Gary M. Vilke, Christian Sloane, Saul Levine, Tom Neuman, Edward Castillo, Theodore C. Chan
DOI: http://dx.doi.org/10.1016/j.ajem.2007.01.005
Published in issue: January 2008
xThe Taser (Taser International, Scottsdale, Ariz) uses high-voltage electricity to incapacitate subjects. We sought to evaluate cardiac rhythm changes during deployment of the Taser on healthy volunteers.
Jaime S. Rosenzweig, Shawn K. Van Deusen, Okemefuna Okpara, Paris A. Datillo, William M. Briggs, Robert H. Birkhahn
DOI: http://dx.doi.org/10.1016/j.ajem.2007.02.028
Published in issue: January 2008
xThe objectives of the study were to examine the last decade of general emergency medicine (EM) literature published in the United States for trends with regard to authorship and multidisciplinary collaboration and to estimate the effect on extramural funding.
Kai-Hung Cheng, Chih-Sheng Chu, Kun-Tai Lee, Ho-Ming Su, Tsung-Hsien Lin, Wen-Chol Voon, Sheng-Hsiung Sheu, Wen-Ter Lai
DOI: http://dx.doi.org/10.1016/j.ajem.2007.03.015
Published in issue: January 2008
xIn reperfusion strategy for ST-elevation myocardial infarction (STEMI), emergency surgical bypass grafting might be considered for patients with significant multivessel coronary diseases complicated by cardiogenic shock. The culprit lesions in STEMI can be predicted from electrocardiographic (ECG) findings. However, whether the complexity of coronary artery lesions in STEMI can be predicted from characteristic ECG findings remained unclear.
Brigitte M. Baumann, Kathryn McCans, Sarah A. Stahmer, Mary B. Leonard, Justine Shults, William C. Holmes
DOI: http://dx.doi.org/10.1016/j.ajem.2007.03.020
Published in issue: January 2008
xThe objective of the study was to determine whether the use of volumetric ultrasound by trained pediatric emergency department (ED) nurses improves first-attempt urine collection success rates.
Jiung-Hsiun Liu, Che-Yi Chou, Yao-Lung Liu, Pen-Yuan Liao, Po-Wen Lin, Hsin-Hung Lin, Ya-Fei Yang
DOI: http://dx.doi.org/10.1016/j.ajem.2007.03.017
Published in issue: January 2008
xAcute organophosphate (OP) poisoning causing alteration in acid-base equilibrium was reported before. Hence, different acid-base statuses may present in patients with acute poisoning due to OP exposure. This study aims to determine the impact of acid-base interpretation in patients with acute OP poisoning before hospitalization in medical care units and to describe the pattern of mortality with different acid-base statuses.
Daniel D. Von Hoff, John G. Kuhn, Howard A. Burris III, Larry J. Miller
DOI: http://dx.doi.org/10.1016/j.ajem.2007.03.024
Published in issue: January 2008
xDespite the growing popularity of intraosseous infusion for adults in emergency medicine, to date there has been little research on the pharmacokinetics of intraosseously administered medications in humans. The objective of the study was to compare the pharmacokinetics of intraosseous vs intravenous administration of morphine sulfate in adults.
Steven P. Frei, William F. Bond, Robert K. Bazuro, David M. Richardson, Gina M. Sierzega, James F. Reed
DOI: http://dx.doi.org/10.1016/j.ajem.2007.06.027
Published in issue: January 2008
xThe purpose of the study was to examine appendicitis outcomes over time as computed tomographic (CT) scanning was incorporated into practice.
Hector Lozano, Dongmei Wu, Jorge Bassuk, Jaqueline Aria, Paul Kurlansky, Gervasio A. Lamas, Jose A. Adams
DOI: http://dx.doi.org/10.1016/j.ajem.2007.10.004
Published in issue: January 2008
xProstaglandins (PGs), particularly PGE2 and PGI2, have a salutary effect on myocardial ischemia-reperfusion–induced myocardial damage.
Wei Zheng, Ling-Zhi Huang, Lian Zhao, Bo Wang, Hui-Bin Xu, Guang-Yi Wang, Zi-Ling Wang, Hong Zhou
DOI: http://dx.doi.org/10.1016/j.ajem.2007.02.007
Published in issue: January 2008
xThe aim of the study was to investigate the changes of the activity of superoxide dismutase (SOD) and the level of malondialdehyde (MDA) in plasma and organ damage during the acute severe hemorrhagic shock (ASHS), as well as to analyze their relationship.
Woo Yong Yoon, Sung Pil Chung, Hahn Shick Lee, Yoo Seok Park
DOI: http://dx.doi.org/10.1016/j.ajem.2007.06.022
Published in issue: January 2008
xThe objective of this study was to compare the efficacy of ethyl chloride spray and ice cube for the control of pain induced by the antibiotic skin test.
Bronwyn Anderson, Anne-Maree Kelly, Debra Kerr, Megan Clooney, Damien Jolley
DOI: http://dx.doi.org/10.1016/j.ajem.2007.06.026
Published in issue: January 2008
xCapillary refill time (CRT) has been taught as a rapid indicator of circulatory status. The aim of this study was to define normal CRT in the Australian context and the environmental, patient, and drug factors that influence it.
Monica Martin Goble, Cathy Benitez, Max Baumgardner, Kathleen Fenske
DOI: http://dx.doi.org/10.1016/j.ajem.2007.06.012
Published in issue: January 2008
xThe aim of this study was to evaluate emergency department (ED) management of childhood syncope, focusing on diagnostic tests ordered, whether a reason for specific testing was recorded, and hospital admission rates.
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.2007.07.004
Published in issue: January 2008
xSince the US terrorist attacks of September 11, 2001, concern regarding use of chemical, biological, or radiological weapons is heightened. Many victims of such an attack would present directly to health care facilities without first undergoing field decontamination. This article reviews basic tenets and recommendations for health care facility–based decontamination, including regulatory concerns, types of contaminants, comprehensive decontamination procedures (including crowd control, triage, removal of contaminated garments, cleaning of body contaminants, and management of contaminated materials and equipment), and a discussion of methods to achieve preparedness.
Vivek S. Tayal, Mark Bullard, Doug R. Swanson, Christian J. Schulz, Katrina N. Bacalis, Susan A. Bliss, H. James Norton
DOI: http://dx.doi.org/10.1016/j.ajem.2007.02.029
Published in issue: January 2008
xWe hypothesized that emergency physician–performed endovaginal ultrasound (EVUS) would change diagnostic decision making in nonpregnant women with right lower quadrant (RLQ) pain.
Sheung-Fat Ko, Miao-Ming Tiao, Fu-Chen Huang, Chie-Song Hsieh, Chung-Cheng Huang, Shu-Hang Ng, Yung-Liang Wan, Tze-Yu Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.009
Published in issue: January 2008
xWe report 2 pediatric cases of small bowel obstruction due to a Meckel's diverticulum complicated with internal hernia. Abdominal multidetector computed tomograms with multiple planar reconstructions revealed a bridge-like lesion with inconspicuous mucosal folds in the right lower quadrant formed by adhesion of the tip of Meckel's diverticulum with the adjacent mesentery, with ileal loops converging at the “bridge” and engorged mesenteric vessels. These 2 cases highlight the feasibility of multidetector computed tomography, especially in the ED, in revealing this unusual etiology of small bowel obstruction.
Deborah B. Diercks, Michael C. Kontos, Jim E. Weber, Ezra A. Amsterdam
DOI: http://dx.doi.org/10.1016/j.ajem.2007.06.014
Published in issue: January 2008
xEmergency department (ED) physicians are critical in the accurate diagnosis, efficient management, and treatment of patients with ST-segment elevation myocardial infarction. The initial reperfusion strategy involves the choice between mechanical reperfusion using primary percutaneous coronary intervention and pharmacologic treatment with fibrinolytics. The benefits of these approaches are time dependent, and practices vary according to institutional resources and local guidelines. Nevertheless, the need for early intervention and the use of certain therapies are well recognized.
Robert E. Fromm Jr, Joseph Varon
DOI: http://dx.doi.org/10.1016/j.ajem.2007.10.012
Published in issue: January 2008
xCardiopulmonary arrest is an all too frequent occurrence. It is estimated that 1000 deaths occur each day in the United States from out-of-hospital cardiac arrest [1]. Many of these deaths are due to ventricular fibrillation that may potentially be reversed by early application of defibrillation [2,3]. Unfortunately, survival rates from out-of-hospital cardiac arrest remain dismal, with overall survival estimates of approximately 5% [4,5]. Efforts to improve outcomes from cardiac arrest have involved early application of defibrillation by professional or lay rescuers [6].
Tze-Kiong Er, Li-Yu Tsai, Ruiz Ginés MA, Bai-Hsiun Chen, Yuh-Jyh Jong
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.003
Published in issue: January 2008
xHuman chorionic gonadotropin (hCG) is a glycoprotein composed of 2 dissimilar subunits, α-and β-subunit, held together by charge interaction. Both subunits are needed for biological activity and are common to other hormones (eg, thyroid stimulating hormone, luteinizing hormone, and follicle stimulating hormone); however, the β-subunit determines the specificity of the biological action of the hormones containing these subunits [1]. In urine, however, a large fraction of the immunoreactivity of hCG is due to a metabolic breakdown product of hCG, for example, regular, intact hCG; nicked hCG; hyperglycosylated hCG; free β-hCG; and a significant amount of β-core fragment [2].
Hugh Parker, Ransford Brenya, Stuart Zarich, Constantine A. Manthous
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.002
Published in issue: January 2008
xBecause chronic obstructive pulmonary disease (COPD) and coronary artery disease coexist in many elderly patients, we explored whether β-agonist aerosols might contribute to coronary events in hospitalized patients with COPD. At the 2007 International Conference of the American Thoracic Society, we presented preliminary data [1] demonstrating that only 4 of 92 patients discharged with a primary diagnosis of COPD over a 9-month period had a secondary diagnosis of MI. All received β-agonist aerosols during hospitalization, and all 4 MIs occurred more than 48 hours after hospital admission.
Toru Hiyama, Masaharu Yoshihara, Shinji Tanaka, Kazuaki Chayama
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.001
Published in issue: January 2008
xThe number of criminal prosecution against physicians has been increasing not only in Western countries but also in Japan [1-4]. Last year, Japanese police arrested an obstetrician for criminal negligence related to treatment of a patient with placental adherence resulting in death. Since then, there are controversies on criminal prosecution. According to the Japanese database of criminal prosecutions pertaining to medical negligence in Japan (1974-2003) [5,6], the number of criminal prosecutions against physicians for the death or injury of a patient was 5 or less per year before 2000, as shown in Fig.
Miguel A. Arias, Marta Pachón, Alberto Puchol, Eduardo Castellanos, Luis Rodríguez-Padial
DOI: http://dx.doi.org/10.1016/j.ajem.2007.09.016
Published in issue: January 2008
xIn an excellent review article, Dovgalyuk et al [1] reviewed in detail the electrocardiographic (ECG) hallmarks in the patient with syncope as well as specific ECG presentations seen in patients with 4 cardiac diseases associated with the occurrence of syncopal episodes, including the Wolf-Parkinson-White syndrome, the Brugada syndrome, the long-QT syndrome, and hypertrophic cardiomyopathy.
Nesligul Yildirim, Mustafa Aydin, Fatih Cam, Oguzhan Celik
DOI: http://dx.doi.org/10.1016/j.ajem.2007.01.003
Published in issue: January 2008
xWe present a case of a 41-year-old man with coronary artery disease who presented with severe chest pain, ST-segment depressions on electrocardiography, low values of blood pressure, and elevated troponin I and creatine kinase isoenzyme MB levels after poisoning with mad honey. Coronary angiography showed normal epicardial arteries. The toxic properties of mad honey as well as hypotension are considered the reasons for the symptoms in the presented case.
Daniel P. Stewart, Luke H. Van Klompenberg
DOI: http://dx.doi.org/10.1016/j.ajem.2007.03.021
Published in issue: January 2008
xA 27-year-old woman presented to the emergency department after a rollover motor vehicle collision. She complained of right shoulder and upper chest pain worse with movement of the arm. She had marked tenderness over the right clavicle with mild local swelling. There was no bony crepitus, and the result of her neurovascular examination was normal. Radiographs of the right shoulder were normal. The chest radiograph (Fig. 1A) showed the medial head of the right clavicle extending beyond the midline (arrow).
Shigeru Hakoda, Hiroshi Shinya, Shun-ichiro Kiuchi
DOI: http://dx.doi.org/10.1016/j.ajem.2007.03.025
Published in issue: January 2008
xPeliosis is a rare lesion characterized by widespread blood-filled cystic spaces, most often detected in the liver and the spleen. Spontaneous splenic rupture caused by splenic peliosis is often fatal. We report the case of a patient who underwent hemodialysis and received erythropoietin. The patient was admitted because of sudden onset of abdominal pain in the left side, and emergency laparotomy was performed. A ruptured enlarged spleen was found with a hematoma at the surface with 1600 mL of nonclotted blood in the peritoneal cavity.
Oyu Kwon, Kyeongryong Lee, Seungwhan Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2007.03.027
Published in issue: January 2008
xParastomal hernia in patients with ileostomy or colostomy is not an uncommon complication in the emergency department (ED). However, parastomal hernia with incarceration or strangulation is a relatively uncommon late complication, which can be seen in an emergency care facility. We present a case study of a patient with a massive strangulated parastomal hernia who was treated with emergency treatment and repair.
Christian M. Neff, Christy L. McCowan
DOI: http://dx.doi.org/10.1016/j.ajem.2007.06.019
Published in issue: January 2008
xA 45-year-old woman was sleeping in the passenger seat of a semitruck driven by her husband when she awoke suddenly, complained of excruciating chest and abdominal pain, and slumped onto the floor of the cab. The patient had been previously healthy with no pertinent past medical, social, or family history.
Maaike Sikma, J.C. Mier, J. Meulenbelt
DOI: http://dx.doi.org/10.1016/j.ajem.2007.06.020
Published in issue: January 2008
xSeizures are often attributed to a low plasma concentration of antiepileptic drugs, although sometimes it can be due to a high plasma concentration of the antiepileptic drug. This case report describes a very severe valproic acid intoxication including paradoxical seizures, which was initially held for a subtherapeutic valproic acid treatment. Applied treatment strategy based on available evidence is discussed. A more careful clinical evaluation at admission might have guided the treating physicians to the right diagnoses from the start.
Laurent Boidron, Anne-Laure Mosca
DOI: http://dx.doi.org/10.1016/j.ajem.2007.06.023
Published in issue: January 2008
xEmergency physicians sometimes have to face rare causes of acute dyspnea. We report a case of laryngopharyngeal compression in a patient with Launois-Bensaude syndrome. This patient had predictive criteria of difficult intubation and failed to respond to noninvasive ventilation (NIV) treatment. The relatively well-supported situation sustained intubation decision until ventilation ceased a few minutes after in-hospital arrival. In this case, in-hospital intubation was better than prehospital's.
Wolfgang Pichler, Franz Josef Seibert, Gerhard Kopeinigg, Wilfried Hartwagner, Wolfgang Grechenig
DOI: http://dx.doi.org/10.1016/j.ajem.2007.06.025
Published in issue: January 2008
xAir bags significantly reduce the risk of severe injury or death during a car accident. Nevertheless, air bags are also known to produce injuries.
Shih-Chung Huang, Shi-Hung Tsai, Tsung-Neng Tsai, Shih-Ping Yang, Shu-Meng Cheng
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.013
Published in issue: January 2008
xType A aortic dissection is usually difficult to diagnose immediately, especially in pain-free patients, leading to catastrophic outcome. Varied presentations had been reported in previous articles including complete atrioventricular block and supraventricular tachycardia. There were no previous reports regarding painless aortic dissection presenting with bigeminal premature ventricular contractions. Here, we report a case of a 55-year-old man who had syncope with bigeminal premature ventricular contractions on initial electrocardiogram at the emergency department, and finally was diagnosed as having aortic dissection by echocardiography.
Po-Liang Cheng, Chi-Ieong Lau, Shih-Wen Hung, Chee-Fah Chong, Li-Wei Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.015
Published in issue: January 2008
xAmantadine, an anti-influenza agent, is commonly used in the treatment of parkinsonism. It also has serotonergic activity. Amantadine can induce toxicity in patient with renal dysfunction because it is excreted mainly in the urine. We report a rare case of amantadine-induced serotonin syndrome in a 78-year-old man with Parkinson's disease and renal failure who developed confusion, hallucination, agitation, myoclonus, fever, diarrhea, and hypertension after amantadine use.
Matthew J. Pirotte, Joseph G. Mueller, Teresa Poprawski
DOI: http://dx.doi.org/10.1016/j.ajem.2007.06.028
Published in issue: January 2008
xThe Brugada syndrome is the result of a cardiac sodium channel mutation and results in characteristic electrocardiographic (ECG) changes. It can lead to ventricular fibrillation and sudden cardiac death. Growing evidence suggests that certain drugs or medical conditions can unmask the Brugada syndrome in a patient with previously normal ECGs and no cardiac history. We report on the fourth case of Brugada syndrome precipitated by lithium. This report emphasizes the fluctuating nature of Brugada-type ECG changes and the need for emergency physicians to recognize that the syndrome can be a dynamic entity on ECG.
Herlon Saraiva Martins, Roberta Vasconcelos Silva, Diogo Bugano, Alfredo Nicodemos Cruz Santana, Rodrigo Antônio Brandão-Neto, Fábio Poianas Giannini, Augusto Scalabrini-Neto, Irineu Tadeu Velasco
DOI: http://dx.doi.org/10.1016/j.ajem.2007.06.029
Published in issue: January 2008
xWe report the case of a patient in cardiac arrest with persistent pulseless electrical activity despite optimal treatment, who returned to spontaneous circulation only after the administration of naloxone. It is possible that naloxone may have a role in pulseless electrical activity/asystole related to opioid intoxication and, perhaps, in cardiac arrest related to hypoxia.
Carrie Davis, Daniel V. Girzadas Jr
DOI: http://dx.doi.org/10.1016/j.ajem.2007.06.030
Published in issue: January 2008
xSarcoidosis is a chronic granulomatous disease affecting people worldwide. Rarely, it can affect the larynx, causing edema and thickening of the supraglottic structures resulting in upper airway obstruction. A 34-year-old African-American man presented to the ED with stridor, dysphonia, and chronic cough. He had been treated for chronic sinus congestion with inhalers but his symptoms progressed. In the ED, he was treated with nebulized racemic epinephrine and intravenous steroids while computed tomography scan and laboratory exams were obtained.
Kristina E. Orio
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.016
Published in issue: January 2008
xSuperior mesenteric artery syndrome is an unusual cause of small bowel obstruction. This is the case of an 18-year-old woman with no prior surgical history who presented to the emergency department with intractable vomiting and midepigastric abdominal pain for 3 days and who was ultimately diagnosed with superior mesenteric artery syndrome. Conservative management resulted in the resolution of her symptoms. Superior mesenteric artery syndrome should be considered as a possible etiology of small bowel obstruction in specific patient populations.
Brigitte M. Baumann, Jennifer Jarecki
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.017
Published in issue: January 2008
xUp to 5% of all facial nerve palsies are due to trauma, with ipsilateral Bell's palsy the most common injury. Facial nerve injury is often due to fracture of the temporal bone with resultant compression of the nerve or complete transection. Less commonly, mandibular fractures can present with a concomitant facial nerve injury. In cases where the nerve injury is incomplete or delayed, prognosis is excellent. When the facial nerve is completely transected, prompt surgical intervention is required for the best cosmetic outcome.
Heather M. Justice, Francis L. Counselman
DOI: http://dx.doi.org/10.1016/j.ajem.2007.06.031
Published in issue: January 2008
xOvarian hyperstimulation syndrome is an iatrogenic complication of ovarian stimulation for assisted reproduction techniques [1]. The syndrome is characterized by cystic enlargement of the ovaries and fluid shifts from the intravascular to the third space [2]. We present a patient with a classic presentation of severe ovarian hyperstimulation syndrome.
Norihiro Kikuchi, Yukio Ishii, Hiroaki Satoh, Morio Ohtsuka, Nobuyuki Hizawa, Yoshio Ohta
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.018
Published in issue: January 2008
xSpontaneous pneumomediastinum (SPM) is an uncommon disease arising most frequently with young adults, and SPM after air travel has never been reported. We show herein a case of SPM after air travel. The exact mechanism of SPM in our patient is unknown, but we suppose that her thin and tall build (body mass index, 16.9 kg/m2) and medical history of bronchial asthma in childhood have some relationship to the development of SPM. In addition to pneumothorax and pulmonary embolism, SPM should be considered in patients with chest pain during and after air travel, especially in young and thin subjects with a history of current or previous bronchial asthma.
F. Alexander de la Fuente, Christopher Hoyte, Sean M. Bryant
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.019
Published in issue: January 2008
xA 23-year-old man presented to the emergency department (ED) complaining of right shoulder pain. His symptoms began suddenly while exercising at home. The patient had been doing push-ups, and after completing approximately 100 repetitions, he felt his right shoulder give way and collapsed into a prone position. He had difficulty getting up from the floor and eventually called out to his friend for assistance. The patient's friend was able to lift him from the floor. He experienced bilateral shoulder pain (albeit the right being much greater than the left) and noted that he had never had these symptoms before.
Carlos G. Duarte
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.020
Published in issue: January 2008
xIn the Emergency Department, splenic rupture is commonly associated with blunt and penetrating abdominal trauma. A case of splenic rupture as a result of a routine colonoscopy is presented, followed by a literature review of this unusual complication. Emergency physicians should have a high index of suspicion for this complication when evaluating postcolonoscopy patients.
Chen-June Seak, Chih-Chuan Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2007.08.002
Published in issue: January 2008
xWe report a first case of acute intoxication with terazosin in a 75-year-old man presenting with bradycardia and hypotension. The patient received supportive treatment and was discharged with no sequelae 48 hours after the admission. The coexistence of bradycardia and terazosin overdose has never been mentioned in any literature. This case report attempts to exemplify the possibility of this connection.
Yoshinobu Kimura, Yasuhiro Kamada, Saori Kimura
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.021
Published in issue: January 2008
xThe current consensus suggests that gastric lavage should not be considered unless a patient has ingested a potentially life-threatening amount of a poison and that the procedure can be undertaken within 60 minutes of ingestion. However, it can be difficult to identify those who might potentially benefit from gastric lavage in some cases because some life-threatening drugs such as tricyclic antidepressants tend to remain in the stomach longer. We report a case that necessitated gastric lavage using abdominal computed tomography (CT).
Carlos Beaumont Caminos, Idoya Zazpe Cenoz, ?ngel Hernández Galán, Clint Jean Louis, Bernabé Fenández Esain, Inmaculada Gimena Ramos
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.022
Published in issue: January 2008
xWe report the case of a 54-year-old woman who presented at the emergency department complaining of cervical pain with no irradiation to superior extremities after a low-energy traffic accident. Physical examination was unremarkable, except for tenderness on percussion of cervical spinous process and pain with flexion and extension of the neck. A lateral cervical radiograph showed a congenital malformation (partial agenesis of the posterior arch of the atlas). Congenital defects of the posterior arch are not frequent, and their incidence is not well known.
DOI: http://dx.doi.org/10.1016/S0735-6757(07)00688-2
Published in issue: January 2008
DOI: http://dx.doi.org/10.1016/S0735-6757(07)00689-4
Published in issue: January 2008
DOI: http://dx.doi.org/10.1016/S0735-6757(07)00690-0
Published in issue: January 2008
DOI: http://dx.doi.org/10.1016/S0735-6757(07)00691-2
Published in issue: January 2008
