C. Geraldine McMahon, John V. Lamont, Elizabeth Curtin, R. Ivan McConnell, Martin Crockard, Mary Jo Kurth, Peter Crean, S. Peter Fitzgerald
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.022
Published online: January 5 2011
xThe aim of this study was to evaluate the diagnostic efficacy of multiple tests—heart-type fatty acid–binding protein (H-FABP), cardiac troponin I (cTnI), creatine kinase-MB, and myoglobin—for the early detection of acute myocardial infarction among patients who present to the emergency department with chest pain.
William M. McDonnell, Douglas S. Nelson, Jeff E. Schunk
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.027
Published online: January 5 2011
xSurges in patient volumes compromise emergency departments' (EDs') ability to deliver care, as shown by the recent H1N1 influenza (flu) epidemic. Media reports are important in informing the public about health threats, but the effects of media-induced anxiety on ED volumes are unclear.
Veronica Sikka, Joseph P. Ornato
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.029
Published online: January 19 2011
xThis study determined the proportion of incident colorectal and lung cancers with a diagnosis associated with an emergency department (ED) visit. The characteristics of these patients and the correlation between diagnosis near an ED visit and stage at diagnosis were also examined.
Yuxi Xiang, Weiyan Zhao, Huiyun Xiang, Gary A. Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.031
Published online: March 3 2011
xFatal drug-related poisoning has been well described. However, death data only show the tip of the iceberg of drug-related poisoning as a public health problem. Using the 2007 Nationwide Emergency Department Sample, this study described the characteristics of emergency department visits for drug-related poisoning in the United States.
Larissa May, Katherine Harter, Kabir Yadav, Ryan Strauss, Jameel Abualenain, Amy Keim, Gillian Schmitz
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.033
Published online: January 31 2011
xCommunity-acquired methicillin-resistant Staphylococcus aureus (MRSA) is the most common cause of purulent skin and soft-tissue infections (SSTIs) in the Unites States. Little is known regarding health care provider management strategies for abscesses in the emergency department (ED). Understanding variability in practice patterns could be an important step in implementing evidence-based guidelines.
Rajiv Arya, Frank Dossantos, Pamela Ohman-Strickland, Mark A. Merlin
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.011
Published online: February 7 2011
xTrauma activation prioritizes hospital resources for the assessment and treatment of trauma patient over all patients in the emergency department (ED). We hypothesized that length of stay (LOS) is longer for nontrauma patients during a trauma activation.
Giovanni Volpicelli, Luciano Cardinale, Paola Berchialla, Alessandro Mussa, Fabrizio Bar, Mauro F. Frascisco
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.035
Published online: January 31 2011
xBedside lung ultrasound (LUS) is useful in detecting radio-occult pleural-pulmonary lesions. The aim of our study is to compare the value of LUS with other conventional routine diagnostic tools in the emergency department (ED) evaluation of patients with pleuritic pain and silent chest radiography (CXR).
Michael M. Haap, Sergios Gatidis, Marius Horger, Reimer Riessen, Hendrik Lehnert, Christian S. Haas
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.013
Published online: January 31 2011
xPulmonary embolism (PE) is a major cause of morbidity and mortality associated with surgery and medical illnesses. In recent years, pulmonary computed tomography angiography (CTA) has become the diagnostic method of choice. However, it remains unclear when to perform CTA and how often a decision based on clinical judgment results in positive or negative findings.
Catherine A. Marco, Jacqueline Nagel, Ellen Klink, David Baehren
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.015
Published online: March 2 2011
xPain is a common presenting complaint among emergency department (ED) patients. The verbal numeric pain scale is commonly used in the ED to assess self-reported pain. This study was undertaken to describe and compare pain scores in a variety of painful conditions and identify factors associated with self-reported pain scores.
Michael Blaivas, Richard Pawl
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.016
Published online: January 31 2011
xThe study aims to define extent of lawsuits filed against emergency physicians (EPs) over point-of-care emergency ultrasound (US) during the last 20 years.
Shinsuke Tanizaki, Shigenobu Maeda, Hiroyuki Hayashi, Hideyuki Matano, Hiroshi Ishida, Jun Yoshikawa, Toru Yamamoto
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.032
Published online: January 31 2011
xIn this retrospective study, we reviewed our protocol consisting of early embolization without acute external fixation in patients with pelvic fracture.
Sassan Naderi, Barbara Barnett, Robert S. Hoffman, Resul Dalipi, Lauren Houdek, Kumar Alagappan, Robert Silverman
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.034
Published online: November 14 2011
xAlthough emergency department (ED) discharge is often based on the presumption of continued care, the reported compliance rate with follow-up appointments is low.
Michael L. Rinke, Elisabeth Dietrich, Traci Kodeck, Kathleen Westcoat
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.012
Published online: January 27 2011
xThis study aims to determine if a prehospital case management intervention reduces transport and nontransport emergency medical system (EMS) responses to frequent EMS users.
Orhan Cinar, Yahya Ayhan Acar, İbrahim Arziman, Erden Kilic, Yusuf Emrah Eyi, Ramazan Ocal
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.014
Published online: January 31 2011
xThis study was designed to determine whether the mainstream end-tidal carbon dioxide (ETCO2) measurement can accurately predict the partial arterial carbon dioxide (Paco2) level of patients presented to emergency department (ED) with acute dyspnea.
Jong Seok Lee, Oh Young Kwon, Han Sung Choi, Hoon Pyo Hong, Young Gwan Ko
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.017
Published online: February 28 2011
xThere is limited literature describing clinical predictors for critically ill patients with cancer who present to the emergency department (ED).
Jerry Ray Baskerville, John Herrick
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.008
Published online: March 16 2011
xThis study focuses on clinically assigned prospective estimated pretest probability and pretest perception of legal risk as independent variables in the ordering of multidetector computed tomographic (MDCT) head scans. Our primary aim is to measure the association between pretest probability of a significant finding and pretest perception of legal risk. Secondarily, we measure the percentage of MDCT scans that physicians would not order if there was no legal risk.
Riccardo Lubrano, Gianni Messi, Marco Elli, Training Center PBLS SIMEUP
DOI: http://dx.doi.org/10.1016/j.ajem.2011.08.006
Published online: October 26 2011
xWe read, with interest, the article by Pozner et al [1] stressing the importance of teaching high-quality chest compressions in cardiopulmonary resuscitation. Teaching and long-time retention of resuscitation skills are influenced by the methodology applied. After the recent publication by ILCOR of “The Universal Algorithm 2010” [2] recommending the adoption of the compression, airway, and breathing (CAB) sequence, AHA introduced new guidelines for pediatric basic life support (PBLS) [3,4]. It is of interest to evaluate if the changes affect the learning process and on the retention of knowledge.
Michael D. Zwank
DOI: http://dx.doi.org/10.1016/j.ajem.2011.08.013
Published online: October 28 2011
xI describe here a novel technique of inserting a 2.5-inch catheter into the internal jugular vein with ultrasound guidance using sterile technique but no barrier precautions.
Wisit Cheungpasitporn, Madiha Alvi, Venkatrao Medarametla
DOI: http://dx.doi.org/10.1016/j.ajem.2011.08.019
Published online: October 28 2011
xWe thank Wu et al [1] for their excellent case study on Guillain-Barré syndrome (GBS). The authors presented a case of GBS with acute urinary retention from autonomic dysfunction. Dysautonomia, including urinary retention, tachycardia, and orthostatic hypotension, can occur in 70% of patients with this syndrome [2]. However, acute urine retention in GBS can be associated with other mechanisms such as Escherichia coli infection.
Vikhyat S. Bebarta, Joseph Maddry, Doug J. Borys, David L. Morgan
DOI: http://dx.doi.org/10.1016/j.ajem.2011.09.005
Published online: November 21 2011
xWe thank the authors for their comments of our study. We agree that an ideal study of acute cyclobenzaprine toxicity would be prospective with blood levels, review of electrocardiograms by 2 reviewers, and prospective collection of data from hospital records. Because this type of study is both expensive and it is difficult to find centers with sufficient cases, it is rarely performed. In lieu of this ideal study, we used a retrospective data set to evaluate a large volume of short-term cases as reported to several poison centers, a source of cases used to develop clinical guidelines [1].
Ari Greenwald, Colleen M. Birmingham, Robert S. Hoffman
DOI: http://dx.doi.org/10.1016/j.ajem.2011.09.006
Published online: December 28 2011
xBebarta et al [1] commendably set out to determine whether patients who overdose on cyclobenzaprine are at risk for developing Tricyclic antidepressant (TCA)-like effects (ie, a widened QRS or ventricular dysrhythmia). This topic is of interest as clear evidence that cyclobenzaprine does not cause cardiotoxic effects could save the health care system considerably with regard to bed use. Unfortunately, this retrospective study fails to definitively answer this question. Moreover, misinterpretation of their findings as proof that cyclobenzaprine overdose does not cause TCA-like cardiotoxicity might place patients at risk.
Friedrich C. Prischl
DOI: http://dx.doi.org/10.1016/j.ajem.2011.09.013
Published online: November 21 2011
xIn patients with chest pain, heart failure (HF), syncope, cardiac arrhythmias, and other, measurement of cardiac troponin (cTn) eases early recognition of high-risk patients. Recently, a high-sensitive troponin assay has shown to improve diagnosis of myocardial infarction or to identify patients at high risk of recurrent infarction and death [1]. However, not infrequently, slightly elevated cTn is seen but without immediate clinical relevance. Elevated cTn is not exclusively specific for myocardial disease.
Ryan Walsh, Hillary Harper, Owen McGrane, Christopher Kang
DOI: http://dx.doi.org/10.1016/j.ajem.2011.09.016
Published online: November 21 2011
xAnterior glenohumeral dislocations are the most common major joint dislocation encountered in the emergency department [1]. Over time, multiple methods for reduction have been described and evaluated, with varying rates of success and complication, such as Hill-Sachs fractures or Bankart lesions [2]. A method of reduction, first described by Dr Neil Cunningham in 2003, was recently published, resulting in a resurgence of this technique that asserts to provide painless, effective shoulder reduction [3-5].
Eve Trebouet, Sophie Prieur, Jérôme Dimet, Damien Lipp, Laurent Orion
DOI: http://dx.doi.org/10.1016/j.ajem.2011.09.022
Published online: November 21 2011
xAn association between stress and coronary events has been documented in many studies [1-4]. Natural disasters are a major source of stress, and numerous studies have established that major earthquakes are followed by an increase in cardiovascular events.
Po-Hua Su, Sen-Kuang Hou, Chorng-Kuang How, Wei-Fong Kao, David Hung-Tsang Yen, Mu-Shun Huang
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.003
Published online: December 28 2011
xUrinary bladder (UB) rupture is an uncommon but serious event, mainly caused by trauma [1,2]. Nontraumatic rupture of UB is called spontaneous UB rupture. Sporadic case reports have been found in the emergency medicine literature [3-5]. The actual incidence of spontaneous UB rupture among the emergency department (ED) visits is still unknown. The clinical features of this condition are vague. Only small proportion of patients could be diagnosed preoperative after the initial onset of this disease [6].
Hesham R. Omar
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.004
Published online: December 28 2011
xI have read the interesting article by Jimmy and Foo [1] in a recent issue of the journal and congratulate them for their observation. The article clearly exemplified that Takotsubo cardiomyopathy (TC) can present with electrocardiographic (ECG) features of pericarditis. In the presented ECG, the widespread concave upwards ST-segment elevation and PR-segment depression (except in aVR and V1) and the absence of reciprocal ST-segment depression is a clear ECG evidence of acute pericarditis. TC with ECG criteria of acute pericarditis is known in the literature and has been previously reported.
Wisit Cheungpasitporn, Promporn Suksaranjit, Sirisak Chanprasert
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.006
Published online: November 21 2011
xWe thank Stone et al [1] for their article on “Bilateral obstructing renal stones: an uncommon cause of acute renal failure.” This was an interesting case presentation in American Journal of Emergency Medicine. The authors presented a case of recurrent calcium stones with bilateral ureteral obstruction. We found an interesting point that should be raised in this case. Approximately 5% of patients with renal stones have concurrent hyperparathyroidism [2]. In addition, most stones in patients with hyperparathyroidism are composed of calcium oxalate [3].
Wisit Cheungpasitporn, Promporn Suksaranjit, Sirisak Chanprasert
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.005
Published online: December 14 2011
xWe thank Mayr et al [1] for their article on “Hypokalemic paralysis in a professional bodybuilder.” The authors presented an excellent case presentation on hypokalemic paralysis. The authors also discussed on common causes of renal and extrarenal potassium losses. Although vomiting can cause fluid loss directly from gastrointestinal tract, potassium depletion in this setting is primarily due to increased urinary losses [2] from the fact that concentration of potassium in gastric secretions is only 5 to 10 mEq/L.
Hossein Sanaei-Zadeh
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.018
Published online: December 28 2011
xI read with interest the case presented by Dr Jadhav et al [1] published in your journal. They presented a patient with aluminum phosphide (ALP) poisoning who developed ventricular tachychardia (VT) unresponsive to treatment with intravenous magnesium sulfate (MgSO4), amiodarone therapy, and electrocardioversion. They concluded that, in previously reported cases of successful conversion of VT associated with ALP poisoning, all patients were hypomagnesemic, whereas serum magnesium levels were normal throughout their patient's hospital course.
Alfred B. Cheng, Deborah A. Levine, James W. Tsung, Colin K.L. Phoon
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.006
Published online: January 27 2011
xInfective endocarditis is an uncommon infection in children and may rarely present to the emergency department. The clinical diagnosis of infective endocarditis in children can be challenging, especially in children without a history of underlying cardiac disease. Misdiagnosis or delayed diagnosis may lead to substantial morbidity and mortality. The modified Duke criteria for diagnosing infective endocarditis include echocardiographic findings as major criteria, vegetations on valves or supporting structures, periannular abscess, or new valvular regurgitation.
Enes Elvin Gul, Halil I. Erdogan, Murat Erer, Mehmet Kayrak
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.009
Published online: February 4 2011
xHerbal therapies are widely used in Turkey. Especially, ginger is mostly recommended to patients with symptoms of flu by their relatives. A 59-year-old woman was admitted to the emergency department (ED) because of sudden loss of consciousness. She was recommended ginger for the relief of flu symptoms. As a result of diagnostic and laboratory evaluation, the probable cause of syncope was ginger usage. This case demonstrated that sometimes herbal therapies are harmful and clinicians must be reminded of this effect.
Nancy Lutwak, Curt Dill
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.010
Published online: January 31 2011
xWe present a case of a 61-year-old male smoker presenting with complaints of nonproductive cough and flulike symptoms. The chest x-ray revealed an enlarged mediastinal silhouette and no evidence of pneumonia. A computerized axial tomography scan was done, which demonstrated a very large thoracic aortic aneurysm with evidence of a hyperattenuating crescent sign, indicative of impending rupture. The patient denied chest and abdominal pain. He went to the operating room and had repair of the aneurysm.
Teresa Camp-Rogers, Geoff Murphy, Anne Dean, Kyle Gunnerson, Darrin Rossler, Michael C. Kurz
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.036
Published online: February 4 2011
xA 58-year-old man presented to the emergency department (ED) pulseless and with severe hypothermia. The patient received standard Advanced Cardiac Life Support (ACLS) measures and mechanical cardiopulmonary resuscitation for 57 minutes before regaining a pulse. In addition to other traditional passive and active measures, the patient was gradually rewarmed (∼1°C per hour) with an endovascular catheter in the ED with therapeutic hypothermia at 33°C maintained for 12 hours during his intensive care unit (ICU) stay.
Matthew Salzman, Jason Friedman
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.037
Published online: February 4 2011
xSplenic laceration is an uncommon complication of cardiopulmonary resuscitation (CPR). We report a case of bystander CPR-induced splenic laceration with hepatosplenic hematoma complicating management of a patient with cardiovascular collapse because of acute myocardial infarction.
Ken-Hing Tan, Shih-Yu Ko, Hee-King Su, Hon-Ping Ma
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.038
Published online: January 24 2011
xA subarachnoid hemorrhage without typical presentation often poses a great challenge to an emergency physician. A 36-year-old man presented to our emergency department with symptoms mimicking extrapyramidal symptoms but was ultimately found to have a ruptured intracranial aneurysm. Emergency craniotomy and aneurysm clipping were performed. Interestingly, involuntary movements of his face, mouth, and limbs diminished soon after the operation. The patient fully regained his verbal function and completely restored his muscle power.
Afzal Azim, Jyoti N. Sahoo, Arvind K. Baronia, Mohan Gurjar, Ratendra K. Singh, Banani Poddar, Armin Ahmed, Piyush Garg, Saurabh Saigal
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.024
Published online: February 28 2011
xDengue is one of the most common mosquito-borne infection affecting more than 50 million people worldwide annually. Most common causes for dengue-associated mortality are shock, bleeding, and respiratory failure.
Cindy Chavez, Eitan Dickman, Lawrence Haines
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.026
Published online: February 7 2011
xA 53-year-old man presented to the emergency department (ED) with neck swelling, shortness of breath, and a change in the sound of his voice. Physical examination revealed an afebrile man speaking in 2- to 3-word sentences with a firm, nontender, nonerythematous mass on the right side of his neck. A bedside ultrasound demonstrated a homogenous mass with internal vascular flow. This constellation of findings was felt to be most consistent with a malignancy. Nasopharyngoscopy confirmed a near obstructing supraglottic mass, and the patient underwent an emergent tracheostomy.
Didem Ay, Esin Yencilek, Mustafa Ferudun Celikmen, Meltem Akkas, Baki Ekci
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.027
Published online: February 28 2011
xSpontaneous rupture of the ureteropelvic junction is a rare entity with diagnostic problems. Here, we reported a case who presented with severe acute abdominal pain mimicking many abdominal problems. Physical examination and laboratory tests did not reveal any specific diagnosis, and an abdominal computed tomographic scan was performed. It showed 4-mm calculus in proximal ureter, grade 2 hydronephrosis, and perinephric fluid collection. The patient undergone to systoscopic procedure, her calculus was removed, and a double-J catheter was placed.
Amr El-Husseini, Alberto Sabucedo, Jorge Lamarche, Craig Courville, Alfredo Peguero
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.029
Published online: February 7 2011
xTumor lysis syndrome (TLS) causes acute kidney injury (AKI) by various pathophysiologies. Herein, we report on a case of recurrent AKI in TLS induced by 2 different mechanisms and highlight the increasing magnitude of acute phosphate nephropathy after wide use of rasburicase.
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00007-1
Published in issue: February 2012
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00008-3
Published in issue: February 2012
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00009-5
Published in issue: February 2012
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00010-1
Published in issue: February 2012
