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.
