Jessica E. Galarraga, Jesse M. Pines
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.001
Published online: June 6 2015
xEmergency department (ED) care is a focus of cost reduction efforts. Costs for acute care originating in the ED, including outpatient and inpatient encounters (i.e. ED episodes), have not been estimated.
Yong Sung Cha, Hyun Kim, Juwon Kim, Oh. Hyun Kim, Hyung Il Kim, KyoungChul Cha, Kang Hyun Lee, Sung Oh Hwang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.021
Published online: September 19 2015
xHemolytic anemia is one of the complications related to the chronic consumption of dapsone. However, in acute dapsone overdose, there have been few case reports regarding hemolytic anemia. Herein, we reported the prevalence and patterns of hemolytic anemia in acute dapsone overdose, and compared clinical features including mortality in the non-hemolytic anemia and the hemolytic anemia groups.
Karolin Wiklund, Klas Gränsbo, Nathalie Lund, Marjaneh Peyman, Lena Tegner, Maria Toni-Bengtsson, Mattias Wieloch, Olle Melander
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.052
Published online: November 9 2015
Open AccessxThe objective was to identify inflammatory biomarkers that predict risk of 90-day mortality in patients with acute dyspnea.
Mian Zeng, Minchan Chang, Haichong Zheng, Bin Li, Yanzhu Chen, Wanmei He, Chunrong Huang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.004
Published online: November 3 2015
xThe level of soluble urokinase-type plasminogen activator receptor (suPAR) is significantly increased in sepsis. We investigated whether suPAR could be a valuable biomarker in sepsis.
Zenon Truszewski, Lukasz Szarpak, Andrzej Kurowski, Togay Evrin, Piotr Zasko, Lukasz Bogdanski, Lukasz Czyzewski
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.003
Published online: November 4 2015
xOut-of-hospital cardiac arrest is a leading cause of mortality and serious neurological morbidity in Europe. We aim to investigate the effect of 3 cardiopulmonary resuscitation (CPR) feedback devices on effectiveness of chest compression during CPR.
Virginia M. Stewart, Hjalti M. Bjornsson, Michelle Clinton, Donald V. Byars
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.006
Published online: November 5 2015
xThe BRIPPED scan is an ultrasound evaluation of pulmonary B-lines, right ventricle size, inferior vena cava collapsibility, pleural and pericardial effusion, pneumothorax, left ventricle ejection fraction, and lower extremity deep venous thrombosis. The primary goal was to evaluate the effect of the BRIPPED scan on the physician's list of differential diagnoses for patients presenting with shortness of breath.
Weiwei Wang, Ting Jiang, Chunyu Li, Jun Chen, Kejiang Cao, Lian-wen Qi, Ping Li, Wei Zhu, Baoli Zhu, Yan Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.007
Published online: November 7 2015
xTo investigate the research status of emergency medicine in China through literature search of international emergency medicine journals and retrospectively compare the outputs of emergency medicine articles of the 3 major regions of China-Mainland (ML), Taiwan (TW), and Hong Kong (HK).
Xianghong Ma, Wenting Duan, Pradeep Poudel, Junwei Ma, Deepak Sharma, Yanmin Xu
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.010
Published online: November 9 2015
Open AccessxTo investigate the clinical characteristics of patients with the fragmented QRS complexes (fQRS) and the predictive value of fQRS in patients undergoing primary percutaneous coronary intervention (p-PCI).
Yusuf Tanrikulu, Ceren Sen Tanrikulu, Mehmet Zafer Sabuncuoglu, Furuzan Kokturk, Volkan Temi, Ercan Bicakci
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.009
Published online: November 10 2015
xPeptic ulcer perforation (PUP) accounts for 5% of all abdominal emergencies and is recognized as a gastrointestinal emergency requiring rapid and efficient clinical evaluation and treatment. The mortality rate ranges from 10% to 40% among patients with perforation. In the present retrospective study, we examined the potential utility of the neutrophil-to-lymphocyte ratio (NLR) in early diagnosis of PUP; we asked whether this ratio allowed PUP and peptic ulcer disease to be distinguished.
Hanbyul Choi, Christopher C. Lee, Ho Jung Kim, Adam J. Singer
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.008
Published online: November 9 2015
xThere are no specific guidelines regarding the exact hand placement location for effective chest compressions. This study was designed to identify the optimal hand placement site over the chest during cardiopulmonary resuscitation (CPR).
Patricia C. Silveira, Ivan K. Ip, Siobhan Sumption, Ali S. Raja, Shahein Tajmir, Ramin Khorasani
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.028
Published online: November 16 2015
xThe objective of the study is to determine impact of a clinical decision support (CDS) tool on documented adherence to the Ottawa Ankle Rules (OAR) and utilization and yield of ankle/foot radiography, for emergency department patients with acute ankle injury.
Emin Uysal, Yahya Ayhan Acar, Ahmet Kutur, Erdem Cevik, Necati Salman, Onur Tezel
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.025
Published online: November 16 2015
xBlood gas analysis is a frequently ordered test in emergency departments for many indications. It is a rapid technique that can analyze electrolyte and metabolites in addition to pH and blood gases. The aim of this study was to investigate the correlation of electrolyte and metabolite results measured by blood gas and core laboratory analyzers.
Kenichi Tetsuhara, Hiroshi Kato, Takashi Kanemura, Ichiro Okada, Nobuaki Kiriu
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.030
Published online: November 16 2015
xThis study aimed to determine whether severe acidemia (pH <7.2) on arrival at the emergency department (ED) is a predictive factor for neurologic outcomes of post–cardiac arrest patients treated with targeted temperature management (TTM).
Don Johnson, Kirk Giles, Alexis Acuna, Crystal Saenz, Michael Bentley, Craig Budinich
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.027
Published online: November 16 2015
xPurposes of this study were to compare tibial intraosseous (TIO) and intravenous (IV) administration of vasopressin relative to return of spontaneous circulation (ROSC) and time to ROSC in an adult swine cardiac arrest model. In addition, the purposes were to compare the concentration maximum (Cmax), time to maximum concentration (Tmax), and odds of ROSC.
Tae Hu Kim, Soo Hoon Lee, Dong Hoon Kim, Ryun Kyung Lee, So Yeon Kim, Changwoo Kang, Jin Hee Jeong, Seong Chun Kim, Sang Bong Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.026
Published online: November 16 2015
xThis study was performed to determine a landmark for chest compression depth for adult cardiopulmonary resuscitation (CPR) using chest computed tomography and to evaluate the validity of the landmark.
Alberto Conti, Simone Bianchi, Caterina Grifoni, Federica Trausi, Sofia Bigiarini, Delia Lazzeretti, Elena Angeli, Francesca Innocenti, Stefano Grifoni
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.044
Published online: November 18 2015
xThe novel analysis of high-frequency QRS components (HF/QRS) has been proposed in patients with chest pain (CP) referred for exercise tolerance test (ex-ECG). We sought to evaluate the prognostic role of exercise high-frequency QRS-analysis (ex-HF/QRS) in patients with recent-onset stable CP, in the emergency setting.
Abolfazl Firouzian, Abbas Alipour, Hale Rashidian Dezfouli, Alieh Zamani Kiasari, Afshin Gholipour Baradari, Amir Emami Zeydi, Hamed Amini Ahidashti, Maryam Montazami, Seyed Mohammad Hosseininejad, Farideh Yazdani Kochuei
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.062
Published online: November 19 2015
xRenal colic (RC) is a common clinical presentation in the emergency department (ED). Prompt and effective pain control is one of the first responsibilities of emergency physicians. The aim of this study was to evaluate the analgesic effect of adding lidocaine to morphine compared to morphine alone in patients presenting to the ED with RC.
Taner Sen, Mehmet Ali Astarcioglu, Lale Dinc Asarcikli, Celal Kilit, Habibe Kafes, Afsin Parspur, Mehmet Yaymaci, Mesut Pinar, Omac Tüfekcioglu, Basri Amasyali
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.068
Published online: December 4 2015
xIn this retrospective study, we investigated the association between air pollution and weather conditions with the incidence of acute myocardial infarction (AMI) in the city of Kutahya.
Brian C. Geyer, David A. Peak, George C. Velmahos, Jonathan D. Gates, Yvonne Michaud, Laurie Petrovick, Jarone Lee, Brian J. Yun, Benjamin A. White, Ali S. Raja
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.067
Published online: December 4 2015
xThe Patient Protection and Affordable Care Act supports the establishment of accountable care organizations (ACOs) as care delivery models designed to save costs. The potential for these cost savings has been demonstrated in the primary care and inpatient populations, but not for patients with emergency conditions or traumatic injuries.
Robert G. Solberg, Brandy L. Edwards, Jeffrey P. Chidester, Debra G. Perina, William J. Brady, Michael D. Williams
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.066
Published online: December 4 2015
xFrequent emergency department (ED) use has been identified as a cause of ED overcrowding and increasing health care costs. Studies have examined the expense of frequent patients (FPs) to hospitals but have not added the cost Emergency Medical Services (EMS) to estimate the total cost of this pattern of care.
Joo Jeong, Kyoung Jun Song, Yu Jin Kim, Jin Seong Cho, Ju Ok Park, Seung Chul Lee, Young Sun Ro, James F. Holmes
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.065
Published online: December 4 2015
xA paucity of data exists on the prevalence and predictors of discharging injured patients against medical advice from emergency departments. The aim of this study is to investigate the association between acute alcohol use and being discharged against medical advice.
Qin Yin, Bo Liu, Caijun Wu, Jun Yang, Chenchen Hang, Chunsheng Li
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.010
Published online: December 12 2015
xThe objective of the study is to investigate the effects of Shen-Fu injection (SFI) on coagulation-fibrinolysis disorders in a porcine model of cardiac arrest.
Jessica L. Weaver, Rebecca E. Barnett, Danielle E. Patterson, Vikram G. Ramjee, Eric Riedinger, Jason Younga, Ernesto A. Sepulveda, Robert C. Keskey, William G. Cheadle
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.008
Published online: December 12 2015
xSmall-bowel obstruction (SBO) is a common cause of admission to the surgical service. On rare occasions, a diagnosed SBO is actually due to large-bowel pathology combined with an incompetent ileocecal valve. The purpose of this study was to investigate this phenomenon.
Roberto Barcala-Furelos, David Szpilman, Jose Palacios-Aguilar, Javier Costas-Veiga, Cristian Abelairas-Gomez, Antonio Bores-Cerezal, Sergio López-García, Antonio Rodríguez-Nuñez
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.006
Published online: December 12 2015
xThe whole drowning process usually occurs within seconds to a few minutes. An early rescue may stop and/or prevent most medical complications. Fins, rescue tube, and rescue board (RB) are the equipment most frequently used by lifeguards. Our objective was to compare, in a water rescue quasiexperimental trial, these different pieces of rescue equipment to define the safest and with the lower rescue time as well as to assess their effects on the lifeguards' physiological state and cardiopulmonary resuscitation (CPR) performance.
Joseph R. Pare, Rachel Liu, Christopher L. Moore, Tyler Sherban, Michael S. Kelleher Jr., Sheeja Thomas, R. Andrew Taylor
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.005
Published online: December 12 2015
xAscending aortic dissection (AAD) is an uncommon, time-sensitive, and deadly diagnosis with a nonspecific presentation. Ascending aortic dissection is associated with aortic dilation, which can be determined by emergency physician focused cardiac ultrasound (EP FOCUS). We seek to determine if patients who receive EP FOCUS have reduced time to diagnosis for AAD.
Florence Leclercq, Anais Iemmi, Nils Kusters, Benoit Lattuca, Guillaume Cayla, Jean-Christophe Macia, Francois Roubille, Mariama Akodad, Jean-Paul Cristol, Anne-Marie Dupuy
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.017
Published online: December 14 2015
xThe purpose was to evaluate the incremental value of copeptin associated with high-sensitivity cardiac T troponin (hs-cTnT) to exclude severe coronary stenosis in patients with coronary artery disease (CAD) and acute chest pain.
Kimberly Roaten, Fuad Khan, Kevin Brown, Carol S. North
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.014
Published online: December 12 2015
xThe objective was to examine the relationship between violence screening items, suicide risk stratification, and disposition in a psychiatric emergency service setting.
Cheng-Yu Chien, Yi-Chia Su, Chi-Chun Lin, Chan-Wei Kuo, Shen-Che Lin, Yi-Ming Weng
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.004
Published online: December 11 2015
xPrevious guidelines suggest up to 15 minutes of cardiopulmonary resuscitation (CPR) accompanied by other resuscitative interventions before terminating resuscitation of a traumatic cardiac arrest. The current study evaluated the duration of CPR according to outcome using the model of a county-based emergency medical services (EMS) system in Taiwan.
Roneet Lev, Sean Petro, Oren Lee, Jonathan Lucas, Amy Stuck, Gary M. Vilke, Edward M. Castillo
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.023
Published online: December 14 2015
xThe Centers of Disease Control and Prevention have declared prescription drug abuse an epidemic in the United States. However, demographic data correlating prescription-related deaths with actual prescriptions written is not well described. The purpose of this study is to compare toxicology reports on autopsy for prescription-related deaths with Prescription Drug Monitor Program (PDMP) data.
Yong Joo Park, Young Sun Ro, Sang Do Shin, Kyoung Jun Song, Seung Chul Lee, Yu Jin Kim, Joo Yeong Kim, Ki Jeong Hong, Jung Eun Kim, Min Jung Kim, Sang Chul Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.024
Published online: December 16 2015
xCase fatality from injury increases exponentially with age. The objective of this study is to identify age effects on case fatality of injury patients by injury mechanism.
Paul Albertine, Samuel Borofsky, Derek Brown, Smita Patel, Woojin Lee, Anthony Caputy, M. Reza Taheri
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.035
Published online: December 18 2015
xWith advancing technology, the sensitivity of computed tomography (CT) for the detection of subdural hematoma (SDH) continues to improve. In some cases, the finding is limited to one or 2 images of the CT examination. At our institution, all patients with an SDH require intensive care unit (ICU) admission, regardless of size. In this report, we tested the hypothesis that patients with a small traumatic SDH on their presenting CT examination do not require the intensive monitoring offered in the ICU and can instead be managed on a hospital unit with a lower level of monitoring.
Rui Liu, Shu-Ming Wang, Xian-Qi Liu, Si-Jia Guo, Hai-Bin Wang, Sen Hu, Fang-Qiang Zhou, Zhi-Yong Sheng
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.040
Published online: December 21 2015
xPyruvate can reduce lipid peroxidation, which plays a critical role in organ injury, in various models. However, it is not fully understood if this inhibition occurs in resuscitation of hemorrhagic shock (HS). This study examines effects of pyruvate Ringer solution (PR) in this respect in rats.
Mary Colleen Bhalla, Jennifer Frey, Sarah Dials, Kristin Baughman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.070
Published online: December 24 2015
xNon–ST-segment elevation myocardial infarctions (NSTEMIs) are more common but less studied than ST-segment elevation myocardial infarctions (STEMIs) treated by emergency medical services (EMS).
Sion Jo, Taeoh Jeong, Jae Baek Lee, Youngho Jin, Jaechol Yoon, Boyoung Park
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.067
Published online: December 23 2015
xThe aim of this study was to investigate the prognostic prediction power of a newly introduced early warning score modified by serum lactate level, the National Early Warning Score–Lactate (NEWS-L) score, among community-acquired pneumonia (CAP) patients. We also compared the NEWS-L score with the pneumonia severity index (PSI) and CURB-65.
Yahya Kemal Günaydın, Bora Çekmen, Nazire Belgin Akıllı, Ramazan Köylü, Ekrem Taha Sert, Başar Cander
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.066
Published online: December 23 2015
xDespite all of the studies conducted on cardiopulmonary resuscitation (CPR), the mortality rate of cardiac arrest patients is still high. This has led to a search for alternative methods. One of these methods is active compression-decompression CPR (ACD-CPR) performed with the CardioPump.
Francesco Santoro, Armando Ferraretti, Riccardo Ieva, Francesco Musaico, Mario Fanelli, Nicola Tarantino, Maria Scarcia, Pasquale Caldarola, Matteo Di Biase, Natale Daniele Brunetti
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.065
Published online: December 22 2015
xThe objectives were to ascertain the prevalence of renal impairment among patients with a takotsubo cardiomyopathy (TTC) episode and whether clinical outcomes are related to renal function.
Michael D. Witting, Siamak Moayedi, Zhaoxin Yang, Cheryll B. Mack
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.062
Published online: December 23 2015
xWhen an intravenous (IV) catheter is needed and the common approach of inspection and palpation fails, an advanced access technique becomes necessary. Our objectives were to estimate pain scores, operator times, success rates, and complication rates when advanced techniques are used in a clinical setting.
Mohammad Jalili, Maryam Bahreini, Amin Doosti-Irani, Rasoul Masoomi, Mona Arbab, Hadi Mirfazaelian
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.074
Published online: December 28 2015
xThis meta-analysis of trials was conducted to evaluate the analgesic and side effects of ketamine-propofol combination (ketofol) in comparison to propofol in procedural sedation and analgesia (PSA).
Xiaojun Zhuo, Lu Xie, Fangying Ruan Shi, Nuo Li, Xiaoyang Chen, Menghua Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.011
Published online: December 12 2015
xCerebral injury is a main factor contributing to a high mortality after cardiac arrest (CA)/cardiopulmonary resuscitation (CPR).
Hecsen Rivera, Joseph Varon
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.056
Published online: December 21 2015
xGreen tea (Camellia sinesis) has been used for centuries for a variety of social and medical purposes. Although the consumption and origin of green tea is considered to have started in China more than 4000 years ago, this herbal preparation rapidly grew in popularity in India, and nowadays around the World. Whether it is used as a beverage or as part of a ritual, green tea usage has grown exponentially in the past few decades. A variety of clinical uses for green tea preparations have been suggested throughout history, in both allopathic and homeopathic environments, including the emergency department [1].
David Kiefer, S. Michael Keller, Anthony Weekes
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.069
Published online: December 4 2015
xDifficult vascular access (DVA) is a common problem. Placement of ultrasound-guided standard length catheters (ultrasound-guided peripheral intravenous [USPIV]) in the internal jugular (IJ) vein is a potential solution.
Jiraporn Sri-on, Gregory Philip Tirrell, Lewis A. Lipsitz, Shan Woo Liu
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.009
Published online: December 12 2015
xThe term mechanical falls is commonly used in the emergency department (ED), yet its definition and clinical implications are not established. It may be used to attribute falls to extrinsic factors in the environment exonerating clinicians from conducting a thorough assessment of the fall's underlying intrinsic causes. We conducted this study to determine how clinicians assess “mechanical” and “nonmechanical” falls; we explored conditions, fall evaluation, and outcomes associated with these diagnoses.
Eitan Dickman, Illya Pushkar, Antonios Likourezos, Knox Todd, Ula Hwang, Saadia Akhter, Sean Morrison
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.016
Published online: December 14 2015
xTo compare pain relief between patients with intracapsular and extracapsular hip fractures who received an ultrasound-guided femoral nerve block (USFNB).
Sattha Riyapan, Jeffrey Lubin
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.015
Published online: December 12 2015
xWe attempted to determine the effect of prearrival instructions that included the specific location of automated external defibrillators (AEDs) in a public venue on the time to defibrillation in a simulated cardiac arrest scenario using untrained bystanders.
Tomoya Hirose, Hiroshi Ogura, Jinkoo Kang, Youhei Nakamura, Hideo Hosotsubo, Etsuko Kitano, Michiyo Hatanaka, Takeshi Shimazu
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.029
Published online: December 18 2015
xC1 inhibitor (C1INH) regulates not only the complement system but also the plasma kallikrein-kinin, fibrinolytic, and coagulation systems. The biologic activities of C1INH can be divided into the regulation of vascular permeability and anti-inflammatory functions. The objective was to clarify the serial change of C1INH in patients with sepsis.
Matthew Hansen, Garth Meckler, William Lambert, Caitlin Dickinson, Kathryn Dickinson, Jeanne-Marie Guise
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.082
Published online: December 30 2015
xCroup, asthma, and anaphylaxis are potentially life-threatening pediatric emergencies. These medical conditions have distinct yet effective treatments. Croup causes upper airway obstruction, although virally mediated edema of the upper airway. Nebulized epinephrine, via its α-1 effect of vasoconstriction, is a highly effective treatment for upper airway obstruction caused by croup [1–5]. Asthma causes lower airway obstruction and is treated with albuterol whose β-2 mechanism causes relaxation of the lower airways [6].
Pavel Kotlarsky, Itai Shavit, Imad Kassis, Mark Eidelman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.090
Published online: January 5 2016
xA pediatric septic hip is a serious condition that must be recognized and treated as early as possible. We describe the clinical course of children with septic hip that were treated with aspiration of the hip joint in the emergency department (AHED).
Patricia Kuang, Nathan D. Mah, Cassie A. Barton, Andrea J. Miura, Laura R. Tanas, Ran Ran
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.084
Published online: January 7 2016
xThe objective of the study is to evaluate the difference in ventricular rate control using an intravenous (IV) metoprolol regimen commonly used in clinical practice in patients receiving chronic β-blocker therapy compared to patients considered β-blocker naive admitted to the emergency department (ED) for atrial fibrillation (AF) with rapid ventricular rate.
Itzhak Brook
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.063
Published online: November 20 2015
xA nonsurgical approach using antimicrobial agents has been advocated as the initial treatment of uncomplicated appendicitis. Several studies and meta-analyses explored this approach. Because many of these studies included individuals with resolving appendicitis, their results were biased. Antimicrobials, however, are warranted and needed for the management of surgical high-risk patients with perforated appendicitis and those with localized abscess or phlegmon. Randomized placebo-controlled trials that focus on early identification of complicated acute appendicitis patients needing surgery and that prospectively evaluate the optimal use of antibiotic treatment in patients with uncomplicated acute appendicitis are warranted.
Mathew Macias, Jordan Peachey, Amal Mattu, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.047
Published online: November 20 2015
xST-segment elevation myocardial infarction (STEMI) is defined as pathologic ST-segment elevation occurring in at least 2 anatomically contiguous leads in a patient with a clinical presentation consistent with acute myocardial infarction (AMI); these findings can suggest the need for urgent revascularization. Unfortunately, the electrocardiogram (ECG) may be nondiagnostic in a large portion of patients who initially present with AMI; furthermore, it is now recognized that ECG patterns that do not meet the traditional diagnostic criteria for STEMI may represent significant AMI—these patterns are generally referred to as the STEMI equivalent patterns in that they are caused by occlusion of an epicardial coronary artery, place significant portions of the left ventricle in jeopardy, and can result in a poor outcome if not recognized and treated appropriately.
