James M. Dargin, Casey M. Rebholz, Robert A. Lowenstein, Patricia M. Mitchell, James A. Feldman
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.001
Published online: October 26 2009
xWe determined the survival and complications of ultrasonography-guided peripheral intravenous (IV) catheters in emergency department (ED) patients with difficult peripheral access.
Ibrahim Abu-Kishk, Eran Kozer, Lee H. Goldstein, Sarit Weinbaum, Adina Bar-Haim, Yoav Alkan, Irena Petrov, Sandra Evans, Yariv Siman-Tov, Matitiahu Berkovitch
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.012
Published online: October 26 2009
xAcute iron intoxication is associated with depletion of reduced glutathione in hepatocytes and changes in the glutathione system enzymes. We hypothesized that treatment with N-acetylcysteine (NAC), a glutathione reducing agent and an antioxidant, would reduce mortality in acute iron intoxication. We used a rat model to test this hypothesis. Male rats were assigned to 4 groups. Group 1 received 400 mg/kg elemental iron by oral gavage, group 2 received the same dose of iron followed by NAC, group 3 received NAC only, whereas group 4 received distilled water.
Peter Stefanski, John W. Hafner, Shanda L. Riley, Kharmene L.Y. Sunga, Timothy J. Schaefer
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.016
Published online: October 26 2009
xThe study aimed to determine the diagnostic usefulness of the genital Gram stain in an emergency department (ED) population.
Troy Madsen, Philip Bossart, Joseph Bledsoe, Kurt Bernhisel, Melissa Cheng, Teanu Mataoa, James Bartlett, Angela McKellar, Wyatt Rivas, Nichole Quick
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.021
Published online: October 21 2009
xFew studies have evaluated emergency department (ED) observation unit chest pain protocols for optimal patient characteristics and admission rates. At our 35 000-visits/y ED, we implemented a chest pain protocol for our observation unit that allowed emergency physicians to admit patients with known coronary artery disease (CAD).
Christopher Fee, Joshua P. Metlay, Carlos A. Camargo Jr, Judith H. Maselli, Ralph Gonzales
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.023
Published online: October 22 2009
xThe study aimed to determine if emergency department (ED)–administered antibiotics for patients discharged home with nonpneumonia acute respiratory tract infections (ARIs) have increased since national pneumonia performance measure implementation, including antibiotic administration within 4 hours of arrival.
Erkan Göksu, Vefa Sayraç, Cem Oktay, Mutlu Kartal, Mehmet Akcimen
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.024
Published online: October 26 2009
xNone of the techniques used for confirmation of endotracheal tube (ET) placement are proven reliable 100% of the time. The purpose of our study is to determine whether ultrasound can accurately detect the passage of ET through the trachea and esophagus and to see whether this visualization is augmented with the use of a metal stylet.
Go-Shine Huang, Mei-Hua Hu, Chian-Her Lee, Chien-Sung Tsai, Tso-Chou Lin, Chi-Yuan Li
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.026
Published online: October 26 2009
xPart of platelet function involves aggregation and activation. Activation leads to platelet P selectin expression and platelet-leukocyte aggregation. Hypertonic saline inhibits platelet aggregation, although the effects of hypertonic saline on platelet activation are not known. We evaluated the effects of hypertonic saline on platelet activation as measured by platelet P selectin expression and platelet-leukocyte aggregation.
Marcus Eng Hock Ong, Yiong Huak Chan, Wan Ping Lin, Wan Ling Chung
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.027
Published online: October 26 2009
xThe aim of the study was to validate the use of the ABCD2 score for the prediction of stroke after transient ischemic attack (TIA) in patients presenting to the emergency department (ED). The ABCD2 scoring is based on 5 factors as follows: age of at least 60 years; blood pressure of at least 140/90 mm Hg; clinical features such as unilateral weakness and speech impairment alone; duration of at least 60 minutes or 10 to 59 minutes; and diabetes.
Donald M. Dawes, Jeffrey D. Ho, Robert F. Reardon, James R. Miner
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.033
Published online: October 26 2009
xSeveral animal studies have shown that the TASER X26 (TASER International, Scottsdale, Ariz) conducted electrical weapon can electrically capture the myocardium when discharged on the thorax. These results have not been reproduced in human echocardiographic studies. A primary limitation of those human studies is that the TASER device was connected by taping the wires into conductive gel on the skin surface of the thorax. This study overcomes those limitations. In this study, a training instructor discharged a TASER X26 into the chests of 10 subjects from a distance of 7 ft so that a 5-second discharge could be administered through the probes as in field exposures.
Nathan L. Timm, Richard M. Ruddy
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.035
Published online: October 26 2009
xThe aim of this study is to describe patient demographics in a pediatric emergency department (PED) during low, average, and high daily census days.
Zeynep Cakir, Sahin Aslan, Zuhal Umudum, Hamit Acemoglu, Ayhan Akoz, Sule Turkyılmaz, Nurınnısa Öztürk
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.032
Published online: October 26 2009
xCarbon monoxide (CO) toxicity may cause persistent injuries in tissues sensitive to hypoxia. Neuropsychiatric sequelae may be observed in about 67% of cases after severe CO exposure.
Patrick Crocker, Omid Zad, Truman Milling, Karla A. Lawson
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.011
Published online: October 9 2009
xThe aim of the study was to examine the interactions between alcohol, bicycle helmet use, experience level, riding environment, head and brain injury, insurance status, and hospital charges in a medium-sized city without an adult helmet law.
Eric A. Gross
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.013
Published online: October 26 2009
xPatients who sustain traumatic vertebral fractures often have multiple other associated injuries. Because of the mechanisms of injury, many of these patients routinely undergo chest computed tomographic (CCT) and/or abdominal/pelvic computed tomographic (APCT) scans to diagnose intrathoracic or intra-abdominal injuries. These scans are routinely reformatted to provide more detailed imaging of the spine. Although the patient does not incur more radiation, the charges associated with this are significant.
Francesca L. Beaudoin, Arun Nagdev, Roland C. Merchant, Bruce M. Becker
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.015
Published online: November 4 2009
xThe primary objective of this study was to determine the feasibility of ultrasound-guided femoral nerve blocks in elderly patients with hip fractures in the emergency department (ED). The secondary objective was to examine the effectiveness of this technique as an adjunct for pain control in the ED.
Michael B. Stone, Arun Nagdev, Michael C. Murphy, Craig A. Sisson
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.019
Published online: October 26 2009
xUltrasound guidance decreases complications of central venous catheter (CVC) placement, but risks of arterial puncture and inadvertent arterial catheter placement exist. Ultrasound-assisted detection of guidewire position in the internal jugular vein could predict correct catheter position before dilation and catheter placement.
Shang-Lin Chou, Ming-Yueh Chou, Wei-Fong Kao, David H.T. Yen, Liang-Yu Yen, Chun-I Huang, Chen-Hsen Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.022
Published online: October 21 2009
xOne of the oldest Chinese herbal medicine, bajiaolian is widely used in traditional therapy. In Taiwan, bajiaolian is the fifth highest cause of poisoning among herbal medicines. The diagnosis is difficult because physicians are unfamiliar with this medicine's multiple presentations in different stages of intoxication.
Adit A. Ginde, Janice A. Espinola, Ashley F. Sullivan, Frederick C. Blum, Carlos A. Camargo Jr
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.028
Published online: October 26 2009
xThe aim of the study was to evaluate use of physician assistants (PAs) and nurse practitioners (NPs) in US emergency departments (EDs).
Nathan P. Charlton, David T. Lawrence, William J. Brady, Mark A. Kirk, Christopher P. Holstege
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.029
Published online: October 7 2009
xDrug-induced prolongation of the QT interval is frequently encountered after medication overdose. Such toxicity can result in degeneration to torsades de pointes (TdP) and require overdrive pacing. We present 3 cases in which intentional medication overdose resulted in QTc prolongation with subsequent degeneration to TdP. Despite appropriate care, including magnesium therapy, each case required overdrive pacing for resolution of TdP. Although rarely encountered, patients with drug-induced TdP can be successfully managed with overdrive pacing.
Wan-Ching Lien, Ai-Wey Ong, Jen-Tang Sun, Ming-Tse Tsai, Ting-I Lai, Yueh-Ping Liu, Shyr-Chyr Chen, Hsiu-Po Wang
DOI: http://dx.doi.org/10.1016/j.ajem.2009.08.024
Published in issue: January 2010
xPyometra is an uncommon disease, referring to accumulation of pus in the uterine cavity [1]. It mostly occurs in postmenopausal women. The classic symptoms of pyometra (lower abdominal pain, purulent vaginal discharge, and enlarged uterus) are nonspecific and easily misdiagnosed as other causes of acute abdomen [1-3]. We report 7 cases with pyometra during a 5-year period. Four cases were diagnosed as urinary tract infection (UTI) initially, and pyometra was diagnosed by imaging studies. All had favorable outcomes, but 1 died because of delayed diagnosis.
Cemil Caliskan, Ozer Makay, Ozgur Firat, Alper Uğuz, Erhan Akgün, Mustafa A. Korkut
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.001
Published in issue: January 2010
xSecretory diarrhea and hypokalemia due to villous adenomas are known as the McKittrick-Wheelock syndrome. It was first described in 1954, by McKittrick and Wheelock [1] as a carcinoma of the colon. We report 4 cases with this rare syndrome and want to draw attention to this question: is it really rare?
Gino Soldati, Sara Sher, Roberto Copetti
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.003
Published in issue: January 2010
xWe evaluated with interest the data from the study of Platz et al [1] recently published in the American Journal of Emergency Medicine. We agree with the high sensitivity attributed to chest ultrasonography in the diagnosis of pneumothorax (PNX), greater than that of chest radiography. We however disagree with the idea of a potential loss of accuracy toward diagnosis of PNX in case of pulmonary contusion. Furthermore, we consider incomplete an approach to an ultrasonographic diagnosis of PNX solely based on the presence or absence of lung sliding and that does not consider the presence of lung points [2] (specific of PNX) or of comet tail artifacts (B-lines) [3].
Elke Platz, Rita Cydulka, Sandra Werner, Jessica Resnick, Robert Jones
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.004
Published in issue: January 2010
xWe would like to thank the readers for their insightful comments. We agree that a combination of several sonographic findings and techniques, such as lung sliding, comet tails, lung point, M-mode, power Doppler, and others, may be needed to confidently rule out the presence of a pneumothorax. However, evaluating these combinations was not the objective of our study. Our study was designed to specifically evaluate whether lung sliding is affected by the presence of pulmonary contusions. This question is of interest because many clinicians consider lung sliding the mainstay of the sonographic evaluation of pneumothorax.
Vui Heng Chong
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.023
Published in issue: January 2010
xI read with interest the publication by Jacobson et al [1] in the recent issue of the journal on confirmatory radiography post-percutaneous feeding tube (PFT) replacement. They highlighted 2 important issues on PFT replacement; the role of radiography and the importance of tract trauma. Overall, they did not show any impact of routine post replacement radiography. Like many other centers, we do not use radiography at all. In our setting, the only time radiography had been used post PFT replacement, tube misplacement was missed.
Yen-Chieh Wang, Chih-Ming Lin, Shao-Kuan Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2009.10.008
Published in issue: January 2010
xFree air demonstrated in supine abdominal radiographs (kidneys, ureters, bladder, or KUB) always suggest potential life-threatening illnesses, yet it is usually overlooked by physicians in modern times. We read with great interest the article of Chiu et al [1], which analyzed in details a variety of intraperitoneal free air signs of hollow organ perforation on many of supine KUB in a recent issue of The American Journal of Emergency Medicine. The authors categorized 4 subgroups of free air signs, including bowel-related, right upper quadrant, peritoneal ligament-related, and other signs; thus, readers are able to learn these classic features systemically through this article.
Erkan Goksu, Cenker Eken, Ozgur Karadeniz, Oguz Kucukyilmaz
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.021
Published online: November 23 2009
xConsumption of herbal remedies has become prevalent throughout the world and can be found easily over the counter. Many times, these are exempt from safety controls, and the consumption may cause adverse effects and complications. In this letter, we present a case of hypoglycemia due to the ingestion of dandelion.
Jian-Liung Wang, Ming-Jer Hsieh, Cheng-Hung Lee, Chun-Chi Chen, I-Chang Hsieh
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.023
Published online: November 23 2009
xSpontaneous dissection of the celiac artery is uncommon and is rarely considered in patients with acute abdomen. However, this condition has been reported frequently in recent years. Subjects are predominantly male and younger than 50 years. Mortality is reportedly high if dissection extends to the hepatic artery and warranted operative or endovascular treatment. Conservative treatment is justified in patients with isolated celiac dissection without bowel ischemia or hemorrhage. This report describes a male patient with celiac dissection presenting with left upper abdomen and chest pain, which subsided after conservative treatment with antihypertensive agents.
Tien-Fa Hsiao, Yenn-Hwei Chou
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.024
Published online: November 23 2009
xStercoral perforation of colon is an extremely rare but life-threatening cause of acute abdomen. Typically, the clinical manifestation is generalized peritonitis, and the diagnosis was made only at laparotomy. This report concerns an illustrative case of stercoral perforation of sigmoid colon that mimicked acute appendicitis, and correct diagnosis was established preoperatively by computed tomography.
Gian Luca Casoni, Sara Tomassetti, Angelo Coffa, Claudia Ravaglia, Venerino Pol
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.027
Published in issue: January 2010
xNegative pressure pulmonary edema, a well-recognized phenomenon, is the formation of pulmonary edema after an acute upper airway obstruction, but pulmonary hemorrhage associated with negative-pressure pulmonary edema is rare. Vigorous inspiratory efforts against an obstructed upper airway (the modified Mueller maneuver) led to the development of acute negative-pressure pulmonary edema. We describe a case of negative pressure pulmonary hemorrhage induced by a candy. The patient required short-term ventilation with continuous positive airway pressure (12 cm H2O) by face mask with rapid resolution of clinical and radiological findings.
Yin-Chun Chang, Chih-Hsien Wang, Yin-Yi Han, Wen-Je Ko, Yung-Chie Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.032
Published in issue: January 2010
xCoronary artery injury after blunt chest injury is rare, and traumatic coronary artery dissection is even rarer. A 24-year-old man, who had previously been healthy without risk factors for coronary artery disease, had a motorcycle accident resulting in mandible and left femoral shaft fractures, with only minor chest wall contusion. Operations for interdental wiring of the mandible, left femoral shaft open reduction, and internal fixation with interlocking nails were performed on the third day. Arterial desaturation was noted immediately after extubation in the operation room.
Charlotte Girard, Christine Payen, Xavier Tchenio, Laurent Holzapfel, Jacques Descotes
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.029
Published in issue: January 2010
xWe report the first case ever published of norepinephrine overdose. A 43-year-old female patient admitted in the emergency department for abdominal pain inadvertently received an intravenous bolus injection of 16 mg norepinephrine instead of the scheduled antispasmodic drug phloroglucinol. She immediately experienced severe tachycardia, hypertensive crisis, peripheral vasoconstriction, and acute cardiac ischemia. Although the initial symptoms subsided within a few minutes, the patient subsequently developed hypotension, severe pulmonary edema, and right cardiac failure.
Daniel Jimenez, Paul Allegretti, Kathy Kallal
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.031
Published in issue: January 2010
xAdult Still disease is a rare inflammatory disorder affecting approximately 2 per million per year. This disorder is characterized by daily spiking fevers, arthritis, and a rash. Early recognition, diagnosis, and treatment can reduce the possibility of long-term complications as well as potentially life-threatening organ damage. Because there are no specific tests available to make the diagnosis of Adult Still disease, a thorough understanding of the specific diagnostic criteria as well as a good physical examination is crucial in making the correct diagnosis.
Nurettin Özgür Doğan, Erkan Temizkan, Fikret Bildik, Ahmet Demircan, Ayfer Keleş
DOI: http://dx.doi.org/10.1016/j.ajem.2009.03.009
Published in issue: January 2010
xMotor vehicle crash victims presenting with ischemic stroke are rare in emergency departments when compared with victims of accidents resulting in intracranial hemorrhagical events. Moreover, traumatic internal carotid artery dissection, which is an important cause of ischemic stroke in motor vehicle trauma patients, is a complication of severe blunt head or neck trauma. We report 2 cases presenting with cerebral infarction after experiencing motor vehicle trauma, which were caused by traumatic carotid artery injuries and managed by different strategies.
Masahiro Mizobuchi, Shigeru Nakamura, Hiromi Muranishi, Makoto Utsunomiya, Atsushi Funatsu, Tomoko Kobayashi, Yoshihisa Enjoji
DOI: http://dx.doi.org/10.1016/j.ajem.2009.03.011
Published in issue: January 2010
xA case of successful recovery from cardiopulmonary arrest and submersion is reported. The victim collapsed due to ventricular fibrillation owing to acute coronary syndrome with double coronary vessel occlusion and was found nearly drowned in a hot bathtub. Although he was resuscitated, he had been hypoxic because of aspiration. Two hours after return of spontaneous circulation, he was transferred to our institution with hypoxia. No attempt of cerebral protection was done before admission. Therapeutic hypothermia was initiated with a veno-venous extracorporeal membrane oxygenation system by direct cooling of circulating blood.
Ozgur Albuz, Nail Ersoz, Zafer Kilbas, Ismail Hakki Ozerhan, Ali Harlak, Ozcan Altinel, Taner Yigit
DOI: http://dx.doi.org/10.1016/j.ajem.2009.03.013
Published in issue: January 2010
xIn this study, a rare case of primary omental torsion was reported. A 20-year-old man presented with right lower quadrant pain and nausea. Physical examination revealed abdominal tenderness in the right iliac fossa, but muscular rigidity was not found. Increased white blood cell count (23,400/mL) was noted in the whole blood count. The patient underwent laparotomy with an initial diagnosis of acute appendicitis. The abdominal exploration revealed a normal appendix and infarcted omentum secondary to torsion on the long axis.
Nicolas Clementy, Olivier Genee, Jerome Fichet, Laurens Mitchell-Heggs, Benoit Fremont, Jonathan Banayan, Bernard Charbonnier, Dominique Perrotin, Emmanuelle Mercier
DOI: http://dx.doi.org/10.1016/j.ajem.2009.03.015
Published in issue: January 2010
xA 78-year-old woman presented with abdominal pain in a suspicion of ethanol intoxication. Baseline 12-lead electrocardiogram showed a major ST-segment elevation suggestive of an acute myocardial infarction. Troponin I was 6.6 ng/mL. Transthoracic echocardiography found normal left ventricular ejection fraction, with no wall motion abnormality or pericardial effusion. Then, amylase and lipase serum levels were 1199 and 3873 IU, respectively, and primary coronary angiography was cancelled. At 48 hours, abdominal CT scan confirmed the diagnosis of severe acute pancreatitis.
Luciano Delgado-Plasencia, Nuria Manes-Bonet, Esther Torres Monzón
DOI: http://dx.doi.org/10.1016/j.ajem.2009.03.020
Published in issue: January 2010
xIngestion of a sharp foreign body can lead to esophageal perforation that is related with high comorbidity. To avoid such complications, early and adequate management of these cases is essential. Currently, the most commonly used extraction technique is endoscopy.
Nils Henninger, Nabil Ahmad, Jane G. Morris
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.008
Published in issue: January 2010
xAbstract
Kuo-Chih Chen, Tzu-Yao Hung, Te-Hao Wang, Tzong-Luen Wang, Chee-Fah Chong
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.006
Published in issue: January 2010
xThe clinical symptoms of adult intussusception are often vague and nonspecific. As a result, its diagnosis is frequently delayed in most cases. Ultrasound is well recognized as an important adjunct in the diagnosis of pediatric intussusception. However, its utility in the detection of adult intussusception is not well established. We report a 79-year-old man who presented to the emergency department with epigastric pain and bilious vomiting for 2 days. Shortly after his arrival, the diagnosis of jejunojejunal intussusception was made with bedside ultrasound performed by the emergency physician.
Allison M. Finley, Michael S. Beeson
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.026
Published in issue: January 2010
xA 44-year-old man presented to the emergency department with jaw pain and swelling. He was found to have osteomyelitis of the mandible caused by Actinomyces species. Although rare, actinomycosis of the head and neck is treatable and curable and should not be forgotten on the differential diagnosis list in the typical patient population with appropriate symptoms.
Meng-Huan Wu, Yu-Che Chang, Cheng-Hsien Wu, Shih-Ching Kang, Jen-Tse Kuan
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.031
Published in issue: January 2010
xAcute gastric volvulus is a rare disease that requires a high index of suspicion for diagnosis and rapid treatment. Many cases occur with a paraesophageal hernia or diaphragmatic eventration. It is potentially life threatening because delayed diagnosis and treatment may result in perforation, infarction, and other lethal results. The signs and symptoms of acute gastric volvulus include abdominal pain and distention, especially in the upper abdomen, and vomiting with progression to nonproductive retching.
Benjamin Burt, Michael Jamieson, Brian Sloan
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.040
Published in issue: January 2010
xThe authors report 2 patients who experienced medial wall blowout fractures. Both patients presented with significant restriction of upgaze, mild proptosis, and crepitus of the upper lid. Computed tomography revealed significant pneumo-orbita filling the superior orbit with inferior displacement of the muscle cone and subcutaneous emphysema. No floor fractures were seen in either patient, but in both cases, the medial wall was breached and was almost certainly the source of the intraorbital air.
Christos D. Karkos, Dimitrios G. Karamanos, Konstantinos O. Papazoglou, Dimitrios N. Papadimitriou, Neophytos Zambas, Ioannis N. Gerogiannis, Thomas S. Gerassimidis
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.033
Published in issue: January 2010
xAxillary artery transection after recurrent anterior shoulder dislocation is extremely rare. We present 2 such patients. The first, a 62-year-old man, presented with acute ischemia and a large hematoma in the axilla and chest wall. The second, a 63-year-old man, had a pseudoaneurysm and palpable peripheral pulses. Both underwent urgent computed tomography, which confirmed the clinical diagnosis, and the patients were taken to the operating room. In the first patient, intraoperative angiogram through both the brachial and the femoral route showed complete disruption of the axillary artery rendering an endovascular approach not possible.
Homer C. Tien, Sandro Scarpellini, Jeannie Callum, Lorraine Tremblay, Sandro Rizoli
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.027
Published in issue: January 2010
xRecent military experience suggests that transfusing fresh frozen plasma and packed red cells in a 1:1 ratio may improve survival in exsanguinating trauma patients. We report the case of a single patient who required massive transfusion after suffering a single gunshot wound. Initially, the patient received FFP:PRBC in 1:2 ratio, but this did not correct laboratory parameters except for INR and clotting factor VII level, which were likely normalized by treatment with recombinant activated factor VII.
Claire Uebbing, Joseph Miller, Clifford Arnold, Mark Walsh
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.036
Published in issue: January 2010
xA 17-year-old girl experienced a head-to-head collision on the soccer field and presented several hours later with central vision loss. Eye examination findings revealed macular edema consistent with whiplash maculopathy. Symptom resolution required 3 months with no intervention necessary. Whiplash maculopathy is a little-known disease pathology in which the proposed mechanism of action involves traction on the eye's vitreous base. Rapid acceleration and deceleration forces cause focal areas of detachment at the retinal pigment epithelial junction and thus result in visual loss.
Chien-Hao Lin, Shyr-Chyr Chen, Wen-Jone Chen, Chien-Hua Huang
DOI: http://dx.doi.org/10.1016/j.ajem.2009.05.002
Published in issue: January 2010
xAcute aortic dissection (AAD) is an important differential diagnosis in the early management of acute chest pain syndrome. Early recognition and treatment are crucial and will lead to a better survival. However, bedside evaluations including the symptoms, signs, or laboratory tests are all not sensitive [Arch Intern Med. 2000; 160(19):2977-2982]. Advanced diagnostic tools, such as contrast-enhanced computed tomography, transesophageal echocardiography, and magnetic resonance imaging, are usually time- and cost-consuming and not readily available in the emergency department [Arch Intern Med.
Jennifer L. Wiler, Christina Price, David R. Fintak, Carol Shields
DOI: http://dx.doi.org/10.1016/j.ajem.2009.05.013
Published in issue: January 2010
xEarly detection and recognition of retinoblastoma, a rare but life-threatening malignancy, are strongly correlated with increased patient survival. Therefore, it is important for the emergency physician to recognize this condition.
DOI: http://dx.doi.org/10.1016/S0735-6757(09)00566-X
Published in issue: January 2010
DOI: http://dx.doi.org/10.1016/S0735-6757(09)00567-1
Published in issue: January 2010
DOI: http://dx.doi.org/10.1016/S0735-6757(09)00568-3
Published in issue: January 2010
DOI: http://dx.doi.org/10.1016/S0735-6757(09)00569-5
Published in issue: January 2010
