Mark A. Merlin, Kimberly T. Baldino, David P. Lehrfeld, Matt Linger, Eliyahu Lustiger, Anthony Cascio, Pamela Ohman-Strickland, Frank DosSantos
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.014
Published online: May 13 2011
xOur objective was to determine if implementing a standard lights and sirens (L&S) protocol would reduce their use and if this had any effect on patient disposition.
Edward M. Castillo, Nitin Prabhakar, Bethi Luu
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.017
Published online: March 16 2011
xUse-of-force (UOF) techniques are used by law enforcement to gain control of noncompliant subjects. The purpose of this study was to assess factors associated with subject and deputy injuries during law enforcement UOF.
Olanrewaju A. Soremekun, Paul D. Biddinger, Benjamin A. White, Julia R. Sinclair, Yuchiao Chang, Sarah B. Carignan, David F.M. Brown
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.024
Published online: March 21 2011
xPhysician screening is one of many front-end interventions being implemented to improve emergency department (ED) efficiency.
Ali Jangjoo, Abdol-Reza Varasteh, Mostafa Mehrabi Bahar, Naser Tayyebi Meibodi, Habibollah Esmaili, Narges Nazeri, Mohsen Aliakbarian, Shahriar H. Azizi
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.027
Published online: March 30 2011
xAcute appendicitis is the most common abdominal emergency in children and young adults. There are a lot of serotonin-containing cells in the appendix, which release serotonin into the bloodstream in response to inflammation. Consequently, serotonin is converted to 5-hydroxyindoleacetic acid (5-HIAA) and secreted into the urine. On this basis, urinary 5-HIAA could be a marker for acute appendicitis. In this study, we investigated the value of 5-HIAA levels in spot urine in the diagnosis of acute appendicitis.
Kohei Hasegawa, Megan L. Fix, Lauren Wendell, Kristin Schwab, Hakan Ay, Eric E. Smith, Steven M. Greenberg, Jonathan Rosand, Joshua N. Goldstein, David F.M. Brown
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.007
Published online: March 30 2011
xMyocardial injury is common among patients with intracerebral hemorrhage (ICH). However, it is challenging for emergency physicians to recognize acute myocardial injury in this population, as electrocardiographic (ECG) abnormalities are common in this setting. Our objective is to examine whether ischemic-appearing ECG changes predict subsequent myocardial injury in the context of ICH.
XinQi Dong, Melissa A. Simon, Denis Evans
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.008
Published online: March 16 2011
xThis study aims to quantify the relation between elder self-neglect and rate of emergency department utilization in a community-dwelling population.
Ching-Chi Lee, Ming-Yuan Hong, Nan-Yao Lee, Po-Lin Chen, Chia-Ming Chang, Wen-Chien Ko
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.012
Published online: April 25 2011
xThe diagnostic performance of serum C-reactive protein (CRP) in prediction of bacteremia among febrile patients visiting an emergency department (ED) was analyzed.
Yu-Chun Wang, Chi-Hsun Hsieh, Chih-Yuan Fu, Chun-Chieh Yeh, Shih-Chi Wu, Ray-Jade Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.014
Published online: May 13 2011
xWith recent advances in radiologic diagnostic procedures, the use of diagnostic peritoneal lavage (DPL) has markedly declined. In this study, we reviewed data to reevaluate the role of DPL in the diagnosis of hollow organ perforation in patients with blunt abdominal trauma.
James F. Holmes, John P. McGahan, David H. Wisner
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.016
Published online: June 6 2011
xThe objective of this study is to determine the rate of intra-abdominal injury (IAI) in adults with blunt abdominal trauma after a normal abdominal computed tomographic (CT) scan. We hypothesize that the risk of subsequent IAI is so low that hospital admission and observation for possible IAI are unnecessary.
Marc-Alexander Ohlow, J. Christoph Geller, Stefan Richter, Ahmed Farah, Stefan Müller, Jörg T. Fuhrmann, Bernward Lauer
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.029
Published online: May 13 2011
xSustained ventricular arrhythmias (VA) complicate 7% to 20% of acute myocardial infarctions. We hypothesized that primary angioplasty (percutaneous coronary intervention [PCI]) and contemporary medical treatment will result in a lower incidence of VA and shorten the time frame of their occurrence. Thus, an electrocardiographic monitoring period of 24 hours should be sufficient to detect more than 95% of all malignant VA.
Maureen Chase, Nina R. Joyce, Erin Carney, Justin D. Salciccioli, Deborah Vinton, Michael W. Donnino, Jonathan A. Edlow
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.002
Published online: April 29 2011
xVertigo is a common emergency department (ED) complaint with benign and serious etiologies with overlapping features. Misdiagnosis of acute stroke may result in significant morbidity and mortality. Magnetic resonance imaging (MRI) is superior to computer tomography (CT) for diagnosis of acute stroke but is costly with limited availability.
Yuan-Sheng Tzeng, Shyi-Gen Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.009
Published online: March 30 2011
xA modified subcutaneous single-injection approach to achieve digital block using a tumescent technique is described.
Chadwick D. Miller, Harold I. Litt, Kim Askew, Daniel Entrikin, J. Jeffrey Carr, Anna Marie Chang, Jane Kilkenny, Benjamin Weisenthal, Judd E. Hollander
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.015
Published online: April 29 2011
xThe aim of this study was to determine if patients presenting with symptoms of acute coronary syndrome and found to have 25% to 50% diameter reduction with coronary computed tomographic angiography (CCTA) are likely to benefit from further diagnostic testing.
Michael C. Bond, Daniel L. Lemkin, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.017
Published online: April 25 2011
xA. Vander Have KL, Perdue AM, Caird MS, Farley FA. Operative versus nonoperative treatment of midshaft clavicle fractures in adolescents. J Pediatr Orthop 2010;30:307-312.
Amal Mattu, Michael C. Bond, Semhar Z. Tewelde, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.023
Published online: May 2 2011
xA. Pokorna M, Necas E, Kratochvil J, et al. A sudden increase in partial pressure end-tidal carbon dioxide (PETCO2) at the moment of return of spontaneous circulation. J Emerg Med 2010;38:614-621.
Christian Landy, David Plancade, Ingrid Millot, Nicolas Gagnon, Julien Nadaud, Jean-Christophe Favier
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.012
Published online: February 10 2012
xWe read with interest the article published by Herring et al [1], describing the interest of the transversus abdominis plane (TAP) block for analgesia in emergency situations.
Hossein Sanaei-Zadeh
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.015
Published online: February 10 2012
xI read with interest the case presented by Witsil et al [1] recently published in the American Journal of Emergency Medicine. They have reported a 47-year-old male patient who had presented to the emergency department (ED) from a detoxification center with suicidal ideation. He had a history of depression and substance abuse (cocaine). His physical examination was unremarkable, except for agitation. His baseline electrocardiogram (ECG) demonstrated a normal sinus rhythm and a QT/QTc of 484/475 milliseconds at a pulse of 58 beats per minute.
Hossein Sanaei-Zadeh
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.028
Published online: February 10 2012
xI would like to address the article published in the February 2011 issue on pages 244.e1-244.e2, titled “The efficacy of obidoxime 72 hours after intoxication by organophosphates.” The authors have presented a patient intoxicated by organophosphate O, S-dimethyl phosphoramidothioate who had presented with typical cholinergic signs and symptoms. The patient had partially been treated by atropine, administration of activated charcoal, ventilator support, and general measures at presentation, that is, 24 hours before the initiation of the management by the authors.
Scott A. Syverud
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.038
Published online: February 10 2012
xBring us your ill, your injured, your wheezing children yearning to breath free. Send us the sickest, the traumatized, to see. To heal, to help, relieve, restore. We lift our lamp, Healthcare's front door.
Stewart Siu-Wa Chan, Nandini Agarwal, Sangeeta Narain, Mandy Man Tse, Cangel Pui-yee Chan, Grace Yung-lam Ho, Colin Alexander Graham, Timothy Hudson Rainer
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.039
Published online: March 2 2012
xThe evaluation of a patient in clinical shock or hypotensive states is often challenging. Recently, our emergency department (ED) has started using a noninvasive cardiac output Doppler ultrasound monitor to assist in the rapid diagnosis of the underlying cause of shock (or hypotensive states, suspected shock) [1-9]. Its use is illustrated in the following 2 cases.
Ernesto Muñoz-Mahamud, Miquel Pons, Alfredo Matamala, Rafael Tibau, Lluis Puig, Jose Cordero-Ampuero, Sebastián García
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.042
Published online: February 10 2012
xSeptic arthritis of the hip is a severe infection and relatively infrequent in the general population. The aim of the present study was to review our experience in septic arthritis of naive hips for the last 18 years.
Franck Petitpas, Thomas Kerforne, Corentin Lacroix, Olivier Mimoz
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.004
Published online: March 2 2012
xWe read with interest the recently published case report by Nguyen et al [1] regarding a novel approach to confirming nasogastric tube placement in the emergency department (ED) using ultrasound of the soft tissues of the neck to visualize the tube in esophagus as well as in the epigastrum to confirm its placement in the stomach.
Joshua Schecter, Jennifer H. Chao
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.025
Published online: March 16 2011
xPosterior urethral valves are the most common cause of urinary obstruction in male children. Presentations of posterior urethral valves beyond the neonatal period include urinary tract infection, abdominal mass, renal failure, diminished urinary stream, crying during micturition, incontinence, dysuria, hematuria, or failure to thrive. Early diagnosis is imperative because early surgical relief of the obstruction is believed to help prevent the progression to end stage renal disease.
Amar P. Jadhav, Maein B. Nusair, Apekshe Ingole, Martin A. Alpert
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.026
Published online: March 16 2011
xInhalation or ingestion of aluminum phosphide (AP) generates phosphine gas on exposure to moisture, which, in turn, produces widespread organ toxicity primarily involving the lungs, heart, liver, and kidneys. Cardiac manifestations of AP poisoning include toxic myocarditis, refractory heart failure, bradyarrhythmias, and tachyarrhythmias including ventricular tachycardia (VT). A 19-year-old depressed male farm worker ingested ten 500-mg tablets of Celphos in a suicide attempt. Each Celphos tablet contains 56% AP.
Terasumi Keiko, Youichi Yanagawa, Susumu Isoda
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.028
Published online: March 16 2011
xAn 81-year-old woman became unconsciousness after complaining of a backache, and then, an ambulance was called. She was suspected to have an aortic dissection by the emergency medical technicians and was transferred to our department. On arrival, she was in shock. Emergency cardiac ultrasound disclosed good wall motion with cardiac tamponade but no complication of aortic regurgitation. Computed tomography of the trunk revealed a type A aortic dissection with cardiac tamponade. During performance of pericardial drainage, she lapsed into cardiopulmonary arrest.
Srikar Adhikari, Jared Marx, Todd Crum
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.029
Published online: March 16 2011
xPatients with acute Achilles tendon injuries from sport-related activities are frequently seen in the emergency department (ED). Missed or delayed diagnosis of an Achilles tendon rupture can result in significant patient morbidity. However, the diagnosis of an Achilles tendon rupture is not always clear clinically. Physical examination maneuvers to assess for a tendon injury can be limited by pain and soft tissue swelling. Ultrasound has been shown to be very sensitive in detecting an Achilles tendon rupture.
Ryan Bodkin, Sandra Schneider, Donna Rekkerth, Linda Spillane, Michael Kamali
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.030
Published online: April 4 2011
xWe report a case of rhabdomyolysis temporally related to the ingestion of a large amount of kava. Kava is a naturally occurring plant used in the United States and elsewhere in the world for its sedative properties. A previous case report also related rhabdomyolysis to the ingestion of kava. It is not clear whether this is an action of the kava itself, perhaps, due to its action on voltage ion channels or, perhaps, due to an adulterant in the product. Our patient developed peak creatine phosphokinase levels in excess of 30 000 U/L but had no significant renal damage.
Servet Altay, Huseyin Altug Cakmak, Serhan Ozcan, Erkan Ilhan, Betul Erer
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.003
Published online: April 25 2011
xA 59-year-old man with a known history of nonobstructive hypertrophic cardiomyopathy and chronic atrial fibrillation was admitted to our clinic with weakness, palpitation, and exertional dyspnea. Electrocardiogram showed atrial fibrillation with high ventricular rate (120 beats per minute), intraventricular conduction delay, and left ventricular (LV) hypertrophy with ST-segment depression and inverted T waves. A transthoracic echocardiogram showed massive LV concentric hypertrophy. Although there was no gradient increase in the LV outflow tract, marked turbulent flow was seen in midventricular region by colored Doppler echocardiography.
J.L. Martindale, E.L. Senecal
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.004
Published online: April 25 2011
xNeck pain with associated rigidity is a concerning clinical presentation that emergency physicians encounter regularly. We present the case of a 58-year-old man with acute neck pain, worsened by movement and swallowing, that was found to be secondary to acute calcific retropharyngeal tendonitis. Patients with severe neck pain, neck stiffness, and odynophagia may have this condition. The diagnosis can be confirmed with imaging, and response to conservative treatment is often dramatic.
Ken-Hing Tan, Sun-Li Chou, Shih-Yu Ko
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.005
Published online: March 30 2011
xAortic arch aneurysm occurs more commonly in the aging population. Rapid expansion and symptomatic patients should undergo aneurysm resection regardless of size. An 87-year-old man was brought to our emergency department because of choking on food during his dinner. The patient did not have hoarseness, dysarthria, dysphagia, as well as other neurologic symptoms. He was finally found to have an aortic arch aneurysm. Swallowing is complex neuromuscular activity consisting essentially of 3 phases: oral, pharyngeal, and esophageal.
Ahmet Yildiz, Cem Bostan, Fatih Akin, Alev Arat Ozkan, Tevfik Gurmen
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.006
Published online: March 30 2011
xConcomitant occurrence of pulmonary embolism and acute coronary syndrome is rare. The early diagnosis and treatment of acute coronary syndrome with right ventricular myocardial ischemia during acute pulmonary embolism (APE) are crucial. The irreversible right ventricular myocardial dysfunction is a major risk factor for mortality from APE. In this case report, we present a 66-year-old female patient with APE who had a significant right coronary artery (RCA) lesion, which was successfully treated with angioplasty and stent implantation.
Eric Dan-Goor, Riaz Asaria, Bill Borthwick, Oliver Firth, Ian Hughes, Darren Sheather, Simon Wilson
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.010
Published online: April 29 2011
xWe report a case of a healthy leisure diver presenting with simultaneous unilateral posterior vitreous detachment and decompression illness. The literature is reviewed for both conditions. There are no known publications associating these 2 entities and leads us to propose that nitrogen bubble formation could have contributed to the etiology of vitreal separation from the retina.
Amin Daoulah, Awad A.R. AlQahtani, Sara R. Ocheltree, Abdulkarim Alhabib, Ali R. Ocheltree
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.018
Published online: April 25 2011
xDrug rash, eosinophilia, and systemic symptoms (DRESS) syndrome represents one pattern of the cutaneous involvement in type IV hypersensitivity reaction to drugs. It is a severe, delayed, idiosyncratic reaction presented as rash with fever, lymphadenopathy, and visceral involvement. There are several reported cases of sulfasalazine-induced DRESS syndrome, but myocardial involvement was rare. High index of suspicion is needed in every patient receiving these drugs for prompt diagnosis and early management.
Nobuhiro Nishiyama, Toshiaki Sato, Yoshiyasu Aizawa, Satoshi Nakagawa, Hideaki Kanki
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.019
Published online: April 4 2011
xDuring therapeutic hypothermia, QT interval is prolonged. In patients with congenital long QT syndrome (LQTs), a longer QT interval was associated with significantly increased risk of cardiac arrest (CA). Therefore, therapeutic hypothermia may have proarrhythmic effects in survivors of CA due to congenital LQTs. A 27-year-old man was resuscitated from CA due to congenital LQTs type 3 and Brugada syndrome. Torsade de pointes (TdP) recurred spontaneously on admission (body temperature, 36.9°C). During mild hypothermia therapy, QTc increased from 499 (36.9°C) to 667 milliseconds (33.8°C), although TdP was not induced.
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00133-7
Published in issue: May 2012
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00134-9
Published in issue: May 2012
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00135-0
Published in issue: May 2012
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00136-2
Published in issue: May 2012
