Alcohol and trauma—in every age group Terry Kowalenko, Bradford Burgess, Susanna M. Szpunar, Charlene B. Irvin-Babcock
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.032
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 4 2013
x The purpose was to determine the proportion of alcohol-positive (AlcPos) trauma patients in different age groups and any association with mortality using the National Trauma Data Bank.
Using process indicators to optimize service completion of an ED drug and alcohol brief intervention program Joanna Akin, J. Aaron Johnson, J. Paul Seale, Gabriel P. Kuperminc
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.021
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: October 21 2014
x The strongest evidence for effectiveness of screening, brief intervention, and referral to treatment (SBIRT) programs is in primary care settings. Emergency department (ED) studies have shown mixed results. Implementation of SBIRT into ED settings is complicated by the type of patients seen and the fast-paced, high-throughput nature of the ED environment that makes it difficult to reach patients flagged for SBIRT services. This study uses data from an ED-based SBIRT program to examine the relationship between screen-positive rate, ED patient flow, and SBIRT service delivery.
Naproxen-induced methemoglobinemia in an alcohol-dependent patient Won Suk Lee, Jang Young Lee, Won Young Sung, Sang Won Seo
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.027
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: April 17 2014
x The authors report a case of acute methemoglobinemia in a patient treated with naproxen for the common cold. A 42-year-old Asian woman began taking naproxen sodium and methocarbamol for mylagia, chills, and coughing. On the day prior to her emergency department (ED) admission, the patient was taking lorazepam, trazodon, and paroxetine in addition to the naproxen and methocarbamol prescribed for the cold symptoms, and she also ingested approximately 300 mL of 20% alcohol. Upon awakening the next morning, the patient experienced dyspnea and dizziness.
Frequent ED users: are most visits for mental health, alcohol, and drug-related complaints? Shan W. Liu, John T. Nagurney, Yuchiao Chang, Blair A. Parry, Peter Smulowitz, Steven J. Atlas
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.006
The American Journal of Emergency Medicine , Vol. 31 , Issue 10 ,
Published online: September 12 2013
x To determine whether frequent emergency department (ED) users are more likely to make at least one and a majority of visits for mental health, alcohol, or drug-related complaints compared to non-frequent users.
The Effect of Ethanol on Lactate and Base Deficit as Predictors of Morbidity and Mortality in Trauma Mark L. Gustafson, Steve Hollosi, Julton Tomanguillo Chumbe, Damayanti Samanta, Asmita Modak, Audis Bethea
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.030
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: January 22 2015
x The objective of this study was to assess the predictive value of lactate and base deficit in determining outcomes in trauma patients who are positive for ethanol.
Pediatric occult methanol intoxication with hyperammonemia Dazhe Cao, Aline B. Maddux, Danielle Mashburn, Christine Vohwinkel, George S. Wang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.031
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: June 17 2015
x A 17-year-old girl presented with one week of fatigue, dyspnea and chest pain. Initial vitals were temperature 36 °C, heart rate 113, blood pressure 127/78, respiratory rate 56, and oxygen saturation 95%. Initial exam was notable for mydriasis and tachypnea. Laboratory tests were significant for bicarbonate level <
ED disposition of the Glasgow Coma Scale 13 to 15 traumatic brain injury patient: analysis of the Transforming Research and Clinical Knowledge in TBI study Jonathan J. Ratcliff, Opeolu Adeoye, Christopher J. Lindsell, Kimberly W. Hart, Arthur Pancioli, Jason T. McMullan, John K. Yue, Daniel K. Nishijima, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.003
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: April 14 2014
x Mild traumatic brain injury (mTBI) patients are frequently admitted to high levels of care despite limited evidence suggesting benefit. Such decisions may contribute to the significant cost of caring for mTBI patients. Understanding the factors that drive disposition decision making and how disposition is associated with outcomes is necessary for developing an evidence-base supporting disposition decisions. We evaluated factors associated with emergency department triage of mTBI patients to 1 of 3 levels of care: home, inpatient floor, or intensive care unit (ICU).
A rational approach to the treatment of alcohol withdrawal in the ED Christine R. Stehman, Mark B. Mycyk
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.029
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 11 2013
x Approximately 7% of the US population abuses or is dependent on alcohol. Patients with alcohol disorders often seek medical attention in Emergency Departments (EDs) for complications directly related to alcohol use or due to other medical issues associated with alcohol use. Because of increasing lengths of stay in EDs, alcohol-dependent patients are at high risk of developing alcohol withdrawal syndrome (AWS) during their ED visit. This article reviews the physiology of alcohol withdrawal as well as the symptoms of this potentially deadly illness for the practicing emergency physician (EP).
Is arterial base deficit still a useful prognostic marker in trauma? A systematic review I. Ibrahim, W.P. Chor, K.M. Chue, C.S. Tan, H.L. Tan, F.J. Siddiqui, M. Hartman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.012
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 14 2015
x Arterial base deficit (BD) has been widely used in trauma patients since 1960. However, trauma management has also evolved significantly in the last 2 decades. The first objective of this study was to systematically review the literature on the relationship between arterial BD as a prognostic marker for trauma outcomes (mortality, significant injuries, and major complications) in the acute setting. The second objective was to evaluate arterial BD as a prognosis marker, specifically, in the elderly and in patients with positive blood alcohol levels.
Subject Index
DOI: http://dx.doi.org/10.1016/S0735-6757(15)00997-3
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published in issue: December 2015
A pilot study of emergency medical technicians' field assessment of intoxicated patients' need for ED care Alexandra H. Cornwall, Nickolas Zaller, Otis Warren, Kenneth Williams, Nina Karlsen-Ayala, Brian Zink
DOI: http://dx.doi.org/10.1016/j.ajem.2011.06.004
The American Journal of Emergency Medicine , Vol. 30 , Issue 7 ,
Published online: November 7 2011
x Alcohol–intoxicated individuals account for a significant proportion of emergency department care and may be eligible for care at alternative sobering facilities. This pilot study sought to examine intermediate-level emergency medical technician (EMT) ability to identify intoxicated individuals who may be eligible for diversion to an alternative sobering facility.
Visits by the elderly to United States EDs for alcohol-related disorders Allison Tadros, Meredith Mason, Danielle M. Davidov, Stephen M. Davis, Shelley M. Layman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.032
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: April 24 2015
x The objectives are to estimate the number of elderly patients presenting to emergency departments (EDs) in the United States from 2006 to 2011 for alcohol-related disorders and examine their demographic and clinical features.
Fomepizole for severe disulfiram-ethanol reactions Margaret Sande, David Thompson, Andrew A. Monte
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.014
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: January 5 2011
x Ingestion of ethanol in the presence of disulfiram may cause a histamine-like reaction due to accumulation of acetaldehyde. These disulfiram-ethanol reactions (DERs) are manifested by hypotension, tachycardia, gastritis, and angioedema. Fomepizole, an inhibitor of alcohol dehydrogenase, may halt progression of this reaction by blocking ethanol metabolism to acetaldehyde. We present 2 cases of disulfiram and alcohol overdose leading to severe reactions unresponsive to fluid resuscitation and treated with a single dose of fomepizole.
Therapeutic hypothermia: a state-of-the-art emergency medicine perspective Joseph Varon, Paul E. Marik, Sharon Einav
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.007
The American Journal of Emergency Medicine , Vol. 30 , Issue 5 ,
Published online: May 13 2011
x Therapeutic hypothermia (TH) has gained popularity as a brain-protective strategy for victims of sudden cardiac death in whom return of spontaneous circulation has been achieved but coma persists. Trials have also demonstrated some advantageous effects of lowering core body temperature after stroke and hypoxic-ischemic encephalopathy of the newborn. In a variety of clinical conditions, TH is still being studied (eg, hepatic encephalopathy and traumatic brain injury). This study describes the historical development of TH, its current applications in emergency medicine, and its potential future uses.
Disulfiram ethanol reaction mimicking anaphylactic, cardiogenic, and septic shock Simon Bourcier, Nicolas Mongardon, Fabrice Daviaud, Laurence Moachon, Marc-Antoine Arnould, Franck Perruche, Frédéric Pène, Alain Cariou
DOI: http://dx.doi.org/10.1016/j.ajem.2012.05.002
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: July 18 2012
x Shock is a common reason for medical intensive care unit admission, with septic and cardiogenic accounting for most of the etiologies. However, the potential severity of adverse side effects of drugs indicates that any medication should be carefully scrutinized for potential pharmacokinetic and pharmacodynamic interactions that may result. We herein report the case of a life-threatening shock mimicking successively anaphylactic, cardiogenic, and septic shock, which was finally related to disulfiram ethanol reaction.
Sex and age differences in ED patients with mental and behavioral disorders due to psychoactive substance use Fanny Le Querrec, Vincent Bounes, Maryse Lapeyre Mestre, Olivier Azema, Nicolas Longeaux, Jean-Christophe Gallart
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.068
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: July 6 2015
x The objectives of this study are to describe an emergency department (ED) adult population with the chief complaint of mental and behavioral disorders due to psychoactive substance use and to investigate sex- and age-related differences.
A description of Medical Examiner prescription-related deaths and prescription drug monitoring program data 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
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 14 2015
x The 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.
Respiratory depression in the intoxicated trauma patient: are opioids to blame? Eleni Shenk, Cassie A. Barton, Nathan D. Mah, Ran Ran, Robert G. Hendrickson, Jennifer Watters
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.053
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: November 3 2015
x Providing effective pain management to acutely intoxicated trauma patients represents a challenge of balancing appropriate pain management with the risk of potential respiratory depression from opioid administration. The objective of this study was to quantify the incidence of respiratory depression in trauma patients acutely intoxicated with ethanol who received opioids as compared with those who did not and identify potential risk factors for respiratory depression in this population. Retrospective medical record review was conducted for subjects identified via the trauma registry who were admitted as a trauma activation and had a detectable serum ethanol level upon admission.
A prospective, randomized, trial of phenobarbital versus benzodiazepines for acute alcohol withdrawal Gregory W. Hendey, Robert A. Dery, Randy L. Barnes, Brandy Snowden, Philippe Mentler
DOI: http://dx.doi.org/10.1016/j.ajem.2009.10.010
The American Journal of Emergency Medicine , Vol. 29 , Issue 4 ,
Published online: March 26 2010
x The aim of this study was to compare phenobarbital (PB) versus lorazepam (LZ) in the treatment of alcohol withdrawal in the emergency department (ED) and at 48 hours.
Clinical predictors for delirium tremens in patients with alcohol withdrawal seizures Dong Wook Kim, Hyun Kyung Kim, Eun-Kee Bae, So-Hee Park, Kwang Ki Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.030
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: February 23 2015
x Delirium tremens (DT) is the severest form of alcohol withdrawal syndrome, frequently after alcohol withdrawal seizures. Delirium tremens occurs in a small proportion of patients with alcohol withdrawal seizures; nevertheless, early identification of high-risk patients is important for intensive preventive management of unexpected episodes due to agitation and its associated increased mortality. However, there are limited studies on clinical predictors of the development of DT in patients with alcohol withdrawal seizures.
Evaluation of motor vehicle accident drivers for attention deficit hyperactivity disorder: Hyperactivity and ADHD in traffic accidents Murat Enis Ardıç, Sadiye Yolcu, Önder Tomruk, Burak Gün, Bülent Erdur, Vermi Değerli, Ismet Parlak
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.035
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: May 31 2014
x Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood brain disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity [1].
Cardiac arrest caused by acute intoxication—insight from a registry David Hörburger, Istepan Kurkciyan, Fritz Sterz, Andres Schober, Mathias Stöckl, Peter Stratil, Thomas Uray, Christoph Testori, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.005
The American Journal of Emergency Medicine , Vol. 31 , Issue 10 ,
Published online: September 9 2013
x The aim of the study was to evaluate the epidemiology and outcome after cardiac arrest caused by intoxication.
Antabuse reaction due to occupational exposure—an another road on the map? Subramanian Senthilkumaran, Ritesh G. Menezes, Gade Ravindra, Narendra Nath Jena, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2013.05.022
The American Journal of Emergency Medicine , Vol. 31 , Issue 8 ,
Published online: June 21 2013
x With reference to the case of Bourcier et al [1], we would like to share our experience of disulfiram reaction observed in a painter due to occupational exposure of alcohol containing solvents during his deaddiction period. In fact, he was referred as septic encephalopathy by the factory medical officer.
Disulfiram-like Reaction with Ornidazole Sertac Guler, Halit Aytar, Murat Soyuduru, Hayri Ramadan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.022
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: March 15 2015
x Many drugs, including the antibiotics that are most commonly used in the emergency department (ED), are known to cause disulfiram-like reactions (DLR). These reactions can cause a wide variety of clinical presentations, from simple signs to symptoms of life-threatening conditions. The responsible mechanism for the reaction is aldehyde dehydrogenase inhibited by disulfiram and is the accumulation of acetaldehyde in the serum. As shown DLR is caused by metronidazole, and imidazole derivatives are not recommended to use with alcohol.
Olanzapine in ED patients: differential effects on oxygenation in patients with alcohol intoxication Michael P. Wilson, Nita Chen, Gary M. Vilke, Edward M. Castillo, Kai S. MacDonald, Arpi Minassian
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.013
The American Journal of Emergency Medicine , Vol. 30 , Issue 7 ,
Published online: May 25 2012
x Agitation has significant consequences for patients and staff. When verbal techniques fail, expert guidelines recommend the use of second-generation antipsychotics (SGAs). Perhaps out of familiarity with haloperidol and benzodiazepines, emergency department (ED) clinicians often pair SGAs with benzodiazepines as well. Use of SGAs such as olanzapine in alcohol-intoxicated (ETOH+) patients or with benzodiazepines is not well studied and may be associated with vital sign abnormalities.
Spur cell anemia in end-stage liver disease: a zebra! Rushikesh Shah, Arpan Patel, Savio John
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.027
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: January 27 2014
x Anemia in alcoholic liver disease has a broad spectrum of differential diagnosis. One of the esoteric pathology that should be considered is spur cell anemia (SCA) in end-stage liver disease patients. Spur cell anemia is a rare type of hemolytic anemia with a grave prognosis. It closely resembles “Zieve syndrome,” which can present similarly and needs to be differentiated for prognostic and treatment purpose. Although presence of SCA indicates poor prognosis in these patients, it is curable with liver transplant, and therefore, early diagnosis is crucial.
Biochemical issues in emergency medicine: diagnostic and therapeutic considerations of selected toxic presentations Christopher Saeui, Nathan Charlton, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.032
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: November 15 2010
x Understanding biochemical concepts can assist in the diagnosis and treatment of certain presentations in the emergency department. Knowledge of the biochemistry responsible for certain presentations in the emergency department as well as behind various therapies also provides physicians better insight into the use of specific treatments. This review will focus on the biochemistry of numerous clinical syndromes, including methemoglobinemia, various poisoning presentations, including cyanide, methanol, and ethylene glycol—with an emphasis on the diagnostic and management considerations in these presentations.
Large-event medicine—event characteristics impacting medical need Riley Moore, Kelly Williamson, Mark Sochor, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.018
The American Journal of Emergency Medicine , Vol. 29 , Issue 9 ,
Published online: October 25 2010
x Large events have been defined in many ways, from the vague description of a focused gathering of people to the more specific description of an event with at least 1,000 spectators and participants who are gathered at a specific location for a defined period of time. Regardless of the definition applied, the actual medical requirements vary considerably from one event to the next. The ability to predict these medical needs allows for the provision of adequate medical support. Many factors contribute to medical need at a large event, including event type, weather (particularly heat index), the presence of alcohol and / or illicit drugs, the number of participants, event duration, crowd demographics, and venue characteristics.
Acute respiratory distress syndrome and outcomes after near hanging Sahar Mansoor, Majid Afshar, Matthew Barrett, Gordon S. Smith, Erik A. Barr, Matthew E. Lissauer, Michael T. McCurdy, Sarah B. Murthi, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.001
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: December 9 2014
x The purpose of this study is to assess the case rate of acute respiratory distress syndrome (ARDS) after near hanging and the secondary outcomes of traumatic and/or anoxic brain injury and death. Risk factors for the outcomes were assessed.
Propofol for benzodiazepine-refractory alcohol withdrawal in a non–mechanically ventilated patient Darrel W. Hughes, Elizabeth VanWert, Lauren LePori, Bruce D. Adams
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.044
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: September 27 2013
x Long-term alcohol use confers neurochemical changes in response to alcohol's exogenous inhibitory effects. Downregulation and decreased sensitivity of γ -aminobutyric acid receptors render benzodiazepines less effective at controlling psychomotor agitation. Propofol has been reported to have successfully relieved alcohol withdrawal syndrome (AWS) symptoms in part because of activation of γ -aminobutyric acid channels in combination with antagonism of excitatory amino acids such as N -methyl-d -aspartate.
Cocaine-induced isolated right ventricular infarction Aiman Smer, Mahesh Anantha Narayanan, Toufik Mahfood Haddad, Harish Devineni, Venkata Alla
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.053
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: December 29 2014
x Cocaine use has been associated with several cardiovascular events. However, isolated right ventricular infarction because of cocaine use has never been reported before. We report a case of isolated right ventricular infarction secondary to cocaine use in a young male with no previous coronary artery disease. To our knowledge, this is the first report of cocaine-induced right ventricular infraction.
Alcoholic ketoacidosis coincides with acute Marchiafava-Bignami disease Ming-Hua Chen, Chun-An Cheng
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.021
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: February 10 2012
x Alcoholism is the major cause of electrolyte and acid-base imbalance and nutrition deficiency. Ketoacidosis is one of major advised effect on alcoholism. Marchiafava-Bignami disease, a rare alcohol-related disorder, characterized by altered mental status, seizure, and multifocal central nervous system signs, which results from progressive demyelination and necrosis of corpus callosum. Here, we presented a 53-year-old man presented as decreased conscious level and 4 extremity rigidity on admission.
The association between acute alcohol consumption and discharge against medical advice of injured patients in the ED 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
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 4 2015
x A 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.
Patterns and correlates of drug-related ED visits: results from a national survey Brian E. Perron, Amy S.B. Bohnert, Sarah E. Monsell, Michael G. Vaughn, Matthew Epperson, Matthew O. Howard
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.044
The American Journal of Emergency Medicine , Vol. 29 , Issue 7 ,
Published online: July 14 2010
x Drug treatment can be effective in community-based settings, but drug users tend to underuse these treatment options and instead seek services in emergency departments (EDs) and other acute care settings. The goals of this study were to describe prevalence and correlates of drug-related ED visits.
Comparison of Clinical Characteristics of Intentional vs Accidental Drowning Patients Seon Hee Woo, Jeong Ho Park, Seung Pill Choi, Jung Hee Wee
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.051
The American Journal of Emergency Medicine , Vol. 33 , Issue 8 ,
Published online: April 29 2015
x Drowning may happen by accident or as a method of committing suicide. The aim of this study was to determine some characteristics of drowning patients who committed intentionally.
Mass-gathering medicine: a descriptive analysis of a range of mass-gathering event types Samuel Locoh-Donou, Yan Guofen, Melanie Welcher, Thomas Berry, Robert E. O'Connor, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.016
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: February 28 2013
x To identify and evaluate the volume, nature, and severity of patient presentations encountered by emergency medical services (EMS) at all mass-gathering events held at or near a southeastern US university. In addition, to compare the existing literature base (single mass-gathering event held in large urban population centers) with a broader variety of events varying in crowd size and locations.
Acute myocardial infarction with normal coronary arteries associated with subclinical Graves disease Nadia Bouabdallaoui, Frederic Mouquet, Pierre Vladimir Ennezat
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.023
The American Journal of Emergency Medicine , Vol. 31 , Issue 12 ,
Published online: September 26 2013
x Myocardial infarction occurring with angiographically normal coronary arteries is rare and often described in young people. This report describes a case of myocardial infarction with normal coronary arteries in a young female patient related to coronary thrombosis complicated by left ventricular apical thrombus in the setting of an unknown and subclinical Graves disease.
Large left upper quadrant mass Amy A. Ernst, Steve J. Weiss, David A. Wachter, Michael D. Stifelman
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.011
The American Journal of Emergency Medicine , Vol. 29 , Issue 6 ,
Published online: August 16 2010
x Causes of left upper quadrant (LUQ) masses include spleen, colonic, pancreatic, and renal etiologies. Emergency department (ED) ultrasound can help differentiate the cause. In this article, we present the case of a 53-year-old female attending Emergency Medicine physician diagnosed with a large palpable LUQ mass. The mass was noted after an episode of moderate nausea and mild LUQ, left lower quadrant, and flank pain. The pain and nausea resolved the following day. The mass was palpable about 10 cm below the left costal margin and was thought initially to be the spleen.
Energy drinks overdose and metabolic abnormalities—a double whammy! Subramanian Senthilkumaran, Suresh S. David, Namasivayam Balamurugan, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.016
The American Journal of Emergency Medicine , Vol. 31 , Issue 6 ,
Published online: April 19 2013
x The article by Dikici et al [1] is interesting. There are increasing reports regarding adverse effect of energy drink (ED) in current literature. Energy drink use has been anecdotally linked with seizure, and there is paucity of evidence-based literature in support of this association. This raises a debate whether the risk is negligible or it is underestimated, due to inadequate reporting [2].
Incentives to participate in clinical trials: practical and ethical considerations Steven L. Bernstein, James Feldman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.020
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: May 28 2015
x Clinical trials often offer incentives to encourage individuals to enroll and to enhance follow-up. The scope and nature of incentives used in emergency department (ED)-based trials are unknown.
Copper-coated thermometer for the prevention of cross-infections: preliminary results Panos Efstathiou, Evangelia Kouskouni, Zaharoula Manolidou, Maria Tseroni, Katerina Karageorgou, Helena C. Maltezou, Athanasios Chalkias, Seraphim Papanikolaou, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.028
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 17 2015
x Research has shown that axillary thermometers are contaminated at a rate of 80% to 100% [1–3]. Although the common digital thermometer is always disinfected with an alcohol solution after each use, disinfection is only partially achieved or fails, potentially leading to resistant bacteria and sepsis [4–6].
Risk factors for QT prolongation associated with acute psychotropic drug overdose Naoya Miura, Takeshi Saito, Takayuki Taira, Rimako Umebachi, Sadaki Inokuchi
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.048
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: October 3 2014
x Antipsychotic/Antidepressant use is a risk factor for QT interval (QT) prolongation and sudden cardiac death. However, it is unclear which drugs are risk factors for QT prolongation and torsades de pointes in cases of psychotropic drug overdose.
Cardiac disease and probable intent after drowning Andreas Claesson, Henrik Druid, Jonny Lindqvist, Johan Herlitz
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.004
The American Journal of Emergency Medicine , Vol. 31 , Issue 7 ,
Published online: May 22 2013
x The aim of this study is to determine the prevalence of cardiac disease and its relationship to the victim's probable intent among patients with cardiac arrest due to drowning.
Vibrio vulnificus sepsis misdiagnosed as simple deep vein thrombosisJe Sung You, Seunghwan Kim, Incheol Park, Seungho Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.031
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: May 25 2012
x A 46-year-old man was transferred to the emergency department and suspected of having a deep vein thrombosis. The patient reported swelling and pain in both lower legs for 16 hours. His medical history included liver cirrhosis secondary to alcohol. A detailed history revealed raw fish consumption 1 day before admission. Within 2 hours of arrival, several hemorrhagic bullae developed in the color-changed lesions of both lower legs. The patient's level of consciousness deteriorated to a stupor. He was admitted to the intensive care unit.
Incidence and patterns of hemolytic anemia in acute dapsone overdose 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
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: September 19 2015
x Hemolytic 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.
Early identification of an atypical case of type A dissection by transthoracic echocardiography by the emergency physician Scott Edward Sparks, Michael Kurz, Doug Franzen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.024
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: December 20 2014
x Thoracic aortic dissection is a lethal disease, and emergency department diagnosis is limited by imperfect diagnostic testing and limited resources; however, this case report illustrates the nonspecific presentation of thoracic aortic dissection and the use of emergency physician use of transthoracic echocardiography with the addition of suprasternal notch views to help differentiate all-cause chest pain and aid in accurate diagnosis, as well as earlier surgical correction for best patient outcomes in cases of thoracic aortic dissection.
An alternative for rapid administration of medication and fluids in the emergency setting using a novel device Neal Lyons, Daniel Nejak, Nadine Lomotan, Robert Mokszycki, Stephen Jamieson, Marc McDowell, Erik Kulstad
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.028
The American Journal of Emergency Medicine , Vol. 33 , Issue 8 ,
Published online: January 21 2015
Open Access x Routes of administration for medications and fluids in the acute care setting have primarily focused on oral, intravenous, or intraosseous routes, but, in many patients, none of these routes is optimal. A novel device (Macy Catheter; Hospi Corp) that offers an easy route for administration of medications or fluids via rectal mucosal absorption (proctoclysis) has recently become available in the palliative care market; we describe here the first known uses of this device in the emergency setting.
Recurrent hypoglycemia in a toddler Marissa Cohen, Sean Zwiebel, Rebecca Jeanmonod
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.074
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: April 30 2015
x Idiopathic ketotic hypoglycemia is the most common cause of hypoglycemia in toddlers. This diagnosis should be considered in any hypoglycemic toddler with no prior history of abnormal growth who is developmentally normal when toxic ingestions and sepsis are inconsistent with the clinical picture. Diagnosis is important in preventing serious long-term sequelae and is made in the setting of hypoglycemia, ketonuria, and ketonemia. Therefore, checking urine and blood ketones is an essential part of the evaluation in any hypoglycemic toddler.
Safety and efficacy of intravenous combination sedatives in the ED Siu Fai Li, Amy Kumar, Susan Thomas, Yelena Sorokina, Vanessa Calderon, Elizabeth Dubey, Lani Lee, Ludmilla Gustave
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.017
The American Journal of Emergency Medicine , Vol. 31 , Issue 9 ,
Published online: August 7 2013
x The objective of the study is to determine the safety of intravenously administered combination sedatives in the emergency department (ED).
Prescription opioid misuse among ED patients discharged with opioids Francesca L. Beaudoin, Steven Straube, Jason Lopez, Michael J. Mello, Janette Baird
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.030
The American Journal of Emergency Medicine , Vol. 32 , Issue 6 ,
Published online: February 27 2014
x The purposes of this study were to determine the prevalence of prescription opioid misuse in a cohort of discharged emergency department (ED) patients who received prescription opioids and to examine factors predictive of misuse.
Urban overdose hotspots: a 12-month prospective study in Dublin ambulance services Jan Klimas, Martin O'Reilly, Mairead Egan, Helen Tobin, Gerard Bury
DOI: http://dx.doi.org/10.1016/j.ajem.2014.07.017
The American Journal of Emergency Medicine , Vol. 32 , Issue 10 ,
Published online: July 30 2014
x Opioid overdose (OD) is the primary cause of death among drug users globally. Personal and social determinants of overdose have been studied before, but the environmental factors lacked research attention. Area deprivation or presence of addiction clinics may contribute to overdose.
Withdrawal Seizures Seen In the Setting of Synthetic Cannabinoid Abuse Christopher S. Sampson, Starr-Mar’ee Bedy, Terry Carlisle
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.025
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: March 15 2015
x The recent rise in the abuse of synthetic cannabinoid receptor agonists (Spice, K2) has led to an increase of patients presenting to emergency departments (EDs) with complications stemming from their abuse. We present a case of withdrawal seizures seen in a chronic abuser of these herbal mixtures who stopped using them abruptly. Seizures have been reported in the literature in the setting of abuse, but not during withdrawal [1].
The impact of overcrowding on the bacterial contamination of blood cultures in the ED Ching-Chi Lee, Nan-Yao Lee, Ming-Che Chuang, Po-Lin Chen, Chia-Ming Chang, Wen-Chien Ko
DOI: http://dx.doi.org/10.1016/j.ajem.2011.05.026
The American Journal of Emergency Medicine , Vol. 30 , Issue 6 ,
Published online: December 14 2011
x This study aims to determine the risk factors associated with the bacterial contamination of blood cultures among adults visiting the emergency department (ED).
Early antidote use associated with noninvasive ventilation in prehospital treatment of methadone intoxication J. Gonzva, B. Prunet, C. Deniel, P. Benner, F. Toppin, P.M. Brun
DOI: http://dx.doi.org/10.1016/j.ajem.2012.06.015
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: September 3 2012
x Opioid addiction is a major public health problem in France. However, because substitution therapies are available, the number of fatal intoxications decreased.
Characteristics of Medicaid enrollees with frequent ED use Roberta Capp, Marjorie S. Rosenthal, Mayur M. Desai, Lauren Kelley, Christopher Borgstrom, Darcey L. Cobbs-Lomax, Peggy Simonette, Erica S. Spatz
DOI: http://dx.doi.org/10.1016/j.ajem.2013.05.050
The American Journal of Emergency Medicine , Vol. 31 , Issue 9 ,
Published online: July 15 2013
x Medicaid enrollees are disproportionately represented among patients with frequent Emergency Department (ED) visits, yet prior studies investigating frequent ED users have focused on patients with all insurance types.
Superwarfarin ingestion treated successfully with prothrombin complex concentrate Olivia Haesloop, Allison Tillick, Graham Nichol, Jared Strote
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.033
The American Journal of Emergency Medicine , Vol. 34 , Issue 1 ,
Published online: May 29 2015
x Superwarfarin, 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.
A retrospective review of the prehospital use of activated charcoal Joseph Villarreal, Christopher A. Kahn, James V. Dunford, Ekta Patel, Richard F. Clark
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.019
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: October 21 2014
x We studied the complications and timing implications of prehospital activated charcoal (PAC). Appropriateness of PAC administration was also evaluated.
Thyrotoxic periodic paralysis presenting with ventricular storm Daniel Weingrow, Faith Quenzer, Rodney Borger
DOI: http://dx.doi.org/10.1016/j.ajem.2012.05.024
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: July 18 2012
x Thyrotoxic periodic paralysis (TPP) is a rare accompaniment to hyperthyroidism in western populations. Severe hypokalemia with resultant muscle weakness and arrhythmias are frequently precipitated by acute stressors or carbohydrate meals from catecholamine release and insulin release, respectively. Ventricular arrhythmia, during the hypokalemic events, usually terminates easily with standard anti-arrhythmic treatment. This report describes a case of TPP complicated by ventricular storm/incessant ventricular tachycardia (VT) with subsequent cardiac arrest.
Who is prescribing controlled medications to patients who die of prescription drug abuse? 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
The American Journal of Emergency Medicine , Vol. 34 , Issue 1 ,
Published online: September 7 2015
x Prescription 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.
Observation vs admission in syncope: can we predict short length of stays? Margaret Lin, Richard E. Wolfe, Nathan I. Shapiro, Victor Novack, Yotam Lior, Shamai A. Grossman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.010
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: August 10 2015
x Rising health care costs demands justifying prolonged hospitalization for syncope, yet predictors of shorter length of stay (LOS) have not been identified.
Spontaneous rupture of spleen masquerading as acute pancreatitis Jyotindu Debnath, Samrat Sonkar, Vivek Sharma, Samar Chatterjee, Vikash Srivastava, Shiv Pankaj Khanna
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.036
The American Journal of Emergency Medicine , Vol. 32 , Issue 4 ,
Published online: November 25 2013
x Splenic rupture most commonly follows blunt abdominal trauma. Nontraumatic rupture of the spleen is rare. Nontraumatic rupture of the spleen has been described in a variety of pathologic conditions, which include neoplastic, infectious, and hematologic diseases affecting the spleen. Spontaneous rupture of nondiseased spleen is extremely rare. We report a case of spontaneous rupture of spleen in a chronic alcoholic clinically simulating acute pancreatitis.
Temperate pyomyositis: a pain in the belly Joseph R. Pare, Elissa M. Schechter-Perkins
DOI: http://dx.doi.org/10.1016/j.ajem.2014.07.016
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: July 29 2014
x Pyomyositis is a rare disease in temperate climates. This case is a unique presentation of pyomyositis of the rectus abdominal muscle mimicking an acute abdominal process. Most reported cases of pyomyositis are of extremity infections with Staphylococcus aureus . This report presents a case of polymicrobial pyomyositis from Haemophylus parainfluenza and Steptococcus viridians infection.
The worst amnesia of your life Muneer Hameer, Aashish Valvani, Hossein Kalantari, Getaw Worku Hassen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.069
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: April 6 2015
x Subarachnoid hemorrhage (SAH) is a medical emergency that can be life threatening or lead to severe disability even if recognized and managed early. Majority of spontaneous SAHs arise from a ruptured saccular aneurysm. However, up to 15% of SAHs do not have a bleeding source and are termed nonaneurysmal SAHs. Although sudden, severe headache is classically associated with aneurysmal SAHs, nonaneurysmal SAHs tend to have a more gradual onset headache and can even present with transient amnesia in about one-third of patients.
Rhabdomyolysis associated with kava ingestion Ryan Bodkin, Sandra Schneider, Donna Rekkerth, Linda Spillane, Michael Kamali
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.030
The American Journal of Emergency Medicine , Vol. 30 , Issue 4 ,
Published online: April 4 2011
x We 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.
Modified carotid sinus massage using an ultrasonography for maximizing vagal tone: a crossover simulation study Seung Min Ha, Young Suk Cho, Gyu Chong Cho, Choong Hyun Jo, Ji Young Ryu
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.011
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: April 10 2015
Open Access x The aim of this study was to ascertain if a modified carotid sinus massage (CSM) using ultrasonography is superior to the conventional CSM for vagal tone generation.
Carboplatin: a new cause of severe type B lactic acidosis secondary to mitochondrial DNA damage François Gilles Brivet, Abdelhamid Slama, Dominique Prat, Frédéric Marc Jacobs
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.005
The American Journal of Emergency Medicine , Vol. 29 , Issue 7 ,
Published online: October 11 2010
x In adults, type B lactic acidosis is rare and generally associated with a toxin, particularly metformin or antiretroviral nucleosides analogues. We report a case of lactic acidosis caused by carboplatin in a 50-year-old woman suffering from primary peritoneal carcinoma. She was admitted for severe lactic acidosis (pH 6.77, lactate 19 mmol/L) associated with multiple organ failure (PaO2 /FiO2 96, creatinine 231 μ mol/L, aspartate aminotransferase >25 000 UI, factor V 13%) occurring during the sixth carboplatin cycle.
Complete blood count at the ED: preanalytic variables for hemoglobin and leukocytes Paolo Carraro, Gianna Vettore, Andrea Padoan, Elisa Piva, Mario Plebani
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.011
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: May 16 2015
x The objective of this study is to determine the ways in which preanalytic factors related to physiologic status can affect the complete blood cell count (CBC) in patients referring to an emergency department (ED).
Day-of-the-week variations in myocardial infarction onset over a 27-year period: the importance of age and other risk factors Philippe Collart, Yves Coppieters, Isabelle Godin, Alain Levêque
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.012
The American Journal of Emergency Medicine , Vol. 32 , Issue 6 ,
Published online: February 19 2014
x The aim of this study was to analyze the day-of-the-week variations of acute myocardial infarction (AMI) over a 27-year period. The effects of sex, age, history of AMI, hypertension, fatality, and temporal changes over the 27-year period were also investigated.
Right lower quadrant abdominal pain, fever, and hypotension: an atypical presentation of meningococcemia Ryan P. Austin, Adam G. Field, William M. Beer
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.028
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: March 17 2015
x A previously healthy, 33-year-old man presented to our emergency department complaining of right lower quadrant abdominal pain with anorexia, nausea, vomiting, diarrhea, and fever. Physical examination revealed hypotension, with rebound tenderness in the right lower quadrant. A computed tomography scan of the abdomen and pelvis revealed a normal appendix but showed findings suggestive of inflammation within the retroperitoneum. The initial suspected diagnosis was appendicitis with dehydration, but after not responding to initial fluid resuscitation and obtaining a computed tomography scan with only retroperitoneal inflammation, other etiologies of sepsis were considered.
Ischemic stroke presenting as fluctuating focal weakness in an otherwise healthy young man Melanie J. Lippmann, Adam H. Miller
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.019
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: March 13 2013
x A 32-year-old man presented to our emergency department (ED) with no complaints after paramedics responded to a fall. Medics noted left-sided weakness on scene. Symptoms were initially absent in the ED, although later recurred, and included dramatically waxing and waning focal weakness. An acute middle cerebral artery ischemic stroke was diagnosed, and tissue plasminogen activator was administered. Despite a fluctuating course of symptoms, our patient ultimately achieved a complete recovery.
Is it Acute Coronary Syndrome or Churg-Strauss Syndrome? Patompong Ungprasert, Narat Srivali, Wisit Cheungpasitporn, Charles S. Schaeffer
DOI: http://dx.doi.org/10.1016/j.ajem.2012.05.005
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: July 18 2012
x Churg-Strauss syndrome (CSS) is a rare vasculitic disorder characterized by chronic rhinosinusitis, asthma, and persistent eosinophilia. Although not a usual prominent initial presentation, cardiac involvement is a major cause of morbidity and mortality in patients with CSS. We report a case of a 72-year-old white man who presented with chest pain and was subsequently diagnosed with CSS with biopsy-proven eosinophilic myopericarditis. We have also included a review of the literatures on cardiac involvement in CSS.
Severe alkalosis and hypokalemia with stanozolol misuse Alexander A.N. Maini, Hector Maxwell-Scott, Daniel J.B. Marks
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.027
The American Journal of Emergency Medicine , Vol. 32 , Issue 2 ,
Published online: October 28 2013
x Stanozolol is a popular androgenic anabolic steroid, used by body builders and athletes for physical performance enhancement. There are few data on its potential adverse effects and no documented cases of it causing severe electrolyte imbalance. Here, we report a patient presenting to a tertiary care emergency department with reduced conscious level, profound hypokalemia, and severe metabolic alkalosis, resulting from stanozolol misuse. This is the first such case reported.
Rotational thromboelastometry along with thromboelastography plays a critical role in the management of traumatic bleeding Miroslav Durila, Martin Malošek
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.038
The American Journal of Emergency Medicine , Vol. 32 , Issue 3 ,
Published online: November 27 2013
x Massive posttraumatic bleeding is the leading cause of potentially preventable death among patients with severe trauma. Immediate diagnosis and treatment of traumatic coagulopathy and its differentiation from surgical bleeding after major trauma are critical in the management of such patients. In this case report, we present a 33-year-old woman who had multiple injuries to the head and trunk in motor vehicle collision, resulting in severe bleeding and necessitating emergency surgery. We demonstrate how repeated rotational thromboelastometry and thromboelastography analyses were used to direct the choice of therapy to stabilize her circulatory system for surgery and to differentiate surgical bleed from coagulopathy.
Early diagnosis of pneumoperitoneum in bowel perforation by capnography: a report of 2 cases Sukhen Samanta, Sujay Samanta
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.039
The American Journal of Emergency Medicine , Vol. 32 , Issue 3 ,
Published online: December 4 2013
x Capnography is commonly used for monitoring purposes. Here, we describe a new application of capnography as a bedside diagnostic modality. In doubtful situations of pneumoperitoneum, intravenous cannula is inserted in abdominal cavity, and capnography wave forms are detected with the help of gas sampling port. Capnography can detect pneumoperitoneum of bowel origin quickly and efficiently when radiology and clinical diagnosis are inconclusive. It can also detect gas in supine position. This technique is useful even in doubtful cases of pneumoperitoneum differentiating from pseudopneumoperitoneum.
Evaluation of the initiation of urine drug screens intended for use in transfer patients Priyanka Vakkalanka, William F. Rushton, Lewis S. Hardison, Matthew C. Bishop, Doris M. Haverstick, Christopher P. Holstege
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.011
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: June 13 2014
x The objective of this study was to determine if signs of clinical intoxication were present in patients who had transfer urine drug screens (UDS) performed and to determine the proportion of patients with UDS orders who were actually transferred to another facility.
Fatal heat stroke associated with topiramate therapy Stephen W Borron, Robert Woolard, Susan Watts
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.013
The American Journal of Emergency Medicine , Vol. 31 , Issue 12 ,
Published online: September 3 2013
x A 40-year-old man with diabetes and seizure disorder was found at home unresponsive and “very hot to touch” by his father 40 minutes before emergency medical services arrival. His usual medications included topiramate, divalproex sodium, and rosiglitazone/metformin. Paramedics administered oxygen, intravenous fluids, and naloxone. They did not witness or report seizure activity. Upon emergency department arrival, the patient was unresponsive (Glasgow Coma Scale 3), hypotensive (94/50 mm Hg), and tachypneic (32 breaths per minute), with a heart rate of 60 beats per minute and elevated rectal temperature peaking at 43.2°C.
Delayed subdural hematoma after receiving enoxaparin for prevention of thromboembolic events from high-risk surgery Randall N. Willard, Antonio E. Muñiz, Francis Chuidian
DOI: http://dx.doi.org/10.1016/j.ajem.2011.05.009
The American Journal of Emergency Medicine , Vol. 30 , Issue 6 ,
Published online: August 1 2011
x Enoxaparin (Lovenox) is a low–molecular weight heparin used to prevent deep venous thrombosis in patients undergoing total hip or knee arthroplasty.
Table of Contents
DOI: http://dx.doi.org/10.1016/S0735-6757(13)00094-6
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published in issue: April 2013
Table of Contents
DOI: http://dx.doi.org/10.1016/S0735-6757(14)00724-4
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published in issue: November 2014
Heart rate–corrected QT interval predicts mortality in glyphosate-surfactant herbicide–poisoned patients Yong Hwan Kim, Jun Ho Lee, Chong Kun Hong, Kwang Won Cho, Yong Hwan Park, Yang Weon Kim, Seong Youn Hwang
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.025
The American Journal of Emergency Medicine , Vol. 32 , Issue 3 ,
Published online: December 23 2013
x Glyphosate-surfactant herbicide is promoted by the manufacturer as having no risks to human health. Glyphosate surfactant has recently been used with increasing frequency in suicide attempts, so clinical toxicologists occasionally encounter cases of severe systemic toxicity. The purpose of this study was to identify the early predictive factors of patients at risk for mortality and the usefulness of the corrected QT interval (QTc interval) for predicting mortality from glyphosate-surfactant intoxication.
Characteristics of intentional fall injuries in the ED Jae Hoon Choi, Sun Hyu Kim, Sun Pyo Kim, Koo Young Jung, Ji Yeong Ryu, Sang Cheon Choi, In Cheol Park
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.053
The American Journal of Emergency Medicine , Vol. 32 , Issue 6 ,
Published online: February 6 2014
x This study was conducted to examine the characteristics of intentional fall injuries and the factors associated with their prognosis.
ED use by older adults attempting suicide Mary W. Carter, Megan R. Reymann
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.003
The American Journal of Emergency Medicine , Vol. 32 , Issue 6 ,
Published online: February 12 2014
x The objective of this study was to describe patterns of older adult patient visits to emergency departments (EDs) for self-harm and suicide-related injuries.
The association between ketamine given for prehospital chemical restraint with intubation and hospital admission Aaron M. Burnett, Bjorn K. Peterson, Samuel J. Stellpflug, Kristin M. Engebretsen, Katherine J. Glasrud, Jordan Marks, Ralph J. Frascone
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.016
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: October 20 2014
x Intramuscular ketamine has become increasingly popular for prehospital chemical restraint of severely agitated or violent patients because of its favorable adverse effect profile, rapid onset, and wide therapeutic window. However, there is currently no literature quantifying the need for intubation or hospital admission for these patients once they reach the emergency department.
Association between time to percutaneous coronary intervention and hospital mortality in non–STEMI: a prospective multicenter observational study Tae Gyun Kim, Sang Do Shin, Kyoung Jun Song, Yu Jin Lee, Eui Jung Lee, Young Sun Ro, Ki Ok Ahn
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.046
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: June 22 2015
x This study aimed to investigate the association between time to percutaneous coronary intervention (PCI) and hospital mortality in non–ST-elevation myocardial infarction (NSTEMI).
Left-sided appendicitis in a 47-year-old man with previously undiagnosed intestinal malrotation Joel L. Moll, Jonathan J. Marti
DOI: http://dx.doi.org/10.1016/j.ajem.2012.07.032
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: October 8 2012
x Diagnosing appendicitis can be a challenge to emergency physicians. A classic presentation of appendicitis is not always reliable, and its lacking does not exclude the condition. However, variations in presentation are often not considered in regard to location of pain. The following case describes common disease with an uncommon location and presentation due to previously undiagnosed intestinal malrotation. The emergency department physician should be aware of the potential for atypical locations of pain in appendicitis and not allow it to delay diagnosis and appropriate surgical intervention.
Death of a young man after overuse of energy drink Sema Avcı, Rıdvan Sarıkaya, Fatih Büyükcam
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.031
The American Journal of Emergency Medicine , Vol. 31 , Issue 11 ,
Published online: July 29 2013
x A 28-year-old-man admitted to emergency department with ventricular tachycardia. Patient had drunk 3 cans of 250-mL energy drink 5 hours before the basketball match; he had palpitation and nausea before the match. After 30 minutes of the match, during the break, patient lost his consciousness. On admission, normal cardiac rhythm was achieved by cardioversion, and the patient was hospitalized and died on the third day. Energy drinks generally contain caffeine, taurine, various vitamins, glucose, and herbal extracts such as guarana and ginseng.
Hypokalemic paralysis in a professional bodybuilder Florian B. Mayr, Hans Domanovits, Anton N. Laggner
DOI: http://dx.doi.org/10.1016/j.ajem.2011.06.029
The American Journal of Emergency Medicine , Vol. 30 , Issue 7 ,
Published online: August 26 2011
x Severe hypokalemia is a potentially life-threatening disorder and is associated with variable degrees of skeletal muscle weakness, even to the point of paralysis. On rare occasions, diaphragmatic paralysis from hypokalemia can lead to respiratory arrest. There may also be decreased motility of smooth muscle, manifesting with ileus or urinary retention. Rarely, severe hypokalemia may result in rhabdomyolysis. Other manifestations of severe hypokalemia include alteration of cardiac tissue excitability and conduction.
A randomized controlled trial of adding intravenous pantoprazole to conventional treatment for the immediate relief of dyspeptic pain Khrongwong Musikatavorn, Ploykaew Tansangngam, Suthaporn Lumlertgul, Atthasit Komindr
DOI: http://dx.doi.org/10.1016/j.ajem.2012.02.001
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: March 30 2012
x Acute, severe dyspeptic pain is a common condition in the emergency department. Despite the traditional “GI cocktail” (GI indicates gastrointestinal), an intravenous (IV) proton pump inhibitor (PPI), a novel acid-lowering drug, has recently been used to treat this condition. The aim of this study was to evaluate the immediate effect of IV pantoprazole in addition to the conventional GI cocktail in the relief of severe dyspeptic pain.
Prevalence of facial trauma and associated factors in victims of road traffic accidents Lorena Marques Nóbrega, Gigliana M.S. Cavalcante, Monalyza M.S.M. Lima, Renata C.R. Madruga, Maria Letícia Ramos-Jorge, Sérgio d'Avila
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.054
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: August 26 2014
x The aim of this study was to determine the prevalence of facial trauma among victims of road traffic accidents and investigate factors associated with it.
ECG signs of acute myocardial ischemia in the prehospital setting of a suspected acute coronary syndrome and its association with outcomes Nguyen Dang Thang, Birgitta Wireklint Sundström, Thomas Karlsson, Johan Herlitz, Björn Wilgot Karlson
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.006
The American Journal of Emergency Medicine , Vol. 32 , Issue 6 ,
Published online: March 17 2014
x The aims of this study were (a ) to determine the prehospital prevalence of electrocardiographic (ECG) signs of acute myocardial ischemia in patients with suspected acute coronary syndrome and (b ) to describe the relationships between the various ECG patterns and the diagnosis of acute myocardial infarction (AMI) and outcomes.
Pulmonary thromboembolism due to paliperidone: report of 2 cases Melike Ceyhan Balcı Şengül, Kemal Kaya, Atakan Yilmaz, Cem Şengül, Mustafa Serinken
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.038
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: December 30 2013
x Venous thromboembolism (VTE) is serious medical condition, which might be caused by psychotropic medications. Previously, antipsychotic-induced VTE due to olanzapine, risperidone, clozapine, and amisulpiride was reported. In this report, we present 2 cases of paliperidone-induced VTE.
Carbon monoxide poisoning deaths in the United States, 1999 to 2012 Kanta Sircar, Jacquelyn Clower, Mi kyong Shin, Cathy Bailey, Michael King, Fuyuen Yip
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.002
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: May 13 2015
x Unintentional, non-fire related (UNFR) carbon monoxide (CO) poisoning deaths are preventable. Surveillance of the populations most at-risk for unintentional, non-fire related (UNFR) carbon monoxide (CO) poisoning is crucial for targeting prevention efforts.
Stove-related injuries treated in EDs in the United States, 1990-2010 Anita Sivam, Lynne M. Rochette, Gary A. Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.034
The American Journal of Emergency Medicine , Vol. 31 , Issue 11 ,
Published online: September 16 2013
x Household stoves are a common source of injury in the United States.
ED ultrasound diagnosis of a type B aortic dissection using the suprasternal view Hans Rosenberg, Khaled Al-Rajhi
DOI: http://dx.doi.org/10.1016/j.ajem.2011.11.012
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: January 13 2012
x Aortic dissection (AD) is one of the most challenging diagnoses in emergency medicine. This is due, in part, to its variable presentation, ranging from abrupt tearing chest pain in a hemodynamically unstable patient to back pain in a stable patient, as well as its high mortality rates. (1) With the expanding role of ultrasound (U/S) performed by emergency physicians, it is possible to make the diagnosis of AD at the bedside before any other imaging modality has been accessed. (2) In this case report, we describe the use of emergency department (ED) bedside U/S and specifically highlight the use of the suprasternal view in the diagnosis of AD.
Life-threatening hypophosphatemia and/or phosphate depletion in a patient with acute lymphoblastic leukemia: a rare case report Yasemin Soyoral, Mehmet Aslan, Senar Ebinc, Yaren Dirik, Cengiz Demir
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.011
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: April 17 2014
x Acute severe hypophosphatemia can be life threatening and is associated with mortality and impaired cardiac and respiratory function. Several conditions including decreased absorption or increased urinary phosphate excretion, shifts from the extracellular to intracellular compartments, and phosphate consumption by rapidly proliferating cells are known to induce moderate to severe acute hypophosphatemia. Although hypophosphatemia and/or phosphate depletion in patients with acute or chronic myeloid leukemia have been reported in the literature, hypophosphatemia due to acute lymphoblastic leukemia (ALL) is very rare.
A case of severe rhabdomyolysis with minor trauma: Is sickle cell trait to blame? Paul Krieger, Nathan Zapolsky, Stephen J. Lowery
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.035
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: June 18 2015
x A 37-year-old man with a past medical history of sickle cell trait (SCT) presented to our emergency department (ED) complaining of upper abdominal pain and bilateral shoulder pain, following an assault the prior evening. He reported being pinned on his back with knees on his chest, and repeated punching to his stomach. Physical exam revealed mild tachycardia and diffuse tenderness to palpation of the abdomen, without guarding, rebound, induration, or external signs of trauma. Bilaterally his shoulder exam revealed limited range of motion secondary to pain and tenderness over the trapezius muscles.
Diverse presentation of spontaneous rupture of urinary bladder: review of two cases and literature Indu Bhushan Dubey, Debajyoti Mohanty, Bhupendra Kumar Jain
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.027
The American Journal of Emergency Medicine , Vol. 30 , Issue 5 ,
Published online: May 13 2011
x The objective of the study was to highlight diagnostic dilemmas and suggest pointers toward early diagnosis of spontaneous rupture of urinary bladder based on case study of 2 patients diagnosed as a case of spontaneous rupture of urinary bladder. A 26-year-old man presented with painless progressive abdominal distension of 1-week duration. In absence of acute abdominal symptoms and signs, the diagnosis of chronic liver disease with ascites was entertained. Peritoneal fluid aspirate demonstrated high urea and creatinine levels.
Red cell distribution width as a predictor of mortality in acute pancreatitis Kazım Şenol, Barış Saylam, Fırat Kocaay, Mesut Tez
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.015
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 11 2013
x Acute pancreatitis (AP) is a common cause for hospitalization worldwide. Identification of patients at risk for mortality early in the course of AP is an important step in improving outcome. Red cell distribution width (RDW) is reflective of systemic inflammation. The objective of this study was to investigate the association between RDW and mortality in patients with AP.
Contents
DOI: http://dx.doi.org/10.1016/S0735-6757(13)00583-4
The American Journal of Emergency Medicine , Vol. 31 , Issue 10 ,
Published in issue: October 2013
Methadone overdose causing acute cerebellitis and multi-organ damage Jessica Rando, Sofia Szari, Gogi Kumar, Hemanth Lingadevaru
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.032
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: June 17 2015
x Methadone is a synthetic opioid that, when taken in supratherapeutic amounts or with accidental ingestion in children, has shown to have adverse effects, especially to the cerebellum [1–5]. Our patient was a 14-year-old male adolescent with no significant past medical history, who presented after being found unresponsive at a friend’s house. Laboratory and imaging investigation revealed acute cardiac damage, acute renal injury, acute liver damage, and cerebellitis. Later, through specialized testing, it was discovered that patient had high levels of methadone in his serum.
