Suleyman Turedi, Tevfik Patan, Abdulkadir Gunduz, Ahmet Mentese, Celal Tekinbas, Murat Topbas, Suleyman Caner Karahan, Esin Yulug, Suha Turkmen, Utku Ucar
DOI: http://dx.doi.org/10.1016/j.ajem.2008.05.002
Published in issue: July 2009
xWe designed this experimental study to determine the value of ischemia-modified albumin in the diagnosis of pulmonary embolism.
Amy A. Ernst, Steven J. Weiss, Jennifer Hall, Ross Clark, Brittany Coffman, Larry Goldstein, Kenlyn Hobley, Todd Dettmer, Craig Lehrman, Melissa Merhege, Bernadette Corum, Tuhama Rihani, Melissa Valdez
DOI: http://dx.doi.org/10.1016/j.ajem.2008.05.003
Published in issue: July 2009
xIn a previous study, no association was found between intimate partner violence (IPV) victims and being an adult who witnessed IPV as a child (ACW).
Theodoros Xanthos, Eleni Bassiakou, Eleni Koudouna, Georgios Rokas, Sotirios Goulas, Ismene Dontas, Evaggelia Kouskouni, Despina Perrea, Lila Papadimitriou
DOI: http://dx.doi.org/10.1016/j.ajem.2008.05.004
Published in issue: July 2009
xFull recovery after cardiopulmonary resuscitation (CPR) is poor. We hypothesized that the coadministration of epinephrine, a β-blocker such as atenolol, and a calcium sensitizer such as levosimendan during CPR would improve survival and postresuscitation myocardial function.
Miquel Sánchez, Beatriz López, Ernest Bragulat, Elisenda Gómez-Angelats, Sonia Jiménez, Mar Ortega, Blanca Coll-Vinent, Oscar Miró
DOI: http://dx.doi.org/10.1016/j.ajem.2008.05.007
Published in issue: July 2009
xTo determine predictors of frequent chest pain unit (CPU) users and to identify characteristics and outcomes of their CPU visits.
José M. De Miguel-Yanes, Javier Muñoz-González, Juan A. Andueza-Lillo, Berta Moyano-Villaseca, Víctor J. González-Ramallo, Ana Bustamante-Fermosel
DOI: http://dx.doi.org/10.1016/j.ajem.2008.05.010
Published in issue: July 2009
xWe had previously demonstrated surviving sepsis campaign guidelines had not had enough impact at our Emergency Department.
Alfred Ngako, Aline Santin, François Hémery, Mirna Salloum, Marie-Jeanne Calmettes, Jérôme Hervé, Jean-Claude Grégo, Eric Roupie, Patrick Maison, Bertrand Renaud
DOI: http://dx.doi.org/10.1016/j.ajem.2008.05.011
Published in issue: July 2009
xTo identify bedside variables that aid in diagnosis of acute coronary syndrome (ACS) and might facilitate rapid triage of patients aged ≥65 years.
Giuseppe De Luca, Paolo Marino
DOI: http://dx.doi.org/10.1016/j.ajem.2008.05.021
Published in issue: July 2009
xTime to treatment has been shown to be a major determinant of mortality in primary angioplasty. The aim of the current study was to perform a meta-analysis of randomized trials evaluating the benefits from pharmacologic facilitation with adjunctive glycoprotein (Gp) IIb-IIIa inhibitors + reduced lytic therapy vs adjunctive Gp IIb-IIIa inhibitors among patients with ST-segment elevation myocardial infarction (MI).
Francis L. Counselman, Catherine A. Marco, Vicki C. Patrick, David A. McKenzie, Luke Monck, Frederick C. Blum, Keith Borg, Marco Coppola, W. Anthony Gerard, Claudia Jorgenson, JoAnn Lazarus, John Moorhead, John Proctor, Gillian R. Schmitz, Sandra M. Schneider
DOI: http://dx.doi.org/10.1016/j.ajem.2009.05.014
Published in issue: July 2009
xThis study was undertaken to describe the current status of the emergency medicine workforce in the United States.
Yunxia Chen, Chunsheng Li
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.001
Published in issue: July 2009
xThe study was conducted to know the significance of brain natriuretic peptide (BNP) for prognosis of septic patients.
Pedro Vela-Zárate, Joseph Varon
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.022
Published in issue: July 2009
xB-type natriuretic peptide level (BNP) was first isolated in porcine brain in 1988 by Sudoh and coworkers [1], showing a relaxation effect on chicken's rectum. Since then, the applications of this neurohumoral marker in the evaluation of cardiac function have grown considerably [2]. The BNP levels increases with volume expansion and pressure overload of the left ventricle, and it is commonly used by clinicians for the diagnosis, stratification, and prognosis of congestive heart failure [3]. In addition, BNP has also been found to be elevated in other clinical syndromes and conditions such as excessive catecholamine release, renal failure, chronic obstructive pulmonary disease, infections, and inflammatory processes [4].
Jared Strote, Monique Mayo, David Townes
DOI: http://dx.doi.org/10.1016/j.ajem.2008.05.020
Published in issue: July 2009
xEmergency department (ED) patients frequently estimate blood loss. How such information should guide evaluation and management, however, is unclear. The objective of this study was to examine ED patient accuracy in estimating blood loss on different surfaces.
Giuseppe De Luca, Ettore Cassetti, Paolo Marino
DOI: http://dx.doi.org/10.1016/j.ajem.2008.04.026
Published in issue: July 2009
xPrevious reports have suggested an impact of patient's risk profile and percutaneous coronary intervention (PCI)–related time delay on the benefits of primary angioplasty as compared with fibrinolysis. However, several factors, such as inappropriate interpretation and definition of delays, missing currently available trials, and arguable risk-benefit analysis, limit the value of these reports. Thus, the aim of the current review is to assess whether the prognostic impact of PCI-related time delay may vary according to patient's risk profile, presentation delay, and type of lytic therapy.
James Hoekstra, Marc Cohen, Robert Giugliano, Christopher B. Granger, Paul A. Gurbel, Judd E. Hollander, Steven V. Manoukian, Jorge F. Saucedo, Charles V. Pollack Jr
DOI: http://dx.doi.org/10.1016/j.ajem.2008.04.032
Published in issue: July 2009
xPublication of the updated, evidence-based American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for the Management of Patients with unstable angina (UA) and non–ST-segment elevation myocardial infarction (NSTEMI) in August 2007 marked yet another incremental shift in best management practices for this important patient population. Many of the new and reinforced recommendations are relevant to practice in the ED. In view of the new guidelines, as well as an abundance of clinical trial evidence that has recently become available, a roundtable involving experts on acute coronary syndromes from cardiology and emergency medicine was convened on October 25, 2007, to examine current issues in the care of patients with UA/NSTEMI from a variety of perspectives.
Xiaoti Xu, Kwan Lau, Breena R. Taira, Adam J. Singer
DOI: http://dx.doi.org/10.1016/j.ajem.2008.05.015
Published in issue: July 2009
xEach year, there are more than 1 million skin tears among the elderly and disabled. Because of their fragile nature, management of skin tears can be very challenging. Methods of wound closure should minimize additional trauma to the skin and promote an optimal wound healing environment while minimizing the risk of infection. The current article reviews the etiology, risk factors, classification, and therapeutic options for treating skin tears. We also review preventive measures to help reduce the incidence of skin tears.
Jose Victor Nable, William Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2008.05.025
Published in issue: July 2009
xAcute myocardial infarction (AMI) is a not uncommon diagnosis in the emergency department. During ST-segment elevation AMI (STEMI), the electrocardiogram (ECG) typically follows a progression of abnormality, beginning with hyperacute T waves and culminating with ST-segment elevation; pathologic Q waves can appear early and/or late in the process. Other findings include T-wave inversion and ST-segment depression which can occur before, during, or after the STEMI event. The evolution of ECG through these changes can occur rapidly after coronary artery occlusion.
Jared Strote, H. Range Hutson
DOI: http://dx.doi.org/10.1016/j.ajem.2009.05.017
Published in issue: July 2009
xWe appreciate the work presented in the recent study of Ho et al [1] entitled “Prolonged TASER Use on Exhausted Humans Does Not Worsen Markers of Acidosis.” Their findings add to a growing literature showing that electrical weapons appear reasonably safe under certain conditions and in certain populations.
Jeffrey D. Ho, Donald M. Dawes
DOI: http://dx.doi.org/10.1016/j.ajem.2009.05.018
Published in issue: July 2009
xWe thank the writers of this letter for their interest in our work and appreciate the opportunity to offer a reply [1]. We agree that our study in question has added to the growing body of literature that seems to demonstrate that the TASER X26 Conducted Electrical Weapon (CEW) exhibits characteristics that are interpreted as reasonably safe [2]. We especially believe this to be true given that its intended purpose is to help control agitated or potentially violent individuals. This, by definition, is always going to involve a high risk of significant injury or death to the subject, the law enforcement officers, or both, regardless of tools or tactics used.
Peyman Soltani, Christopher M. Malozzi, Bernard Abi Saleh, Bassam Omar
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.037
Published in issue: July 2009
xA 64-year-old man with severe emphysema presented to our institution with sudden onset of shortness of breath due to tension pneumothorax. His electrocardiogram revealed new extreme right axis deviation, which resolved after treatment of the pneumothorax. This case highlights one of several previously described manifestations of tension pneumothorax on an electrocardiogram. Although these changes are not specific, pneumothorax should be in the differential of patients presenting with shortness of breath and new right axis deviation on electrocardiogram.
Nese Colak Oray, Basak Bayram, Sedat Yanturali, Onder Limon, Selim Suner
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.007
Published in issue: July 2009
xRenal infarction is a rarely seen clinical condition with a nonspecific presentation. It often presents as renal colic or an acute abdomen and is initially misdiagnosed. In patients who present to the emergency department (ED) with abdominal pain or flank pain resistant to treatment, renal infarction must be considered, especially if they have thromboembolic risk factors. Abdominal computerized tomography with intravenous contrast is the choice of imaging because of its high sensitivity.
Hui Yue, Feihu Zhou, Hui Liu, Hongjun Kang, Liang Pan, Bin Gu, Qing Song
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.040
Published in issue: July 2009
xThe study aimed to report a case of exertional heat stroke with multiple organ dysfunction successfully treated by early use of cold hemofiltration. The patient's hyperthermia was refractory to conventional cooling procedures, and he developed renal dysfunction. We applied early, cold continuous hemofiltration (room temperature [28°C] for the first 2.5 hours and 35°C thereafter) at a flow rate of 3 to 4 L/h. The patient's body temperature fell below 38.0°C within 2.5 hours and was kept below 38.0°C by use of cold hemofiltration.
Cristina Vincentelli, Enrique G. Molina, Morton J. Robinson
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.042
Published in issue: July 2009
xOverwhelming postsplenectomy infection (OPSI) is a low-incidence entity with a high mortality rate despite aggressive therapy. Although initial symptoms may be mild and nonspecific, it can progress rapidly to Waterhouse-Friderichsen syndrome with full blown septic shock and disseminated intravascular coagulation (DIC). Overwhelming postsplenectomy infection is known to occur at any time after splenectomy, even in patients who have received pneumococcal immunization and/or chemoprophylaxis. Although the term OPSI gives the impression of a “postsurgical” complication, it has been seen in association with conditions predisposing to functional hyposplenism and in children with congenital asplenia.
Ming-Tso Yan, Sung-Seng Yang, Hung-Yi Chu, Shih-Hua Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.044
Published in issue: July 2009
xA 40-year-old woman presented to emergency department with progressive muscle weakness, unstable gait, difficulty in concentrating, and amnesia over 6 months. Her neurologic examination showed wide-based gait and truncal ataxia. Brain magnetic resonance imaging revealed diffuse atrophy of cerebral cortex, cerebellar hemisphere, and vermis. Blood biochemistry showed hyperchloremia (134 mmol/L) and negative anion gap (sodium 141, bicarbonate 20 mmol/L), pointing to the diagnosis of bromide intoxication confirmed by a higher and toxic serum bromide level (14.4 mmol/L).
Arif Wahab, Muzaffar U. Rabbani, Shagufta Wahab, Rizwan A. Khan
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.045
Published in issue: July 2009
xAluminium phosphide poisoning is one of the commonest agents of suicidal poisoning in countries where its availability is not tightly regulated. Aluminium phosphide poisoning is associated with numerous complications usually related to the inhibition of cytochrome oxidase and lipid peroxidation of membranes; however, physical complications are few and far between. Spontaneous self-ignition is one such complication that is very rarely encountered and reported. In this case report, we share our experience in one such case.
Andrew S. Bomback, John T. Woosley, Abhijit V. Kshirsagar
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.002
Published in issue: July 2009
xThe rising prevalence of chronic and end-stage kidney disease is accompanied by a concomitant rising risk of hyperkalemia in these patients. Sodium polystyrene sulfonate (Kayexalate, sanofi-aventis, Bridgemater, NJ) is a commonly used treatment of hyperkalemia. We present a case of Kayexalate-induced colonic necrosis as a reminder of this rare, but potentially avoidable, toxicity of a commonly used medication.
Meng-Kai Huang, Chien-Chih Chen, Tzong-Luen Wang, Yi-Kung Lee, Yung-Cheng Su
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.003
Published in issue: July 2009
xAcute peripheral arterial occlusive disease caused by emboli is an uncommon but limb-threatening disease. Without timely diagnosis and prompt management, irreversible damage to the function of limbs is inevitable. We report a patient with acute onset of paraplegia. The initial impression was neurologic insult. However, the relative low blood pressure and pale appearance of bilateral lower limbs made us search for other possible diagnoses. Bedside duplex ultrasound was performed and revealed bilateral femoral artery occlusion.
Alexandra Chomut, Rebecca Jeanmonod, Donald Jeanmonod, Robert Ward
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.004
Published in issue: July 2009
xCarotid artery dissection is a major cause of ischemic stroke in young adults, usually preceded by trivial to significant trauma. When focal neurologic deficit or classic traumatic history is absent, the diagnosis can be elusive. We describe a case of bilateral carotid artery dissection in a 36-year-old woman with no antecedent cervical trauma or manipulation. Because the patient presented without neurologic deficit, diagnosis was not made on the patient's first presentation to the emergency department.
Youichi Yanagawa, Yu Hongo, Hiroshi Shiozaki, Keiko Kamakura, Masahiro Sonoo, Masakatsu Motomura
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.005
Published in issue: July 2009
xA 69-year-old male who presented in a coma due to sudden respiratory arrest was transferred to our hospital. After endotracheal intubation with manual ventilation, he became alert and his neurologic findings were within the normal range, except for palsy of the respiratory muscles. Biochemical analyses of the blood and brain computed tomography failed to indicate the cause of the respiratory arrest. An edrophonium test did not improve the respiratory arrest. An urgent electromyogram at the dorsal interossei, biceps, and sternocleidomastoideus muscle and a repetitive nerve stimulation test at the trapezius and deltoid muscle were also negative on the first hospital day.
Philippe Gottignies, Tarek El Hor, Joseph Kengni Tameze, Anatol Basaula Lusinga, Jacques Devriendt, Philippe Lheureux, David De Bels
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.008
Published in issue: July 2009
xWe present the case of a 77 year-old man who voluntarily ingested 5 grams of crushed roots from an Aconit napel plant. Aconitine is the main alkaloid present in this plant. It is highly toxic and its poisoning induces severe cardiac and neurologic disturbances. Severe ventricular arrhythmias are particularly difficult to treat and no standard protocol is available. In vitro experiments on isolated cells or heart tissues have used aconitine to induce action potentials and magnesium to stop them. We successfully used magnesium sulfate as only antiarrhythmic agent to treat the severe arrhythmias in this patient.
Solon Solomon, Angelos Pefanis, Georgios S. Papaetis, Charilaos Ginos, Prokopis Kythreotis, Apostolos Achimastos
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.010
Published in issue: July 2009
xIdiopathic systemic capillary leak syndrome (Clarkson's disease) is a disease of unknown etiology, characterized by transient, recurrent episodes of capillary hyperpermeability that results in leakage of fluids and proteins from the intravascular to extravascular space. Clinically, it presents with hypotension, hemoconcentration, and hypoalbuminemia. After a few days, the capillary permeability normalizes and the extravasated fluids and proteins return to the blood circulation. The present case report describes a previously healthy, 50-year-old man who experienced recurrent episodes of abdominal pain and hypovolemic shock.
Giuseppe Famularo, Laura Gasbarrone, Giovanni Minisola, Claudio De Simone
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.011
Published in issue: July 2009
xHeparin-induced thrombocytopenia (HIT) carries an increased risk of venous or arterial thrombosis. However, thrombosis is recognized in less than a half of those patients, and HIT is almost rare during treatment with enoxaparin or other low-molecular-weight heparins.
Charles J. Fasano, Adam K. Rowden
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.017
Published in issue: July 2009
xWe present a case of an 82-year-old African American male who presented to the ED with rapaglinide-induced hypoglycemia who was successfully treated with the administration of subcutaneous octreotide. Repaglinide is an oral agent for the treatment of type 2 diabetes. It is a representative of meglitinide class of medications—a relatively new therapeutic option for physicians to treat type 2 diabetes of which only Prandin repaglinide and Starlix natglinide are available in the United States. Numerous case reports and a recently published prospective trial have demonstrated the clinical benefit of octreotide for the treatment of hypoglycemia from both acute and chronic sulfonylurea toxicity.
Huseyin Ozkurt, Fikriye Yilmaz, Nagihan Bas, Halil Coskun, Muzaffer Basak
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.020
Published in issue: July 2009
xAcute colonic pseudo-obstruction (ACPO), the so-called Ogilvie's syndrome, is a rare condition and is characterized by the sign of large-bowel obstruction without a mechanical cause. Acute colonic pseudo-obstruction is a life-threatening digestive complication and is usually observed in critically ill patients. It may cause ischemic necrosis and colonic perforation with a mortality rate as high as 50%. The most common conditions associated with it are medical or surgical ones such as trauma, burns, neurologic disorders, or series infection.
Hueng-Chuen Fan, Ann-Chin Wang, Chung-Ping Lo, Kai-Ping Chang, Shyi-Jou Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.021
Published in issue: July 2009
xCarbon monoxide intoxication may affect cerebral cortex, cerebral white matter, and basal ganglia, but the damage of a cerebellum sparing cerebrum is rare and less attention in patients with carbon monoxide poisoning. Here, we present an 8-year-old girl who initially presented in a comatose status with a high level of carboxyhemoglobin (19.8%). Her brain computed tomography and magnetic resonance imaging showed a diffuse hypodense lesion within her cerebellum. Her youth at the time of exposure and immediate hyperbaric oxygen therapy may account for her good recovery.
Tze-Kiong Er, Bin-Hong Cheng, Miguel Ángel Ruiz Ginés
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.022
Published in issue: July 2009
xCerobrospinal fluid (CSF) analysis is a set of laboratory tests that examine a sample of the fluid surrounding the brain and spinal cord. The purpose of a CSF analysis is to diagnose medical disorders that affect the central nervous system such as meningitis, metastatic tumors, syphilis, hemorrhaging or multiple sclerosis. In our stat laboratory, stat examination of CSF includes visual observation of color and clarity of tests for glucose, protein, lactate, red blood cell count, white blood cell count with differential, Pandy test, acid-fast stain and Gram stain.
Alfonso Lagi, Simona Spini, Sergio Gallori
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.029
Published in issue: July 2009
xA 53-year-old male patient came to our observation for an unusual association between cerebral vein thrombosis (CVT) and Guillain-Barrè syndrome (GBS). Headache and focal neurologic deficit of the facial and hypoglossal cranial nerves were the main clinical findings on presentation at the emergency department. The presence of CVT, as suggested by initial CT scan, was confirmed by subsequent magnetic resonance imaging (MRI) and low-molecular-weight heparin treatment was begun.
Dan Quan, Anne-Michelle Ruha
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.033
Published in issue: July 2009
xBlack widow spider, or Latrodectus mactans, bites often cause patients to seek medical attention for treatment of pain. Severe envenomations may also be associated with hypertension, tachycardia, and muscle spasms. Priapism has infrequently been reported in association with these envenomations. We report a case of a 7-year-old boy who was envenomated by an L mactans spider, resulting in prolonged pain, hypertension, and priapism. The use of equine-derived L mactans antivenom led to immediate resolution of pain and hypertension, but priapism was slow to resolve.
Tze-Kiong Er, Po-Chi Chen, Jih-Jin Tsai
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.036
Published in issue: July 2009
xIn this article, we report a 38-year-old man who presented to our emergency department with an infection of Plasmodium ovale malaria. Accurate diagnosis of the Plasmodium species is essential for adequate treatment of malaria. Peripheral smear examination for malarial parasite is the gold standard in confirming the diagnosis of malaria. Thick and thin smears prepared from the peripheral blood are used for this purpose. To identify Plasmodium species, microscopic examination of Wright-Giemsa stain blood smears has been the diagnostic method of choice.
DOI: http://dx.doi.org/10.1016/S0735-6757(09)00284-8
Published in issue: July 2009
DOI: http://dx.doi.org/10.1016/S0735-6757(09)00285-X
Published in issue: July 2009
DOI: http://dx.doi.org/10.1016/S0735-6757(09)00286-1
Published in issue: July 2009
DOI: http://dx.doi.org/10.1016/S0735-6757(09)00287-3
Published in issue: July 2009
