Barth L. Wilsey, Scott M. Fishman, Margie Crandall, Carlos Casamalhuapa, Klea D. Bertakis
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.005
Published in issue: March 2008
xThis qualitative study sought to identify perceived barriers to diagnosing and treating patients with chronic pain in the emergency department (ED).
Julie J. Cooper, Elizabeth M. Datner, Jesse M. Pines
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.008
Published in issue: March 2008
xWe derived and tested a protocol to automatically order a chest radiograph (CXR) at emergency department triage for patients with signs and symptoms of pneumonia to reduce time to antibiotics.
Polly Bijur, Anick Bérard, Jordan Nestor, Yvette Calderon, Michelle Davitt, E. John Gallagher
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.010
Published in issue: March 2008
xStudies of data from the 1990s are often cited as evidence of racial and ethnic disparities in pain management. Subsequent evidence supporting this association has not been consistent. The objective was to assess whether there are racial or ethnic disparities in receipt of analgesics for pain from long-bone fractures more recently and in a different region of the United States. We conducted a retrospective chart review of 449 patients. Twenty-three percent (53/235) of Hispanic patients, 31% (41/133) of African American patients, and 26% (21/81) of white patients did not receive analgesics.
Ching-Hsing Lee, Chia-Pang Shih, Kuang-Hung Hsu, Dong-Zong Hung, Chih-Chuan Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.011
Published in issue: March 2008
xThe purpose of this study was to establish an early prognostic model of patients with glyphosate-surfactant (GlySH) herbicide intoxication.
Roma Hernandez, Ashok Jain, Lucas Rosiere, Sean O. Henderson
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.012
Published in issue: March 2008
xTo improve the diagnostic accuracy of identifying acute appendicitis, imaging modalities, such as ultrasound and the computed tomography scan, are used in combination with the history and physical examination. There is no reliable single laboratory marker to assist with this diagnosis. During inflammation, enterochromaffin cells in the appendix secrete serotonin, and 5-hydroxyindoleacetic acid (5-HIAA), a serotonin metabolite excreted in urine, has been found to be elevated in patients presenting with acute appendicitis.
Karl Mischke, Thomas Schimpf, Christian Knackstedt, Christian Eickholt, Peter Hanrath, Malte Kelm, Patrick Schauerte
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.017
Published in issue: March 2008
xIncreasing duration of ventricular fibrillation (VF) is associated with a higher risk of ineffective resuscitation. In addition, precountershock chest compression can influence defibrillation success. Transesophageal defibrillation may increase defibrillation success because of the proximity of the esophagus to the heart. We evaluated the efficacy of transesophageal defibrillation compared with standard transthoracic defibrillation after long episodes of VF.
Jared Strote, Reed Simons, Mickey Eisenberg
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.030
Published in issue: March 2008
xWe examine the safety and efficacy of emergency medical technicians (EMTs) providing treatment to stable hypoglycemic patients without transport or paramedic involvement, which is currently beyond their scope of practice.
Mary W. Carter, Shalini Gupta
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.033
Published in issue: March 2008
xThe objectives of this study were to examine the epidemiology of injury among older adults treated in emergency departments (EDs) and to explore the effect of advanced age and nursing home residence on associated outcomes.
Theodoros Xanthos, Konstantinos A. Ekmektzoglou, Ioannis S. Vlachos, Dimitrios Dimitroulis, Serafim Tsitsilonis, Theodore Karatzas, Despina N. Perrea
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.034
Published in issue: March 2008
xThe use of adenosine on failure of vagal maneuvers in patients with paroxysmal supraventricular tachycardia (PSVT) is recommended. The aim of the present study was to identify a possible prognostic index for the efficacy of adenosine in PSVT.
Eduard Zaloshnja, Ted Miller, Paul Jones, Toby Litovitz, Jeffrey Coben, Claudia Steiner, Monique Sheppard
DOI: http://dx.doi.org/10.1016/j.ajem.2007.10.014
Published in issue: March 2008
xThis study analyzes the association between center usage rates and the rates of nonadmitted visits to emergency departments (EDs) for poisoning.
Cheng-Ting Hsiao, Leng-Jye Lin, Chi-Jei Shiao, Kuaing-Yu Hsiao, I-Chuan Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.014
Published in issue: March 2008
xDermatologic complaints are common presentations in the ED. Hemorrhagic bullae are an example of dermatologic manifestation caused by variable etiologies. The life-threatening skin lesion usually is an external sign of a systemic or immune response stimulated by an infection, toxin, medication, or disease process. Although most patient with life-threatening skin lesion, such as hemorrhagic bullae, may appear ill, patients who present in the early course of illness may appear well but deteriorate rapidly.
Wojciech Kosiak, Dominik Swieton, Maciej Piskunowicz
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.012
Published in issue: March 2008
xBody fluid status is one of the most important parameters estimated during every clinical examination. In many disorders, the therapy and its effectiveness depend on appropriate evaluation of body water status. There are some useful methods of evaluating body fluid incontinence; however, all of them are burdened with some limitations, especially when used in the emergency department. We introduce a new sonographic parameter, the “inferior vena cava (IVC)/aorta (Ao) diameter (IVC/Ao) index,” as a convenient, quick, and effective way of evaluating body fluid status.
Barbara Olasov Rothbaum, Debra Houry, Mary Heekin, Amy Selvig Leiner, Jill Daugherty, L. Shakiyla Smith, Maryrose Gerardi
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.006
Published in issue: March 2008
xEarly interventions to prevent PTSD have been limited in scope and effectiveness. This pilot study examines the feasibility and preliminary effectiveness of a model for brief preventive intervention: 1-session individualized exposure-based therapy delivered in the emergency department (ED). Eligible patients who experienced exposure to a traumatic event in the previous 24 hours were screened and assigned to assessment-only (n = 5) or intervention (imaginal exposure, n = 5) conditions. Both groups returned for 1-week follow-up.
Shih-Hung Tsai, Shi-Jye Chu, Ching-Wang Hsu, Shu-Meng Cheng, Shih-Ping Yang
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.031
Published in issue: March 2008
xCardiac troponins (cTn) are frequently assessed in patients presenting at the emergency department (ED) with chest pain and various diseases in which myocardial injury may be involved. Cardiac troponins are no longer only used for diagnostic investigations in acute coronary syndrome but may also provide valuable information regarding screening, prognosis, and risk stratification and help to guide therapeutic planning and ED dispositioning of patients with many different types of critical illnesses.
Stephen W. Smith, William Heegaard, Fouad A. Bachour, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.032
Published in issue: March 2008
xA case of inferior and right ventricular acute myocardial infarction in the presence of left bundle-branch block is presented. The electrocardiogram manifests disproportional, discordant ST elevation in leads II, III, and aVF and in leads V1 through V4.
Matthew O'Connor, Nancy McDaniel, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.034
Published in issue: March 2008
xThe following article in this series will describe common arrhythmias seen in the pediatric population. Their definitions and clinical presentations along with electrocardiogram (ECG) examples will be presented. In addition, ECG changes seen in acute toxic ingestions commonly seen in children will be described, even if such ingestions do not produce arrhythmias per se. Disturbances of rhythm seen frequently in patients with unrepaired and corrected congenital heart disease will be more fully discussed in the third article of this series.
Magdali Sedlak, Oliver J. Wagner, Bettina Wild, Sawas Papagrigoriades, Aristomenis K. Exadaktylos
DOI: http://dx.doi.org/10.1016/j.ajem.2007.06.006
Published in issue: March 2008
xFor decades, digital rectal examination (DRE) was thought to be an indispensable examination in every patient with suspected appendicitis, although since 1901, authors have pointed out that the rectal examination rarely provides useful information [1-4]. Furthermore, there are important moral and increasingly legal arguments highlighting the need to ensure that only evidence-based examinations should be performed [5]. It is therefore both wise and a necessity to explore these issues before proceeding with a controversial examination.
Renana Shor, Yulian Tilis, Mona Boaz, Zipora Matas, Asora Fux, Aaron Halabe
DOI: http://dx.doi.org/10.1016/j.ajem.2007.08.005
Published in issue: March 2008
xParathyroid hormone–related protein (PTHrP) is the humoral factor responsible for hypercalcemia of malignancy [1].
Roberto Manfredini, Benedetta Boari, Raffaella Salmi, Fabio Manfredini, Vincenzo Gasbarro, Francesco Mascoli, Massimo Gallerani
DOI: http://dx.doi.org/10.1016/j.ajem.2007.08.006
Published in issue: March 2008
xAcute aortic dissection and rupture are life-threatening cardiovascular emergencies usually associated with high mortality. In analogy with other major adverse cardiovascular events, there is considerable evidence that dissection and rupture of aortic aneurysms are not randomly distributed over time but demonstrate temporal variations [1].
Robert P. Rifenburg, Karl G. Ambroz, Shu B. Chan
DOI: http://dx.doi.org/10.1016/j.ajem.2007.08.012
Published in issue: March 2008
xAn important aspect of emergency medicine (EM) is proper interpretation of plain radiographs. In many institutions, it is the responsibility of the emergency physician to interpret plain radiographs and provide treatment before a radiologist's reading [1]. This is especially true when EM residents (EMR) begin moonlighting in emergency departments (EDs) where there is no in-house 24-hour radiology coverage.
Michael A. Miller, Mark E. Levsky, David Masneri, Dina Parekh, Doug Borys
DOI: http://dx.doi.org/10.1016/j.ajem.2007.08.014
Published in issue: March 2008
xNisoldipine is a dihydropyridine calcium-channel antagonist medication, most often used in a modified release form. It has been prescribed in the United States for less than 10 years. Although the medication has been shown to be safe in common therapeutic use, information on the toxicity and exposure patterns of nisoldipine is sparse, with no robust clinical toxicity data and few case reports found in the medical literature [1,2]. Our goal was to study the characteristics of nisoldipine exposures identified through phone calls made to the state of Texas Poison Control Centers (PCC) over a 7-year period, from 2000 to 2006, in an attempt to describe exposure patterns and to identify a weight-based toxicity profile for patients exposed to nisoldipine.
Giuseppe Ristagno, Antonino Gullo
DOI: http://dx.doi.org/10.1016/j.ajem.2007.08.015
Published in issue: March 2008
xWe appreciated the study by Chen et al [1] in which an elegant comparison of the efficacy of epinephrine with that of vasopressin during cardiopulmonary resuscitation (CPR) was performed. Under the setting of asphyxia cardiac arrest in adult rabbits, epinephrine, but not vasopressin, increased the survival rate. Administration of epinephrine was in fact followed by greater coronary perfusion pressures and thereby a higher likelihood of return of spontaneous circulation (ROSC). These results confirm precedent observations obtained in pediatric models of asphyxia cardiac arrest, whereas in other experimental models of adult asphyxia cardiac arrest in large animals, the superiority of epinephrine has not been proven yet [2].
Lu Xie
DOI: http://dx.doi.org/10.1016/j.ajem.2007.09.008
Published in issue: March 2008
xI agree with your opinion that unsuccessful outcomes after successful CPR are in part due to impaired cerebral function caused by ischemic brain injury. Epinephrine is currently a suboptimal drug for CPR and needs to be evaluated further. The problem is how to reduce or avoid the adverse effect of epinephrine during and after CPR. If possible, we should do our best to search for a better therapeutic drug for cardiac arrest.
Chin-Kun Liao, Hung-Jung Lin, Kuo-Tai Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2007.10.006
Published in issue: March 2008
xThe laryngeal mask airway (LMA) is a supraglottic airway device used to maintain an airway and provide positive pressure ventilation [1]. Because the LMA provides access to the larynx and trachea, its potential use as a route of drug administration is apparent. Salbutamol and surfactant have been delivered via the LMA, and desired therapeutic goals have been achieved [2,3]. Previous studies have shown that drug administration via the LMA resulted in lower plasma concentration than drug delivery into the trachea [4,5].
Richard F Edlich
DOI: http://dx.doi.org/10.1016/j.ajem.2007.10.015
Published in issue: March 2008
xLaura Landro speaks eloquently about a dangerous gap in trauma care in her editorial in the Wall Street Journal[1]. She indicates that trauma from injuries including accidents, falls, and violence is the leading cause of death for Americans younger than 44 years, accounting for more than 140000 lives and permanently disabling 80000 people annually. She points out that only 1 in 4 accident victims living in an area served by a coordinated system is able to transfer patients to designated trauma centers from less equipped hospitals according to the American College of Surgeons, which sets standards for trauma care.
Kennon Heard, Scott Wilber, Manish N. Shah
DOI: http://dx.doi.org/10.1016/j.ajem.2007.10.027
Published in issue: March 2008
xAdverse drug events are a major cause of preventable hospital admissions and emergency department (ED) visits [1]. Although many of these events are not easily prevented, it is clear that some medications are more likely than others to cause these events [1]. The recent article by Hustey et al [2] defines potentially inappropriate medications using the list developed and refined by Fick et al [3]. As Hustey et al noted [2], this list was defined for use by primary care clinics. Although some of these medications may be used for the same purpose in the ED (eg, the use of muscle relaxants or propoxyphene), we believe that these criteria are not universally applicable to the ED.
Giuseppe Lippi, Gian Cesare Guidi
DOI: http://dx.doi.org/10.1016/j.ajem.2007.11.001
Published in issue: March 2008
xThe health care systems are experiencing an unprecedented rate of changes worldwide, which inevitably involve laboratory medicine. A variety of strategies have been proposed to cut down the costs of laboratory diagnostics by increasing automation, using personnel with less education and training, and reducing the use of laboratory resources. There is evidence that laboratory testing only reaches its highest usefulness when enhanced efficiency and efficacy are pursued by a multifaceted strategy that comprehends indications, recommendations, or guidelines on the appropriate use of tests according to well-defined clinical contexts [1].
Yoav Paz
DOI: http://dx.doi.org/10.1016/j.ajem.2007.11.009
Published in issue: March 2008
xI read with great interest the article “A New Cardiopulmonary Resuscitation Method Using Only Rhythmic Abdominal Compression. A Preliminary Report” [1]. The authors suggest a new method of cardiopulmonary resuscitation (CPR) for the treatment of ventricular fibrillation (VF) by performing only abdominal compression cardiopulmonary resuscitation (OAC-CPR), that is, rhythmic compression of the abdominal organs to force the abdominal vascular bed content into the coronary circulation. The authors also mentioned that this is in contrast to the latest American Heart Association guidelines for CPR [2].
Leslie A. Geddes
DOI: http://dx.doi.org/10.1016/j.ajem.2007.11.010
Published in issue: March 2008
xI am pleased to respond to the Letter-to-the-Editor from Dr Paz. Dr Paz states that the pig may not be the best animal model for the study and cites references already known to me. I agree, but he does not propose a better model. As a matter of fact, I have performed defibrillation studies on horses, ponies, sheep, goats, calves, dogs, large rabbits, and one camel. I am no stranger to these species. I have published more than 100 papers on ventricular fibrillation in peer-reviewed journals. I am the coauthor with Tacker on the first book devoted entirely to defibrillation (Electrical Defibrillation by Tacker and Geddes, CRC Press, 1980).
Eric M. Rottenberg
DOI: http://dx.doi.org/10.1016/j.ajem.2007.11.011
Published in issue: March 2008
xGeddes et al [1] published a preliminary animal study introducing a new method of cardiopulmonary resuscitation (CPR) in which rescuers use only abdominal compressions (OAC) to resuscitate sudden ventricular fibrillation cardiac arrest, which they referred to as OAC-CPR. They reported that the idea of using abdominal compressions during CPR originated with Ralston et al [2] who studied the use of interposed abdominal compressions (IAC) with standard chest-compressions CPR (or IAC-CPR). They suggested that it was logical to explore the potential of using abdominal compressions without chest compressions because blood flow during IAC-CPR was found to be double that of standard chest-compressions CPR, therefore prompting them to conduct their study.
Leslie A. Geddes
DOI: http://dx.doi.org/10.1016/j.ajem.2007.11.012
Published in issue: March 2008
xRegarding the Ralston introduction of interposed Abdominal Compression (IAC) CPR, she did her work in my lab in 1980; the paper appeared in 1982 [1]. In all cases, the ventricles were fibriliating. The paper by Coletti et al [2] was published in the same year, but OAC was used to assist the failing beating dog heart. We agree, OAC is a safe and useful method of assisting the circulation as was shown in our paper by the increasing coronary perfusion when compared in the SAME animal using standard chest-compression CPR.
L.A. Geddes
DOI: http://dx.doi.org/10.1016/j.ajem.2007.11.019
Published in issue: March 2008
xIn the article “A new cardiopulmonary resuscitation method using only rhythmic abdominal compression: a preliminary report” by Leslie A. Geddes ME, PhD, DSc; Ann Rundell PhD; Aaron Lottes BCh, MBA, PhD; Andre Kemeny MS; and Michael Otlewski BS, published in the September 2007 issue of AJEM, the units for coronary perfusion index should be mm Hg-s, not mm Hg/s.
Seung-Whan Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2008.01.001
Published in issue: March 2008
xIn the article “Massive parastomal hernia with strangulation” published in the January 2008 issue of AJEM, the author names should be:
Michael Secko, Shahriar Zehtabchi
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.016
Published in issue: March 2008
xLipomatosis is a nonmalignant disease of unknown origin distinguished by overgrowth of nonencapsulated fatty tissue usually in the abdominal and pelvic cavities. Limited cases of complicated mediastino-abdominal lipomatosis have been described in the literature. We present a case of complicated diffuse lipomatosis mimicking ascites in a 65-year-old man.
Suchdeep Raj Bains, Anita Kedia, Carlos A. Roldan
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.018
Published in issue: March 2008
xPericarditis was the primary manifestation of aortic dissection in these 2 young men. Both patients had no phenotypic characteristics of Marfan or Ehlers-Danlos syndrome. These patients had pleuritic chest pain and characteristic electrocardiographic changes consistent with pericarditis. However, timely performed transthoracic echocardiograms revealed proximal aortic dissection with hemopericardium noted at surgery in both cases. Although the sensitivity of transthoracic echocardiogram for proximal aortic dissection is approximately 60%, certain findings can alert the physician to the possibility of aortic dissection.
Jenaro A. Fernández-Valencia, Sebastian García, Salvio Prat
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.019
Published in issue: March 2008
xPasteurella multocida, a gram-negative coccobacillus, is a commensal in the nasopharynx of many animals. P multocida infections most commonly involve the skin, soft tissues, and respiratory tract, particularly in immunosuppressed patients. The present case illustrates a severe articular infection caused by this bacterium, leading to septic shock, in an elderly, otherwise healthy woman, after a simple scratch of a cat.
Etienne Puymirat, Matthieu Biais, Fabrice Camou, Jérome Lefèvre, Olivier Guisset, Claude Gabinski
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.020
Published in issue: March 2008
xLemierre syndrome is a rare clinical entity, characterized by thrombosis of the internal jugular vein that develops after an oropharyngeal infection. We report the case of a 22-year-old woman hospitalized initially for cellulitis of the face. In view of the aggravation of the clinical state (septic shock and multiple organ failure), a computed tomography of the neck was performed and revealed a thrombosis of the right internal and external jugular veins. The patient was treated with antibiotics, heparin, and by a surgical excision for the vascular lesions associated with ligation of jugular veins.
Wei-Chieh Chiu, Tien-Yi Huang, Wan-Chen Ku, Ma Lih, Warren Wang
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.021
Published in issue: March 2008
xOrbital subcutaneous emphysema develops when air enters the surrounding soft tissue. This occurs as a result facial bone trauma, iatrogenic dental and otolaryngeal procedures, and gas-producing infectious microorganisms. Case reports regarding this phenomenon after sneezing are very uncommon. Although orbital subcutaneous emphysema is not a true emergency, it can be distressful to patients. This case serves to bring awareness to emergency department physicians regarding the possibility of a nontraumatic orbital subcutaneous emphysema and its related complications.
Oğuzhan Karatepe, Mustafa Tükenmez, Kemal Hünerli, Gamze Cıtlak, Artur Salmaslıoglu, Muharrem Battal, Yeşim Erbil
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.022
Published in issue: March 2008
xAdult intussusception represents 1% of patients with bowel obstructions and requires a surgical approach. Malignancy is associated with 31% of small bowel intussusception and 70% of large bowel intussusception. Intestinal intussusception caused by ascaris, however, is very uncommon. This report describes our experience of this rare cause of intussusception and its clinical findings.
Warren Wang, Chen-June Seak, Shu-Chen Liao, Te-Fa Chiu, Jih-Chang Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.027
Published in issue: March 2008
xWe report the first case of cardiac tamponade in a 14-year-old female patient with an underlying illness of mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes (MELAS). The patient underwent a subxiphoid pericardiocentesis and pericardiotomy smoothly and was discharged with no sequelae. The coexistence of massive pericardial effusion and MELAS has never been mentioned in any literature. This case report attempts to exemplify the possibility of this connection.
Kuang-Yu Hsiao, Cheng-Ting Hsiao, Leng-Jye Lin, Chi-Jei Shiao, I-Chuan Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.028
Published in issue: March 2008
xTransient ischemic attack is one of the most common causes of transient neurologic deficit. Anemic hypoxia results from reduced hemoglobin content with normal arterial oxygen tension and saturation. Anemic hypoxia caused by blood loss or hemolysis has not been considered as an independent factor leading to significant neurologic problems because cerebral homeostasis adjusted by the physiologic regulation in cerebral hemodynamics and oxygenation would meet the brain oxygen requirement in most circumstances even with profound anemia.
Murat Pekdemir, Serkan Yilmaz, Murat Ersel, Hasan Tahsin Sarisoy
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.029
Published in issue: March 2008
xHeadache represents up to 4% of all emergency department (ED) visits. Emergency physicians generally are concerned with identifying those patients whose headaches are caused by life-threatening conditions. Cerebral venous sinus thrombosis may be difficult to diagnose clinically because of its various and nonspecific manifestations. The most frequent but least specific symptom of sinus thrombosis is severe headache, which is present in more than 90% of adult patients. In the case report we present, a patient had severe headache and was diagnosed until third ED visit at different hospitals.
Arie Eisenman, Victoria Rusetski, Diana Sharivker, Zehava Yona, Daniel Golani
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.035
Published in issue: March 2008
xFugu is a delicate dish prepared from Lagocephalus scleratus, a poisonous fish that contains tetrodotoxin—a very potent neurotoxin. It is usually confined to the Indo-Pacific Ocean where it is responsible for many accidental deaths each year. This very weird case report is about an Israeli couple that was poisoned by this fish caught for the first time in the eastern Mediterranean Sea. The prompt identification of the yet unrecognized fish by professional zoologists enabled an immediate effective treatment.
Wei-Hsiu Liu, Cheng-Ta Hsieh, Yung-Hsiao Chiang, Guann-Juh Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.036
Published in issue: March 2008
xSpontaneous spinal epidural hematoma is a rare condition of spinal cord compression, and emergent decompressive surgery is strictly indicated. Early recognition, accurate diagnosis, and rapid treatment may result in decreased morbidity and improved outcome. Here, we present a case of a 50-year-old man who sustained sudden onset of severe back pain, followed by progressive weakness and numbness over bilateral lower limbs. Magnetic resonance imaging of thoracic spine demonstrated an epidural mass extending from T6 through T8, causing spinal cord compression.
Cheng-ting Hsiao, Leng-jye Lin, Kuang-yu Hsiao, Meng-hua Chou, Shih-hsin Hsiao
DOI: http://dx.doi.org/10.1016/j.ajem.2007.06.024
Published in issue: March 2008
xGlyphosate-surfactant is used extensively as a nonselective herbicide. Suicidal attempts with glyphosate-surfactant herbicide (GlySH) has been encountered with increasing frequency. The effect of GlySH intoxication often involves multiple systems. We report a case of a severely intoxicated man who developed chemical pneumonitis and respiratory failure after suicidal ingestion of GlySH. Acute pancreatitis, which was never covered by any previous case reports, developed in the first day, and the symptom persisted for 10 days during hospitalization.
Andrew K. Chang, Gretchen S. Lent, Diana Grinberg
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.024
Published in issue: March 2008
xA 45-year-old man with dilated cardiomyopathy, atrial fibrillation, and hypertension presented to the emergency department with palpitations and shortness of breath for 2 days after running out of his medications. An electrocardiogram disclosed atrial fibrillation with rapid ventricular response. The patient was hemodynamically unstable and failed multiple cardioversion attempts up to 360 J. A second defibrillator was then attached and the patient successfully cardioverted once both defibrillators were set to their maximum levels, thus delivering a total of 720 J.
Yu-Tzu Tsao, Wei-Chi Tsai, Shih-Ping Yang
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.026
Published in issue: March 2008
xDouble gap metabolic acidosis represents the high anion gap metabolic acidosis combined with raised serum osmolal gap due to retention of unmeasured osmole with accompanied metabolite. We describe a 62-year-old man diagnosed with community-acquired pneumonia undergoing continuous sedation in the context of asynchronous mechanical ventilation. High anion gap metabolic acidosis coupled with high plasma osmolal gap was noted with resultant severe bradyarrhythmia. d-Lactic acidosis and high serum concentration of propylene glycol (PG) eventually established the diagnosis of lorazepam-induced PG intoxication.
Ko-Chiang Hsu, Ann-Ching Wang, Shyi-Jou Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.027
Published in issue: March 2008
xDelayed-onset facial nerve paralysis is a rather uncommon complication of a mastoid bone fracture for children younger than 10 years. We routinely arrange a cranial computed tomography (CT) for patients encountering initial loss of consciousness, severe headache, intractable vomiting, and/or any neurologic deficit arising from trauma to the head. However, minor symptomatic cranial nerve damage may be missed and the presenting symptom diagnosed as being a peripheral nerve problem. Herein, we report a case of a young boy who presented at our emergency department (ED) 3 days subsequent to his accident, complaining of hearing loss in the right ear and paralysis of the ipsilateral face.
Nathan Charlton, Thomas Cook
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.028
Published in issue: March 2008
xThe presentation of new-onset neck mass in the emergency department can represent serious pathology, and its evaluation often uses expensive and time-consuming imaging technologies such as computed tomography and magnetic resonance imaging. Clinician-based ultrasound allows physicians to quickly evaluate these masses in a cost-effective manner. We present the case of a young girl with progressive abdominal pain and a 1-day history of lateral neck mass evaluated by clinician-based ultrasound.
Warren Wang, Chien-Sheng Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.029
Published in issue: March 2008
xThe initial recognition of acute myocardial infarction at the time of the emergency department (ED) visit may be difficult in the absence of typical presentations such as chest pain, diaphoresis, and radiation tenderness. Headache angina, although reported in several instances in the past with variable patient outcomes, is still an uncommon phenomenon in patients with acute myocardial infarction. We report a patient with inferior myocardial infarction who presented to the ED with a complaint of severe headache and subsequent cardiogenic shock secondary to ventricular fibrillation.
