Keith S. Boniface, Hamid Shokoohi, E. Reed Smith, Kari Scantlebury
DOI: http://dx.doi.org/10.1016/j.ajem.2009.12.001
Published online: April 14 2010
xThe aim of this study was to examine the capability of ultrasound-naïve paramedics to obtain interpretable Focused Assessment With Sonography for Trauma (FAST) images under the remote direction of emergency physicians (EPs).
Marcy Rosenberg, Sarah Greenberger, Amit Rawal, Janese Latimer-Pierson, Josef Thundiyil
DOI: http://dx.doi.org/10.1016/j.ajem.2009.12.002
Published online: April 5 2010
xWe sought to determine the agreement of physician estimates compared with Broselow tape measurements in accurately determining children's weights. Our secondary objective was to evaluate whether physician adjustment of the Broselow tape weight measurement is a better estimate of pediatric weight compared with either method alone.
Eui Jung Lee, Sang Do Shin, Kyoung Jun Song, Seong Chun Kim, Jin Seong Cho, Seung Chul Lee, Ju Ok Park, Won Chul Cha
DOI: http://dx.doi.org/10.1016/j.ajem.2009.11.020
Published online: April 26 2010
xOur study compared clinical decision time between patients managed with a point-of-care chemistry test (POCT) and patients managed with the traditional central laboratory test (CLT).
Elizabeth Schoenfeld, Keith Boniface, Hamid Shokoohi
DOI: http://dx.doi.org/10.1016/j.ajem.2009.11.021
Published online: April 26 2010
xThe objective of the study was to assess the success rate of emergency department (ED) technicians in placing ultrasound (US)-guided peripheral intravenous (IV) catheters.
Brandon C. Maughan, Lei Lei, Rita K. Cydulka
DOI: http://dx.doi.org/10.1016/j.ajem.2009.12.004
Published online: April 29 2010
xThe study objectives were to identify emergency department (ED) handoff practices and describe handoff communication errors among emergency physicians.
Vincent Bounes, Caroline Barniol, Vincent Minville, Charles-Henri Houze-Cerfon, Jean Louis Ducassé
DOI: http://dx.doi.org/10.1016/j.ajem.2009.12.005
Published online: March 29 2010
xThe aim of the study was to analyze factors predicting pain relief and adverse events in patients receiving opioids for acute pain in a prehospital setting.
Tie Gang Li, Yong Yan, Na Na Wang, Min Zhao
DOI: http://dx.doi.org/10.1016/j.ajem.2009.12.006
Published online: April 5 2010
xCarbamazepine (CBZ) poisoning has been occurring more frequently. We describe the use of synthesized resin–absorbed hemoperfusion in the therapy of a 48-year-old man who developed carotic, cardiovascular shock and multiorgan dysfunction due to a CBZ overdose (the highest concentration of drug >20 mg/L; therapeutic range, 8-12 mg/L). The treatment was very successful; and the patient eventually was discharged with a full recovery and no complications, although his diagnosis and treatment had been delayed for 56 hours.
Alexis A. Cochran, George L. Higgins III, Tania D. Strout
DOI: http://dx.doi.org/10.1016/j.ajem.2009.11.023
Published online: April 5 2010
xWe sought to determine the rate of intussusception in 3 age groups (traditional pediatric-age [T], nontraditional pediatric-age [N], and adult-age [A]) and to compare group characteristics.
Christy L. Hopkins, Scott T. Youngquist, Eliza Johnson, Troy Madsen
DOI: http://dx.doi.org/10.1016/j.ajem.2009.12.013
Published online: April 26 2010
xThis study examined hospital outcomes in elderly patients injured at winter resorts.
Michael M. Hirschl, Christian Wollmann, Sebastian Globits
DOI: http://dx.doi.org/10.1016/j.ajem.2009.12.016
Published online: May 3 2010
xPharmacologic cardioversion of atrial fibrillation (AF) is a reasonable mode of treatment if the arrhythmia is of recent onset. Results concerning the response rates of different drugs, respectively, in daily clinical practice and data with regard to the parameters associated with successful cardioversion are not very prevalent.
Christopher S. Weaver, Kevin M. Terrell, Robert Bassett, William Swiler, Beth Sandford, Sara Avery, Anthony J. Perkins
DOI: http://dx.doi.org/10.1016/j.ajem.2009.12.017
Published online: April 26 2010
xEmergency physicians routinely perform emergency department procedural sedation (EDPS), and its safety is well established. We are unaware of any published reports directly evaluating the safety of EDPS in older patients (≥65 years old). Many EDPS experts consider seniors to be at higher risk. The objective was to evaluate the complication rate of EDPS in elderly adults.
David J. Carlberg, Sarah Tsuchitani, Kevin S. Barlotta, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.041
Published online: May 3 2010
xParoxysmal supraventricular tachycardia (PSVT), a common dysrhythmia seen in the emergency department (ED), is usually managed without difficulty and with a favorable prognosis. Serum cardiac troponin I (cTnI) testing provides important risk stratification information in certain patients; its use in PSVT patients, however, has not been explored. A retrospective review of consecutive adult ED PSVT patients seen for 21 months was performed. Fifty-four PSVT patients were identified on the basis of International Classification of Disease, Ninth Edition codes and the ED patient log at a university hospital.
Solveig Aune, Thomas Karlsson, Johan Herlitz
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.048
Published online: May 3 2010
xTime between onset of cardiac arrest and start of treatment is of ultimate importance for outcome. The length of time it takes to expose the chest in out-of-hospital cardiac arrest (OHCA) is not known. We aimed to compare the time from onset of OHCA until the time at which the chest was exposed using a new device (S-CUT; ES Equipment, Gothenburg, Sweden) and a pair of scissors.
Michael E. Winters, Tsuyoshi Mitarai, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.009
Published online: May 3 2010
xMarchick MR, Kline JA, Jones AE. The significance of non-sustained hypotension in emergency department patients with sepsis. Intensive Care Med 2009;35:1261-1264.
Peter P. Monteleone, Kostas Alibertis, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.030
Published online: May 3 2010
xPrecordial percussion is a technique by which a manual force is applied repeatedly to the chest of a patient experiencing an unstable bradycardic or asystolic rhythm. The force is used not to defibrillate the myocardium as is the case with the “precordial thump” in pulseless ventricular tachycardia/ventricular fibrillation but rather to initiate a current through the myocardium in the form of an essentially mechanically paced beat. In this review, we discuss the physiology and utility of precordial percussion, or precordial thump, in the emergency setting as a very temporary bridge to more effective and permanent pacing techniques.
Zhanna Livshits, Delbert Clark, Miguel Gutierrez, Robert S. Hoffman
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.016
Published online: April 29 2011
xThe recent article by Heard et al [1] heightened awareness of the challenges faced by physicians evaluating “body stuffers.” Although serious complications after cocaine body stuffing, such as seizures, typically occur rapidly after ingestion, there is at least 1 report of delayed seizures in a crack cocaine body stuffer, occurring at 10 to 24 hours postingestion [2]. This presents a controversy in defining an appropriate time for observation under medical supervision.
Christian T. Ross, Rawle A. Seupaul
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.013
Published online: April 25 2011
xThe March 1, 2001, Institute of Medicine (IOM) report “Crossing the quality chasm” states: “It is in inadequate handoffs that safety often fails first” [1]. On the tails of the Institute of Medicine observations, the Joint Commission on Accreditation of Healthcare Organizations formed a task force to address error in handoff communications. With its initial recommendations, this task force identified standardization of handoff methods to be critical for successful handoffs [2].
Gioacchino Li Cavoli, Calogera Tortorici, Luisa Bono, Carlo Giammarresi, Angelo Ferrantelli, Carmela Zagarrigo, Onofrio Schillaci, Angelo Tralongo, Rotolo Ugo
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.024
Published online: April 4 2011
xWe read with interest the article of Dr Wills et al [1] regarding metformin overdose and lactic acidosis. We would like to report our experience on acute kidney injury (AKI) associated with metformin therapy. Metformin is the most commonly prescribed branded diabetes mellitus medication in the United States. Despite labeled contraindications including renal dysfunction and congestive heart failure requiring pharmacologic treatment, its use is often associated with an inappropriate prescription. In the United States, the incidence of metformin-induced severe lactic acidosis is estimated 6.3% per 100 000 patient year and may occur in patients with previously normal renal function.
Jiang Lin, Hu Zupeng, Chen Zi, Hu Hong, Yang Minjie, Song Ting, Xu Siyuan
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.025
Published online: April 4 2011
xEmergency physicians in urban China, like their counterparts in the West, are facing greater pressures than before. One of the outcomes of medical reform and economic development in China has been a new reliance by patients to use the emergency department as their first choice for medical care. Moreover, an experienced emergency physician in Shanghai typically works 25 days per month, has only 5 days of vacation/holiday leave, and will see 30 to 80 (and, in unusual situations, 100 or more) patients within an 8-hour shift.
Jeanine A. Ward, Matthew Zuckerman, Charles A. Adams Jr., Anthony Napoli
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.026
Published online: April 25 2011
xAlthough data indicate 3,4-Methylenedioxymethamphetamine (MDMA) and methamphetamine use in New England, little is known about recent specific MDMA and methamphetamine use in the state of Rhode Island [1,2]. Therefore, given the potential increased burden of these agents in our region, we decided to undertake a study to determine the types of amphetamines used in our local trauma patients. Prior studies have implicated a potential association between amphetamine use and trauma [3,4]. As such, it may also be important to determine the specific patient demographics of those using these substances in Rhode Island from both an epidemiologic and treatment perspective.
Ludo F.M. Beenen, Rob Adams, Rudolph W. Koster, Taco Otto
DOI: http://dx.doi.org/10.1016/j.ajem.2010.05.006
Published online: August 5 2010
xIn cardiopulmonary resuscitation, computed tomography (CT) imaging could be of decisive importance to therapeutic strategy making but is yet unavailable because of incompatibility of CT scanning and manual chest compressions.
Mohammadreza Hafezi Ahmadi, Hamidreza Seifmanesh, Malek Alimohammadi, Ali Delpisheh, Masoud Yasemi, Hadi Peyman
DOI: http://dx.doi.org/10.1016/j.ajem.2010.05.007
Published online: July 16 2010
xMesenteric cysts are typically described as benign interabdominal lesions. Basically, mesenteric cysts are rare with an incidence rate of between one case per 27 000 to one case per 25 000. The etiology has not been clearly discovered yet. It can occasionally be asymptomatic or present with acute life-threatening manifestations such as acute abdominal emergency that occurs in 10% of cases. It can arise from any site on the gastrointestinal tract. When it manifests with right lower quadrant (RLQ) pain and tenderness, it is difficult to distinguish from appendicitis, especially when there are no definite diagnostic criteria.
Fatih Büyükcam, Mustafa Çalık, Mansur Kürşat Erkuran, Huriye Akay
DOI: http://dx.doi.org/10.1016/j.ajem.2010.05.008
Published online: August 5 2010
xGlucocorticoids are commonly used as potent anti-inflammatory agents in several conditions. Hypokalemia and muscle weakness can be rarely seen after administration of high-dose glucocorticoids. In this report, we describe an acute onset of hypokalemia and muscle weakness after low dose of methylprednisolone therapy.
Reza Taslimi, Keihan Golshani
DOI: http://dx.doi.org/10.1016/j.ajem.2010.05.016
Published online: September 27 2010
xCongenital fibrinogen disorders are rare in emergency departments (EDs). We describe 2 cases with different presentations; the first was a 27-year-old woman with a known case of congenital hypofibrinogenemia who presented with nausea, vomiting, abdominal pain, and distension. She reported a history of concentrated fibrinogen use (1000 mg/d) for 4 days without visiting any physician. She was diagnosed as having thrombosis of mesenteric and portal veins with intestinal ischemia. The second was a 28-year-old woman with congenital afibrinogenemia who came to our ED with abdominal pain.
Ausami Abbas, Manish Thakker, Michael Booth, Ian Rechner
DOI: http://dx.doi.org/10.1016/j.ajem.2010.05.019
Published online: August 16 2010
xTension gastrothorax is a rare, potentially life-threatening complication associated with diaphragmatic defects. Most reported cases in the literature have described this condition as a complication of congenital diaphragmatic hernia, in patients with hiatus hernia, or in the postoperative setting. It is an extremely rare complication following diaphragmatic injury and usually manifests as a delayed presentation of an undiagnosed traumatic diaphragmatic hernia. Early diagnosis and differentiation from other conditions that are more commonly associated with “tension” phenomena are essential.
Beatrice Hoffmann
DOI: http://dx.doi.org/10.1016/j.ajem.2010.05.020
Published online: August 16 2010
xSialolithiasis with salivary gland obstruction is a rare disease and can mimic more frequently occurring illnesses such as facial and dental infection or abscess. Salivary stones located in the gland or duct system can be diagnosed using high-frequency sonography, and these findings can be differentiated from ultrasound appearance of cellulitis and abscess. Additional information obtained by sonography such as number, size, and location of stones help determine prognosis of stone passage and can guide initial management of the symptomatic patient in the emergency setting.
Arif Wahab, R.B. Panwar, Vipin Ola, Shaista Alvi
DOI: http://dx.doi.org/10.1016/j.ajem.2010.05.021
Published online: August 18 2010
xSecondary hyperkalemic paralysis is a rare disease entity, and initial presentation with sine wave pattern is even rarer. We report a case of acute onset flaccid quadriparesis due to hyperkalemia and sine wave pattern in electrocardiogram.
Hadim Akoglu, Belgin Akan, Serhan Piskinpasa, Omer Karaca, Fatih Dede, Deniz Erdem, Mahinur Demet Albayrak, Ali Riza Odabas
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.005
Published online: August 16 2010
xMetformin-associated lactic acidosis is a well-recognized complication in diabetic patients receiving metformin. Only a few cases of voluntary metformin intoxication presented with metformin-associated lactic acidosis have been reported, and they mostly described patients with diabetes mellitus. Cases of voluntary acute metformin intoxication in nondiabetic, previously healthy subjects are rarely reported, and their characteristics and prognosis are less known. We report a 34-year-old healthy man who presented to the emergency department after taking 170 metformin 850-mg tablets in a suicide attempt.
Luke White, Gagangeet Sandhu
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.006
Published online: October 28 2010
xAcute colonic pseduo-obstruction (ACPO), or Ogilvie syndrome, is a syndrome of colonic obstructive symptoms and dilatation in the confirmed absence of mechanical obstruction. It carries a high mortality, which increases with the duration of the disease. Because the pathophysiology is thought to involve an excess of sympathetic activation with parasympathetic inhibition, the acetylcholinesterase inhibitor neostigmine has replaced surgical management as the primary mode of therapy. The optimal dose, rate, and frequency of neostigmine administration remain largely unexplored.
Meltem Akkaş Camkurt, Didem Ay, Husamettin Akkucuk, Hulya Ozcan, Mehmet Mahir Kunt
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.007
Published online: August 16 2010
xA 76-year-old female patient, while receiving nebulized ipratropium bromide and salbutamol treatment of pneumonia and dyspnea, developed mydriasis in the left eye (left, 6 mm; right, 2 mm) on the third day of the treatment. Because the patient was incoordinated to the mask treatment, leakage of the medications to the left eye occurred. The patient was diagnosed as having pharmaceutical pupil. Afterward, nebulization treatment was stopped. Within 24 hours, the pharmaceutical pupil got back to normal.
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00180-X
Published in issue: June 2011
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00181-1
Published in issue: June 2011
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00182-3
Published in issue: June 2011
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00183-5
Published in issue: June 2011
