Norman A. Paradis, Gregory Young, Stanley Lemeshow, James E. Brewer, Henry R. Halperin
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.002
Published in issue: May 2010
xThe ASPIRE trial (AutoPulse Assisted Prehospital International Resuscitation) was multicenter exception from consent clinical trial that compared mechanical cardiopulmonary resuscitation (CPR) with a device (AutoPulse-CPR) to traditional manual CPR (manual-CPR) in out-of-hospital cardiac arrest. Enrollment was suspended early due to safety concerns. One site (site C) made a potentially important protocol change midtrial, and enrollment at that site was noted to be independently associated with outcome.
Ahmet Guzel, Serap Karasalihoglu, Hakan Aylanç, Osman Temizöz, Tufan Hiçdönmez
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.025
Published online: November 23 2009
xThe aim of this study was to investigate the relationship between intracranial injury and serum tau protein levels in pediatric patients with minor head trauma (MHT).
Jason S. Haukoos, Mallory D. Witt, Roger J. Lewis
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.034
Published online: February 8 2010
xFor many patients, it is difficult to define the benefit derived from a visit to the emergency department (ED). No criterion standard exists that defines benefit from emergency treatment compared to routine outpatient care, and our limited ability to estimate benefit from emergency treatment has significant implications for emergency care-related health services research. The objectives of this study were to develop a decision algorithm to be used in estimating benefit of emergency treatment (EBET) and to assess its reliability when applied to patients making unscheduled ED visits.
Yi-Ming Weng, Yu-Che Chang, Yu-Jr Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.035
Published online: February 8 2010
xThis study evaluated the effects of pain assessment at triage on analgesia provision to pediatric patients with closed long-bone fractures in the emergency department (ED).
Jiann-Hwa Chen, Chiu-Liang Tseng, Shin-Han Tsai, Wen-Ta Chiu
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.036
Published online: February 8 2010
xThe aims of this study are to analyze the factors that predispose the occurrence of ventricular arrhythmia (VA) in young patients with a first acute myocardial infarction (AMI) in the emergency department (ED) and to establish predictive implications.
Tsai-Nung Kuo Chou, Yuan-Ti Lee, Yi-Yu Lai, Wai-Nang Chao, Cheng Yang, Chun-Chieh Chen, Po-Hui Wang, Ding-Bang Lin, Ruey-Hong Wong, Shiuan-Chih Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.037
Published online: November 23 2009
xThe purpose of this study was to explore the predictive factors for mortality in primary septicemia or wound infections caused by Vibrio vulnificus.
Franca Dipaola, Giorgio Costantino, Francesca Perego, Marta Borella, Andrea Galli, Giulia Cantoni, Franca Barbic, Francesco Casella, Pier Giorgio Duca, Raffaello Furlan, on behalf of the STePS investigators
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.039
Published online: November 23 2009
xThe study aimed to compare the efficacy of the Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk score, San Francisco Syncope Rule, and clinical judgment in assessing the short-term prognosis of syncope.
Jonathan Glauser, Charles L. Emerman, Deepak L. Bhatt, W. Frank Peacock IV
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.004
Published online: February 8 2010
xPlatelet aspirin resistance is reported to be as high as 45%. The prevalence of emergency department (ED) platelet aspirin resistance in suspected acute coronary syndrome (ACS) is not described. Our purpose was to determine the prevalence of platelet aspirin resistance.
Belkan Uzun, Zeynep Kekec, Emel Gurkan
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.016
Published online: February 8 2010
xDespite progress in management, patients with sickle cell disease who are experiencing acute painful episode are often incompletely treated. We compared meperidine and tramadol with respect to their effects on the hemodynamics and pain relief in patients with sickle cell disease who were admitted to the emergency department with painful crisis. A total of 68 patients with sickle cell disease were randomly assigned to receive either tramadol 1.5 mg/kg (n = 34) or meperidine 1 mg/kg (n = 34). Hemodynamic parameters were recorded at regular intervals after analgesic infusions.
Taku Taira, Breena R. Taira, Matt Carmen, Jasmine Chohan, Adam J. Singer
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.023
Published online: February 8 2010
xThe lower threshold for D-dimer in evaluating patients with low clinical risk of venous thromboembolism (VTE) ranges from 200 to 500 ng/mL. We compared the rates of VTE in patients based on D-dimer values. We hypothesized that the rate of VTE in low-risk patients with D-dimer levels less than 500 would be less than 1%.
Rafael Perelló, Òscar Miró, María Angeles Marcos, Manel Almela, Ernest Bragulat, Miquel Sánchez, Carlos Agustí, José M. Miro, Asunción Moreno
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.024
Published online: March 26 2010
xHIV-1–infected patients have higher incidence of community-acquired pneumonia (CAP) and risk of complications. Bacteremia has been associated with a higher risk of complications in such patients. We investigated factors associated with bacteremia in HIV-1–infected patients with CAP presenting at the emergency department.
Ozlem Kar Kurt, Sibel Alpar, Tugrul Sipit, Selma Firat Guven, Hakan Erturk, Mikail Koray Demirel, Meliha Korkmaz, Mutlu Hayran, Bahar Kurt
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.031
Published online: November 23 2009
xThe aim of this study was to evaluate the diagnostic contribution of alveolar dead space fraction (AVDSf) measured using capnography in patients admitted with suspected pulmonary embolism (PE). A total of 58 patients who were admitted to our hospital with suspected PE between October 2006 and January 2008 were included in this study. All patients were assessed using the Wells clinical score, capnography, computed tomographic pulmonary angiography, D-dimer measurement, lower-extremity venous Doppler ultrasonography, and V/Q scintigraphy.
Yu-Chao Lin, Chih-Yen Tu, Shinn-Jye Liang, Hung-Jen Chen, Wei Chen, Te-Chun Hsia, Chuen-Ming Shih, Wu-Huei Hsu
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.033
Published online: November 23 2009
xThere has been a paucity of data regarding the efficacy and safety of small-bore chest tubes (pigtail catheter) for the management of pneumothorax in mechanically ventilated patients.
Troy Madsen, Matthew Dawson, Joseph Bledsoe, Philip Bossart
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.034
Published online: November 23 2009
xRoutine serial hematocrit measurements are a component of the trauma evaluation for patients without serious injury identified on initial evaluation. We sought to determine whether serial hematocrit testing was useful in detecting significant intra-abdominal injuries in trauma patients in our observation unit.
Michael R. Preusch, Florian Bea, Jens Roggenbach, Hugo A. Katus, Jana Jünger, Christoph Nikendei
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.040
Published online: April 5 2010
xEven among health care professionals, resuscitation performance has been shown to be poor. So far, it remains unclear whether cardiac arrest staff with frequent practice in resuscitation requires training to adapt to the new International Liaison Committee on Resuscitation (ILCOR) guidelines of 2005. This study evaluated the need for basic life support training in nurses with emergency experience.
Chu-Lin Tsai, Ashley F. Sullivan, Adit A. Ginde, Carlos A. Camargo Jr.
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.041
Published online: November 23 2009
xThe aim of this study was to evaluate the quality of care provided by physician assistants or nurse practitioners (ie, midlevel providers [MLPs]) in acute asthma, as compared with that provided by physicians.
Adam K. Rowden, Christopher P. Holstege, Marcia L. Buck, David L. Eldridge
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.036
Published online: February 8 2010
xNumerous transdermal medicinal patches are currently available on the pharmaceutical market. Patients who ingest transdermal medicinal patches, either accidentally or intentionally, typically present to emergency departments (EDs) [1,2]. Such cases are not benign and may develop adverse outcomes [2]. For example, over a 2-year period, a network of 15 regional poison centers received 453 reports of intentional fentanyl patch abuse. One hundred fifty-seven of those cases involved the actual ingestion of the patch [2].
Sulieman Hamid, Fiona Bainbridge, Anne-Maree Kelly, Debra Kerr
DOI: http://dx.doi.org/10.1016/j.ajem.2009.03.005
Published online: February 26 2010
xSerial electrocardiographic and biomarker data are used to rule out acute coronary syndrome (ACS) in emergency department (ED) patients with chest pain. These do not identify coronary artery disease (CAD). Functional tests are often used but have limitations. Multislice computed tomography coronary angiography (MSCT-CA) is evolving rapidly, raising the possibility of fast, accurate, and relatively noninvasive anatomical testing for CAD. We aimed to quantify the proportion of ED rule-out ACS patients suitable for MSCT-CA.
Masanao Kobayashi, Akira Fujiwara, Hiroshi Morita, Yasuhisa Nishimoto, Takayuki Mishima, Masahiko Nitta, Toshihiro Hotta, Toshimasa Hayashi, Yasuyuki Hayashi, Kenji Sato
DOI: http://dx.doi.org/10.1016/j.ajem.2009.03.006
Published online: February 8 2010
xThe study aimed to clarify the difficulties concerning insertion of advanced airway devices during cardiac arrest.
Samuel Delerme, Samuel Castro, Yonathan Freund, Pierre Nazeyrollas, Marie-Odile Josse, Béatrice Madonna-Py, Edwin Rouff, Bruno Riou, Patrick Ray
DOI: http://dx.doi.org/10.1016/j.ajem.2009.03.023
Published online: March 26 2010
xPrevious studies suggested that variation of pulse oximetric plethysmographic (POP) waveform amplitude (ΔPOP) could predict fluid responsiveness in mechanically ventilated patients. Our objective was to correlate the variations of ΔPOP and the variations of cardiac index (CI) induced by passive leg raising (PLR) in spontaneously breathing volunteers.
Alex L. Rogovik, Jeremy N. Friedman, Jeeshan Persaud, Ran D. Goldman
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.002
Published online: March 26 2010
xChildren with sickle cell disease (SCD) are considered at risk for bacteremia, especially when they present to the emergency department (ED) with fever.
Thomas E. Goffman
DOI: http://dx.doi.org/10.1016/j.ajem.2009.03.024
Published online: February 26 2010
xBioterrorism is a big word thrown about like a brickbat by politicians. As a start, we should all know of the most feared agents, which are a subset of the category A list from the 72 select agents compiled by the Centers for Disease Control and Prevention (CDC). It would appear that even emergency department (ED) personnel would be worth reintegrating this knowledge [1]. To save time and space, the author will simply describe those biologics most feared by Homeland Security such as smallpox, plague, Ebola, and anthrax.
Carlos Lojo Rial
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.017
Published in issue: May 2010
xAdult onset of Still disease is a fascinating disorder of unclear etiology that mimics many conditions ranging from autoimmune diseases, malignancy, and infection [1,2]. The disease is a diagnosis of exclusion; and making such a diagnosis solely on at the basis of bloods tests, a chest x-ray, and an echocardiogram is very brave. Adult onset of Still disease is a difficult diagnosis to make in the emergency department; and as mentioned in the exclusion criteria provided by the authors, the main diagnosis to exclude are infections and malignancy especially of hematologic origin [3].
Oscar M.P. Jolobe
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.022
Published in issue: May 2010
xGiven the fact that Streptococcus pneumoniae is the commonest bacterial cause of community-acquired pneumonia (CAP) [1], the urine antigen test (Binax) that can generate results in 15 minutes [2,3] might prove useful in identifying the underlying cause in most patients with CAP, well within the recommended 4-hour therapeutic time window, thereby reducing the likelihood of inappropriate empiric prescription of antibiotics [4], with its attendant risk of generating antibiotic resistance [5]. In 2 recent studies, the Binax urine antigen immunochromatographic test was positive in 85% to 88% of cases of bacteremic pneumococcal pneumonia [2,3].
Mohammad Jalili
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.027
Published in issue: May 2010
xIn an article published in the October issue of your journal, Chang et al [1] questioned the validity of this notion that presence of new—or presumed new—left bundle-branch block (LBBB) predicts the presence of acute myocardial infarction (AMI). In this cohort study, the researchers follow a large group of adult patients with either chest pain or other angina equivalents (if interpreted by the treating physician as such) who had an electrocardiogram. They find that the prevalence of AMI among the small subgroup of patients (0.6%) who manifested LBBB on their electrocardiograms and in whom the LBBB is not known to be old (7.3%) was not significantly different from those with known old LBBB (5.2%) or those without LBBB (6.1%).
Anna Marie Chang, Judd E. Hollander
DOI: http://dx.doi.org/10.1016/j.ajem.2009.11.002
Published in issue: May 2010
xWe appreciate the comments made by Chang et al [1], concerning our article, “Lack of association between left bundle branch block and acute myocardial infarction in symptomatic ED patients.” The evidence you cite all derived from studies of patients with documented acute myocardial infarction (AMI), nicely documents that both presumed new and confirmed old left bundle branch block (LBBB) are associated with AMI. Our article extends this observation to patients with potential acute coronary syndrome (ACS) who have not yet been determined to have AMI.
Alain Michaud, Jean-Yves Dupuis
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.043
Published in issue: May 2010
xWe read with interest the latest study by Dawes et al [1]. Using echocardiography, they failed to establish a link between electrically induced arrhythmias and a 5-second TASER X26 discharge in the chest of 10 healthy volunteers. This is in agreement with the results of Swerdlow et al [2], who found that the initial rhythm observed in nearly 95% of the TASER-related deaths is asystole or pulseless electrical activity, not ventricular arrhythmia (VF). When put together, the results of those studies suggest that TASER-induced VF is possible, but it is a rare phenomenon that is probably not electrically induced.
Ophir Lavon, Dan Hershko, Erez Barenboim
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.001
Published in issue: May 2010
xPrehospital rescue operations are often challenging events demanding highly trained professional personnel and proper equipment [1]. These events may be complicated by the setting of geographically inaccessible areas that demand airborne hoist rescue, in particular for patients requiring continuous mechanical ventilation. The only operational aeromedical program in Israel compatible with hoist rescue missions is the Air Force Rescue and Aeromedical Evacuation Unit (RAEU). Each RAEU team consists of a flight surgeon and a flight paramedic joined by 3 rescue operators.
Nigel S. Jenkins, Mark Knights, Carsten Eickmann, Mark Payne
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.020
Published in issue: May 2010
xWe read with interest the case report of Walsh et al in September's issue of the American Journal of Emergency Medicine, “Adenosine-induced cardiopulmonary arrest in a patient with paroxysmal supraventricular tachycardia” [1] (SVT). We recently found success in using the α-agonist metaraminol to terminate SVT.
Benjamin W. Stull, Timothy J. Meehan
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.019
Published in issue: May 2010
xWe would like to comment upon the response generated by our original case report, “Adenosine-induced cardiopulmonary arrest in a patient with paroxysmal supraventricular tachycardia.” Although we are grateful for the attention our report has generated, we have some concerns regarding the specifics of the query.
Dorothy L. Robinson
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.022
Published in issue: May 2010
xWe know that alcohol increases the risk of injury. In Maryland, for cyclists with blood alcohol of 80 mg/dL, the increase was 20-fold [1]; and it was 10-fold for cyclists in Finland with blood alcohol of 100 mg/dL [2].
Truman J. Milling Jr., Patrick Crocker
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.008
Published in issue: May 2010
xThe main point of the letter appears to be an attempt to control for alcohol when assessing the putative protective effect of helmets in bicycling head and brain injury. The problem here is that the study found no significant effect of helmets on head and brain injury; so controlling for alcohol, unless one expects alcohol to be protective, seems somewhat superfluous.
Rainer Gatz
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.001
Published in issue: May 2010
xThe recent article by Volpicell [1], as indeed others published by him earlier, are of great interest and practical utility to all who practice bedside echography on their emergency and intensive care patients, like I have been doing for some 15 years now. Do allow me to add just 2 practical suggestions to Volpicelli's article, with which I otherwise fully agree.
Oscar M.P. Jolobe
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.002
Published in issue: May 2010
xThe issue of target organ damage in adults older than 18 years with asymptomatic hypertension is one which is relevant, not only in the context of renal failure [1] but also in the context of adverse left ventricular remodeling, given the fact that in the latter context, blood pressure elevation at the age of 20 years has been shown to be a predictor of left ventricular hypertrophy 20 years later[2]. Furthermore, in view of the fact that hypertensive subjects with a mean age of 54.3 years with coexisting chronic kidney disease and left ventricular hypertrophy have a 2.5-fold increase in coronary heart disease (P = .034) and fourfold increase in stroke (P = .002), versus counterparts with neither of those complications[3], it has to be recognized that “combined cardiac and renal involvement defines a very high-risk phenotype affected by worse prognosis than any single damage” [4].
Antony V. George, Jenny J. Lu, Matthew V. Pisano, Jessica Metz, Timothy B. Erickson
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.003
Published in issue: May 2010
xCarfentanil, formerly known as Wildnil, is a synthetic μ-opioid agonist with a clinical potency 10,000 times that of morphine and 100 times that of fentanyl. Its only approved use is by veterinarians as a tranquilizing agent to rapidly incapacitate exotic wildlife for examination and procedures. Human poisonings from carfentanil have not been documented to date. A 47 year-old veterinarian developed drowsiness within two minutes after being splashed in the eyes and mouth with a dart containing 1.5 mg carfentanil citrate and 50 mg xylazine hydrochloride, intended for the sedation of elk.
Wei-Pang Hsu, Pei-Ching Hsiao
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.027
Published in issue: May 2010
xSeymour et al [1] (Feb. 28 issue) report that pelvic examination is unnecessary in pregnant patient with a normal bedside ultrasound (US)—a finding that doubts the value of pelvic examination in the management of early pregnancy-related complaints in the emergency department. As we know, US has been known as the third eye of a doctor and provides invaluable information about female internal genital organ as well as pregnancy status. However, can US really replace formal pelvic examination? First, no one can be sure that the symptoms associated with pregnancy were definitely due to obstetric problem beforehand? For example, early pregnancy with vaginal bleeding, mostly, the bleeding may be due to threatened abortion, but it can also be due to vaginitis, cervical polyps, or even cervical cancer.
Amanda Seymour, Alfred Sacchetti
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.026
Published in issue: May 2010
xWe would like to thank Drs Hsu and Hsiao for their comments on our recent report on the use of ultrasound in pregnant patients. We certainly agree that identifying a nonobstetric source of any complaint in a pregnant patient can be difficult if not impossible. However, in the context of the emergency department (ED), it may not be necessary to identify the exact cause of a problem such as vaginal spotting. If the patient is not bleeding heavily and a viable intrauterine pregnancy is visualized on bedside ultrasound, then any of the other etiologies for minor vaginal bleeding such as a cervical polyp may be safely left to the patient's primary obstetric provider for diagnosis.
Yushi U. Adachi, Shigehito Sato
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.029
Published in issue: May 2010
xWe read with great interest the publication by Stone et al [1] in the recent issue of the journal about the ultrasound detection of guidewire position for avoiding arterial guidewire placement. They demonstrated that guidewire visualization within the jugular vein predicted venous catheter placement with a sensitivity and specificity of 100% and 100%, respectively, in all 20 adult patients. As the author discussed, the use of real-time ultrasound guidance decreases complication, especially arterial puncture [2].
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.018
Published in issue: May 2010
xIn the article “Systemic manifestations following ingestion of small amounts of acetic acid by a child,” published in Am J Emerg Med 2007; 25(6):738.e1-738.e2, the author names were listed incorrectly. The correct byline is below.
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.019
Published in issue: May 2010
xThe article, “Negative pressure pulmonary hemorrhage induced by a candy,” published in Am J Emerg Med 2010; 28(1):112.e3-112.e5 had an error in the byline. The correct name of the last author is Venerino Poletti.
Richard Paula, Brad Peckler, Mai Nguyen, David Orban, Tara Butler
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.013
Published online: February 26 2010
xPromethazine is a commonly used drug in emergency departments to treat headaches and nausea. It is generally considered safe, but after thoroughly reviewing the literature, multiple instances of tissue toxicity were documented. We describe a cluster of 3 cases of promethazine-related tissue toxicity in our community. Two patients experienced extensive complications related to local necrosis, one leading to gangrene requiring amputation, and the other developing chronic pain and hypersensitivity, with a permanent decrease range of motion.
Ying-Sheng Shen, Wei-Lung Chen, Jiann-hwa Chen, Yung-Lung Wu, Hung-Yi Kuo
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.015
Published online: March 26 2010
xSyncope is commonly encountered in emergency department patients. The causes are numerous and include certain life-threatening illnesses that must be rapidly considered and excluded from the differential diagnosis. This article reports on a case of a painless acute aortic dissection and having collapsed 3 times within 1 day. The rupture of the patient's proximal dissection (ascending aorta) into the pericardial space with low cardiac output may have lead to his intermittent syncope (especial during postural change).
Ahmed Nadeem, Paul Allegretti
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.016
Published online: April 5 2010
xWe describe the case of blurred vision in a 60-year-old woman on digoxin. There have been few case reports of vision abnormalities due to digoxin toxicity. We present the case of a patient who presented for bilateral blurred vision, weakness, diarrhea, and nausea and a digoxin level of 8.4 ng/mL. This case reminds the emergency physician to remain vigilant of the unusual presentations of digoxin toxicity.
Joseph B. Miller, Gurujot Khalsa, Taher Vohra
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.018
Published online: February 26 2010
xWe report a case of a spontaneous spinal epidural hematoma presenting as constipation and flank pain in a patient on warfarin. The patient initially complained of these symptoms and was evaluated for renal colic or an aortic aneurysm. On the patient's second emergency department visit, he developed progressive paralysis and never regained neurological function. An adynamic ileus causing constipation may have been an early neurological finding in the patient's presentation. This case report illustrates a critical diagnosis to consider in the evaluation of an anticoagulated patient with flank or back pain.
Joseph A. Zito, Christopher C. Lee, Scott Johnson, Adam Singer, Jeffrey Vacirca
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.019
Published online: February 26 2010
xWe present a case of a 25-year-old woman with posterior leukoencephalopathy syndrome presenting with acute bilateral visual loss and headache to our emergency department. The patient had a history of pure red blood cell dysplasia as a consequence of chronic hepatitis C and recently started rituximab after failing hepatitis C virus therapy, steroids, and intravenous IgG.
Bruno Espirito Santo de Araújo, Juliana Milward Borchert, Paulo Gustavo Manhães, Fabienne Antunes Ferreira, Mariana Severo Ramundo, Maria Cíceras Silva-Carvalho, Antonio Carlos Seabra, Sandra Helena Victal, Agnes Marie Sá Figueiredo
DOI: http://dx.doi.org/10.1016/j.ajem.2009.08.010
Published online: March 11 2010
xDiseases caused by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) are frequently associated with skin and soft tissue infections. However, unusual life-threatening infections in immunocompetent children and young adults have increasingly been reported, such as necrotizing fasciitis, pyomyositis, septic thrombophlebitis of the extremities, rapidly progressive and necrotizing pneumonia, acute hematogeneous osteomyelitis, septic thrombophlebitis, and Waterhouse-Friderichsen syndrome.
Ching-Kuo Lin, Yu-Wa Lau, Fu-Yuan Wang, Wei-Che Lee, Tzeng-Jih Lin, Hon-Man Chan
DOI: http://dx.doi.org/10.1016/j.ajem.2009.08.005
Published online: March 29 2010
xWearing a crash helmet when riding a motorcycle is strongly suggested and regulated to prevent casualties in traffic accidents. Herein, the authors report the case of a 22-year-old male patient sent to their emergency department by ambulance because of motorcycle crash on the way home, an exceptional case of airway compression and dysphonia after fixing the strap of a crash helmet on the neck in a traffic accident. This case is different from those seen in whiplash trauma, wherein laryngeal ruptures are often caused by vertical traction on the larynx and trachea, and is much like the severe contusion of the larynx and rupture of thyroid cartilage, which results in hemorrhage and causes death by suffocation.
Wen-I Liao, Yen-Yue Lin, Shi-Jye Chu, Ching-Wang Hsu, Shih-Hung Tsai
DOI: http://dx.doi.org/10.1016/j.ajem.2009.08.006
Published online: March 10 2010
xOne of the most popularly used Chinese herbal medicines (CHMs) is ginseng, which is a highly valued herb in the Far East and has gained popularity in the West during the last decades. Ginseng has been reported to have pharmacological effects, including modulation of immune response and anticancer, antiaging, anti-amnestic, cardiovascular protective, and wound-healing effects. It is known that ingestion of ginseng can cause false-positive reading in certain digoxin immunoassays; however, bradyarrhythmia-caused by ginseng-associated digitalis glycoside–like effect has not been reported before.
Jonathan R. Dalzell, Colette E. Jackson, Mark C. Petrie, Kerry J. Hogg
DOI: http://dx.doi.org/10.1016/j.ajem.2009.08.007
Published online: March 10 2010
xCoronary vasospasm in the transplanted heart is a rare phenomenon. We report an unusual case of coronary vasospasm–induced myocardial infarction (MI) in a transplant recipient. The pathophysiology of this rare and potentially catastrophic phenomenon is also discussed.
Shilpi Singh Gupta, Onkar Singh, Ankur Hastir
DOI: http://dx.doi.org/10.1016/j.ajem.2009.08.011
Published online: March 29 2010
xWe describe a case of a female child who presented with right-sided proptosis and pain, in which here eye as her sole complain 3 days after she had injury to her head. On investigation, she was found to have ipsilateral subfrontal extradural hematoma, which was not suspected clinically. Only 5 such cases have been mentioned, and thus, pathogenesis is not understood. This case is discussed along with possible mechanism of this extremely infrequent phenomenon.
