Fredric M. Hustey, Michael D. Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2006.05.016
Published in issue: February 2007
xThe objectives of this study were to determine the effect of screening examinations for depression on the care of older emergency department (ED) patients and to assess recognition of depression by emergency physicians (EPs). This was a prospective interventional study of 267 patients 70 years or older. Patients were screened for depression using the Short-Form Geriatric Depression Scale, and the results were presented to EPs after assessing EP recognition of depression. The prevalence of depression was 16.5% (44/267; 95% confidence interval, 12.0%-20.9%).
Ersin Aksay, Sedat Yanturali, Selahattin Kiyan
DOI: http://dx.doi.org/10.1016/j.ajem.2006.06.005
Published in issue: February 2007
xThe purpose of this study was to evaluate the value of elevated cardiac troponin I (cTnI) for prediction of complicated clinical course and in-hospital mortality in patients with confirmed acute pulmonary embolism (PE).
Robert Jan Derksen, Fred C. Bakker, Elly S.M. de Lange-de Klerk, Irma M. Spaans, Emil A. Heilbron, Bart Veenings, Henk J.Th.M. Haarman
DOI: http://dx.doi.org/10.1016/j.ajem.2006.06.011
Published in issue: February 2007
xTo cope with emergency departments (EDs) being progressively overcrowded, the concept of specialized emergency nurses (SENs) was conceived. In this study, the ability of SENs to treat ankle/foot injuries was assessed.
Koji Morishita, Masanori Gushimiyagi, Mikio Hashiguchi, Gerald H. Stein, Yasuharu Tokuda
DOI: http://dx.doi.org/10.1016/j.ajem.2006.06.013
Published in issue: February 2007
xWe aimed to develop a clinical prediction rule to distinguish pelvic inflammatory disease (PID) from acute appendicitis in women of childbearing age.
Wendy Macias Konstantopoulos, John Pliakas, Christine Hong, Katie Chan, Gina Kim, Lauren Nentwich, Stephen H. Thomas
DOI: http://dx.doi.org/10.1016/j.ajem.2006.06.016
Published in issue: February 2007
xThis study retrospectively analyzed 123 patients undergoing helicopter emergency medical services transport for ischemic stroke (ischemic cerebrovascular accident) to the Massachusetts General Hospital during 2000-2004. To assess for system improvements over time, data were analyzed between the 2 consecutive 30-month periods comprising the 5-year study. Patients transported during the latter 30 months were transported from lesser distances (P = .002), were more likely to be younger than 65 years (P = .005), and were more likely to have documented symptom onset time (P = .03) and National Institutes of Health Stroke Scale (odds ratio, 3.6; 95% confidence interval, 1.7-7.6; P = .001).
Chien-Cheng Huang, Hong-Chang Lo, Hsien-Hao Huang, Wei-Fong Kao, David Hung-Tsang Yen, Lee-Min Wang, Chun-I Huang, Chen-Hsen Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2006.06.010
Published in issue: February 2007
xThe objective of the study was to investigate initial clinical characteristics that can suggest an early diagnosis of patients with acute renal infarction presenting with flank and/or abdominal pain in the emergency department (ED).
Filip M. Szymański, Marcin Grabowski, Krzysztof J. Filipiak, Grzegorz Karpiński, Łukasz A. Małek, Przemysław Stolarz, Anna Hrynkiewicz, Janusz Kochman, Robert Rudowski, Grzegorz Opolski
DOI: http://dx.doi.org/10.1016/j.ajem.2006.06.014
Published in issue: February 2007
xThe aim of our study was to analyze electrocadiographic changes in patients with acute myocardial infarction related to the occlusion of diagonal (DG) or marginal (MG) branch. We selected 13 cases with DG and 12 with MG occlusion on angiography and evaluated their electrocardiogram (ECG) patterns on admission obtained in emergency department (ED) of university hospital with catheterization laboratory serving everyday interventional cardiology duty for ACS. Most characteristic ECG changes in acute occlusion of DG observed in 12 patients (92.3%) included ST-segment elevation in leads V2 and V3 (mean, 1.2 ± 0.5 mm; maximum, 1.7 mm) and ST-segment depression in leads II and III (mean, 0.9 ± 0.4 mm; maximum, 1.5 mm).
Alain Rudiger, Jens P. Hellermann, Raphael Mukherjee, Ferenc Follath, Juraj Turina
DOI: http://dx.doi.org/10.1016/j.ajem.2006.06.018
Published in issue: February 2007
xMisplacement of electrodes can change the morphology of an electrocardiogram (ECG) in clinical important ways. To assess the frequency of these errors in different clinical settings, we collected ECGs routinely performed at the cardiology outpatient clinic and the intensive care unit. Lead misplacement was suspected when one of the following morphological changes occurred: QRS axis between 180° and −90°, positive P wave in lead aVR, negative P waves in lead I and/or II, very low (<0.1 mV) amplitude in an isolated peripheral lead, or abnormal R progression in the precordial leads.
Patrick Ray, Ghislaine Badarou-Acossi, Alain Viallon, David Boutoille, Martine Arthaud, David Trystram, Bruno Riou
DOI: http://dx.doi.org/10.1016/j.ajem.2006.07.012
Published in issue: February 2007
xThe aim of this study was to evaluate the usefulness of various laboratory results for differential diagnosis of bacterial (BM) and nonbacterial meningitis (NBM) with negative initial Gram stain.
Kristi L. Koenig, Connie J. Boatright, John A. Hancock, Frank J. Denny, David S. Teeter, Christopher A. Kahn, Carl H. Schultz
DOI: http://dx.doi.org/10.1016/j.ajem.2006.06.012
Published in issue: February 2007
xThe protection of health care facility (HCF) staff from the effects of weapons of mass destruction has gained heightened attention since the 9-11 terrorist attacks. One critical component of protection is personal protective equipment (PPE). No universal standard exists for an “essential” level of PPE for HCF staff. The absence of such a standard raises the need for development of national policy for PPE levels, particularly in HCFs. We describe a process used by the Veterans Health Administration for recommending policy for “essential” PPE levels.
Fabrice Agésilas, Alexandre Herbland, Ruddy Valentino, Denise Rieux, Jocelyne Lebrun, Christian Crombé, Hossein Mehdaoui, Pascal Schlossmacher, Florence Gey
DOI: http://dx.doi.org/10.1016/j.ajem.2006.04.009
Published in issue: February 2007
xA 41-year-old woman was recently admitted from the emergency department to our intensive care unit for severe dyspnea indicating immediate intubation and mechanical ventilation. She had a medical history of severe chronic arterial hypertension requiring 4 classes of antihypertensive drugs, complicated by chronic renal failure with conservative miction and intermittent dialysis. On examination, she was afebrile, fine crackles were heard over the right anterior chest, blood pressure was 180/110 mm Hg, heart rate was 100 beat/min, and she was oliguric.
Michael A. Miller, David A. Masneri, Thomas Herold
DOI: http://dx.doi.org/10.1016/j.ajem.2006.04.015
Published in issue: February 2007
xCalcium channel blocker (CCB) ingestions are potentially life-threatening, accounting for as many as one third of all cardiovascular deaths reported to the Toxic Exposure Surveillance System during any given year [1]. Deaths from CCB ingestion invariably exhibit serious toxicity within 12 hours of ingestion, independent of whether the preparation is sustained (SR) or immediately released. Nifedipine has often been viewed as a relatively benign CCB, especially in the setting of simple pediatric ingestion [2].
Federico Bilotta, Giovanni Rosa, Roberto Delfini, Raffaella Pinto, Brenno Fiorani
DOI: http://dx.doi.org/10.1016/j.ajem.2006.05.029
Published in issue: February 2007
xA periorbital penetrating wound can be complicated by intracranial foreign body displacement even in the presence of a small orifice and in asymptomatic patients [1-3]. We recently treated an asymptomatic patient with a periorbital penetrating wound that was complicated by intracranial nail penetration.
Marc E. Levsky, Laurie B. Pemberton, Michael A. Miller, Gene Wallace
DOI: http://dx.doi.org/10.1016/j.ajem.2006.05.024
Published in issue: February 2007
xTwo healthy men (ages, 24 and 29 years) who were roommates presented with complaints of red, warm, nonpruritic, minimally tender, and indurated areas on their forearms 24 hours after they received a purified protein derivative of Mycobacterium tuberculosis (PPD) intradermally in those sites as part of routine tuberculosis screening. An image of the arm of one of the patients is shown in Fig. 1. A review of the vaccination logbook (Fig. 2) of the clinic that provided the PPD verified that the individuals had been injected with dT instead of PPD.
Nevin Kollannoor Chinnan, Ajay Rathore, Ashraf Ibrahim Mohamed Shabaan, Wael Al Samman
DOI: http://dx.doi.org/10.1016/j.ajem.2006.06.009
Published in issue: February 2007
xTension pyopneumothorax is a medical emergency that occurs as a rare complication of pneumonia or subpleural abscess eroding into the pleural space characterized by an air-fluid level on chest radiograph. We present a case of a tracheostomized child who developed tension pyopneumothorax on mechanical ventilator. Attempts to relieve the tension by needle decompression using 14G cannula failed necessitating intercostal drainage tube placement. The child was successfully treated with intercostal drainage and parenteral antibiotics.
Marilyn Geninatti, Marc Thames
DOI: http://dx.doi.org/10.1016/j.ajem.2006.08.009
Published in issue: February 2007
xA 57-year-old woman presented to the emergency department (ED) with chest pain and electrocardiographic (EKG) changes that were suggestive of an ST-segment elevation myocardial infarction (STEMI). Her pain was not eased by aggressive treatment with aspirin, β-blockers, antithrombins, nitrates, HMG–coenzyme A reductase inhibitors, and antithrombolytics.
Fadi Braiteh, Margaret B. Row
DOI: http://dx.doi.org/10.1016/j.ajem.2006.10.001
Published in issue: February 2007
xA 58-year-old man with well-controlled type 2 diabetes mellitus was found to have a well-differentiated adenocarcinoma of the head of the pancreas during a workup of jaundice and weight loss. An attempted Whipple procedure was aborted because the mass invaded the superior mesenteric vascular axis, and only a palliative biliary bypass was performed. Two months later, recurrent cholestasis was alleviated by placement of a metallic biliary endoprosthesis followed by 6 weeks of neoadjuvant gemcitabine and external beam radiation therapy.
Sharon R. Wilson, Bobbie Schauer, Daniel D. Price
DOI: http://dx.doi.org/10.1016/j.ajem.2006.08.008
Published in issue: February 2007
xHydrocephalus without progressive warning signs resulting in a sudden life-threatening event is underemphasized in the literature [1-4]. Patients typically exhibit symptoms of elevated intracranial pressure but may present with vague nonspecific complaints that are initially misdiagnosed [4-7].
Pascal Fangio, Bernard De Jonghe, Corinne Appéré-De-Vecchi, Jean-Claude Lachérade, Jean-Pierre Terville, Hervé Outin, Joël Dagorn
DOI: http://dx.doi.org/10.1016/j.ajem.2006.08.007
Published in issue: February 2007
xAmong the new antidepressant drugs, venlafaxine, a serotonin noradrenergic reuptake inhibitor, shares many of the known toxic effects of tricyclic agents [1]. We describe a case of venlafaxine poisoning complicated by acute left ventricular failure with pulmonary edema not related to a membrane-stabilizing effect.
Mecit Kantarci, Hayri Ogul, R. Murat Karasen
DOI: http://dx.doi.org/10.1016/j.ajem.2006.08.006
Published in issue: February 2007
xWe describe the case of an unusual (unbelievable) giant wooden foreign body traversing the neck via the glabella. The relationship between the giant wooden foreign body and the nasopharynx air column was demonstrated through multidetector computed tomography (CT). The wooden foreign body mimicking air on a standard CT window setting was distinguished from air with the use of a higher CT window setting. Cases of accidental penetration injury of the head and neck by foreign bodies are not rare, but the entry of giant wooden foreign bodies into the neck via the glabella has never been reported in the literature.
Ronald K. Moy, Alicia M. Salazar, Shu B. Chan
DOI: http://dx.doi.org/10.1016/j.ajem.2006.08.005
Published in issue: February 2007
xAn 88-year-old man presented to the emergency department (ED) with a history of constant, epigastric pain, nausea, and vomiting while eating dinner just before arrival. The patient denied any hematemesis, fevers, chills, chest pain, dyspnea, diarrhea, recent travel, or intake of suspect foods. His last bowel movement was earlier that day. Past medical history was significant for peptic ulcer disease and hernia repair.
Joanne Litkey, Michael W. Dailey
DOI: http://dx.doi.org/10.1016/j.ajem.2006.08.004
Published in issue: February 2007
xWe present a case of anticholinergic toxicity associated with the ingestion of lupini beans by a woman of Italian decent. A literature review and discussion accompany the case report.
Youichi Yanagawa, Naoyuki Kaneko, Toshihisa Sakamoto, Yoshiaki Okada
DOI: http://dx.doi.org/10.1016/j.ajem.2006.06.008
Published in issue: February 2007
xHemorrhagic lesions in fat embolism syndrome (FES) have been rarely detected by magnetic resonance imaging (MRI). However, the results of autopsies demonstrated petechia or purpura distributed throughout the white matter macroscopically, and hemorrhagic and anemic lesions with classic findings of perivascular hemorrhages [1]. Herein we report a case of FES with multiple hypointensity signal lesions detected by T2*-weighted MRI imaging (T2*-WI), which suggested the occurrence of minute hemorrhages in the brain.
Wei-Lung Chen, Su-Hen Chang, Jiann-hwa Chen, Yung-Lung Wu
DOI: http://dx.doi.org/10.1016/j.ajem.2006.08.003
Published in issue: February 2007
xA 39-year-old woman with a history of migraine presented to the emergency department (ED) with complaint of thunderclap headache associated with vomiting since the morning of the visit. She described the condition as much more intense and severe than any previous headache she had experienced. She denied any fever, chills, or neurologic symptoms. She had no head injury, meningitis exposure, and carbon monoxide exposure, and no history of tobacco, alcohol, or drug use.
M. Cumhur Sivrikoz, Egemen Döner, M. Cumhur Tulay
DOI: http://dx.doi.org/10.1016/j.ajem.2006.07.009
Published in issue: February 2007
xA 23-year-old male patient was transferred to the emergency department because of a traffic accident. Physical examination revealed a hematoma on the left clavicle and decreased breath sounds over the left hemithorax. Chest x-rays revealed a left clavicle fracture, intraparenchymal contusion, and elevation of the left diaphragma. A pneumothorax was not observed. Thorax computed tomography (CT) revealed massive parenchymal contusion in the left hemithorax and air liquid level consistent with intraabdominal herniation (Fig.
Eleanor A. Erwin, Francis L. Counselman
DOI: http://dx.doi.org/10.1016/j.ajem.2006.06.007
Published in issue: February 2007
xThe history and physical examination fail to identify up to 50% of patients with ectopic pregnancy at the time of initial emergency department (ED) evaluation [1]. We discuss the case of a patient with ectopic pregnancy that presented as rectal pain. Review of the literature failed to describe any similar presentation of ectopic pregnancy.
Bradley V. Pearson, David W. Kuhns
DOI: http://dx.doi.org/10.1016/j.ajem.2006.06.006
Published in issue: February 2007
xA 31-year-old woman presented to our emergency department (ED) after falling on her left outstretched hand. The patient reported hearing a pop at the time of injury and was subsequently unable to supinate her left hand. Upon examination, she was carefully holding her left arm semiflexed and in adduction as motion at the elbow caused considerable pain. Circulation, sensation, and motor function were preserved distal to the injury. Further examination revealed that her pain localized to the radial head.
Bo Seung Kang
DOI: http://dx.doi.org/10.1016/j.ajem.2006.10.002
Published in issue: February 2007
xSince the first report at 1970, air compressor injuries with orbital facial emphysema have been reported in approximately 11 English literatures [1]. Among these, 3 cases were pneumocephalus-associated severe injuries [2-4]. In the English literature, this is one of the most severe cases with head and neck emphysema after air compressor injury, which I reported to the government's labor department as a rare serious injury.
Amanda L. Wilson, Michael W. Kaufman, Richard B. Thomson Jr, Patrick J. Gavin
DOI: http://dx.doi.org/10.1016/j.ajem.2006.10.003
Published in issue: February 2007
xToxic shock syndrome (TSS) is an acute systemic illness characterized by fever, rash, hypotension, and multiorgan failure. We describe a case of fulminant fatal TSS associated with Staphylococcus aureus laryngotracheitis, initially diagnosed as viral pharyngitis.
Chee-Fah Chong, Yu-Ming Lin, Chun-Chieh Chao, Shih-Tsuo Shen, Tse-Yu Huang
DOI: http://dx.doi.org/10.1016/j.ajem.2006.11.001
Published in issue: February 2007
xA severely distended intrathoracic stomach is a rare complication of hiatal hernia which simulates tension pneumothorax by causing pulmonary and hemodynamic compromise. Emergency physicians should consider this condition (also known as tension gastrothorax) in patients presenting with apparent tension pneumothorax who have a preceding history of abdominal pain but no evidence of trauma or positive pressure ventilation. Patients with gastrothorax noted on the chest radiograph should receive nasogastric (NG) decompression promptly if they develop early signs of tension pneumothorax.
Ricky Kue, Francis Renzi
DOI: http://dx.doi.org/10.1016/j.ajem.2006.11.002
Published in issue: February 2007
xRetrobulbar hemorrhage is an ophthalmologic emergency resulting in increased intraocular pressure with ophthalmic artery compromise and loss of vision from retinal ischemia [1]. We report a case of unilateral retrobulbar hemorrhage in a patient experiencing a syncopal seizure after dental extraction. A 33-year-old man was brought to the ED after a witnessed tonic seizure with rightward gaze preference. Three hours earlier, the patient underwent bilateral mandibular wisdom tooth extraction. Subsequently after office discharge, the patient experienced nausea and vomiting from persistent oropharyngeal bleeding.
Sawako Ohigashi-Suzuki, Yasushi Saito, Ichiro Tatsuno
DOI: http://dx.doi.org/10.1016/j.ajem.2006.11.003
Published in issue: February 2007
xTakotsubo cardiomyopathy (TC)—ampullar cardiomyopathy—is a novel cardiac syndrome that has acute onset of chest pain, electrocardiographic change, and minimal elevation of cardiac enzymes resembling acute myocardial infarction without any evidence of myocardial ischemia or injury. Its characteristic image in angiography is a transient left ventricular (LV) apical ballooning having the appearance of takotsubo, Japanese for octopus trap [1-3]. We report here a rare case of a 69-year-old woman with type 2 diabetes mellitus (DM) who exhibited myocardial depression with the typical wall motion abnormality seen in TC during a period of sepsis.
Bulent Erdur, Ibrahim Turkcuer, Aytac Bukiran, Omur Kuru, Ismail Varol
DOI: http://dx.doi.org/10.1016/j.ajem.2006.11.005
Published in issue: February 2007
xLatrodectism is a clinical entity with characteristic symptoms and signs caused by the effect of a spider's poison on different organs, especially the nervous and cardiovascular system. Acute myocardial damage after envenomation is not common, and cardiac manifestations after a black widow spider bite are rarely observed and their prognostic significance is not known. We report a 22-year-old man with myocardial ischemia caused by the bite of a black widow spider (Latrodectus tredecimguttatus). He had characteristic anxiety, severe hypertension, nausea, vomiting, tremor, generalized pain (especially in the lower extremities), diaphoresis, and rhabdomyolysis.
Ali A. Sovari, Farhad Farokhi, Abraham G. Kocheril
DOI: http://dx.doi.org/10.1016/j.ajem.2006.11.004
Published in issue: February 2007
xA 55-year-old woman with a history of hypertension presented to the emergency department with a complaint of chest pain. She had similar chest pains in the past, and a cardiac catheterization 2 years ago showed significant coronary stenosis. At that time, a stent placement was recommended, but she refused. She did not take any medication on a regular basis. She had retrosternal chest pain on exertion in the past 2 years, but it became significantly worse in the 3 days before presentation, being precipitated even with minimum exertion and associated with shortness of breath and nausea.
Hsin-Yi Lin, Tzong-Luen Wang, Chee-Fah Chong, Chien-Chih Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2006.11.006
Published in issue: February 2007
xAcute renal infarction is an uncommon disease. Patients usually complain of acute unilateral flank pain, low back pain, and abdominal pain with or without hematuria. Because of unspecific symptoms and rarity, detection of renal infarct is often delayed or misdiagnosed as nephrolithiasis, pyelonephritis, acute gastroenterolitis, and unspecific abdominal pain. Herein, we report a patient with acute right renal infarction secondary to abdominal aortic thrombosis with right renal artery involvement, who presented with misleadingly migratory pain of acute appendicitis.
Thomas Hillemacher, Anja Schanze, Thomas Kraus, Johannes Kornhuber, Stefan Bleich
DOI: http://dx.doi.org/10.1016/j.ajem.2006.11.007
Published in issue: February 2007
xNasal desmopressin, a widely used antidiuretic hormone (ADH) analog is a well-established pharmaceutical to treat patients suffering from central diabetes insipidus [1]. Hyponatremia is a well-known side effect of desmopressin treatment and is, in many cases, associated with inappropriate use by the patients [2]. We present a case in which a suspected abuse of desmopressin might be a possible explication for recurrent hyponatremia in a patient having central diabetes insipidus.
Charles E. Cady, Andrew L. Cardoni, Michael J. Berger
DOI: http://dx.doi.org/10.1016/j.ajem.2006.11.009
Published in issue: February 2007
xPosterior knee dislocations are usually a result of tremendous force, often resulting from motor vehicle crashes. Although rare, they are considered one of the most serious knee injuries and require prompt assessment and orthopedic referral. Many times, there is spontaneous reduction before medical evaluation; thus, the true frequency of knee dislocations is unknown [1-3,6]. Careful evaluation of the knee is required following a mechanism consistent with such injury because of potential disastrous complications.
Murat Ersel, Selahattin Kiyan, Ersin Aksay, Bortecin Eygi, Tanzer Calkavur
DOI: http://dx.doi.org/10.1016/j.ajem.2006.11.008
Published in issue: February 2007
xBecause of the protective effect of overlying muscles and bones, injuries of axillary arteries are uncommon. Axillary artery dissection due to direct blunt trauma is very rare. Early recognition of these injuries in the emergency department is critically important because of the need for securing early hemostasis and prompt revascularization. We report a case of axillary artery dissection due to blunt shoulder trauma.
Caroline Boulouffe, Dominique Vanpee, Laurence Gabriel
DOI: http://dx.doi.org/10.1016/j.ajem.2006.11.010
Published in issue: February 2007
xA 68-year-old woman presented to the emergency department complaining of chest pain, which was triggered by emotional stress when she lost her bag, that had lasted for several hours. The patient also complained of dyspnea. Her physical examination findings were normal. Electrocardiography showed a moderate ST elevation in the anterior precordial derivations with a prolonged QT interval. The cardiac enzymes were moderately elevated, with the creatine kinase level at 97 UI/L (normal, 15-190 UI/L), the creatine kinase–MB level at 4.52 ng/mL (normal, 0-3.2 ng/mL), and the C-troponin level at 1.91 ng/mL (normal, <0.08 ng/mL).
Timothy R. Hurtado, Francis A. Clarkson
DOI: http://dx.doi.org/10.1016/j.ajem.2006.11.012
Published in issue: February 2007
xPneumocephalus is a rare complication of an autologous epidural blood patch. We present the case of a 40-year-old woman who developed a severe headache from pneumocephalus, which was the result of an epidural blood patch procedure being performed to treat a postdural puncture headache.
Je Sung You, Sung Pil Chung
DOI: http://dx.doi.org/10.1016/j.ajem.2006.10.006
Published in issue: February 2007
xA 21-year-old man presented with a severe headache that had lasted for several hours. His physical examination findings were unremarkable. Noncontrast computed tomography scan showed extensive aneurysmal dilatation of the right internal carotid artery (Fig. 1A and B). Computed tomography angiography showed prominent multifocal fusiform aneurysms involving the petrous and proximal cavernous portions of the internal carotid artery with perianeurysmal thrombosis (Fig. 2). The patient's symptoms improved after conservative treatment, which included anticoagulation, and he was eventually discharged.
Nicole J. Watring, Thomas W. Wagner, James J. Stark
DOI: http://dx.doi.org/10.1016/j.ajem.2006.10.005
Published in issue: February 2007
xA 47-year-old man presented to the emergency department (ED) with a chief complaint of severe left upper quadrant (LUQ) abdominal pain radiating to the back and vomiting that began abruptly 11 hours before arrival. He denied any history of trauma, falls, fever, diarrhea, or urinary complaints.
Daniel R. Rodgers
DOI: http://dx.doi.org/10.1016/j.ajem.2006.11.011
Published in issue: February 2007
xThe electrocardiogram (ECG) is a critical source of information in patients with possible acute coronary syndromes, and its correct interpretation is a daily responsibility of the emergency physician. A recent study demonstrated that only 34% of initial ECGs are diagnostic of acute myocardial infarction [1]. Underlying changes in ECG morphology such as left bundle branch block or ventricular pacing further complicate interpretation [2]. This previously unreported case is that of acute myocardial infarction in the setting of ventricular pseudofusion, an apparent arrhythmia resulting from normal pacemaker function.
OYu Kwon, SungPil Chung, KyeongRyong Lee, SeungWhan Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2006.10.004
Published in issue: February 2007
xCertain significant complications after bee stings, such as cerebral hemorrhage, acute myocardial infarction, acute pulmonary hemorrhage, and acute renal failure, are scarcely described in the literature [1-3]. We experienced and report a very unusual complication in a hypotensive patient caused by bee sting and intravenous epinephrine injection consecutively.
Vei-Ken Seow, Chee-Fah Chong, Tzong-Luen Wang, Jiann-Ruey Ong
DOI: http://dx.doi.org/10.1016/j.ajem.2006.11.014
Published in issue: February 2007
xAcute myocardial infarction is a potentially life-threatening disease that must be diagnosed early and accurately at the emergency department. Its diagnosis may be difficult if manifested solely as a severe explosive headache in a young, nondiabetic, and nonobese man. We report a case of ST-elevation myocardial infarction that was initially misdiagnosed as a case of headache until routine electrocardiography was obtained.
Shih-Yu Ko, Ken-Hing Tan, Chung-Yu Cheng-Huang, Meng-Kai Huang, Vei-Ken Seow, Chien-Chih Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2006.11.017
Published in issue: February 2007
xComplete transection of the common iliac artery without initial presentation of shock signs is exceedingly rarely reported as a consequence of acute blunt abdominal injury, in part because of its protected position in the retroperitoneum. It may result in fatal hemorrhage if not dealt with by the emergency physician in a brisk and effective manner. We report a 33-year-old man who presented to the emergency department with lower abdominal pain after blunt abdominal trauma without shock signs and with negative findings in focused abdominal sonography for trauma (FAST) initially.
Yu-Hui Chiu, Chorng-Kuang How, Chii-Hwa Chern, Lee-Min Wang, Chun-I Huang
DOI: http://dx.doi.org/10.1016/j.ajem.2006.11.019
Published in issue: February 2007
xWe present a case of meningococcal myocarditis in volume and inotrope refractory shock that improved over a 3-day period after successful cardiac rescue with intra-aortic balloon counterpulsation.
Wim P.M. Houdijk
DOI: http://dx.doi.org/10.1016/j.ajem.2006.06.017
Published in issue: February 2007
xRecently, Ray et al [1] reported on the accuracy of the rapid quantitative D-dimer assay that is performed on the bioMérieux VIDAS system. In their outpatient population with a venous thromboembolism (VTE) prevalence of 28%, the reported sensitivity (78%) and specificity (41%) resulted in a too low negative predictive value (NPV) of 84%. The specificity is in agreement with that reported by previous studies, but the sensitivity is clearly at odds [2]. A recent meta-analysis concluded that a negative result with the VIDAS D-dimer test is considered as diagnostically useful as a normal lung scan or negative duplex ultrasound [2].
Ryotaro Wake, Daiju Fukuda, Minoru Yoshiyama, Kenei Shimada, Junichi Yoshikawa
DOI: http://dx.doi.org/10.1016/j.ajem.2006.06.015
Published in issue: February 2007
xA number of studies have reported a daily and yearly variation in the occurrence of acute myocardial infarction (AMI) [1,2]. It has been shown that the circadian variation of AMI is the result of an increase in the incidence of plaque rupture during the morning hours [3]. These studies have shown a relation between the solar motion and the occurrence of AMI. Less information is available regarding the effect of the moon on coronary artery disease. Previous reports have shown lunar phases do not relate to the occurrence of AMI [4,5].
Michael P. Somers, Jesse M. Pines, William J. Brady, Dominique Caovan
DOI: http://dx.doi.org/10.1016/j.ajem.2005.04.010
Published in issue: February 2007
xWe write to you with results from an internet-based survey of practicing emergency physicians (EPs) and their use of additional lead electrocardiograms (ECGs) in patients with chest pain suspected of acute coronary syndromes; after review of the clinical information and ECG, the physician was then asked if he/she would consider fibrinolysis.
