Kyle Shaver, Steven Weiss, Darren Braude
DOI: http://dx.doi.org/10.1016/j.ajem.2008.11.019
Published online: January 25 2010
xLittle is known about the accuracy of the medical record to document sedation-related events (SREs). Our hypotheses were that, when compared to a reference database (RD), a procedural sedation quality assurance registry (PSQAR) and medical records were accurate documentation of SREs.
Nurullah Gunay, Beril Kose, Seniz Demiryurek, Nurdan Ozlu Ceylan, Ibrahim Sari, Abdullah T. Demiryurek
DOI: http://dx.doi.org/10.1016/j.ajem.2008.11.020
Published online: October 26 2009
xAnticholinesterase poisoning is an important health problem in developing countries, and understanding of its underlying mechanisms is essential for the effective treatment. This study is designed to examine the effects of Y-27632, a selective Rho-kinase inhibitor, on organophosphate-induced cardiac toxicity and mortality in rats. Rats were randomly divided into 4 groups: control (corn oil), dichlorvos (30 mg/kg intraperitoneally), and 1- and 10-mg/kg Y-27632 + dichlorvos groups. After 6 hours of intraperitoneal injection, venous blood and cardiac samples were obtained, biochemical or immunohistochemical analyses were performed, and the intensity of muscle fasciculation was recorded.
Yu-Che Chang, Chip-Jin Ng, Yu-Chuan Chen, Jih-Chang Chen, David Hung Tsang Yen
DOI: http://dx.doi.org/10.1016/j.ajem.2008.11.021
Published in issue: March 2010
xTo improve the management quality and monitoring for common pediatric illnesses in the general emergency department (ED), we examined the effect of physician specialty training on medical resource use and patient outcomes.
Meng-Hua Chen, Jun-Yu Lu, Lu Xie, Jun-Hui Zheng, Feng-Qing Song
DOI: http://dx.doi.org/10.1016/j.ajem.2008.11.023
Published online: January 25 2010
xBecause different species may require different doses of drug to produce the same physiologic response, we were provoked to evaluate the dose-response of epinephrine during cardiopulmonary resuscitation (CPR) and identify what is the optimal dose of epinephrine in a rat cardiac arrest model.
Adam Goldstone, Andrew Bushnell
DOI: http://dx.doi.org/10.1016/j.ajem.2008.11.024
Published online: October 26 2009
xWe sought to determine the incidence of alternative diagnosis in patients with a history of kidney stones who experience recurrent symptoms and undergo repeat computed tomography (CT) imaging at their return to the emergency department (ED).
Mark A. Merlin, Matthew Saybolt, Raffi Kapitanyan, Scott M. Alter, Janos Jeges, Junfeng Liu, Susan Calabrese, Kevin O. Rynn, Rachael Perritt, Peter W. Pryor II
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.009
Published online: October 26 2009
xThis study proposes that intranasal (IN) naloxone administration is preferable to intravenous (IV) naloxone by emergency medical services for opioid overdoses. Our study attempts to establish that IN naloxone is as effective as IV naloxone but without the risk of needle exposure. We also attempt to validate the use of the Glasgow Coma Scale (GCS) in opioid intoxication.
Erik B. Kulstad, Rishi Sikka, Rolla T. Sweis, Ken M. Kelley, Kathleen H. Rzechula
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.014
Published online: February 8 2010
xDespite the growing problems of emergency department (ED) crowding, the potential impact on the frequency of medication errors occurring in the ED is uncertain. Using a metric to measure ED crowding in real time (the Emergency Department Work Index, or EDWIN, score), we sought to prospectively measure the correlation between the degree of crowding and the frequency of medication errors occurring in our ED as detected by our ED pharmacists.
Chao-Jui Li, Chia-Te Kung, Ber-Ming Liu, Chu-Chung Chou, Chin-Fu Chang, Tung-Kung Wu, Tzu-An Liu, Yan-Ren Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.018
Published online: February 8 2010
xThe study aimed to determine the factors predictive of sustained return of spontaneous circulation (ROSC) in children with out-of-hospital cardiac arrest (OHCA) of noncardiac origin.
Kevin M. Takakuwa, Frances S. Shofer, Judd E. Hollander
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.021
Published online: February 8 2010
xThe study aimed to determine whether aspirin therapy was differentially administered according to race, sex, or age in patients with undifferentiated chest pain who presented to an urban academic emergency department.
Didem Ay, Meltem Akkas, Bulent Sivri
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.011
Published online: January 25 2010
xThis study is designed to analyze retrospectively patients who present to adult emergency department (ED) from January 1, 2002, to February 28, 2002. Age, sex, presentation time to ED, length of stay in emergency service, consultations, the number of patients who need to be hospitalized and also the number of hospitalized patients, diagnosis categories, and discharge instructions are analyzed. It is found that patients in most admissions are at 21 to 25 years of age. At night, the number of visits is decreased.
Joseph R. Shiber, Emily Fontane, Ademola Adewale
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.026
Published in issue: March 2010
xEpidemiologic studies of stroke in the 1970s and 1980s have reported the percentage of ischemic stroke as 73% to 86%, with hemorrhagic stroke as only 8% to 18%; the remainder was undetermined (due to not performing computed tomographic [CT] scanning or an autopsy). In our clinical work, it appeared anecdotally to the authors that we were seeing more hemorrhagic strokes than these previously quoted figures.
Scott B. Davidson, Paul A. Blostein, Sheldon B. Maltz, George England, Thomas Schaller
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.002
Published online: January 25 2010
xFlying ultralight aircraft is a popular and growing form of recreation. However, there is considerable risk involved in this activity. This study was undertaken to catalogue the injury patterns, surgical procedures, and complications of patients involved in ultralight crashes in southwest Michigan.
James W. Tsung, Christopher C. Raio, Daniela Ramirez-Schrempp, Michael Blaivas
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.003
Published online: October 26 2009
xThe diagnosis of cholecystitis or biliary tract disease in children and adolescents is an uncommon occurrence in the emergency department and other acute care settings. Misdiagnosis and delays in diagnosing children with cholecystitis or biliary tract disease of up to months and years have been reported in the literature. We discuss the technique and potential utility of point-of-care ultrasound evaluation in a series of pediatric patients with suspected cholecystitis or biliary tract disease.
Michael B. Stone, Cynthia Moon, Darrell Sutijono, Michael Blaivas
DOI: http://dx.doi.org/10.1016/j.ajem.2008.11.022
Published online: October 26 2009
xUltrasound guidance for central venous catheterization improves success rates and decreases complications when compared to the landmark technique. Prior research has demonstrated that arterial and/or posterior vein wall puncture still occurs despite real-time ultrasound guidance. The inability to maintain visualization of the needle tip may contribute to these complications. This study aims to identify whether long-axis or short-axis approaches to ultrasound-guided vascular access afford improved visibility of the needle tip.
Rebecca L. Rao, Raquel M. Schears
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.020
Published online: November 23 2009
xTo characterize prescription medication use and survival effect among nonagenarians with an emergency department (ED) visit, we performed a retrospective chart review for all nonagenarians presenting to the ED in 2002. Data were collected on medication number and category and on survival after discharge. At admission, patients were taking no medications (3.2%), 1 to 4 medications (35%), 5 to 9 medications (51.9%), or at least 10 medications (9.9%); the median number increased by 2 at discharge (P < .001).
Stephen A. Shiver, Matthew Lyon, Michael Blaivas, Srikar Adhikari
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.009
Published online: February 8 2010
xVenous thromboembolic disease is a major cause of mortality and morbidity.
W.T. Longstreth Jr, Ronit Katz, David L. Tirschwell, Mary Cushman, Bruce M. Psaty
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.025
Published online: February 8 2010
xSince publication in 1995 of the National Institute of Neurological Disorders and Stroke (NINDS) trial of intravenous tissue plasminogen activator (IV tPA) for acute ischemic stroke, the benefit and frequency of use of IV tPA in the elderly have remained uncertain.
Mohan Punja, Dustin G. Mark, Jonathan V. McCoy, Ramin Javan, Jesse M. Pines, William Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.017
Published online: February 8 2010
xInflammatory disorders of the heart, although uncommon in the general population, often present initially to the emergency department. Symptoms and clinical manifestations are shared with other more common cardiopulmonary diseases, particularly acute coronary syndrome and congestive heart failure, making prompt diagnosis challenging. This review will highlight some of the clinical and electrocardiographic features that will help early diagnosis and differentiation of inflammatory cardiac disorders from other more common conditions.
Matthew P. Borloz, Dustin G. Mark, Jesse M. Pines, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.019
Published online: February 8 2010
xThe differentiation of narrow complex tachycardias is a common diagnostic conundrum encountered by emergency physicians. Although a number of published algorithms are available to assist the clinician in evaluating features of the 12-lead electrocardiogram (ECG), many of these are too cumbersome, requiring multiple decisions and introducing treatment suggestions within the diagnostic framework. To optimize the diagnosis of the narrow complex tachycardia, we propose 3 separate algorithms tailored to address varying levels of available clinical information.
Gen-Min Lin, Chih-Lu Han
DOI: http://dx.doi.org/10.1016/j.ajem.2009.11.017
Published in issue: March 2010
xDangas et al [1] reported that in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) with contemporary anticoagulation regimens, a 600-mg loading dose of clopidogrel may safely reduce 30-day ischemic adverse event rates compared with a 300-mg loading dose. Although the higher dose demonstrated better 30-day clinical outcomes in multivariable and propensity score analysis, the emphasis should be put on whether the statistic advantages were mainly present in higher risk groups in this setting.
Keenan Bora, Cynthia Aaron
DOI: http://dx.doi.org/10.1016/j.ajem.2009.12.003
Published in issue: March 2010
xWe read with great interest the report by Drs Herres, Ryan, and Salzman entitled “Delayed Salicylate Toxicity With Undetectable Initial Levels After Large-dose Aspirin Ingestion” [1]. The authors have uncovered many of the pitfalls that have plagued treatment of aspirin-poisoned patients and make it such a difficult ingestion to treat appropriately. It also brings home the point that salicylate intoxication, like acetaminophen, may seem relatively innocuous in the face of worsening toxicity.
Cliff Reid, Karel Habig
DOI: http://dx.doi.org/10.1016/j.ajem.2009.12.021
Published in issue: March 2010
xDr Barthélémy and colleagues' interesting case report demonstrates the importance of the identification of pericardial tamponade, the utility of ultrasound, and the possibility of excellent outcome in patients with tamponade due to a right ventricular stab wound who receive timely surgical intervention [1].
Meltem Akkaş Camkurt, Figen Coşkun, Nalan Metin Aksu, Erhan Akpınar, Didem Ay
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.029
Published online: February 8 2010
xUltrasound (US) is a simple, easily accessible, and noninvasive method. Thus, it is commonly used. The bladder should be sufficiently filled to acquire pelvic images by US. This report describes water poisoning in 3 patients with no hepatic, cardiac, or renal disease. Both patients had a history of excessive fluid intake.
Mark Fenig, Robin Lowman, Byron P. Thompson, Philip H. Shayne
DOI: http://dx.doi.org/10.1016/j.ajem.2009.05.011
Published in issue: March 2010
xPosterior sternoclavicular joint dislocations (PSCJDs) are extremely rare, emergent injuries. We present an unprecedented case of a 16-year-old boy without any initial history or signs of trauma who died of a brachiocephalic vein laceration secondary to an occult PSCJD. The pathophysiology, treatment, and diagnosis of PSCJD are discussed.
Rosanne S. Naunheim, Teya Casner
DOI: http://dx.doi.org/10.1016/j.ajem.2009.05.008
Published in issue: March 2010
xAn estimated 1.5 million head injuries occur in the United States each year, with approximately 2% resulting in epidural hematomas. Epidural hematomas can be difficult to recognize clinically because the patient may not have a loss of consciousness or may have a brief loss of consciousness with a normal neurological examination. It is important to recognize patients with epidurals because the reported mortality for unrecognized epidural hematoma is as high as 40%. We report a novel method of identifying brain abnormality in a patient with a normal neurological examination result using a bedside handheld automated electroencephalogram device.
Kshitij Mankad, Edward Hoey, Ki Sing Yap
DOI: http://dx.doi.org/10.1016/j.ajem.2009.06.017
Published in issue: March 2010
xReversible encephalopathy syndrome is a multietiological condition, the pathophysiology of which lies in the breach of the blood-brain barrier due to increased local cerebral perfusion pressure. Patients present clinically in nonspecific ways; acute computed tomography is often unrevealing, and as such, there should be a low threshold for early magnetic resonance imaging even in the acute setting because misdiagnosis may lead to mismanagement. Although initially described to present with changes depicted on imaging in the “posterior aspects” of the brain, more recent literature has focused attention on the fact that signal changes may occur anywhere in the brain.
Rip Gangahar, Deepak Doshi
DOI: http://dx.doi.org/10.1016/j.ajem.2009.07.004
Published in issue: March 2010
xFocused assessment with sonography in trauma (FAST) scan can be used by emergency physicians in the diagnosis of diaphragmatic rupture in blunt abdominal trauma. We introduce a new feature ‘Rip’s absent organ sign’ on FAST scan in the diagnosis of acute diaphragmatic rupture.
Frédéric Lemesle, Florence Lemesle, Walid Nicola, Annie Pierre Jonville-Béra
DOI: http://dx.doi.org/10.1016/j.ajem.2009.07.007
Published in issue: March 2010
xWe describe the first case of stress cardiomyopathy secondary to a drug-drug interaction. A 44-year-old man was admitted for acute agitation, hallucinations, tachycardia, and fever within 2 hours of ingestion of naltrexone prescribed to stop alcohol consumption. He had been receiving methadone (120 mg/d) for several months for a history of heroin use; thus, acute opiate withdrawal syndrome secondary to naltrexone treatment was diagnosed. Because electrocardiography showed diffuse ST-segment elevation, a transthoracic echocardiography was performed.
Edward T.D. Hoey, Kshitij Mankad
DOI: http://dx.doi.org/10.1016/j.ajem.2009.07.015
Published in issue: March 2010
xTransthoracic echocardiography is an established means of diagnosing a pericardial effusion and has become the reference guidance modality for drainage of symptomatic collections. However, echocardiographic drainage is not feasible in all patients for a variety of technical and patient-related factors. Computed tomography (CT)–directed pericardiocentesis using a standard Seldinger technique is an alternative means of draining pericardial effusions and overcomes many of the limitations associated with echocardiography.
Hossein Saidi, Mofidi Mani
DOI: http://dx.doi.org/10.1016/j.ajem.2009.07.016
Published in issue: March 2010
xIt is known from studies in young athletes that creatine supplements have beneficial effects on muscular functional capacity, so it is being widely used as a performance-enhancing substance in both professional and amateur sports men and women. They are approved and considered relatively safe, but there have been a few case reports of renal dysfunction associated with their use. We present the case of a patient who developed acute renal failure and lactic acidosis while using creatine and metformin simultaneously.
Peter Michael Zechner, Gernot Aichinger, Marcel Rigaud, Gernot Wildner, Gerhard Prause
DOI: http://dx.doi.org/10.1016/j.ajem.2009.07.021
Published online: October 26 2009
xWe present 2 cases of dyspneic patients, where prehospital lung ultrasound helped to distinguish between pulmonary edema and acute exacerbation of chronic obstructive pulmonary disease.
Baptiste Vallé, Philippe Frontin, Vincent Bounes, Charpentier Sandrine, Vincent Minville, Ducassé Jean-Louis
DOI: http://dx.doi.org/10.1016/j.ajem.2009.07.027
Published in issue: March 2010
xWe report the case of a 46-year-old patient who presented a chest pain with ST-segment elevation in precordial leads V1 (2 mm), V2 (4 mm), and V3 (3 mm). Thrombolytic therapy was initiated with the combination tenecteplase tissue plasminogene activator, aspirin, and heparin. Further electrocardiogram and cardiac enzymes measured every 2 hours during the first 24 hours remained normal, and after a computed tomography of the abdomen, the patient was taken to surgery for an exploratory abdominal operation that revealed pancreatic cholangiocarcinoma.
Dietrich Jehle, Michael Meyer, Seth Gemme
DOI: http://dx.doi.org/10.1016/j.ajem.2009.07.022
Published in issue: March 2010
xTherapeutic hypothermia has been shown to clearly benefit comatose survivors of cardiac arrest. It is reasonable to postulate that if therapeutic hypothermia is beneficial for the neurological injury of cardiac arrest, then it may have a role in the treatment of near-hanging suffocation injuries. We report a retrospective series of 2 patients who received mild therapeutic hypothermia for their comatose state after a near-hanging injury. The exclusionary criteria and protocols that we use for comatose survivors of cardiac arrest were used.
Jason R. Stone, Tristan L. Knutson, Christopher Kang
DOI: http://dx.doi.org/10.1016/j.ajem.2009.07.025
Published in issue: March 2010
xBilateral renal calculi are an uncommon cause of acute renal failure (ARF). The causes of ARF include prerenal, obstructive (or postrenal), and intrinsic [1,2]. Postrenal causes account for 5% to 15% of cases of ARF [3]. This case report will present a case of acute renal failure secondary to bilateral obstructing ureteral calculi.
DOI: http://dx.doi.org/10.1016/S0735-6757(10)00058-6
Published in issue: March 2010
DOI: http://dx.doi.org/10.1016/S0735-6757(10)00059-8
Published in issue: March 2010
DOI: http://dx.doi.org/10.1016/S0735-6757(10)00060-4
Published in issue: March 2010
DOI: http://dx.doi.org/10.1016/S0735-6757(10)00061-6
Published in issue: March 2010
