Melissa L. Shear, Jonathan N. Adler, Sanjay Shewakramani, Jon Ilgen, Olanrewaju A. Soremekun, Sara Nelson, Stephen H. Thomas
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.011
Published online: March 10 2010
xThis study's objectives were to assess administration of a rapidly dissolving transbuccal fentanyl tablet to patients in emergency department (ED) with orthopedic extremity pain. The main end point was time required to achieve a 2-point drop on a 0 to 10 pain scale.
Hsien-Hung Cheng, Pai-Chun Yen
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.029
Published online: March 26 2010
xKillip classification is a valuable prognostic stratification for patients with acute myocardial infarction. Patients with high initial glucose levels also have adverse outcomes. We hypothesize that an increase in the Killip classification rank of patients with acute myocardial infarction might be associated with increase in initial glucose levels.
Brandon K. Wills, Sean M. Bryant, Peter Buckley, Ben Seo
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.012
Published online: July 16 2009
xMetformin-associated lactic acidosis (MALA) is well described in patients taking therapeutic metformin who develop renal failure or other serious comorbid conditions. Metformin-associated lactic acidosis from acute overdose has also been described in case series but is debated by some clinicians, arguing that metformin overdose does not cause lactic acidosis. Our aim was to perform a multicenter poison control database review to determine if MALA can occur in mono-overdose patients with no comorbid conditions.
Abhinav Chandra, Bret Nicks, Eric Maniago, Amre Nouh, Alexander Limkakeng
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.014
Published online: March 26 2010
xThe objective of this study was to describe the prevalence of pneumonia-like signs and symptoms in patients admitted from the emergency department (ED) with a diagnosis of community acquired pneumonia (CAP) but subsequently discharged from the hospital with a nonpneumonia diagnosis.
Ying-Ju Chen, Sen-Kuang Hou, Chorng-Kuang How, Chii-Hwa Chern, Hong-Chang Lo, David Hung-Tsang Yen, Chun-I Huang, Chen-Hsen Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.024
Published online: March 26 2010
xThe aims of the study were to evaluate the incidence of newly diagnosed primary overt hypothyroidism among adults admitted through the emergency department (ED) and to assess how previously undiagnosed hypothyroidism presents.
Patrick Crocker, Omid Zad, Truman Milling, Todd Maxson, Benjamin King, Elbert Whorton
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.038
Published online: March 26 2010
xThe aim of this study was to characterize the human cytokine response to Texas crotaline envenomation before and after antivenom administration.
Gary Senula, Alfred Sacchetti, Sandra Moore, Teena Cortese
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.035
Published online: February 26 2010
xAccess to propofol remains a challenge for many emergency physicians. This report examines changes in patient care after the introduction of propofol to an emergency department formulary.
Yao-Chun Hsu, Jyh-Ming Liou, Chen-Shuan Chung, Cheng-Hao Tseng, Tzu-Ling Lin, Chieh-Chang Chen, Ming-Shiang Wu, Hsiu-Po Wang
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.037
Published online: March 29 2010
xThis study aimed to identify pre-endoscopic clinical parameters independently associated with 6-week mortality and to develop a prognostic model in cirrhotic patients with acute upper gastrointestinal (UGI) bleeding.
Murat Orak, Mehmet Üstündağ, Cahfer Güloğlu, Ayhan Özhasenekler, Ömer Alyan, Ebru Kale
DOI: http://dx.doi.org/10.1016/j.ajem.2009.05.012
Published online: February 26 2010
xThe aim of this study was to research the effectiveness of the heart-type fatty acid binding protein (H-FABP) in the early diagnosis of acute coronary syndrome (ACS) in patients admitted to emergency service (ES) within 6 hours of onset of chest pain.
Keith Wrenn, Brent Lorenzen, Ian Jones, Chuan Zhou, Dominik Aronsky
DOI: http://dx.doi.org/10.1016/j.ajem.2009.05.001
Published online: March 26 2010
xThe aim of this study was to identify factors other than work hours in the emergency department (ED) work environment contributing to resident stress.
Alberto Conti, Beatrice Del Taglia, Yuri Mariannini, Giuseppe Pepe, Simone Vanni, Stefano Grifoni, Rosanna Abbate, Antonio Michelucci, Luigi Padeletti, Gian Franco Gensini
DOI: http://dx.doi.org/10.1016/j.ajem.2009.05.005
Published online: March 26 2010
xPatients with acute atrial fibrillation with a history of mild structural heart disease could be considered for rhythm conversion.
Scott A. Bier, Douglas J. Borys
DOI: http://dx.doi.org/10.1016/j.ajem.2009.05.015
Published online: March 10 2010
xEvery year, emergency medical services (EMS) providers respond to thousands of calls for toxic ingestions. Many systems have begun using poison control centers (PCCs) when unsure of disposition. We sought to determine the type of exposures EMS personnel were using the PCCs for and treatments suggested. Secondary end points included transport rate after consulting the PCC and amount of money saved by avoiding unnecessary transports.
Yi-Heng Liu, Yu-Chao Lin, Shinn-Jye Liang, Chih-Yen Tu, Chia-Hung Chen, Hung-Jen Chen, Wei Chen, Chuen-Ming Shih, Wu-Huei Hsu,
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.041
Published online: February 26 2010
xLittle is known about the efficacy and safety of ultrasound-guided pigtail catheters for the management of various pleural diseases in the emergency department, ward, and intensive care unit.
Martin Gellerstedt, Angela Bång, Emma Andréasson, Anna Johansson, Johan Herlitz
DOI: http://dx.doi.org/10.1016/j.ajem.2009.05.009
Published online: March 10 2010
xThe aim of this study was to evaluate (a) the differences between men and women in symptom profile, allocated life support level (LSL), and presence of acute myocardial infarction (AMI), life-threatening condition (LTC), or death and (b) whether a computer-based decision support system could improve the allocation of LSL.
Tiekuan Du, Yanping Zhang, Jack S. Wu, Houli Wang, Xu Ji, Tengda Xu, Yi Li, Lingjie Xu, Matthew R. Lewin
DOI: http://dx.doi.org/10.1016/j.ajem.2009.06.019
Published online: March 26 2010
xMany studies have identified strong correlations between winter months and acute, unintentional carbon monoxide (CO) poisoning. In this study, we aimed to investigate the incidence pattern of acute domicile-related CO poisoning in Beijing and its relation with climatic factors.
Mani Mofidi, Abbas Hasani, Nahid Kianmehr
DOI: http://dx.doi.org/10.1016/j.ajem.2009.06.002
Published online: March 26 2010
xBlunt abdominal trauma is a leading cause of morbidity and mortality among all age groups. A multiplicity of diagnostic modalities exists to evaluate the abdomen. We sought to assess the diagnostic performance of base deficit (BD) in identifying intra-abdominal injury in patients with blunt abdominal trauma.
Chia-Ying Tseng, Ju-Sing Fan, Shu-Chuan Yang, Hsien-Hao Huang, Jen-Dar Chen, David Hung-Tsang Yen, Chun-I Huang
DOI: http://dx.doi.org/10.1016/j.ajem.2009.08.002
Published online: March 10 2010
xLong-term use of warfarin can provide benefits in the treatment of many diseases, but adverse bleeding events are unpreventable because of a narrow therapeutic range.
Charles C. Miller III, Katherine Calder-Becker, Francois Modave
DOI: http://dx.doi.org/10.1016/j.ajem.2009.08.004
Published online: March 26 2010
xPulmonary edema related to water immersion has been reported in military trainees and scuba and breath-hold divers, but rarely in the community. To date, no risk factors for this phenomenon have been identified by epidemiological methods. Recently, sporadic reports of swimming-induced pulmonary edema (SIPE) have emerged in the triathlon community. We surveyed the population of a national North American triathlon organization (USA Triathlon) to determine prevalence of and risk factors for symptoms compatible with SIPE.
Chad Kessler, Jennifer Chen, Curt Dill, Gary Tyndall, Mark D. Olszyk
DOI: http://dx.doi.org/10.1016/j.ajem.2009.08.008
Published online: March 26 2010
xThe Veterans Health Administration (VHA) has reformed its emergency medical services.
Charles J. Fasano, Adam K. Rowden, Gerald F. O'Malley, Elizabeth Aguilera, Kennon Heard
DOI: http://dx.doi.org/10.1016/j.ajem.2009.08.025
Published online: March 26 2010
xThe objective of this study was to measure the serum insulin and C-peptide concentrations among diabetic patients known to be taking sulfonylurea agents who presented to the emergency department with hypoglycemia thought to be due to therapeutic usage as opposed to overdose. A recently published systematic review of 22 articles involving 76 patients with sulfonylurea-induced hypoglycemia (glucose <49 mg/dL) resulting from accidental ingestion or intentional overdose found that patients had an average serum insulin concentration of 3.9 μIU/mL or higher and an average serum C-peptide concentration of 1.4 ng/mL or higher.
Aaron Harries, Sachita Shah, Nathan Teismann, Daniel Price, Arun Nagdev
DOI: http://dx.doi.org/10.1016/j.ajem.2009.06.026
Published online: September 18 2009
xWe present the case of a 26-year-old man with significant periorbital trauma after blunt head trauma. Ultrasound techniques for evaluation of extraocular movements and pupillary light reflex are described as a proposed adjunct to physical examination and manual retraction of the eyelids.
Sadie J. Carter, Carl A. Germann, Angelo A. Dacus, Timothy W. Sweeney, Andrew D. Perron
DOI: http://dx.doi.org/10.1016/j.ajem.2009.05.024
Published online: March 11 2010
xPosterior elbow dislocations are the most common type of elbow dislocation and are usually caused by a fall on an outstretched hand. Although the incidence of elbow dislocation complications is rare, the emergency physician is responsible for evaluation and identification of concomitant neurovascular injuries. Failure to identify neurovascular compromise after elbow dislocation or reduction can potentially lead to severe morbidity with limb ischemia, neurologic changes, compartment syndrome, and potential loss of limb.
Michael Mallin, Hunter Louis, Troy Madsen
DOI: http://dx.doi.org/10.1016/j.ajem.2009.07.019
Published online: September 18 2009
xUltrasound-guided subclavian (SC) access is an inadequately described procedure in the current literature. We recommend using the endocavitary (EC) probe to perform supraclavicular (SUP) SC line placement and evaluate emergency medicine residents' skill and comfort in using this technique after an education session.
Sachita Shah, Akshay Dalal, R. Malcolm Smith, Giliane Joseph, Selwyn Rogers, George S.M. Dyer
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.017
Published online: August 16 2010
xPortable ultrasound in mass casualty disasters has emerged as a useful imaging modality to aid in clinical care and victim triage [1,2]. As portable ultrasound technology has become more durable, and charitable programs can rapidly provide machines to deploy with humanitarian workers, it has become possible to routinely use this imaging modality in disaster triage settings. Although a wide variety of potential ultrasound applications in mass casualty patient care exists [3], prior published studies of use of ultrasound in disaster are limited to abdominal hemoperitoneum [4] and renal Doppler studies in patients with crush injury [5].
Ruggero M. Corso, Emanuele Piraccini, Vanni Agnoletti, Giorgio Gambale
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.019
Published online: August 16 2010
xThe 2005 American Heart Association Cardiopulmonary Resuscitation (CPR) Guidelines emphasize minimizing the interruption of chest compression to maximize coronary and cerebral perfusion pressure [1]. More specifically, these guidelines suggest that skilled operators should be able to secure the airway either without interrupting chest compression or with only a brief pause to visualize vocal cords to allow the passage of the tracheal tube (TT). Previous studies have shown that chest compression prolongs the time needed for intubation and increases the risk of esophageal intubation [2].
Richard F. Edlich, Jamie J. Clark, Holly S. Stevens, Jill J. Dahlstrom, K. Dean Gubler, Willam B. Long III
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.023
Published online: August 16 2010
xTo the Editor,
Al Hallstrom, Thomas D. Rea, Michael R. Sayre, James Christenson, Leonard Cobb, Vincent N. Mosesso Jr., Andy R. Anton
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.001
Published online: August 16 2010
xWe read with interest the article by Paradis et al [1] offering a reanalysis of the AutoPulse Assisted Prehospital International Resuscitation (ASPIRE) trial originally published in 2006 [2]. Paradis and colleagues conclude a temporal relationship existed between the AutoPulse and 4-hour survival among a post hoc study population. They report that the outcome of the intervention arm improved during the course of the study among 4 of the 5 sites, which may represent a learning curve in the intervention arm.
Norman A. Paradis, Gregory Young, Stanley Lemeshow, James E. Brewer, Henry R. Halperin
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.002
Published in issue: October 2010
xWe appreciate the letter and additional data provided by Sayre et al. We believe their response is actually supportive of our concerns: (1) individual ASPIRE trial sites lacked homogeneity before and during the trial [1]; (2) the protocol and execution of the trial allowed individual sites to change the protocol during the trial; (3) the apparent potential harm from the use of the device appears to be isolated to one site after a change in the protocol at that site.
Gen-Min Lin, Chih-Lu Han
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.004
Published in issue: October 2010
xWe read with interest the work by Liao et al [1], which described an 83-year-old woman who developed atrial fibrillation with slow ventricular response possibly related to ginseng. The authors reasoned the bradyarrhythmia due to digitalis glycoside–like effects of ginseng in the condition of renal failure that have not been reported before. In fact, the negative chronotropic and inotropic effects of ginseng and its main active component, ginsenosides, had been well documented by Wu and Chen [2] since 1988.
Wen-I Liao, Shih-Hung Tsai
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.003
Published in issue: October 2010
xWe would like to thank the readers for their questions and commentary on our recently published article “Bradyarrhythmia Caused by Ginseng in a Patient with Chronic Kidney Disease” [1]. We agree that the exact pharmacological mechanism of herbal medicine can be complex. We appreciate that the negative chronotropic and inotropic effect as well other amiodarone-like pharmacological properties of some ginsenosides can also contributed the development of cardiac dysrhythmia [2]. However, we also note that this study is an animal study with 17 dogs [2].
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.010
Published in issue: October 2010
xIn the article “Pancreatic cholangiocarcinoma as an ST-elevation myocardial infarction with thrombolytic therapy” in the American Journal of Emergency Medicine 2010;28(3):389.e3-389.e5, there was an error in the byline. The correct byline is:
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.011
Published in issue: October 2010
xIn the article, “Spontaneous coronary artery dissection in a postpartum woman presenting with chest pain” Am J Emerg Med 2010; 28(5):641.e5-641.e7, there was an error in order of the byline. The correct byline is:
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.012
Published in issue: October 2010
xIn the article “Timely identification of bacterial pathogens may reduce inappropriate antibiotic prescription” in the American Journal of Emergency Medicine 2010;28(4):519-520, there was an error in the byline. Dr Jolobe was incorrectly listed as an MD. The correct byline is below.
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.013
Published in issue: October 2010
xIn the article “The differential diagnosis includes reversible cerebral vasoconstrictor syndrome” in the American Journal of Emergency Medicine 2010;28(5):637, there was an error in the byline. Dr Jolobe was incorrectly listed as an MD. The correct byline is below.
David T. Um, Jason D. Heiner, Christopher S. Kang
DOI: http://dx.doi.org/10.1016/j.ajem.2009.12.014
Published online: April 5 2010
xBack pain is a common complaint in the emergency department with etiologies causing temporary discomfort to immediate life threats. Spinal arachnoid cysts are thought to be rare and usually asymptomatic entities that have been known to cause progressive back pain. We report a case of an atypical cause of acute back pain in an otherwise healthy man with no findings initially concerning for a serious cause of his symptoms. His pain resolved in the emergency department, but he returned the next day with lower extremity monoparesis due to a previously undiagnosed arachnoid cyst requiring decompressive surgery.
Tahrina Salam, Panagiotis Stavrakas, Louisa Wickham, James Bainbridge
DOI: http://dx.doi.org/10.1016/j.ajem.2009.12.015
Published online: March 29 2010
xAirbags protect against serious head injury but can cause ocular injury. Here we describe bilateral simultaneous globe ruptures associated with airbag deployment in a motor vehicle incident.
Yves Benabu, Carolyne Laplante, Christian Berthelot
DOI: http://dx.doi.org/10.1016/j.ajem.2009.12.018
Published online: March 29 2010
xIn recent years, the notion of the hyperdense posterior cerebral artery sign has been put forward as an early marker of acute stroke and a prognostic marker. Although much less frequent than a dense middle cerebral artery sign, it is important to recognize such a sign especially when accompanying symptoms are present and potential revascularization is feasible. We present a case of a hyperdense posterior cerebral artery sign with resulting ischemic involvement of the posterior cerebral artery territory.
Glenn W. Stambo, Brian Montague
DOI: http://dx.doi.org/10.1016/j.ajem.2009.12.023
Published online: April 26 2010
xPulmonary embolism is a common and sometimes devastating disease caused by many factors most commonly deep venous thrombosis. Treatment is typically systemic anticoagulation depending on patient clinical presentation. For patients with life-threatening pulmonary embolism, intravenous tissue plasminogen activator (Activase; Genentech, South San Francisco, Calif) is the most common medication given emergently at the time of presentation. Computed tomographic angiography of the chest has advanced the diagnosis and potential treatment options for patients with life-threatening pulmonary embolism.
Chao-Liang Chou, Ya-Ju Lin, Helen L. Po, Cheng-Kuei Chang
DOI: http://dx.doi.org/10.1016/j.ajem.2009.12.024
Published online: April 5 2010
xArterial dissection is an uncommon cause of ischemic stroke and a big challenge to diagnose before initiation of thrombolytic therapy within such a narrow therapeutic window. We present a 47-year-old woman who encountered a rare but lethal complication—subarachnoid hemorrhage—after intravenous thrombolytic therapy within an adequate time window. The stroke mechanism may have been spontaneous dissection of the intracranial internal carotid artery extending to the middle cerebral artery. We review the literature and believe that this is the first patient complicated with a subarachnoid hemorrhage after intravenous tissue plasminogen activator.
Anette Mortensen, Nikolaj Friis Hansen, Ole Mikael Schiødt
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.007
Published online: April 5 2010
xIngestion of a button battery can result in serious complications if the battery becomes lodged in the esophagus. We report a case of a 14-month-old child who died from exsanguination caused by an aortoesophageal fistula caused by a 20-mm lithium button battery lodged in the esophagus. Recommendations concerning diagnostics, treatment, and follow-up are described.
Ahmet Kaya, Serkan Ordu, Enver Sinan Albayrak, Mesut Aydin, Ismail Erden, Hakan Ozhan
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.009
Published online: May 3 2010
xThrombolysis with streptokinase is routinely used for the treatment of acute myocardial infarction. Hematoma of the tongue, vocal cord, uvula, and pharyngeal hemorrhage after streptokinase treatment is a very rare condition. Herein, we describe a case of lingual hematoma after thrombolysis with streptokinase in a patient with acute myocardial infarction.
Hsing-Lin Lin, Liang-Chi Kuo, Yuan-Chia Cheng, Jiun-Nong Lin, Shing-Ghi Lin, Tsung-Ying Lin, Wei-Che Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.012
Published online: May 3 2010
xCervical spinal epidural hematoma is rare, and most cases are reported sporadically as caused by spontaneous bleeding. Traumatic cervical epidural spinal hematoma is extremely rare, and mimicking the symptoms of brachial plexus injury has never been reported. We describe a 32-year-old man who sustained a motorcycle accident and had multiple trauma with bilateral lung contusion and spleen laceration. He had left clavicle bone fracture and was diagnosed to have brachial plexus injury with the symptoms of weakness and paresthesia of left upper limb.
Tzu-Yao Hung, Tzong-Luen Wang, Ruei-Fang Wang, Tzu-Yao Hung
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.016
Published online: May 3 2010
xOur case demonstrates that pulmonary embolism can also occurred to a middle-aged adult man with minor trauma as simple avulsion fracture.
Hai Yu, Da Zhu, Peng Liang, Bin Liu
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.018
Published online: May 3 2010
xPenetrating cardiac injury is a rare medical emergency but with very high mortality. A quick and clear diagnosis and treatment strategy is of paramount importance in this emergency situation. Intraoperative transesophageal echocardiogram (TEE) is now considered to have an important role to play in this process. We then presented a case of a 42-year-old man who had 2 stab wounds and arrived in emergency department with altered consciousness, two 4-cm laceration over his left fourth intercostals space near the cardiac apex, and eighth intercostals space in posterior axillary line; blood pressure was maintained 74/40 mm Hg with infusion of vasoactive drug and colloid.
DOI: http://dx.doi.org/10.1016/S0735-6757(10)00343-8
Published in issue: October 2010
DOI: http://dx.doi.org/10.1016/S0735-6757(10)00344-X
Published in issue: October 2010
DOI: http://dx.doi.org/10.1016/S0735-6757(10)00345-1
Published in issue: October 2010
DOI: http://dx.doi.org/10.1016/S0735-6757(10)00346-3
Published in issue: October 2010
