Stefano Parlamento, Roberto Copetti, Stefano Di Bartolomeo
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.009
Published in issue: May 2009
xThe aim of this study is to assess the ability of bedside lung ultrasound (US) to confirm clinical suspicion of pneumonia and the feasibility of its integration in common emergency department (ED) clinical practice.
Yu-Cheng Hong, Meng-Hua Chou, Estella H. Liu, Cheng-Ting Hsiao, Jen-Tse Kuan, Ju-Chan Lin, I-Chuan Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.010
Published in issue: May 2009
xOvercrowding in hospitals, especially in EDs, is a serious problem in the United States, Europe, and Taiwan. However, the association between prolonged ED boarding stay and mortality in patients with necrotizing fasciitis remains underinvestigated.
Mieczyslaw Szyszkowicz, David M. Stieb, Brian H. Rowe
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.013
Published in issue: May 2009
xA variety of environmental factors have been identified as possible triggers for migraine and other headache syndromes.
Sean P. Collins, Christopher J. Lindsell, Michael C. Kontos, Michel Zuber, Peter Kipfer, Christine Attenhofer Jost, Douglas Kosmicki, Andrew D. Michaels
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.014
Published in issue: May 2009
xPatients presenting with acute dyspnea are often a diagnostic dilemma. A bedside tool that accurately and rapidly identifies increased left ventricular (LV) filling pressure would be helpful. We evaluated acoustic electrocardiography for this purpose.
Oner Mentes, Mehmet Eryılmaz, Ali Harlak, Halil Yaman, Taner Yıgıt, Onder Ongoru, Mujdat Balkan, Orhan Kozak, Turgut Tufan
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.016
Published in issue: May 2009
xAcute appendicitis is one of the most common surgical emergencies. Diagnosis is usually made depending on the presenting history, clinical evaluation, and laboratory tests. The aim of this study was to investigate the role of urinary 5-hydroxyindoleacetic acid (U-5-HIAA) in the early diagnosis of acute appendicitis.
Jeffrey D. Ho, Donald M. Dawes, Laura L. Bultman, Ronald M. Moscati, Timothy A. Janchar, James R. Miner
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.017
Published in issue: May 2009
xThere are safety concerns about TASER conducted electrical weapon (CEW) use on humans, and there have been media reports of adverse human outcomes after CEW exposure. Conducted electrical weapons are often used on physically exhausted subjects. A single CEW application of a CEW is generally accepted to be 5 seconds of exposure. Some exposures in reality involve more than 5 seconds. We sought to determine if a prolonged (15 seconds) CEW exposure on exhausted humans caused acidosis, hyperkalemia, serum lactate change, or troponin change.
David J. Wallace, Bonnie Arquilla, Richard Heffernan, Martin Kramer, Todd Anderson, David Bernstein, Michael Augenbraun
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.020
Published in issue: May 2009
xWe describe a field simulation that was conducted using volunteers to assess the ability of 3 hospitals in a network to manage a large influx of patients with a potentially communicable disease. This drill provided the opportunity to evaluate the ability of the New York City Department of Health and Mental Hygiene's (NYC-DOHMH) emergency department chief complaint syndromic surveillance system to detect a cluster of patients with febrile respiratory illness.
Abdulkadir Gunduz, Emine Sayın Meriçé, Ahmet Baydın, Murat Topbaş, Hüküm Uzun, Süleyman Türedi, Asım Kalkan
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.021
Published in issue: May 2009
xThe aim of this study was to describe current patterns of monitoring and treatment of mad honey intoxication to make recommendations for a more standardized approach to care of patients with mad honey poisoning.
Tyler W. Barrett, Michelle Schierling, Chuan Zhou, J. Drew Colfax, Stephan Russ, Paige Conatser, Penny Lancaster, Keith Wrenn
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.025
Published in issue: May 2009
xThe primary intention of spiral computed tomography (SCT) in trauma patients is to identify significant injuries. However, unanticipated information is often discovered. We hypothesize that SCT often identifies clinically significant incidental findings in trauma patients.
Ryan D. Wells, Phillip Mason, Joseph Roarty, Melissa Dooley
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.026
Published in issue: May 2009
xTreatment success of cellulitis in the age of community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA). A comparison of initial antibiotic choice and treatment success in the pre- and post-CAMRSA eras.
Markus B. Skrifvars, James Boyd, Markku Kuisma
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.027
Published in issue: May 2009
xThe objective of this study is to determine whether prearrest shock and respiratory insufficiency influence outcome in patients with emergency medical service–witnessed out-of-hospital cardiac arrest.
Hamid Shokoohi, Robert Shesser, Jeffrey P. Smith, Michael C. Hill, Robert Hirsch
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.033
Published in issue: May 2009
xThe aim of this study is to investigate the correlation between cardiac troponin I (cTnI) values and the pulmonary artery obstruction index assessed with spiral computed tomography (CT) scan in emergency department (ED) patients with pulmonary embolism (PE).
Marc A. Bellazzini, Peter M. Rankin, Ronald E. Gangnon, Lars Petter Bjoernsen
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.034
Published in issue: May 2009
xThe aim of this study is to determine which maneuvers result in greatest cross-sectional area (CSA) of the internal jugular vein (IJV) and reduce collapsibility as measured by ultrasound during simulated venipuncture.
Cosima Wandaller, Michael Holzer, Fritz Sterz, Armin Wandaller, Jasmin Arrich, Thomas Uray, Anton N. Laggner, Harald Herkner
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.036
Published in issue: May 2009
xTo determine whether during the initial phase of head and neck cooling, jugular bulb temperature (Tjb; which may reflect brain temperature) is lower than esophageal temperature (Tes).
Jenaro A. Fernández-Valencia, Jordi Cuñe, Jose M. Casulleres, Ana Carreño, Salvio Prat
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.040
Published in issue: May 2009
xThe Spaso technique has been recently described as a new, simple, and effective manoeuvre for reducing anterior shoulder dislocation. However, there is a lack of series in the English literature. The aim of the study was to evaluate the results obtained with the introduction of this technique in an emergency department.
Mineji Hayakawa, Satoshi Gando, Hiroyuki Okamoto, Yasufumi Asai, Shinji Uegaki, Hiroshi Makise
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.043
Published in issue: May 2009
xThe purpose of the study is to investigate the influence of cardiopulmonary resuscitation (CPR) time before the first defibrillation.
Linda A. Regan, Robert S. Hoffman, Lewis S. Nelson
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.044
Published in issue: May 2009
xWe investigated the difference in incidence of acute akathisia related to the rate of infusion in patients receiving metoclopramide for acute nausea, vomiting, or migraine headache in the emergency department (ED).
Amal Mattu, Michael C. Bond, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.038
Published in issue: May 2009
xBody R, McDowell G, Carley S, et al. Do risk factors for chronic coronary heart disease help diagnose acute myocardial infarction in the emergency department? Resuscitation 2008;79:41-45.
Daniel Garcia, Amal Mattu, Christopher P. Holstege, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2008.01.059
Published in issue: May 2009
xIntraventricular conduction abnormalities are commonly seen on the electrocardiograms of patients in the emergency department population. The significance of such a finding can vary widely. When placed into clinical context, determination and description of an intraventricular conduction delay (IVCD) can assist in the management of a number of pathologies—directly cardiac and otherwise. The IVCDs discussed in this review include the unifascicular blocks (right bundle branch block [RBBB], left anterior fascicular block [LAFB], and left posterior fascicular block [LPFB]) and the bifascicular blocks (left bundle branch block, RBBB plus LAFB, and RBBB plus LPFB).
Chi Kit Yuen, Ka Leung Mok, Pui Gay Kan, Yau Tak Wong
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.037
Published in issue: May 2009
xWe read with interest the article “Bedside ultrasound for verification of shoulder reduction” by Halberg et al [1] and would like to raise a few comments. We feel curious that the authors could produce any ultrasound images of the shoulder of diagnostic quality by using ultrasound beam of 60 MHz as described by the authors. It is exceedingly rare to use diagnostic ultrasound of frequency as high as 60 MHz in the emergency room for assessing musculoskeletal problems. The penetrating power of ultrasound beam is inversely related to the frequency of the ultrasound; with a frequency of 60 MHz, most of the ultrasound will be attenuated by the soft tissue before being reflected by the bones in the shoulder, the imaging quality will certainly be very suboptimal.
Michael J. Halberg
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.039
Published in issue: May 2009
xThis is a response to a letter to the editor regarding the article “Bedside ultrasound for verification of shoulder reduction.”
David A. Lacquiere, Andrew M.B. Heard
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.012
Published in issue: May 2009
xWe congratulate Archan et al [1] on their successful management of the Can't Intubate, Can't Ventilate (CICV) scenario in the field; however, we question whether their unconventional approach would result in a successful outcome if repeated by others.
Sylvia Archan, Rainer Gumpert, Bernhard Kuegler
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.013
Published in issue: May 2009
xWe thank (Drs Lacquiere and Heard) for their interest in our case report and their valuable comments. However, we would like to stress that we merely described the very successful management of a highly challenging situation in the field. We did not attempt to question the validity of recognized difficult airway algorithms.
George N. Kounis, George D. Soufras, Sophia A. Kouni, Nicholas G. Kounis
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.025
Published in issue: May 2009
xThere are 2 cardiac diseases of hypersensitivity etiology that affect the myocardium and the coronary arteries, respectively. The first is an inflammatory disease affecting the myocardium and the cardiac conduction system manifesting as a complication of drug therapy [1]. The second is the concurrence of acute coronary syndromes with conditions associated with mast cell activation, involving interrelated and interacting inflammatory cells, and including allergic or hypersensitivity and anaphylactic or anaphylactoid insults [2].
Sahin Aslan, Mucahit Emet, Mustafa Uzkeser
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.026
Published in issue: May 2009
xWe have read “Kounis syndrome” and surprised to see the common points of this disease with “hypersensitivity myocarditis,” which we reported a case recently [1]. We believe that most of the emergency physicians have knowledge about drug-induced acute coronary syndrome, bee stings or viper venom poisoning-related myocardial infarction, but only a few of us know that all these coronary syndromes come out to a common pathophysiologic mechanism and a common name: hypersensitivity coronary syndrome (Kounis syndrome) [2].
P. Ken Gillman
DOI: http://dx.doi.org/10.1016/j.ajem.2009.03.001
Published in issue: May 2009
xDay and Jeanmonod [1] overinterpret a single case report that contains low reliability evidence and suggest that a patient exhibited serotonin toxicity (ST), and that this justifies a caution about cyclobenzaprine. They perpetuate misunderstandings about ST by misinterpreting some of the material they cite, and some additions to their literature review are required.
Luke T. Day, Rebecca K. Jeanmonod
DOI: http://dx.doi.org/10.1016/j.ajem.2009.03.002
Published in issue: May 2009
xThis is an interesting article by Dr Gillman. He certainly raises many salient points, and his authority on the subject is not in question. However, Dr Gillman's interest seems to be more toward a detailed review of both serotonin syndrome and the pharmacokinetics of cyclobenzaprine. It does not address the consideration which was at the core of our article, namely, that there are substances both known and unknown that have both overt and covert serotonin agonism. In doing so, his article, although valuable and in many aspects correct, misses the proverbial clinical forest for the academic trees.
Oliver J. Wagner
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.018
Published in issue: May 2009
xIn the letter “Is there still a role for rectal examination in suspected appendicitis in adults?” published in Am J Emerg Med 2008;26(3):359-360, author Zimmermann was omitted. The correct byline appears below.
Shih-Hua Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.019
Published in issue: May 2009
xIn the article “In-flight Valsalva maneuver induced life-threatening Wünderlich syndrome,” published in Am J Emerg Med 2008;26(6):732.e5-6 listed the authors out of order. The correct byline is below.
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.020
Published in issue: May 2009
xThe article “Adverse events associated with ketamine for procedural sedation in adults” by Reuben J. Strayer and Lewis S. Nelson was published without its acknowledgment in Am J Emerg Med 2008;26(9):985-1028. The acknowledgment is below.
Neeraj Gupta, Christopher C. Lee, Tae Ho Lim, Adam J. Singer
DOI: http://dx.doi.org/10.1016/j.ajem.2008.07.019
Published in issue: May 2009
x6-Mercaptopurine (6-MP), although an effective immunosuppressive when used in the treatment of certain cancers, can have devastating effects when ingested accidentally or used in excessive amounts. We report here the case of an unintentional ingestion of a large amount of 6-MP by a woman with hypothyroidism who was erroneously given this antimetabolic agent by her pharmacist instead the propylthiouracil (PTU) she was actually prescribed. This is one of several documented cases in which 6-MP has been dispensed instead of PTU.
Michael Zwank
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.038
Published in issue: May 2009
xA nasopharyngeal airway is an adjunct used to relieve airway obstruction due to tongue relaxation in an unconscious or semiconscious patient. It is considered a safe procedure in patients without massive facial trauma or basilar skull fracture. This is a report of a healthy patient undergoing procedural sedation who sustained a middle turbinectomy upon placement of a nasal trumpet to assist ventilation. He subsequently developed severe epistaxis that resolved only after multiple attempts of packing both by the emergency physician as well as the otolaryngology service.
Usha Sethuraman, Marjan Siadat, Cynthia A. Lepak-Hitch, Demetris Haritos
DOI: http://dx.doi.org/10.1016/j.ajem.2008.07.040
Published in issue: May 2009
xPulmonary embolisms (PEs) are easily missed both in children and adults because of the varied presentations and subtle clinical findings. Abdominal pain as the presenting symptom of PE is extremely rare in children and only reported as occasional case reports in adults. We present a series of 2 cases of PE presenting as acute abdomen. Case 1 is a 14-year-old adolescent boy who presented to a pediatric emergency department with abdominal pain, whereas case 2 is a 22-year-old man who presented to the adult emergency department of the same institution with abdominal pain.
Julie Gorchynski, Joe Hwang, Thomas McLaughlin
DOI: http://dx.doi.org/10.1016/j.ajem.2008.07.041
Published in issue: May 2009
xSpinal epidural abscess is a rare debilitating disease that if left untreated may result in serious morbidity and mortality. Most cases involve the level of 3 or 4 vertebrae, but in very rare cases may affect the whole spine. The most common pathogen found in spinal abscesses is Staphylococcus aureus, which involves approximately two thirds of cases. The recent introduction of methicillin-resistant strains of S aureus has left physicians with the challenging task of identifying and treating this serious condition.
Evan S. Schwarz, Michael Barra, Michael M. Liao
DOI: http://dx.doi.org/10.1016/j.ajem.2008.07.042
Published in issue: May 2009
xNew studies have shown the benefit of initiating a hypothermia protocol in the survivors of cardiac arrest. Although the data have shown an improved neurologic end point in patients initially in ventricular fibrillation or pulseless ventricular tachycardia, there is still debate about whether patients initially in other rhythms would benefit from hypothermia after return of spontaneous circulation. This is a report of a 17-year-old male found to be in asystole after sustaining a TASER injury, who was treated with a hypothermia protocol after return of spontaneous circulation and left the hospital with intact neurologic function.
Henry David
DOI: http://dx.doi.org/10.1016/j.ajem.2008.07.043
Published in issue: May 2009
xLemierre syndrome an extremely rare and unreported disease typically results from oropharyngeal infection and/or local tissue trauma with invasion of the parapharyngeal soft tissue with bacteria [1]. Once local tissue invasion occurs, internal jugular vein septic thrombophlebitis with or without metastatic complications may occur. The etiology of Lemierre syndrome is generally Fusobacterium necrophorum, reported to be present in approximately 80% of the cases [2]. The outcome of Lemierre syndrome in the preantibiotic era was nearly always fatal.
Yee-Fung Lin, Sheng-Chuan Hsi, Yue-Quen Chen, Wei-Zen Long
DOI: http://dx.doi.org/10.1016/j.ajem.2008.07.044
Published in issue: May 2009
xHead injury is very commonly seen in the emergency department (ED) worldwide, and almost, an unenhanced computed tomography scan of the brain suffices for patients seen in the ED presenting after trauma or with a new neurologic deficit. Intracranial lipomas are usually asymptomatic, and they are often an occasional finding. In head injury cases, lipomas are easily to be misdiagnosed as pneumocranium on brain computed tomography with low-density attenuation image. We presented an extremely rare case of interhemispheric lipoma presenting to an ED as a lesion of acute brain insult.
Michael B. Stone
DOI: http://dx.doi.org/10.1016/j.ajem.2008.08.002
Published in issue: May 2009
xA 22-year-old female presented to the emergency department (ED) with fever, chest pain, and right leg pain. The patient's chest pain was severe, diffuse, and pleuritic and reminded her of “when I had acute chest syndrome.” Her medical history included hemoglobin SS disease, acute chest syndrome, pneumonia, and avascular necrosis of the right femoral head.
Wen-Yi Huang, Yu-Yi Chien, Chia-Lun Wu, Wei-Chieh Weng, Tsung-I Peng, Hsien-Chih Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2008.08.004
Published in issue: May 2009
xPituitary apoplexy is a rare but life-threatening disorder. Clinical presentation of this condition includes severe headache, impaired consciousness, fever, visual disturbance, and variable ocular paresis. Signs of meningeal irritation are very rare. However, if present and associated with headache, fever, and pleocytosis, meningeal irritation may lead to misinterpretation as infectious meningoencephalitis. To the best of our knowledge, pituitary apoplexy with an initial presentation mimicking infectious meningoencephalitis had rarely been reported in the literature.
Kim A. Williams Jr, Pelagia Kouloumberis, Herbert H. Engelhard
DOI: http://dx.doi.org/10.1016/j.ajem.2008.08.005
Published in issue: May 2009
xAmusement park ride injuries have been newsworthy events for many years. The multitude and severity of these injuries has been reported many times over the past 20 years and includes spinal cord and vertebral injuries, subarachnoid hemorrhage, internal and vertebral artery dissections, and even a few cases of subdural hematoma (SDH) [1]. There has also been as many theories to explain these injuries as there have been injuries themselves including how G forces and rotational acceleration can cause both neuroparenchymal and neurovascular injury [2].
DOI: http://dx.doi.org/10.1016/S0735-6757(09)00159-4
Published in issue: May 2009
DOI: http://dx.doi.org/10.1016/S0735-6757(09)00160-0
Published in issue: May 2009
DOI: http://dx.doi.org/10.1016/S0735-6757(09)00161-2
Published in issue: May 2009
DOI: http://dx.doi.org/10.1016/S0735-6757(09)00162-4
Published in issue: May 2009
