Jihad Mallat, Damien Michel, Pascale Salaun, Didier Thevenin, Laurent Tronchon
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.039
Published online: January 31 2011
xThe aim of this study was to define the nature of metabolic acidosis in patients with septic shock on admission to intensive care unit (ICU) using Stewart method. We also aimed to compare the ability of standard base excess (SBE), anion gap (AG), and corrected AG for albumin and lactate (AGcorr) to accurately predict the presence of unmeasured anions (UA).
Mary Josephine Hessert, Michael Juliano
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.021
Published online: February 7 2011
xThe possibility of spontaneous miscarriage is a common concern among pregnant women in the emergency department (ED).
Hsin-Chin Shih, Mu-Shun Huang, Chen-Hsen Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.025
Published online: February 7 2011
xWe investigated the correlation of proinflammatory transcript nuclear factor κB (NF-κB) and antioxidative gene transcript nuclear factor-erythroid 2–related factor 2 (Nrf2) expressions in peripheral blood mononuclear cells (PBMCs) with the tumor necrosis factor α (TNF-α) response after endotoxin stimulation and the clinical outcome of severely injured patients.
Cristina Villa-Roel, Xiaoyan Guo, Brian R. Holroyd, Grant Innes, Lyndsey Wong, Maria Ospina, Michael Schull, Benjamin Vandermeer, Michael J. Bullard, Brian H. Rowe
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.035
Published online: March 2 2011
xOvercrowding is an important issue facing many emergency departments (EDs). Access block (admitted patients occupying ED stretchers) is a leading contributor, and expeditious placement of admitted patients is an area of research interest. This review examined the effectiveness of full capacity protocols (FCPs) on mitigating ED overcrowding.
Ming-Cheh Ou, Chung-Chu Pang, Dennis Ou, Chin-Hsu Su
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.008
Published online: February 28 2011
xAbdominal palpation with Ou MC manipulation (APOM) has showed to be more sensitive than bimanual pelvic examination for the diagnosis of pelvic inflammatory disease in women with acute abdomen (JEM. 2010;). This study compared APOM with traditional abdominal palpation (AP) for diagnostic reliability and enquired into the mechanism of APOM.
Donna Mendez, A. Chantal Caviness, Long Ma, Charles C. Macias
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.010
Published online: March 30 2011
xThe objective of this study was to compare the diagnostic accuracy of an abdominal ultrasound to that of a highly suggestive abdominal radiograph combined with signs and symptoms of intussusception.
Emilie S. Powell, Rahul K. Khare, D. Mark Courtney, Joe Feinglass
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.011
Published online: February 28 2011
xEarly aggressive resuscitation in patients with severe sepsis decreases mortality but requires extensive time and resources. This study analyzes if patients with sepsis admitted through the emergency department (ED) have lower inpatient mortality than do patients admitted directly to the hospital.
Patrick Ray, Sandrine Charpentier, Camille Chenevier-Gobeaux, Tobias Reichlin, Raphael Twerenbold, Yann-Erick Claessens, Patrick Jourdain, Bruno Riou, Christian Mueller
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.008
Published in issue: March 2012
xThe main objective of this multicentric study was to evaluate the additional value of copeptin to conventional cardiac troponin (cTn) for a rapid ruling out of acute myocardial infarction (AMI) in patients with acute chest pain and a previous history of coronary artery disease (CAD).
Sion Jo, Taeoh Jeong, Jae Baek Lee, Young Ho Jin, Jaechol Yoon, Yong Kyu Jun, Boyoung Park
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.019
Published online: February 10 2012
xHyperlactatemia may be associated with poor outcome in patients with ischemic stroke because it reflects a state of tissue perfusion. This study aims to know whether initial hyperlactatemia in the emergency department (ED) is associated with poor outcome in patients with ischemic stroke.
Evelyne D. Trottier, Benoit Bailey, Nathalie Lucas, Anne Lortie
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.020
Published online: February 7 2011
xThe objective of this study is to evaluate the effectiveness of prochlorperazine and the rate of akathisia in children with severe migraine.
Sang Hoon Oh, Young Min Kim, Han Joon Kim, Chun Song Youn, Seung Pill Choi, Jung Hee Wee, Soo Hyun Kim, Won Jung Jeong, Kyu Nam Park
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.022
Published online: February 7 2011
xIt is often difficult to diagnose acute myocardial infarction (AMI) in patients who resuscitated after out-of-hospital cardiac arrest (OHCA) and had a delayed elevation in cardiac marker. This study explored whether elevations in cardiac marker were due to coronary artery occlusion or resulted from other causes.
Michael Mallin, Matthew Dawson, Erika Schroeder, Burke Hatch, Isaac Jackson, Matthew Ahern, Chris Bossart, Troy Madsen
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.023
Published online: February 21 2011
xEvaluation of rates of spontaneous abortion (SAB) may aid in counseling pregnant patients seen in the emergency department (ED). A recent chart review reported an SAB rate of 10% among ED patients with a documented intrauterine pregnancy (IUP) and cardiac activity on ultrasound. We sought to prospectively evaluate outcomes among pregnant ED patients with documented cardiac activity on ultrasound.
Eleftheria S. Panteli, Fotini Fligou, Chrisaugi Papamichail, Ioannis Papapostolou, Georgios Zervoudakis, Christos D. Georgiou, Kriton S. Filos
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.031
Published online: February 28 2011
xThe aim of this study was to measure the production of superoxide radical (O2−), a direct indicator of oxidative stress, in 4 vital organs of rats subjected to hemorrhagic shock. For this purpose, and for the first time, a new quantitative assay for the ex vivo measurement of O2− via an established 1:1 molar relationship between O2− and 2-OH-ethidium was used. The production of lipid hydroperoxides (LOOHs), a standard method of evaluation of oxidative stress, was also used for reasons of comparison.
Sanjay Arora, Daniel Cheng, Benjamin Wyler, Michael Menchine
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.002
Published online: February 14 2011
xAlthough patients with diabetic ketoacidosis (DKA) are expected to have total body potassium depletion, measured levels may be normal or elevated due to extracellular shifts of potassium secondary to acidosis. Because insulin therapy decreases serum potassium levels, which creates potential to precipitate a fatal cardiac arrhythmia in a patient with hypokalemia, the American Diabetes Association (ADA) recommends obtaining a serum potassium level before giving insulin. Although the ADA guidelines are clear, the evidence on which they are based is largely anecdotal.
Matthew Lyon, Perry Walton, Valori Bhalla, Stephen A. Shiver
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.009
Published online: February 21 2011
xThe presence of the sonographic sliding lung sign (SLS) is a sensitive indicator for the absence of a pneumothorax.
Harry Beyer, David Cherkas
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.038
Published online: February 28 2011
xRemoving foreign bodies from the cornea can often present a challenge for even the most experienced clinician. The classic removal technique is with a needle on a syringe. Because the average thickness of the human cornea is only 560 μm (more than 0.5 mm), patients' fear and inability to cooperate with the procedure make perforation and further corneal damage a real risk. Other methods such as using a cotton swab often lack the fine motor control and precision needed to completely dislodge a foreign body (FB).
Teresa Camp-Rogers, Michael C. Kurz, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.011
Published online: April 25 2011
xA myriad of hospital-wide initiatives have been implemented with the goal of decreasing door-to-balloon time. Much of the evidence behind the common strategies used is unknown; multiple strategies have been suggested in the reduction to the use of this important time-sensitive intervention. Among 8 primary strategies, 2 have substantial evidence to support their implementation in the attempt to reduce door-to-balloon time in ST-segment elevation myocardial infarction (STEMI), including emergency physician activation of the cardiac catheterization laboratory and prehospital activation of the STEMI alert process.
Yuki Akihisa, Koichi Maruyama, Rieko Yamada, Tomoko Higashi, Akira Ogura, Tomio Andoh
DOI: http://dx.doi.org/10.1016/j.ajem.2011.09.009
Published in issue: March 2012
xAlthough plastic single-use laryngoscope blades avoid preventable contamination that may occur in reusable metal blades [1-3], several studies have reported on their poor performance, presumably because of insufficient rigidity [4,5]. Recently, light-emitting diode (LED) light handles, providing bright and bluish-white light, became commercially available. We compared the intubation performance of plastic single-use laryngoscope blades using an LED light handle with reusable laryngoscopes in easy and difficult airways during cardiopulmonary resuscitation (CPR) in an infant manikin.
Hesham R. Omar
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.029
Published online: December 28 2011
xI have read the interesting article by Amrein et al [1] in a recent issue of the journal regarding posttraumatic occult pneumothorax, which is now increasingly recognized due to the widespread availability of computed tomographic (CT) scans and the advent of the extended focused assessment with sonography for trauma (eFAST) in most centers. The case not only exemplified the phenomenon of occult pneumothorax but also the predictability of occult pneumothorax. The presence of subcutaneous emphysema in the neck or thoracic wall whether clinically or on chest x-ray should be an immediate trigger for obtaining a chest CT scan or ultrasonography to rule out pneumothorax for 3 reasons.
Athanasios Chalkias, Theodoros Xanthos
DOI: http://dx.doi.org/10.1016/j.ajem.2011.11.001
Published online: December 29 2011
xCardiac arrest is a daunting emergency and a leading cause of death worldwide. Despite the progress in cardiopulmonary resuscitation (CPR) as well as in the diagnosis and treatment of postcardiac arrest syndrome, survival rates remain disappointing low. Restoration of spontaneous circulation is just the first step toward complete recovery, and many patients will require multiple organ support during the postresuscitation period. Characteristically, of those patients admitted to intensive care units, only 25% to 56% will survive to hospital discharge [1].
Mohammad Vasei
DOI: http://dx.doi.org/10.1016/j.ajem.2011.11.002
Published online: January 13 2012
xI read the article published in the journal, written by Jangjoo et al, discussing the validity of urinary 5-hydroxyindoleacetic acid (5-HIAA) in the diagnosis for acute appendicitis (AA). The authors showed approximately 44% sensitivity and 81% specificity [1].
Giovanni Maria Vincentelli, Maria Rosaria Pirro, Francesca Bacchiarri, Valentina Panetta, Filippo Alegiani, Raffaele Landolfi
DOI: http://dx.doi.org/10.1016/j.ajem.2011.11.013
Published online: January 13 2012
xTo evaluate the physician's perception of risk of venous thromboembolism and the use of pharmacological prophylaxis in nonsurgical patients, we performed a cross-sectional study by collecting data of 875 patients, hospitalized in 23 internal medicine and 10 emergency medicine units of 21 different institutions of Lazio, Italy. The physicians of the participating units were requested to provide information, filling in a data form, which included for each patient, the items considered by the Chopard and Kucher score systems [1,2] as well as by the recommendations of the ACCP08; in addition, also the single bed rest criterion was considered [3].
Anthony L. Oliver, Gerald S. Poplin, Christopher A. Kahn
DOI: http://dx.doi.org/10.1016/j.ajem.2011.11.014
Published online: February 10 2012
xThe likelihood of an influenza pandemic places public agencies under pressure to ensure readiness for local outbreaks. Emergency Medical Services (EMS) is a critical infrastructure that needs to be part of preparedness and response planning for a severe pandemic. Legal and regulatory frameworks should recognize prehospital capabilities as lawmakers attempt to facilitate capacity-building collaboration, which is critical to disaster response. The prehospital system's lack of surge capacity has been detailed [1-5], and agencies seek direction regarding preparedness planning from state agencies [6,7].
Hossein Sanaei-Zadeh
DOI: http://dx.doi.org/10.1016/j.ajem.2011.11.018
Published in issue: March 2012
xI read with interest the case presented by Dikici et al [1] recently published in the American Journal of Emergency Medicine. They presented a 49-year-old male patient who had developed epileptic seizure and cardiopulmonary arrest about 1 hour after the bee sting. Cardiopulmonary resuscitation (CPR) and tracheal intubation had been done. Brain computed tomography performed at the emergency department was isodense. However, in the second brain computed tomography taken about 36 hours after admission, subarachnoid hemorrhage (SAH), as well as diffused edema, in both hemispheres was evident.
Hossein Sanaei-Zadeh
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.006
Published online: January 13 2012
xI read with interest the study conducted by Vogel et al [1] recently published in your journal. They performed a case-control study at 2 urban hospitals and found that the patients with dental pain were at increased risk for accidental overdose with acetaminophen compared with the patients who took acetaminophen for other reasons. Their cases were retrospectively selected by chart review from those patients whose principle diagnostic code (International Classification of Diseases, Ninth and Tenth Revisions) had been confirmed as acetaminophen overdose within an 18-month period.
Kennon Heard, Jody Vogel
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.005
Published online: January 24 2012
xWe thank the author for the interest in our article. The main inclusion criterion was a discharge diagnosis of acetaminophen poisoning (based on the structured International Classification of Diseases, Ninth Revision, search), so all patients were diagnosed by the treating physician (not the researcher) as acetaminophen poisoning. In most cases, the diagnosis was based on a history of excessive use, but in some cases, the clinician may have diagnosed acetaminophen toxicity in patients who reported therapeutic dosing but had laboratory findings suggestive of acetaminophen poisoning (such as transaminase elevation or supratherapeutic serum acetaminophen concentrations).
Meral Mert, Fatma Betül Uzuncan, Munevver Mertsoylu Aydin, Gonenc Kocabay, Adile Ortaköylü
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.033
Published online: February 28 2011
xMost cases of pulmonary edema presenting with hypercalcemia are associated with malignant hypercalcemia and related with metastatic calcification. Most patients have predisposing factors such as hematological and solid organ malignancies and chronic renal failure. Pulmonary edema, induced by moderate hypercalcemia, which is associated with primary hyperparathyroidism, has not been reported previously. A 72-year-old female patient was admitted to the emergency service with pulmonary edema and moderate hypercalcemia because of primary hyperparathyroidism.
Lei Lei, Omar Velasco, Flavia Nobay
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.037
Published online: February 28 2011
xRadiation sialadenitis is an uncommon adverse reaction to radioactive iodide therapy. Sialadenitis due to radiation exposure has a dose-related damage that can follow an acute or chronic inflammatory nature. We present a case of a patient who developed radiation sialadenitis after radioactive iodide therapy for papillary thyroid cancer resulting in severe parotid swelling and swelling, which resulted in an emergency department visit and had complete resolution with conservative management.
Min-Po Ho, Chih-Jung Chang, Chun-Yen Huang, Ching-Juing Yu, Kuang-Chau Tsai, Hsin-An Chen, Wing-Keung Cheung
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.001
Published online: February 28 2011
xSpontaneous rupture of the short gastric artery is an extremely rare event that can cause abdominal apoplexy or spontaneous hemoperitoneum. For the emergency physician, simultaneous restoration of circulatory volume and a rapid diagnosis remain central to a successful outcome in such critical cases. We reported a 21-year-old man who initially presented with watery diarrhea and abdominal fullness followed by vomiting after the ingestion of alcohol but was later diagnosed with hemoperitoneum, resulting in hemorrhagic shock due to spontaneous rupture of the small branches of the short gastric artery.
Sophie Jambet, Boris Guiu, Pierre Olive-Abergel, Aurélie Grandvuillemin, Jean-Michel Yeguiayan, Pablo Ortega-Deballon
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.005
Published online: February 28 2011
xSeveral drugs used in psychiatry may induce constipation, paralytic ileus, or acute megacolon (Ogilvie's syndrome). We report here 2 cases of patients presenting with fatal abdominal compartment syndrome related to the absorption of antidepressants and benzodiazepines. Two patients (a 27-year-old man and a 57-year-old woman) with a previous psychiatric history and treatment with psychiatric drugs were admitted to the emergency department for coma. Both presented hypothermia; a hard, distended abdomen; and ischemia of the lower limbs.
Kristen L. Ochs, Michele Zell-Kanter, Mark B. Mycyk, TOXIKON Consortium
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.007
Published online: April 4 2011
xThe elderly are particularly sensitive to delirium-inducing medications. We report a case of a 93-year-old woman who developed anticholinergic delirium from subcutaneous diphenhydramine that she received in the emergency department. This patient was reportedly allergic to “caine” anesthetic agents, and thus, subcutaneous diphenhydramine was administered as an alternative local anesthetic, as recommended in emergency medicine textbooks. Within 20 minutes of administration, the patient developed agitation, tachycardia, dilated pupils, and dry skin, consistent with a classic anticholinergic toxidrome.
Constance S. Kwan, Charles C. Worrilow, Inna Kovelman, Jeffrey M. Kuklinski
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.012
Published online: March 30 2011
xHiccups, or singultus, are the result of spontaneous and repetitive contractions of the diaphragm. In most cases, episodes of singultus are benign and self-limited. However, prolonged attacks can result in significant discomfort, morbidity, and even death. Although the etiology of hiccups is theoretical at best, a wide array of treatments has been proposed with varying efficacy. Both pharmacologic and nonpharmacologic treatments target different components of the hiccup reflex, which includes the vagus and phrenic nerves, the respiratory center in the upper medulla, and the motor neurons in the diaphragm, glottis, and external intercostal muscles.
Sean Sachdev, Hariharan Thangarajah, Judith Keddington
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.013
Published online: March 30 2011
xColonoscopy is a commonly performed medical procedure generally considered safe and effective. Rare complications include postpolypectomy bleeding and perforation. A far less common and more unusual complication is splenic injury. We present the case of a patient who developed this very outcome, presenting to the emergency department with abdominal pain several hours after the procedure. The mechanism of such injury is not known but has been hypothesized to be either traction on the splenocolic ligament or previously formed adhesions, direct blunt injury, or special maneuvers used to advance the colonoscope.
Subramanian Senthilkumaran, Ramachandran Meenakshisundaram, Namasivayam Balamurgan, Krishnanswamy SathyaPrabhu, V Karthikeyan, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.018
Published online: March 16 2011
xAcute phosphate toxicity following rectal administration of phosphate-containing preparations was documented earlier. However, acute phosphate toxicity due to inhalation of monoammonium phosphate (MAP) is rarely reported. The present report describes the systemic toxicity following intentional inhalation of MAP, a dry chemical powder present in fire extinguishers, in a 25-year-old healthy man with normal renal function resulting in hyperphosphatemia (11.0 mg/dL), hypocalcemia (ionized calcium, 1.18 mg/dL; total calcium, 3.6 mg/dL), hypomagnesemia (1.2 mg/dL), seizures, and 4 episodes of pulseless polymorphic ventricular tachycardia requiring defibrillation.
Wei-Hsin Chiang, Sung-Chun Tang, Jiann-Shieh Jeng
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.019
Published online: March 30 2011
xThrombolytic therapy is relatively contraindicated in aortic dissection (AD)–related cerebral and myocardial ischemia for high risk of bleeding. We report a 52-year-old woman experiencing acute cerebral and myocardial ischemia arising from AD. Intravenous recombinant tissue plasminogen activator treatment was held immediately when carotid duplex revealed common carotid artery dissection and chest computed tomography confirmed the existence of type A AD. Emergent surgery completely reversed her neurologic deficit and myocardial injury.
Peter Michael Zechner, Susanne Rienmüller, Katrin Dorr, Christina Genger, Herbert Wurzer
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.020
Published online: March 30 2011
xWe present the case of a patient with abdominal pain, in which gallbladder perforation was detected by contrast-enhanced ultrasound. A 90-year-old patient presented to the emergency department with a complaint of acute abdominal pain and vomiting. An abdominal ultrasound revealed a thickened gallbladder wall and small amounts of perihepatic fluid. Because these findings were suspicious for gallbladder perforation and contrast-enhanced computed tomography could not be performed because of a history of monoclonal gammopathy, a contrast-enhanced ultrasound scan was performed.
Manish Modi, Veenu Singla, Jasmina Ahluwalia, Aman Sharma, Sudesh Prabhakar, Niranjan Khandelwal, Dhananjay Duberkar
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.022
Published online: March 16 2011
xRisk of cerebrovascular disease is increased in patients with HIV infection; however, cerebral venous sinus thrombosis is not commonly reported in this condition. We report a case of young man with intracranial hemorrhage whose radiologic investigations revealed thrombosis of the left transverse and sigmoid sinuses extending into the left internal jugular vein. On further investigations, he was found to be positive for HIV-1, and his procoagulant workup showed protein S deficiency. He was started on anticoagulant therapy, after which he showed gradual recovery.
Francesco Massari, Filippo Mastropasqua, Massimo Iacoviello, Vincenzo Nuzzolese, Daniele Torres, Gaspare Parrinello
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.023
Published online: March 16 2011
xGlucocorticoid administration is not recommended in patients with heart failure because of its related sodium and fluid retention. However, previous experimental and clinical studies have demonstrated that glucocorticoids can also induce a diuretic effect and improve renal function in patients with acute decompensated heart failure (ADHF) with refractory diuretic resistance. We report the case of a 65-year-old man with a known diagnosis of aortic stenosis, systolic ventricular dysfunction, and chronic obstructive pulmonary disease who was admitted for ADHF.
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00069-1
Published in issue: March 2012
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00070-8
Published in issue: March 2012
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00071-X
Published in issue: March 2012
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00072-1
Published in issue: March 2012
