Geoffrey E. Hayden, Rachel E. Tuuri, Rachel Scott, Joseph D. Losek, Aaron M. Blackshaw, Andrew J. Schoenling, Paul J. Nietert, Greg A. Hall
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.039
Published online: August 26 2015
xEarly identification of sepsis in the emergency department (ED), followed by adequate fluid hydration and appropriate antibiotics, improves patient outcomes.
William P. Qiao, Emilie S. Powell, Mark P. Witte, Martin R. Zelder
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.052
Published online: September 7 2015
xProlonged emergency department (ED) wait times could potentially lead to increased mortality. Studies have demonstrated that black patients waited significantly longer for ED care than nonblack patients. However, the disparity in wait times need not necessarily manifest across all illness severities. We hypothesize that, on average, black patients wait longer than nonblack patients and that the disparity is more pronounced as illness severity decreases.
Susannah G. Cafardi, Jesse M. Pines, Partha Deb, Christopher A. Powers, William H. Shrank
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.049
Published online: September 7 2015
xWe examined trends in the use of observation services and the relationship between index service type (observation services, emergency department [ED] visits, inpatient stays) and both clinical outcomes and Medicare payments.
Chi-Chun Lin, Chan-Wei Kuo, Chip-Jin Ng, Wen-Cheng Li, Yi-Ming Weng, Jih-Chang Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.001
Published online: September 7 2015
xIn the provision of high-quality cardiopulmonary resuscitation (CPR) by health care providers, factors associated with high-quality CPR should be explored.
Rafael Oliveira Ximenes, Alberto Queiroz Farias, Augusto Scalabrini Neto, Márcio Augusto Diniz, Gabriel Taricani Kubota, Maurício Menezes Aben-Athar Ivo, Caroline Gracia Plena Sol Colacique, Luiz Augusto Carneiro D'Albuquerque, Roger Daglius Dias
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.004
Published online: September 10 2015
xPatients with cirrhosis have high risk of bacterial infections and cirrhosis decompensation, resulting in admission to emergency department (ED). However, there are no criteria developed in the ED to identify patients with cirrhosis with bacterial infection and with high mortality risk.
Roneet Lev, Oren Lee, Sean Petro, Jonathan Lucas, Edward M. Castillo, Gary M. Vilke, Christopher J. Coyne
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.003
Published online: September 7 2015
xPrescription drug–related fatalities remain a significant issue in the United States, yet there is a relative lack of knowledge on the specialty-specific prescription patterns for drug-related deaths.
Daniel D. Singer, Henry C. Thode Jr., Adam J. Singer
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.015
Published online: September 25 2015
xPreviously, analgesics were avoided in suspected appendicitis to avoid masking the diagnosis. We determined use of analgesia in patients with appendicitis to determine recent trends over time and explore predictors of use of analgesia.
Bobby M. Wellsh, Jerzy M. Kuzma
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.013
Published online: September 19 2015
xPediatric forearm fractures are a common presentation in emergency departments in Papua New Guinea. Often these children undergo “blind” closed reduction with reduction adequacy assessed by standard radiographs. This study aims to demonstrate the safety and efficacy of ultrasound (US) in guiding closed reduction of pediatric forearm fractures in a resource-limited setting.
Ali Kemal Erenler, Ramazan Kocabaş, Tolga Doğan, Hacı Kemal Erdemli, Mücahit Yetim
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.008
Published online: September 19 2015
xThe aim of this study was to investigate Paraoxanase 1 (PON-1) activity in patients with ST-elevated and non–ST-elevated acute myocardial infarction (AMI) and to determine its correlation with Gensini scores (GSs).
James M. Burgert, Arthur D. Johnson, Jose Garcia-Blanco, Jacob Froehle, Todd Morris, Ben Althuisius, Jennifer Richards, Christopher Castano
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.007
Published online: September 19 2015
xIt is unknown if the anatomical distance of intraosseous (IO) epinephrine injection from the heart affects resuscitative outcome. The purpose of this study was to explore the relationships between the anatomical distance of IO epinephrine injection and measures of resuscitative outcome in an adult swine model of ventricular fibrillation (VF).
Nobuyasu Komasawa, Takashi Cho, Ryosuke Mihara, Toshiaki Minami
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.016
Published online: September 19 2015
xThe utility of the gum-elastic bougie (GEB) as an assistive device for tracheal intubation during chest compressions has not been sufficiently validated. This study aimed to compare the utility of the GEB during chest compressions on an adult manikin.
Jamie L. Estock, Holly K. Curinga, Airan Li, Lorin B. Grieve, Christopher R. Brackney
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.011
Published online: September 19 2015
xThe goal of this study was to compare chest compression interruption times required to apply, adjust, and remove 2 different automated chest compression (ACC) devices using the same evaluation protocol.
Mehdi Torabi, Amirhossein Mirafzal, Azam Rastegari, Neda Sadeghkhani
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.014
Published online: September 19 2015
xShock Index (SI) is considered to be a predictor of mortality in many medical and trauma settings. Many studies have shown its superiority to conventional vital sign measurements in mortality prediction.
Julia Fuzak Freeman, Christopher Ciarallo, Lara Rappaport, Maria Mandt, Lalit Bajaj
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.012
Published online: September 19 2015
xPrehospital pediatric airway management is difficult and controversial. Options include bag-mask ventilation (BMV), endotracheal tube (ETT), and laryngeal mask airway (LMA). Emergency Medical Services personnel report difficulty assessing adequacy of BMV during transport. Capnography, and capnograph tracings in particular, provide a measure of real-time ventilation currently used in prehospital medicine but have not been well studied in pediatric patients or with BMV. Our objective was to compare pediatric capnographs created with 3 airway modalities.
Beng Leong Lim, Charmaine Manauis, Marxengel L. Asinas-Tan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.009
Published online: September 18 2015
xWe investigated delayed outcomes of patients with minor head injury, warfarin, and a normal initial head computer tomographic (CT) scan finding.
Wei-Lung Chen, Chi-Hung Huang, Jiann-Hwa Chen, Henry Chih-Hung Tai, Su-Hen Chang, Yung-Cheng Wang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.032
Published online: September 22 2015
xThe study aims to assess if electrocardiographic (ECG) abnormalities could predict the development of neurogenic pulmonary edema (NPE) within 24 hours in cases of spontaneous subarachnoid hemorrhage (SAH).
Ernest Moy, Rosanna M. Coffey, Brian J. Moore, Marguerite L. Barrett, Kendall K. Hall
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.031
Published online: September 22 2015
xDuration of a stay in an emergency department (ED) is considered a measure of quality, but current measures average lengths of stay across all conditions. Previous research on ED length of stay has been limited to a single condition or a few hospitals. We use a census of one state’s data to measure length of ED stays by patients’ conditions and dispositions and explore differences between means and medians as quality metrics.
Taka-aki Nakada, Naohisa Masunaga, Shota Nakao, Maiko Narita, Takashi Fuse, Hiroaki Watanabe, Yasuaki Mizushima, Tetsuya Matsuoka
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.048
Published online: October 2 2015
xPhysiological parameters are crucial for the caring of trauma patients. There is a significant loss of prehospital vital signs data of patients during handover between prehospital and in-hospital teams. Effective strategies for reducing the loss remain a challenging research area. We tested whether the newly developed electronic automated prehospital vital signs chart sharing system would increase the amount of prehospital vital signs data shared with a remote trauma center prior to hospital arrival.
Sophia Sheikh, Phyllis Hendry, Colleen Kalynych, Brittany Owensby, Jennifer Johnson, Dale F. Kraemer, Donna Carden
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.045
Published online: October 5 2015
xLow health literacy and patient activation are linked to unmet health needs, excess emergency department (ED) use, and hospital admission. However, most studies have assessed these measures in non-ED populations.
Norman A. Paradis
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.010
Published online: September 18 2015
xThe author observes that an incremental approach to improving basic life support (BLS) has met with limited success. Rather than continuing to optimize each of the broadly different techniques for increasing forward blood flow, we should evaluate a combination of techniques. Because human providers would likely be unable to apply such a combination, the next generation in the chain of survival, after immediate manual BLS, should be a machine. As envisioned, this machine would incorporate optimized circumferential constriction, anteroposterior compression with forceful decompression, and partial airway obstruction into one system—a combination of combinations.
Chiaki Takahashi, Hiroshi Okudera, Masahiro Wakasugi
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.039
Published online: October 2 2015
xIn 2002, Ohta and the Emergency Coma Scale Society began the development of a new coma scale, the Emergency Coma Scale (ECS), and established it the following year (Table 1) [1-3]. The ECS combines the advantages of the Glasgow Coma Scale (GCS) and the Japan Coma Scale (JCS). We predict that the ECS could achieve higher agreement and accuracy and has a sufficiently simple structure to be accepted by comedicals including nurses and paramedics. To prove these hypotheses, we designed a multicenter study called the “ECS Co-Operative Multi-center Evaluation Trial: E-COMET” [4].
Michael Gottlieb, Damali Nakitende, Deborah Kimball, Errick Christian, John Bailitz
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.021
Published online: October 15 2015
xTube thoracostomies (TT) are performed for a variety of indications including pneumothorax, hemothorax, and empyema. Studies have demonstrated complication rates ranging from 1.1% to 9.5%, depending upon the provider level of experience [1–5]. Complications can include incorrect tube placement, persistent air leaks, kinked tubing, and provider injury.
Lukasz Szarpak, Andrzej Kurowski, Piotr Zaśko, Katarzyna Karczewska, Lukasz Czyzewski, Lukasz Bogdanski, Piotr Adamczyk, Zenon Truszewski
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.018
Published online: October 15 2015
xIntubation with a double-lumen tube (DLT) is important for one-lung ventilation and facilitates thoracic surgery. A DLT allows for suctioning, ventilation therapy (eg, positive airway pressure), and bronchoscopy of each lung [1]. However, compared to the single-lumen tracheal tube, DLTs have a larger outer diameter and are longer and more complex in structure. A standard tracheal tube can be inserted into the tracheal more precisely, causing less tissue damage [2,3]. To avoid trauma to the upper airway and to shorten intubation time, an adequate and complete glottic viewing is required.
Catherine A. Marco, Christopher Fagan, Catherine Eggers, William Trautman, Dennis Mann, James E. Olson
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.023
Published online: October 15 2015
xAbdominal pain is a common emergency department (ED) chief concern [1]. A variety of features have been used to assess patients including history, comorbid conditions, physical examination, laboratory testing, and radiographic testing [2–8]. The validity of patient self-assessments is highly variable [9–14].
Zenon Truszewski, Lukasz Szarpak, Silvia Samarin, Andrzej Kurowski, Piotr Adamczyk, Lukasz Czyzewski
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.024
Published online: October 16 2015
xEnsuring an adequate gas-exchange is a cornerstone in the treatment of patients in pre-hospital setting. Oxygenation and ventilation can be performed without advanced techniques using bag-valve-mask ventilation and an oropharyngeal tube, but it should be remembered that each patient pre-hospital care should be treated as a patient with a full stomach, and bag-valve-mask ventilation thus increases the risk of vomiting and aspiration of gastric contents into the respiratory tract. According European Resuscitation Council and American Heart Association Guidelines 2010 for Cardiopulmonary Resuscitation (CPR), endotracheal intubation is the gold standard for airway management during CPR.
Lukasz Szarpak, Andrzej Kurowski, Piotr Adamczyk, Lukasz Czyzewski, Zenon Truszewski, Piotr Zaśko
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.020
Published online: October 15 2015
xPeripheral intravenous (IV) access is preferred in the treatment of critical patients in prehospital emergency settings. However, IV might be difficult, especially in dehydrated patients, those in shock, following chemotherapy, obese with edema or IV drug users. Failure rates of IV access in the emergency setting are described around 10–40% and average time needed for peripheral IV catheterization is reported between 2.5 and 16 min in patients with difficult IV access [1]. The use of intraosseous (IO) access in medical or trauma resuscitation is endorsed by the European Resuscitation Council, the American College of Critical Care Medicine, the American Heart Association, the American College of Emergency Physicians or even the US Army Committee on Tactical Combat Casualty Care.
Laszlo Littmann
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.022
Published online: October 15 2015
xWe read with great interest the case report by Drs Durant and Singh on the peculiar pattern of ST elevation caused by acute occlusion of the first diagonal branch of the left anterior descending coronary artery (LAD-D) [1]. In our experience too, such high lateral infarcts (STEMIs) are frequently missed even by experienced emergency medicine physicians because of the apparently noncontiguous nature of ST elevation in the electrocardiogram (ECG). We have developed a simple educational tool that can help conceptualize and recall the typical ST changes seen in high lateral STEMI.
Shinji Nakahara, Tetsuya Sakamoto, Hiroto Ikeda, Kahoko Nakazawa, Yoichi Katayama, Seizan Tanabe, Yasuhiro Yamamoto
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.016
Published online: October 15 2015
xEmergency and critical care centers (ECCCs) in Japan are specialized tertiary care centers, certified by the Ministry of Health, Labour and Welfare, providing the highest level of care to severely ill and injured patients. Currently, more than 270 centers are operating nationwide. Their hospital performance, particularly patient outcomes, has not been well evaluated.
Eric M. Rottenberg
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.014
Published online: October 15 2015
xPirotte and colleagues [1] reported on 2 cases where a bougie was successfully placed by a direct laryngoscopy; however, after failure of troubleshooting measures, digital manipulation was required to overcome difficulty in advancing the endotracheal tube (ETT) past the vocal cords. In the first case, rapid sequence induction and neuromuscular blockade was used. The second patient was intubated during cardiac arrest with ongoing chest compressions.
Cem Ozgonul, Murat Kucukevcilioglu, Gokcen Gokce
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.047
Published online: October 25 2015
xWe read with great interest the recent published article by Budhram et al [1] in which authors aimed to determine the prevalence of monocular and binocular mobile vitreous opacities in the vitreous chamber in an asymptomatic population at normal and high gain levels. In conclusion, the authors stated that mobile vitreous opacity in the vitreous chamber was uncommon at normal gain levels but relatively common at high gain settings and found both unilaterally and bilaterally. Although it is a well-designed and straightforward study, there is a point that we would like to add for a proper understanding of the issue, to avoid giving a wrong message to readers.
Tiziana Ciarambino, Luigi Elio Adinolfi, Mauro Giordano
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.040
Published online: May 15 2015
xOur patient is a 42-year-old woman with muscle paralysis, muscle weakness, and fever. On admission, a neurologic examination showed proximal and distal weakness in the leg. Serum creatine phosphokinase and serum myoglobin level were markedly increased (5600 UI/L and 5197 UI/L, respectively). There was no sign of renal failure. Nerve conduction study was negative. Serologic studies for virus titers showed the antibody immunoglobulin M cytomegalovirus. Muscle weakness and its paralysis, fever, and serum creatine kinase level gradually improved after the administration of methylprednisolone intravenous.
Yen-Ting Yeh, Chun-Yang Huang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.038
Published online: April 24 2015
xAs the most dramatic and fatal complication, left ventricular free-wall rupture (LVFWR) used to present in approximately 3% of patients with acute myocardial infarction. After the introduction of primary percutaneous coronary intervention, the incidence of LVFWR decreased but remained approximately 1.7% [1]. Left ventricular free-wall rupture occurs in patients with transmural myocardial infarction, which is almost exclusively ST-elevation myocardial infarction (STEMI) [2]. This condition carries a high mortality as a result of hemopericardium and cardiac tamponade.
Fatih Karaaslan, Emre Yurdakul, Murat Baloglu, Musa Ugur Mermerkaya, Sinan Karaoglu
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.037
Published online: April 27 2015
xWe report a case of spontaneous, bilateral Achilles rupture in a 33-year-old man with no specific risk factors. The rupture occurred after a heavy impact during a sports activity, and although the rupture was painful, he was able to mobilize slowly. After a clinical examination confirmed the diagnosis, ultrasonography and magnetic resonance imaging evaluation of the Achilles tendons revealed bilateral ruptures. The patient underwent bilateral conservative treatment and subsequently embarked on a comprehensive rehabilitation program with a good functional outcome at follow-up.
Katherine R. Flannery, Sean P. Wilson, Jacob Manteuffel
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.064
Published online: April 30 2015
xCentral venous catheterization is often necessary for the safe administration of medications that are caustic to peripheral veins, to place temporary transvenous pacemakers and to provide invasive hemodynamic monitoring in the critically ill. While a wide range of complications are known to occur with insertion of these catheters, there is a paucity of cases associated with cardiac arrest during the catheters placement. We describe an unusual case of sustained ventricular tachycardia and subsequent cardiac arrest that occurred during an ultrasound guided central venous catheter placement for a patient in septic shock.
Anup Katyal, Muhammad Ali Javed
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.083
Published online: May 1 2015
xDuplication of the inferior vena cava (IVC) has been reported in literature. This achieves clinical significance in the setting of lower extremity venous thromboembolism with a contraindication for anticoagulation. We describe a case of lower extremity deep vein thrombosis with duplicate IVC. Anticoagulation was contraindicated in this case leading to successful treatment with double IVC filters. We conducted a PubMed search for all current English language published literature, where filters were placed in the presence of duplicate IVC.
Billy Huh, Carlos J. Roldan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.084
Published online: May 1 2015
xMedical technology has impacted the overall life expectancy. Many conditions traditionally considered fatal are now curable. Surviving chronic diseases and aging of the population have increased the number of people with chronic pain. Many devices are also available to manage severe refractory pain. As such, implantable drug-delivery system (IDDS) is a small battery-powered, programmable pump implanted under the subcutaneous tissue of the abdomen and connected to a small catheter tunneled into the spine.
Olivia Haesloop, Allison Tillick, Graham Nichol, Jared Strote
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.033
Published online: May 29 2015
xSuperwarfarin, a common component of rat poison, can cause long-lasting, severe coagulopathy and life-threatening hemorrhage when ingested. We report a case of intentional rat poison consumption with subsequent hemorrhage and hypotension requiring rapid coagulopathy reversal and resuscitation in the emergency department. In addition to traditional blood products, prothrombin complex concentrate was administered. Although prothrombin complex concentrate is increasingly used for severe hemorrhage in anticoagulated patients, it may be particularly useful in superwarfarin ingestions given the extreme, persistent coagulapathies that can occur.
Matthew Turner, David Solarz
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.030
Published online: May 29 2015
xEvery year, nearly 250000 atrial fibrillation patients require temporary interruption of anticoagulation therapy for invasive procedures, acute illness, or bleeding events [1]. Rivaroxaban is an oral anticoagulant that works by inhibiting factor Xa leading to a blockage of thrombin production, which inhibits platelet aggregation and thrombus formation. As with other anticoagulants, there is an increased risk of a thrombotic event occurring when rivaroxaban therapy is temporarily interrupted (TI) or prematurely discontinued.
Anıl Er, Taner Kemal Erdağ, Aykut Çağlar, Özgür Kümüş, Murat Duman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.029
Published online: May 29 2015
xLuc abscess is an uncommon suppurative complication of otitis media. Unfamiliarity of this complication leads to delayed diagnosis and treatment. This abscess is usually benign. Infection in the middle ear spreads via anatomic preexisting pathways, and this process results with subperiosteal pus collection. Conservative treatment with drainage under empirical wide spectrum antibiotic is efficient. Here, we present a 9-year-old boy who had left facial swelling after a period of otalgia, diagnosed as Luc abscess without mastoiditis.
Süleyman Anlıaçık, Ali Ulvi Uca, Hasan Hüseyin Kozak, Zehra Akpınar
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.025
Published online: May 29 2015
xMultiple sclerosis affects many regions of the central nervous system and leads to visual, oculomotor, motor, sensorial, cerebellar, and cognitive disorders. In addition to classic clinical findings, sudden paroxysmal symptoms triggered by motion, hyperventilation, or sensory stimulus may occur. In this article, we present a case of convergence spasm attended by paroxysmal symptoms, a rarely observed situation but one which can have complete recovery through administration of 5-day intravenous (IV) methylprednisolone therapy, together with its imaging findings and video records.
Sang Kyoon Han, Soon Chang Park, Sung Hwa Lee, Seok Ran Yeom, Sung Wook Park
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.027
Published online: May 29 2015
xCurrent guideline recommends that immediate coronary angiography (CAG) should be considered in all postcardiac arrest patients in whom acute coronary syndrome is suspected. In the setting of out-of-hospital cardiac arrest (OHCA), obtaining clinical data such as chest discomfort and medical diseases associated with acute coronary syndrome can be difficult. Therefore, emergency physicians depend on electrocardiographic findings after return of spontaneous circulation (ROSC) when they have to decide whether emergency CAG should be performed.
Haluk Un, Mehmet Dogan, Omer Uz, Zafer Isilak, Mehmet Uzun
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.028
Published online: June 3 2015
xHemodynamically unstable patients with supraventricular tachycardias (SVTs) should be treated with electrical cardioversion. If the patient is stable, acute termination of tachycardia can be achieved by vagal maneuvers or medical therapy. The Valsalva maneuver, carotid massage, and ice to the face are the most common vagal maneuvers. In our experience with patients, we observed that vagal stimulation increases with lying backward. Our suggested maneuver is based on quickly lying backward, from a seated position.
Clément Hoffmann, Julien Bouix, Chrystelle Poyat, Laure Alhanati, Jean-Pierre Tourtier, Elisabeth Falzone
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.034
Published online: May 29 2015
xCarbon monoxide poisoning is the most common cause of fatal poisoning worldwide and can lead to severe brain damages. We report a delayed encephalopathy after a severe carbon monoxide poisoning with uncommon magnetic resonance imaging findings.
Lia I. Losonczy, Emily Lovallo, C. Daniel Schnorr, Daniel Mantuani
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.055
Published online: June 13 2015
xNeurogenic stunned myocardium is a rare disease entity that has been typically described as a consequence of subarachnoid hemorrhage and, less commonly, seizures. Here we describe a case of a healthy young woman who drank excessive free water causing acute hyponatremia complicated by cerebral edema and seizure, leading to cardiogenic shock from neurogenic stunned myocardium. Two days later, she had complete return of her normal cardiac function.
Zhi-Ping Zhang, Xi Su, Cheng-Wei Liu, Dan Song, Jian Peng, Ming-Xiang Wu, Yu-Chun Yang, Bo Liu, Cheng-Yi Xu, Fang Wang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.054
Published online: June 13 2015
xLeft ventricular free wall rupture usually leads to acute hemopericardium and sudden cardiac death resulting in cardiac tamponade. Rarely, only a few patients with subacute free wall rupture such as oozing-type ventricular rupture or left ventricular false aneurysm may permit time for pericardiocentesis and surgery. We report a 63-year-old man with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention about 12 hours from the onset, and cardiac tamponade occurred on the second day.
Shiro Gonai, Yoshito Kamio, Tomoyuki Matsuoka, Manabu Harunari, Yutaka Saito, Kiyotsugu Takuma
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.053
Published online: June 13 2015
xAlthough techniques for autoreduction of anterior shoulder dislocation have been developed, no reports have detailed an autoreduction method using the zero position and traction on the affected arm. Therefore, we developed a new autoreduction technique using the zero position and gentle autotraction. The objective of this study is to present our experience with a new method for autoreduction of anterior shoulder dislocation called the GONAIS (a backronym for “Grasp a waist-high object, Opposite arm assists, Nonsedated, Autoreduction/autotraction, Immobilize the grasped object, and Squatting and stooping”) method.
Brett Sweeney, Soheila Talebi, David Toro, Kristhiam Gonzalez, Jean-Paul Menoscal, Ronald Shaw, Getaw Worku Hassen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.052
Published online: June 13 2015
xSynthetic cannabinoids (SC) have exploded on to the scene. With this rise in SC use, the number of complications and potential adverse effects are also well documented in the literature and is on the rise. The most frequently cited side effects are behavioral in nature and range for severe agitation to psychosis and delirium. We report a case of hyperthermia with severe rhabdomyolysis from SC use.
Mustafa Topuz, Yusuf Kılınc, Cagdas Can, Mehmet Coskun, Murat Cayli
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.051
Published online: June 13 2015
xTrauma-related embolic events in pulmonary vascular bed are generally due to fat or thrombus embolism. In this report, we present a patient who had severe hypoxia and tachycardia at postoperative period after surgery of an open tibia fracture. Because of the clinical and electrocardiographic findings, we calculated patients Wells score as “pulmonary embolism likely” (>4 points, 28%-52% pulmonary embolism risk), and we performed chest contrast computed tomography. There was no abnormal finding in contrast to chest contrast computed tomography that could suggest fat or thrombus embolism.
Elif Nisa Unlu, Ali Nihat Annakkaya, Ege Gulec Balbay, Leyla Yilmaz Aydın, Sinem Safcı, Mertay Boran, Derya Guclu
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.050
Published online: June 8 2015
xAbstract
Vincenzo De Santis, Manuela Negri, Cecilia Nencini, Maurizio Fusari
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.049
Published online: June 8 2015
xTargeted temperature management (TTM) may be considered on an individual basis after cardiac arrest in a comatose pregnant patient. The only 3 cases published so far describing the use of TTM in this setting have conflicting results in terms of fetal outcome.
