DOI: http://dx.doi.org/10.1016/S0735-6757(00)90037-8
Published in issue: January 2000
Francis M Fesmire
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90038-X
Published in issue: January 2000
xIt has been shown that a rise in creatine kinase MB bank (CK-MB) of ≥ + 1.6 ng/mL in 2 hours is more sensitive and equally specific for detection of acute myocardial infarction (AMI) as compared with a 2-hour CK-MB ≥ 6 ng/mL during the emergency department (ED) evaluation of chest pain. Because cardiac specific troponin I (cTnl) is thought to have similar early release kinetics as compared with CK-MB mass, we undertook a retrospective cohort study in 578 chest pain patients whose baseline CK-MB and cTnl was less than two times the hospital's upper limits of normal and who underwent a 2-hour CK-MB and cTnl to compare sensitivities and specificities of the 2-hour delta CK-MB (ΔCK-MB) and delta cTnl (ΔcTnl) for AMI and 30-day Adverse Outcome (AO).
Alan L Causey, John A Tilelli, Mark E Swanson
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90039-1
Published in issue: January 2000
xTo determine if routine, noninvasive parameters could be measured which predict early (4–6 hour) discharge from the emergency department (ED) in mildly symptomatic and asymptomatic victims of childhood near-drowning, a retrospective cohort study was undertaken. Patients with fresh water near-drowning were studied over a 3-year period who presented with Glascow Come Scale (GCS) ≥13 and required no advanced life support prior to or ≤4 hours after ED presentation. Three groups of patients were found: 39 patients (81%) had normal pulmonary examination (PEx) and normal room air oxygen saturation (RASaO2) by 4 to 6 hours and did not deteriorate during the hospital admission (<24 hours); 5 patients (10%) had normal PEx by 4 to 6 hours and RASaO2 by 8 to 12 hours and did not deteriorate during hospitalization (<24 hours).
Richard M Levitan, E.Andrew Ochroch, Sarah Stuart, Judd E Hollander
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90040-8
Published in issue: January 2000
xThe intubating laryngeal mask airway (ILMA) is a newly available device designed to allow for blind endotracheal intubation and treatment of patients with difficult airways. We studied the intubation success rates and speed with initial use of this device on an intubation manikin to determine whether this device might be easily used by trained and untrained personnel. Rapid and successful intubation with a device requiring limited or no training could have widespread implications for both health care providers and laypersons.
Janet M Williams, Ann C Chinnis, Daniel Gutman
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90041-X
Published in issue: January 2000
xIn this article we describe health promotion practices of emergency physicians (EPs). A survey was mailed to members of the West Virginia American College of Emergency Physicians. Main outcomes included the EP's beliefs regarding health promotion, perceived roles in health promotion, and perceived effectiveness in modifying the behavior of patients. Over 90% of respondents routinely asked about cigarette smoking and half about alcohol use. A minority routinely asked about illicit drug use, diet, exercise, domestic violence, or stress.
Georg Petroianu, Jie Liu, Ursula Helfrich, Wolfgang Maleck, Roderich Rüfer
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90042-1
Published in issue: January 2000
xWe will examine the correlation between various bee venom phospholipase A2 (PLA2) concentrations and several parameters of coagulation in human plasma in order to offer a rationale for requesting a particular laboratory coagulation test after bee sting(s). We will also evaluate in vitro the influence of clinically available drugs with a noncompetitive inhibitory effect on PLA2 on the anticoagulant effect of bee venom PLA2. Prothrombin index (PTi), partial thromboplastin time (PTT), antithrombin III (AT III), soluble fibrin monomers (SFM), the activity of coagulation factors I, II, V, and VIII, and thrombelastography (TEG) parameters (split point [Sp], reaction time [R], kinetic time [K], coagulation time [R + K], maximal amplitude [MA], and the growth angle [α]) were determined before and after addition of 1.4, 2.7, and 4.1 units (1, 2, and 3 μg protein respectively) of bee venom PLA2.
E.Brooke Lerner, Ronald Moscati
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90043-3
Published in issue: January 2000
xIn this article we seek to determine the duration of immobilization in patients presenting to the emergency department (ED). We conducted a 10-week prospective study of a convenience sample of patients transported to a level one trauma center immobilized with a backboard and cervical collar. Total backboard time (TBT) was measured from the time the ambulance left the scene to the time the patient was removed from the backboard, while total ED backboard time (TEDBT) was measured from the time of arrival at the ED to the time of backboard removal.
Hiroshi Iwama, Yoichi Akama, Choichiro Tase
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90044-5
Published in issue: January 2000
xThirty-five rabbits were divided randomly into 5 groups: sham operation, 10 minutes clamping bicarotid trunk (partial ischemia, PI), and 3 groups of 5, 7, and 10 minutes clamping left subclavian artery and bicarotid trunk (global ischemia, GI). Systolic arterial pressure increased slightly in the PI group, but doubled in the GI groups during clamping. Heart rate did not change in the PI group, but decreased transiently in the GI groups during clamping. Brain temperature decreased gradually in the GI groups during clamping, but did not change in the PI group.
Matitiahu Berkovitch, Amir Livne, Gili Lushkov, Michael Segal, Clara Talmor, Yedidia Bentur, Julia Klein, Gideon Koren
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90045-7
Published in issue: January 2000
xDue to its high cost and need for parenteral administration, the standard iron chelator deferoxamine is not used in many individuals with acute and chronic iron poisoning worldwide. Deferiprone is the first oral iron chelator to be shown to be effective in chronically iron overloaded thalassemia patients. Its efficacy, by oral administration, in acute iron poisoning has not been tested. Our objective was to determine whether orally administered deferiprone can reduce the mortality of rats following acute, toxic, oral doses of iron.
Richard Lanoix, Lee V Leak, Theodore Gaeta, Joel R Gernsheimer
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90046-9
Published in issue: January 2000
xIn this article we seek to evaluate the diagnostic accuracy of emergency physicians performing emergency ultrasonography in the setting of an emergency medicine training program. A prospective observational study was performed at an inner city Level I trauma center with an emergency medicine residency training program. From July 1994 to December 1996 a convenience sample of ultrasound exams was recorded. The diagnostic quality (“acceptable or technically limited”) was determined by a board-certified cardiologist or radiologist with fellowship training in ultrasonography.
Paul R Sullivan, Allan B Wolfson, Ronald D Leckey, Jane L Burke
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90047-0
Published in issue: January 2000
xIn this article we try to determine how frequently emergency physicians (EPs) suspected the diagnosis in acute aortic dissection (AD). In this retrospective descriptive study, we identified all patients with the final diagnosis of AD initially evaluated in 1 of 3 emergency departments (EDs) over a 5-year period. Patients were included if AD was not suspected before ED evaluation. Patients undergoing thoracic aorta imaging as the initial ED study were defined as suspected AD. Forty-three patients totaling 44 presentations were identified.
Rebecca Allen, Linda F Cushman, Stephen Morris, Joseph Feldman, Christine Wade, Don McMahon, Michael Moses, Fredi Kronenberg
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90048-2
Published in issue: January 2000
xThis small, pilot study examined presenting complaint, brief health history, use of complementary and alternative medicine (CAM), and sociodemographic characteristics, among patients attending the emergency department (ED) of a large urban hospital. The sample (n = 50) was primarily Dominican and of low socioeconomic status. Almost half had used CAM for their presenting complaint or another health problem during the past year, most commonly in the form of medicinal plants made into herbal teas. CAM users were more likely to be female, longer-term residents of the United States, and to have also used religious practices for health problems.
Jonathan D Apfelbaum, Stephen V Cantrill, Neil Waldman
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90049-4
Published in issue: January 2000
xCervical spine instability in the neurologically intact patient following penetrating neck trauma has been considered rare or non-existant. We present a case of a woman with an unstable C5 fracture without spinal cord injury after a gunshot wound to the neck. Considerations regarding the risk of cervical spine instability are discussed, as well as suggestions for a prudent approach to such patients.
Peter C Ferrera, Holly May Wheeling
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90050-0
Published in issue: January 2000
xInjuries to the sternoclavicular (SC) joint are infrequently encountered. However, retrosternal SC joint dislocations are potentially life-threatening injuries which must be recognized by the examining physician and treated as soon as possible. Plain radiography often fails to fully distinguish SC joint injuries, and computed tomography has emerged as the diagnostic modality of choice for defining the injury complex and surrounding injuries. We have encountered 6 cases of SC joint injuries over the past 3 years and describe their presentation and management.
Timothy Janchar, Chris Samaddar, David Milzman
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90051-2
Published in issue: January 2000
xEffective planning is essential for medical personnel preparing to provide emergency care at mass gatherings. At large concerts where audience members participate in “moshing,” crowd surfing, and stage diving, there may be a potential for a dramatic increase in injuries requiring medical attention. Injuries seen at emergency medical stations at 3 concerts, all with large mosh pits, over 4 event days were recorded and evaluated. Each event day had over 60,000 attendees. A total of 1,542 medical incidents (82.9 per 10,000) were reported over the 4 event days.
Sean P Bush, Paul Giem, Richard S Vetter
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90052-4
Published in issue: January 2000
xFour cases of envenomation by green lynx spiders (Peucetia viridans) are reported. Despite the unusual appearance and occasional aggressive behavior of this spider, envenomation caused only local pain, pruritis, erythema, and induration. No local necrosis or systemic symptoms occurred. Treatment included tetanus immunization, wound care, and symptomatic therapy.
Stephen W Corbett, Philip D White, William A Wittlake
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90053-6
Published in issue: January 2000
xTo determine if an informational videotape affected patient's attitudes towards their emergency department visit, we conducted a prospective study using a convenience sample of patients waiting to be seen at a southern California emergency department. Patients waiting to be treated were randomized to view an informational videotape or to receive standard management (no videotape). The informational videotape lasted 6 minutes and served to orient the patients to the emergency department. It showed the sequence of steps from entry into the department to discharge, the nature of triage and causes for delays, the different services offered by the emergency department, and the roles of each of the department staff members.
William Durston, Richard Swartzentruber
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90054-8
Published in issue: January 2000
xReducing badly displaced or angulated pediatric forearm fractures in the emergency department can be difficult. Multiple attempts at reduction may be required, with repeated trips to the radiology department, before an adequate reduction is achieved. We have recently found that bedside ultrasound by emergency physicians is very helpful in guiding the reduction of difficult forearm fractures, allowing the physician to assess the adequacy of the reduction at the patient's bedside. In this report, we describe the technique we have developed for ultrasound-guided fracture reduction and present three case histories showing the usefulness of this technique.
Douglas J Wheaton, Kyriakos Tsalamandris
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90055-X
Published in issue: January 2000
xThe delayed presentation of an abdominal bleed in a victim of a fall is a rare occurrence. In the multiple injured patients, even with an intact sensorium, competing pain from associated injuries may mask the pain from a occult injury. Although a rare occurrence of abdominal injury in an asymptomatic neurologically intact patient, in the patient requiring a computed tomography scan of a spinal fracture, it may be worthwhile to image the abdomen and pelvis as well to rule out a concomitant occult abdominal injury.
James Martin, Elizabeth M Datner, Jeanmarie Perrone
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90056-1
Published in issue: January 2000
xA 39-year-old woman developed bilateral proptosis, photophobia, and pain with extraocular movements over the course of 5 days. Her findings initially were ocular pain and photophobia which progressed to periorbital edema and nasal discharge ultimately resulting in proptosis with vertical globe displacement and decreased visual acuity. She was diagnosed with corneal abrasion and sinusitis respectively during two initial emergency department visits. On her third visit to the emergency department within 4 days, she developed acute visual deficits.
Tighe Zimmers
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90057-3
Published in issue: January 2000
Timothy F Witham, Anthony M Kaufmann
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90058-5
Published in issue: January 2000
xA sudden and severe headache is the most common presentation of an acutely ruptured cerebral aneurysm. A similar headache in the absence of subarachnoid blood has rarely been ascribed to an unruptured cerebral aneurysm, but may result from acute aneurysm expansion and indicate a high risk of future rupture. We present a patient who developed a sudden, severe, “thunderclap” headache, with no associated neurological deficit. Computed tomogram and lumbar cerebral spinal fluid obtained 5.5 hours after headache onset were negative for subarachnoid hemorrhage.
Joshua M Kosowsky, Alan B Storrow, Steven C Carleton
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90059-7
Published in issue: January 2000
xPatients with acute cardiogenic pulmonary edema (ACPE) are commonly seen in the emergency department (ED). Although the majority of patients respond to conventional medical therapy, some patients require at least temporary ventilatory support. Traditionally, this has been accomplished via endotracheal intubation and mechanical ventilation, an approach that is associated with a small but significant rate of complications. The past 2 decades have witnessed increasing interest in methods of noninvasive ventilatory support (NVS), notably continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP).
Eric A Savitsky, Scott R Votey
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90060-3
Published in issue: January 2000
xEach year hundreds of thousands of children receive care in emergency departments after head injury. Minor head injuries account for a majority of these injuries. The prevalence, morbidity, and costs associated with pediatric minor head injuries make it an important topic. We review the management of pediatric minor head injury, emphasizing current areas of controversy, including criteria for neuroimaging, indications for hospitalization, the role of anticonvulsant therapy, and the long-term neurobehavioral sequelae of pediatric minor head injury.
Brent A Fisher, William A Wittlake
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90061-5
Published in issue: January 2000
xSeventy-seven percent of emergency physicians (EPs) work as either employees or independent contractors (ICs). In contrast, other hospital-based physicians such as radiologists and anesthesiologists have a much higher percentage of ownership in their medical practices. The development of a high percentage of nonownership arrangements among EPs finds a useful historical comparison in the industrialization of nonhealth care workers over the past 100 years. Unless significant changes occur in emergency medicine (EM) organization and practice structures, EPs will have less self-determination over their practice compared with other specialties.
Darilyn Campbell-Falck, Tamara Thomas, Troy M Falck, Narco Tutuo, Kathleen Clem
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90062-7
Published in issue: January 2000
xMedical resources routinely used for intravenous hydration and resuscitation of critically ill patients may be limited in remote regions of the world. When faced with these shortages, physicians have had to improvise with the available resources, or simply do without. We report the successful use of coconut water as a short-term intravenous hydration fluid for a Solomon Island patient, a laboratory analysis of the local coconuts, and a review of previously documented intravenous coconut use.
Kelly C Jeong, Ethan B Foxman, Sami A Mazbar, William P Muldowney
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90063-9
Published in issue: January 2000
Toru Kato, Nobuo Yoshimoto, Makoto Sawano, Yuichi Hamabe
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90064-0
Published in issue: January 2000
Kuo-Cheng Lan, Ming-Ying Liu, Shih-Chun Lee, Chin-Pyng Wu
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90065-2
Published in issue: January 2000
Kenneth R Patton, Peter C Ferrera
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90066-4
Published in issue: January 2000
Kevin L Ferguson, Victoria V Harris
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90067-6
Published in issue: January 2000
Robert D Ecker, David Galiani, Marcia Carney, Albert Valente
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90068-8
Published in issue: January 2000
Adam J Singer, Bruce T Sanders, Agnes Kowalska, Mary Jo Stark, Mazhar Mohammad, Gerard X Brogan
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90069-X
Published in issue: January 2000
Antonio Dueñas, Salvadora Felipe, Marta Ruiz-Mambrilla, Juan C Martín-Escudero, Carlos García-Calvo
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90070-6
Published in issue: January 2000
James R Roberts, Michael I Greenberg
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90071-8
Published in issue: January 2000
Antonio Boba
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90072-X
Published in issue: January 2000
Douglas C McCrory, Vic Hasselblad
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90073-1
Published in issue: January 2000
