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.
