Tyler W. Barrett, David M. DiPersio, Cathy A. Jenkins, Meg Jack, Nicole Streiff McCoin, Alan B. Storrow, Lori M. Singleton, Patricia Lee, Chuan Zhou, Corey M. Slovis
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.028
Published online: March 29 2010
xThe objective of the study was to assess whether ondansetron has superior nausea reduction compared with metoclopramide, promethazine, or saline placebo in emergency department (ED) adults.
Geertje Thuijls, Joep P.M. Derikx, Fred J. Prakken, Bregje Huisman, Annemarie A. van Bijnen Ing, Ernest L.W.E. van Heurn, Wim A. Buurman, Erik Heineman
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.029
Published online: March 26 2010
xDiagnosis of acute appendicitis (AA) remains a surgical dilemma, with negative appendectomy rates of 5% to 40% and perforation suggestive for late operative intervention in 5% to 30%. The aim of this study is to evaluate new plasma markers, representing early neutrophil activation, to improve diagnostic accuracy in patients suspected for AA.
Huijun Hu, Xiaowen Pan, Yi Wan, Qi Zhang, Wenbin Liang
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.030
Published online: March 26 2010
xDelayed encephalopathy after acute carbon monoxide poisoning (DEACMP) is a disease with poor prognosis. The present study was conducted to determine the factors that affect the prognosis of DEACMP patients.
Mark J. Collin, Benjamin Weisenthal, Kristy M. Walsh, Christine M. McCusker, Frances S. Shofer, Judd E. Hollander
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.031
Published online: March 26 2010
xPrior studies found that young adult chest pain patients without known cardiac disease with either no cardiac risk factors or a normal electrocardiogram (ECG) are at low risk (<1%) for acute coronary syndromes (ACS) and 30-day cardiovascular events. Longer-term event rates in this subset of patients are unknown. We hypothesized that patients younger than 40 years without past cardiac history and a normal ECG are at less than 1% risk for 1-year adverse cardiovascular events.
Stephen B. Freedman, Maggie Couto, Laurie Spooner, J. Kimberly Haladyn
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.032
Published online: March 29 2010
xThe objective of this study is to determine if intensive gastroenteritis education results in greater caregiver knowledge and a reduction in future emergency department (ED) visits.
Jasmine Malek, Robert Rogers, Joseph Kufera, Jon Mark Hirshon
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.034
Published online: March 29 2010
xInfection with the HIV has developed into a chronic illness, with longer-term complications increasingly being seen. There is increasing evidence that infection with HIV may be associated with a hypercoagulable state. This study examines the association of HIV infection with the incidence of both pulmonary embolism and deep venous thrombosis.
Chad Kessler, Vaishal M. Tolia, Xui Xie, Ravi Kasi, Bradley Kutka
DOI: http://dx.doi.org/10.1016/j.ajem.2009.10.001
Published online: March 26 2010
xDuring its first decade in existence from 1979 to 1988, the American Board of Emergency Medicine (ABEM) instituted a clause that granted board certification to non–emergency medicine (EM)-trained physicians who had completed a minimum number of hours working within an emergency department (ED) [1,2]. This practice was discontinued by 1988 as ABEM began to place a stronger emphasis on hiring EM residency–trained, board-certified (BC) physicians to staff EDs [2,3]. Although improvements were seen in EDs nationally, the same positive changes were not seen in Veteran's Affairs (VA) EDs [4].
Owen Hanley, James Miner, Erik Rockswold, Michelle Biros
DOI: http://dx.doi.org/10.1016/j.ajem.2009.10.002
Published online: April 5 2010
xThe study aimed to determine the prevalence of chronic illness and chronic pain in emergency department (ED) patients across demographic backgrounds.
Win Sen Kuan, Kanwar Sudhir Lather, Malcolm Mahadevan
DOI: http://dx.doi.org/10.1016/j.ajem.2009.11.005
Published online: April 5 2010
xThe objective of this study was to compare an expedited 24-hour management pathway against traditional inpatient ward management of patients with primary spontaneous pneumothorax (PSP) and recurrent spontaneous pneumothorax (RSP).
Maria Moreira, Jennie Buchanan, Kennon Heard
DOI: http://dx.doi.org/10.1016/j.ajem.2009.11.022
Published online: April 26 2010
xOften, patients are brought in to the emergency department after ingesting large amounts of cocaine in an attempt to conceal it. This act is known as body stuffing. The observation period required to recognize potential toxic adverse effects in these patients is not well described in the literature. We sought to validate a treatment algorithm for asymptomatic cocaine body stuffers using a 6-hour observation period by observing the clinical course of cocaine body stuffers over a 24-hour period. A retrospective chart review was performed on all patients evaluated for witnessed or suspected stuffing over 2 years using a standardized protocol.
Robert H. Birkhahn, Elizabeth Haines, Wendy Wen, Lakshmi Reddy, William M. Briggs, Paris A. Datillo
DOI: http://dx.doi.org/10.1016/j.ajem.2009.12.007
Published online: April 5 2010
xWe examined the use of point-of-care (POC) testing of cardiac biomarkers against standard core laboratory testing to determine the time-savings and estimate a cost-benefit ratio at our institution.
James A. Feldman, Sheilah Bernard, Patricia Mitchell, Casey M. Rebholz
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.023
Published online: November 26 2010
xMisclassification of the electrocardiogram (ECG) contributes to treatment errors in patients with acute coronary syndrome. We hypothesized that cardiology ECG review could reduce these errors.
William J. Brady, Amal Mattu, Robert E. O'Connor
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.029
Published online: November 9 2010
xPatients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS) must be evaluated expeditiously. A primary goal of the early evaluation is the identification of significant ST-segment changes, with immediate identification of patients having ST-segment elevation (STE) myocardial infraction (STEMI). Rapid and accurate interpretation of the 12-lead electrocardiogram (ECG) represents an extremely important skill during this early, time-sensitive evaluation. The emergency physician most often is responsible for ECG interpretation at this crucial step in the process of care.
Deborah L. Zvosec, Stephen W. Smith, Trinka Porrata, A. Quinn Strobl, Jo Ellen Dyer
DOI: http://dx.doi.org/10.1016/j.ajem.2009.11.008
Published online: April 29 2010
xγ-Hydroxybutyrate (GHB) and its prodrugs are drugs of abuse that were also sold as “dietary supplements.” Users present to emergency departments with overdose, impaired driving, withdrawal, and associated trauma. We compiled a series of GHB-associated deaths to elucidate lethal risks, GHB concentrations, cointoxicants, products, uses, and medical interventions. Death records were reviewed for toxicology, autopsy findings, and history. Inclusion cutoffs were as follows: 5/10 mg/L of GHB (antemortem blood/urine) and 50/20/7 mg/L of GHB (postmortem blood/urine/vitreous).
Anne-Claire Durand, Stéphanie Gentile, Bénédicte Devictor, Sylvie Palazzolo, Pascal Vignally, Patrick Gerbeaux, Roland Sambuc
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.003
Published online: April 26 2010
xNonurgent visits to emergency departments (ED) are a controversial issue; they have been negatively associated with crowding and costs. We have conducted a critical review of the literature regarding methods for categorizing ED visits into urgent or nonurgent and analyzed the proportions of nonurgent ED visits. We found 51 methods of categorization. Seventeen categorizations conducted prospectively in triage areas were based on somatic complaint and/or vital sign collection. Categorizations conducted retrospectively (n = 34) were based on the diagnosis, the results of tests obtained during the ED visit, and hospital admission.
Yusuf Sezen, Unal Guntekin, Hakan Buyukhatipoglu, Zekeriya Kucukdurmaz
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.030
Published online: December 15 2010
xWe thank to Dr Gen-Mib Lin for his/her interest in our case. Actually, we agree with Dr Gen-Mib Lin; however, our clinical approach paralleled to our clinical facilities. As stated by the author, in the treatment of acute decompensated myocarditis, intraaortic balloon pump, extracorporeal membrane oxygenation, and left ventricular assist devices have been used. However, in our pediatrics clinic, such devices have not been provided. That is why the patient was followed medically.
Gen-Min Lin, Chih-Lu Han
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.031
Published online: December 15 2010
xWe appreciate the experience by Sezen et al [1], who described a 12-year-old boy who developed life-threatening, acute toxic myocarditis and heart failure after a scorpion bite, for whom aggressive medical treatment with inotropic agents, diuretics, and parenteral corticosteroids resulted in rapid clinical resolution. To our knowledge, the natural course of fulminant myocarditis is related to the underlying etiologies including severe ischemia, toxic/metabolic agents, infection, and inflammation [2].
Nicolas Kluger
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.009
Published online: December 27 2010
xI read with great interest the case report by Hessert and Devlin [1], recently published in the Journal, regarding a case of cutaneous vasculitis that occurred shortly after tattooing. This case has to be added to the 3 prior cases previously published [2-4]. Of note, a case of retinal vasculitis was also reported [5]. If the time lag between tattooing and purpura undoubtedly points out the tattooing procedure as responsible for such event, I am not convinced with the diagnosis of hypersensitivity vasculitis induced by tattoo pigments/dyes made by the authors according to the data in hand [1].
Tsung-Ying Lin, Wei-Che Lee, Ching-Ying Wu
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.018
Published online: December 3 2010
xLaeben et al reported a study about low-dose ketamine for analgesia in the emergency department (ED) [1]. However, there was concern about the patient group in this study which may interfere with their conclusion when applied to the general population. Twenty-eight (80%) of the 35 studied cases had the record of chronic pain medication use or illicit drug abuse. As far as our ED is concerned, patients with these records represent a very different issue of analgesia from that of ordinary people. Tolerance or dependence of opioids or opioid-like agents was frequently seen in these patients, which make them become a “drug seeker” in the ED, and thus, analgesia or so-called improvement of pain for them is more complicated.
Oscar M P Jolobe
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.023
Published online: December 15 2010
xAs shown in the recent study [1], and in other studies [2-5], there is a high probability that patients with left circumflex artery (LCx) thrombosis will fall into the category of non–ST-segment elevation myocardial infarction (NSTEMI), and this is true also when diagnostic levels of troponin are utilized, typically 12 hours or more after onset of chest pain, for the purpose of distinguishing patients with NSTEMI from patients with unstable angina (UA) [5]. At that point in time, even in the event that subsequent angiography identifies total occlusion of the infarct-related artery, percutaneous intervention (PCI) is unlikely to alter the natural history of that particular episode of myocardial infarction, given the fact that the procedure will have been undertaken beyond the therapeutic time window of 3 hours recommended for PCI management of acute myocardial infarction (AMI) [6,7].
Malcolm Lemyze, Jihad Mallat, Didier Thevenin
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.024
Published online: December 15 2010
xMetformin is believed to be the most prescribed antidiabetic drug in the world, with more than 40 million prescriptions filled in 2008 for generic metformin alone in the United States [1]. The reason for this huge popularity is that metformin is a very efficient oral glucose-lowering drug reducing mortality and morbidity especially in overweight and obese patients [2]. However, metformin has been incriminated to produce severe lactic acidosis in a substantial number of cases [3]. This life-threatening complication has been called metformin-associated lactic acidosis (MALA) and not metformin-induced lactic acidosis because the cause-effect relationship between the 2 events treatment by metformin and appearance of severe lactic acidosis is still a contentious issue [4].
Tzu-Chin Wu
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.029
Published online: December 15 2010
xI read the article “Combination of white blood cell count with liver enzymes in the diagnosis of blunt liver laceration” by Lee et al [1] with great interest. In their study, they came to the conclusion that “In patients with blunt abdominal trauma, elevated WBC counts together with elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are strongly associated with liver laceration and warrant further imaging studies and management.” They also proposed an algorithm for managing patients with occult hepatic injuries after blunt abdominal trauma.
Deborah French, Jean Branch, Alan H.B. Wu, Lisa Winston, Eberhard W. Fiebig
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.002
Published online: December 15 2010
xA 32 year-old man was brought to the emergency department (ED) via ambulance after repeated generalized tonic-clonic seizures at home and en route to the hospital. The patient had a history of epilepsy following brain surgery for complications related to a sinus infection at the age of 17 years.
Brunhild M. Halm, Rodney B. Boychuk, Adrian A. Franke
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.016
Published online: May 3 2010
xOver the past decades, ultrasonography (US) expanded from radiology to many different specialties including emergency medicine. In 1999, the American Academy of Emergency Medicine published its position statement defining point-of-care (POC) US as a sonographic imaging procedure by an emergency physician on a patient in the emergency department (ED) in an effort to detect acute medical problems. In 2001, the American College of Emergency Physicians issued a policy statement on the use of emergency US, endorsing its use in EDs nationwide.
Nathalie Soumagne, Stéphane Chauvet, Delphine Chatellier, René Robert, Jean-Mathias Charrière, Paul Menu
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.017
Published online: May 3 2010
xTaxine, a yew tree toxin, is highly cardiotoxic. We report the case of a patient who developed severe cardiac failure and ventricular fibrillation after consuming yew leaves and who made a full recovery after extracorporeal life support. Yew poisoning can be added to the list of potential indications of extracorporeal life support for refractory toxic cardiogenic shock.
Giovanni Volpicelli, Bruno Audino
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.020
Published online: May 3 2010
xLung ultrasound is extremely useful in the bedside diagnosis of pneumothorax. The lung point, which is the sonographic demonstration of the point on the chest wall where the pleural layers adhere again, represents the limit of the pneumothorax extension and allows estimation of its volume. This sonographic sign is not only highly accurate in ruling-in pneumothorax but also helps the clinician in deciding whether to place a chest tube. We report a case of a young patient with spontaneous pneumothorax showing a double lung point.
Ming Yin, Qing Tian, Hong Shen
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.023
Published online: May 3 2010
xRoller coasters are probably one of the more popular rides at amusement parks around the world, and there are few reported injuries. We report a case of symmetric diffuse upper lobe hemorrhage resulting from roller coaster in a previously healthy woman. The clinical course, management, and etiology of her case are discussed; and the literature is reviewed. To our knowledge, pulmonary hemorrhage in this setting has not yet been described.
Janet Smereck, Michael Ybarra
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.033
Published online: May 3 2010
xA patient with acute hip pain out of proportion to physical findings and inability to weight bear despite negative plain films warrants further in-depth evaluation. Correctly diagnosing the cause of hip pain, a common emergency department (ED) complaint, may be a challenge in the geriatric population (Perron A, Miller M, Brady W. Orthopedic pitfalls in the ED: radiographically occult hip fracture. Am J Emerg Med 2002; 20: 234-7; Cannon J, Silvestri S, Munro M. Imaging choices in occult hip fracture.
Fayaz A. Sofi, Sheikh Hilal Ahmed, Majid A. Dar, Dhobi G. Nabhi, Showkat Mufti, Mohammad Akbar Bhat, Parvez Nazir Tabassum
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.034
Published online: August 5 2010
xDiaphragmatic hernias in adults usually pose a diagnostic challenge; the presentations are varied and range from acute abdominal pain with features of gut obstruction, pleuritic chest pain, breathlessness, to a pregnant woman with pain abdomen. The usual cause in adults is posttraumatic. Because of varied presentations, the diagnosis is often delayed.
Baiqiang Li, Ling Jia, Danbing Shao, Hongmei Liu, Shinan Nie, Wenjie Tang, Baohua Xu, Zongfeng Hu, Haichen Sun
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.007
Published online: July 14 2010
xTrichloroisocyanuric acid is a high-efficiency and-low toxicity fungicide and bleach. It is commonly used as disinfectant for industrial circulating water, swimming pools, restaurants, and other public places in China. When trichloroisocyanuric acid is put into water, chlorine gas is produced. Chlorine gas is a potent pulmonary irritant that causes acute damage in both the upper and lower respiratory tracts (J Toxicol Clin Toxicol. 1998;36(1-2):87-93). Pneumomediastinum is a rare complication in patients with acute chlorine gas poisoning.
Yoshito Kamijo, Toshimitsu Ide, Ayako Ide, Kazui Soma
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.011
Published online: August 5 2010
xIt is proposed that the significant elevation of interleukin-6 (>400 pg/mL) in cerebrospinal fluid during the early phase of carbon monoxide poisoning may be a predictive biomarker for the development of delayed encephalopathy. A 52-year-old man presented to the emergency department with severe carbon monoxide poisoning. On arrival, the patient was comatose with decorticate rigidity (Glasgow Coma Scale, E1V1M3). His core body temperature, measured in the urinary bladder, was 32.4°C. Laboratory blood analysis revealed elevated CO-Hb (36.0%) and metabolic acidosis with elevated lactate (pH 7.081; base excess [BE], −19.2 mmol/L; HCO3, −9.8 mmol/L; lactate, 168.8 mg/dL).
Hesham Hussein, Ayman El-Menyar, Emad Ahmed, Abdulrazzak Gehani
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.012
Published online: August 5 2010
xDobutamine induced ST-segment elevation in the absence of obstructive coronary artery disease is a rare condition. We report a case of a 37-year-old man, a smoker, who developed severe chest pain associated with transient ST-segment elevation in anterolateral leads and significant segmental wall motion abnormalities during dobutamine stress echocardiography that was immediately relieved by sublingual nitrates without evidence of acute myocardial infarction. Coronary angiogram showed patent epicardial coronary arteries.
Denis J. Dollard, John B. Fobia
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.013
Published online: August 5 2010
xLower quadrant abdominal pain is a common complaint evaluated in emergency departments (EDs).The number of differential diagnoses is lowered when the pain in a male patient is associated with a palpable tender mass. These diagnoses include inguinal hernia, inflamed inguinal lymph node, rectus sheath hematoma, cryptorchidism, mass derived from the spermatic cord, and polyorchidism. We report a case of extra scrotal spermatocele causing lower quadrant abdominal pain that was misdiagnosed as an inguinal hernia on several ED visits.
Tzu-Yao Hung, Shang Li, Po-Shen Chen, Liang-Ting Wu, Yuh-Jeng Yang, Li-Ming Tseng, Kuo-Chih Chen, Tzong-Luen Wang, Tzu-Yao Hung
DOI: http://dx.doi.org/10.1016/j.ajem.2010.05.001
Published online: August 5 2010
xAcute epiglottitis is a true airway emergency in the emergency department (ED). The patient may appear very toxic and rapidly progress to respiratory distress and life-threatening condition. The inflammatory process includes not only epiglottis but also the rest of the supraglottic area including the vallecula, aryepiglottic folds, and arytenoids. Soft tissue swelling over this windpipe area can be very dramatic. The criterion standard of diagnosis is direct inspection of cherry red and swollen epiglottis by laryngoscopy in the operation room with immediate access to anesthetists or ear, nose, and throat specialists.
John G. Galbraith, Joseph S. Butler, Simon P. Blake, Gemma Kelleher
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.015
Published online: August 5 2010
xSacral insufficiency fractures are an important and treatable cause of severe back pain. Despite publication of several case reports since its original description in 1982, awareness of these injuries remains inadequate in emergency medicine. Most patients are elderly women presenting with intractable lower back pain. Postmenopausal osteoporosis is the most significant risk factor. Marked sacral tenderness is common. Neurologic impairment is rarely detectable. Routine radiography of the spine and pelvis is usually inconclusive.
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00025-8
Published in issue: March 2011
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00026-X
Published in issue: March 2011
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00027-1
Published in issue: March 2011
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00028-3
Published in issue: March 2011
