 subjects (349 men) were included: 350 Saudi Arabians, 39 Filipinos, 95 Indians, 17 Sri-Lankans, and 57 Caucasians.
Atima Chumpa, Ron L. Kaplan, Michele M. Burns, Michael W. Shannon
DOI: http://dx.doi.org/10.1053/ajem.2001.27141
Published in issue: November 2001
xNalmefene is a newer, long-acting opioid antagonist. Its use in children for the elective reversal of emergency department procedures has not been investigated. The objective was to evaluate the safety of nalmefene in children. An open-label pediatric clinical trial was performed. The study was conducted at the emergency department of an urban, university-affiliated children's hospital and consisted of children aged 6 months to 12 years who required procedural sedation where an opioid agent was administered.
Wally W. Lee, Ann E. Burelbach, David Fosnocht
DOI: http://dx.doi.org/10.1053/ajem.2001.28038
Published in issue: November 2001
xThis study compares emergency department (ED) pain management expectations in Hispanic versus non-Hispanic white patients with painful conditions. A prospective convenience sample of patients was enrolled at a university ED. Patient expectations of pain relief were recorded on a 100-mm visual analogue scale (VAS). Surveys from 58 Hispanics and 408 non-Hispanic whites were completed and used for data analysis. Sample size was adequate to detect a minimum difference in pain relief of 13 mm. Both groups had similar chief complaints and degree of pain at presentation.
Richard J. Harper, William J. Brady, Andrew D. Perron, Michael Mangrum
DOI: http://dx.doi.org/10.1053/ajem.2001.24486
Published in issue: November 2001
xSince the first introduction of implantable pacemaker approximately 50 years ago, these devices have become increasingly more common and more complex. It is estimated that there are approximately 1 million patients with implanted pacemakers in the United States and, with an aging population, the number of pacemakers is certain to increase. This review focuses on basics of pacemaker function as well as the common rhythm disturbance issues and other clinical syndromes that the emergency physician is likely to encounter.
Geoffrey K. Isbister
DOI: http://dx.doi.org/10.1053/ajem.2001.28325
Published in issue: November 2001
xVenomous fish stings are a common environment hazard worldwide. This study investigated the clinical effects and treatment of venomous fish stings. A prospective observational case series of patients presenting with venomous fish stings was conducted in tropical northern Australia. Twenty-two fish stings were included; subjects were 3 females and 19 males; mean age 35 (range 10-63). 9 by stingrays, 8 by catfish, 1 by a stonefish, 1 by a silver scat (Selenotocota multifasciata), and 3 by unknown fish.
Giuseppe Barbaro, Stacy D. Fisher, Giuseppe Giancaspro, Steven E. Lipshultz
DOI: http://dx.doi.org/10.1053/ajem.2001.28323
Published in issue: November 2001
xCardiac complications associated with the AIDS may present to emergency physicians and are often secondary to opportunistic infections or malignancy, but may also be associated with other aspects of the human immunodeficiency virus (HIV) or its treatment. In this review article, we will discuss HIV-associated cardiac disease which may be encountered in the ED, emphasizing the prevalence, pathogenesis, and treatment of related disorders. (Am J Emerg Med 2001;19:566-574. Copyright © 2001 by W.B. Saunders Company)
Barry D. Fuchs, Janet McMaster, Gregory Smull, Joanne Getsy, Basil Chang, Rosemary A. Kozar
DOI: http://dx.doi.org/10.1053/ajem.2001.28328
Published in issue: November 2001
xDespite an increased risk of motor vehicle crashes (MVC) in patients with obstructive sleep apnea (OSA), we hypothesized that OSA was not considered in drivers admitted to trauma centers after an injury-producing MVC. A retrospective study on drivers involved in MVCs admitted to a level 1 trauma center was performed, with crash cause determined and the frequency of sleep studies recorded. A questionnaire was also mailed to 240 trauma centers seeking information on evaluation of patients with unexplained causes for MVCs, including screening for OSA.
Geoffrey A. Answini, Mark L. Sturdevant, Ronald F. Sing, David G. Jacobs
DOI: http://dx.doi.org/10.1053/ajem.2001.28034
Published in issue: November 2001
xClassic teaching suggests that blunt thoracic aortic rupture (BTAR) results from high-speed deceleration injury mechanisms. Our recent experience with a patient who sustained fatal aortic rupture resulting from a low-speed crushing injury emphasizes the importance of maintaining a high index of suspicion for BTAR, even in patients with “low-risk” injury mechanisms. Several potential pathophysiologic mechanisms of BTAR are discussed. (Am J Emerg Med 2001;19:579-582. Copyright © 2001 by W.B. Saunders Company)
Andrew D. Perron, William J. Brady, Ronald F. Sing
DOI: http://dx.doi.org/10.1053/ajem.2001.28333
Published in issue: November 2001
xTibial femoral knee dislocation is a severe injury, with a real potential for limb-threatening vascular compromise, primarily caused by injury to the popliteal artery. When unrecognized or inadequately evaluated and treated, these injuries often lead to a high incidence of morbidity and potential limb loss. Emergency medicine practitioners should be vigilant for vascular injury associated with knee dislocation. This review article examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency practitioner.
Tighe Zimmers
DOI: http://dx.doi.org/10.1053/ajem.2001.28039
Published in issue: November 2001
xDying patients go through a series of arrhythmias, each one a bit more ominous. This patient, a 94-year-old, had been in rapid decline at a nursing home, and paramedics had been called.
Ruben Olmedo, Lewis Nelson, Jason Chu, Robert S. Hoffman
DOI: http://dx.doi.org/10.1053/ajem.2001.21720
Published in issue: November 2001
xThe current recommendations for body-packers are based on packet content, the presence of drug toxicity, or of bowel obstruction. Asymptomatic patients are usually treated with activated charcoal and whole bowel irrigation (WBI). Surgical removal of packets is advocated in symptomatic cocaine body-packers and in those with bowel obstruction. Currently, surgery is regarded as definitive. However, we report 2 body-packers who show the limitations of this technique. These cases show the importance of confirming the absence of drug packets in the gastrointestinal (GI) tract as the definitive end-point in the treatment of body-packers.
Takashi Yokota, Yasuo Kunii, Shu Kikuchi, Yasuo Yamada, Hidemi Yamauchi
DOI: http://dx.doi.org/10.1053/ajem.2001.28035
Published in issue: November 2001
xA major drawback of submission of so-called incident reports for medical institutions is that such reports may be able to be obtained on request by patients and to be used as evidence in malpractice lawsuits. In Japan, there are no established rules concerning the use of accident reports in medical lawsuits. More debate is needed for voluntary report systems to become established in medical institutions throughout Japan. (Am J Emerg Med 2001;19:597. Copyright © 2001 by W.B. Saunders Company)
Richard B. Birrer, Beth A. Garven
DOI: http://dx.doi.org/10.1053/ajem.2001.28332
Published in issue: November 2001
x—Seventy five percent of children who aspirate foreign bodies (FBs) are younger than 3 years of age; <1% are fatal choking events.1-13 Foods, in general, are responsible for 70% of episodes.12,14,15 The most commonly aspirated FB (38%) is a peanut.14,16 Nuts account for approximately 50% of all aspirated FBs in children throughout the world.1,17-19 In addition, a wide variety of objects may be aspirated by children including seeds, insects, plastic toy parts, pins, pens, bones, balloons and crayons.
Lengsu-William Chin, Ming-Tsen Lin, Hsiu-Po Wang, Han-Mo Chiou, Wen-Jone Chen
DOI: http://dx.doi.org/10.1053/ajem.2001.28047
Published in issue: November 2001
x—Sigmoid volvulus is the third leading cause of colonic obstruction, surpassed by malignancy and diverticulitis. It often affects elderly debilitated patients who tolerate poorly the physiologic consequences of colonic obstruction.1 Sigmoid volvulus is an abdominal catastrophe, with reported mortality rate up to 35% from each episode.2 Diagnosis and management of abdominal emergencies must be established rapidly and safely. Usually, coffee-bean sign on plain x-ray film is a sign of volvulus, but only in some patients.
Joseph O. Di Duro
DOI: http://dx.doi.org/10.1053/ajem.2001.28324
Published in issue: November 2001
x—Seigel and Neiders' strong conclusions1 raise serious issues that must be addressed. A common misconception is that people in “good health” seek chiropractic care. On the contrary, the patients who seek chiropractic care are often the most difficult who present to physicians in that they have already explored the gamut of modern medicine without results.
David Siegel
DOI: http://dx.doi.org/10.1053/ajem.2001.28050
Published in issue: November 2001
xWe agree that it is frequently difficult to prove a cause and effect relationship in emergency medicine. Several investigators have maintained that some vascular injuries that occurred after manipulation were a natural consequence of an underlying medical condition.1,2 Dr. DiDuro shows the difficulty in determining a cause and effect relationship by describing several other risk factors for vertebral artery dissection that this patient may or may not have had such as an underlying arteriopathy or nonatherosclerotic vasculopathy.
Joji Inamasu, Takashi Horiguchi, Ryoichi Saito, Yoshiki Nakamura, Kiyoshi Ichikizaki, Kazushi Takahashi, Tomoko Shimanouchi
DOI: http://dx.doi.org/10.1053/ajem.2001.28041
Published in issue: November 2001
x—A rare case of interhemispheric subdural empyema in a young man is reported. The disease should be included in the differential diagnosis of patients who present with focal neurologic signs together with meningeal irritability. Brain computed tomography (CT) with contrast enhancement is the examination of choice in the ED for such patients.
Hsin-Ling Lee, Eugene Yu, How-Ran Guo
DOI: http://dx.doi.org/10.1053/ajem.2001.28043
Published in issue: November 2001
x—Thyroid storm and diabetic ketoacidosis (DKA) are both endocrine emergencies. The combination of diabetes mellitus (DM) with thyrotoxicosis is well known, and one condition usually precedes the other1,2 but the coexistence of DKA and thyrotoxic crisis is rare.3,4 We report a case of thyroid storm in a woman, previously diagnosed with hyperthyroidism, who also presented with DKA.
Kevin Moissinac, Boon Chong Se To, Ngoh Chin Liew, Yunus Gul
DOI: http://dx.doi.org/10.1053/ajem.2001.28331
Published in issue: November 2001
x—The diagnosis of ruptured abdominal aortic aneurysm (AAA) is not uncommonly delayed or initially missed.1,2,3,4,5 Patients present with atypical manifestations, in the absence of the classical diagnostic triad of abdominal and back pain, hypotention, and a pulsatile abdominal mass. We report an elderly patient who at urgent inguinal exploration of a possibly strangulated left inguinal scrotal hernia was found to have inguinal extension of a retroperitoneal hematoma secondary to abdominal aortic aneurysm rupture.
David Siegel
DOI: http://dx.doi.org/10.1053/ajem.2001.28045
Published in issue: November 2001
x—Atrial fibrillation, which is frequently seen in the elderly, can create a considerable risk of embolic cerebrovascular events. Thyrotoxicosis, an uncommon cause of atrial fibrillation, is a diagnosis seldom seen in primary care. The emergency physician should be aware of the risk of arterial embolism and the issues surrounding urgent anticoagulation. The following case report illustrates a complication of thyrotoxicosis-induced atrial fibrillation in a young adult.
Ronald F. Sing, Toan T. Huynh, Michael A. Gibbs, Andrew D. Perron
DOI: http://dx.doi.org/10.1053/ajem.2001.27139
Published in issue: November 2001
x— Airway control is the most vital intervention in the initial care of the severely ill or injured patient. Contemporary case series have shown that prehospital clinicians can perform endotracheal intubation with a high success rate; over 95% of the time when rapid sequence intubation techniques are used.1-4
Andrea Vogler, David C. Seaberg
DOI: http://dx.doi.org/10.1053/ajem.2001.28037
Published in issue: November 2001
x—Blunt cardiac injury (BCI) can be a lethal result of nonpenetrating chest injury. The clinical presentation is often subtle.1 The diagnosis of BCI is difficult because of coexisting injuries and the nonspecificity of available diagnostic tests. The following case shows an unusual manifestation of BCI in a patient discharged from the ED after seemingly minor trauma.
DOI: http://dx.doi.org/10.1016/S0735-6757(01)80234-5
Published in issue: November 2001
DOI: http://dx.doi.org/10.1016/S0735-6757(01)70001-0
Published in issue: November 2001
xEDITOR J. Douglas White, MD, MPH, Medical College of Virginia/VCU, Richmond
