Vitamin deficiencies in acutely intoxicated patients in the ED Siu Fai Li, Julie Jacob, Jimmy Feng, Miriam Kulkarni
DOI: http://dx.doi.org/10.1016/j.ajem.2007.10.003
The American Journal of Emergency Medicine , Vol. 26 , Issue 7 ,
Published in issue: September 2008
x Physicians often administer intravenous multivitamins to intoxicated patients in the emergency department (ED); however, this practice is not supported by evidence from any prior study. We determined the prevalences of vitamin deficiencies in patients presenting to our ED with alcohol intoxication.
Does the clinical use of ethanol-based hand sanitizer elevate blood alcohol levels? A prospective study Michael A. Miller, Alex Rosin, Marc E. Levsky, Manish M. Patel, Timothy J.D. Gregory, Chad S. Crystal
DOI: http://dx.doi.org/10.1016/j.ajem.2006.05.006
The American Journal of Emergency Medicine , Vol. 24 , Issue 7 ,
Published in issue: November 2006
x Ethanol-based hand sanitizers (EBHSs) are used in most health care facilities in the United States. Infection control personnel advocate the use of generous quantities of EBHS before and after contact with patients. Although it is assumed that little systemic absorption of ethanol occurs during EBHS use, many alcohols are absorbed to varying degrees via the transdermal route. Ethanol intoxication by employees in the medical workplace is a potentially serious finding, and it is of forensic and medical-legal importance to elucidate the effects of frequent use of EBHS upon serum blood ethanol levels (BELs).
Diagnosis and misdiagnosis of poisoning with the cyanide precursor acetonitrile: Nail polish remover or nail glue remover? Petrie M. Rainey, William L. Roberts
DOI: http://dx.doi.org/10.1016/0735-6757(93)90100-P
The American Journal of Emergency Medicine , Vol. 11 , Issue 2 ,
Published in issue: March 1993
x Accurate diagnosis of acetonitrile ingestion is critical to management. Often this involves differentiating nail polish remover (acetone) from nail glue remover (acetonitrile). Initial symptoms of acetonitrile ingestion are indistinguishable from those of acetone and common alcohols. However, acetonitrile is metabolized to cyanide, producing severe delayed toxicity. Acetonitrile produced increased serum osmolality and osmolal gap, but these findings are non-specific and normal values cannot rule out potentially fatal exposure.
Potential use of warm butyl alcohol vapor as adjunct agent in the emergency treatment of sea water wet near-drowning William H. Waugh
DOI: http://dx.doi.org/10.1016/0735-6757(93)90052-D
The American Journal of Emergency Medicine , Vol. 11 , Issue 1 ,
Published in issue: January 1993
x The short-term course of sea water wet near-drowning was studied in anesthetized rabbits breathing spontaneously. Therapeutic trials were incorporated using warm n-butyl alcohol vapor both in inspired air and in inspired oxygen. The purpose was to determine if butyl alcohol vapor might alleviate the hypoxemia of sea water aspiration, possibly by a defoaming action on the fine foam bubbles of alveolar origin in the lung edema even without tracheal foam being present. The findings from 20 rabbits without overt tracheal foam, that had aspirated 2.05 mL/kg of sea water and were placed 10-minutes postaspirationally into four different inhalational treatment groups, showed remarkable differences.
Serum osmolality in alcohol ingestions: Differences in availability among laboratories of teaching hospital, nonteaching hospital, and commercial facilities Teddi F. Eisen, Peter G. Lacouture, Alan Woolf
DOI: http://dx.doi.org/10.1016/0735-6757(89)90164-2
The American Journal of Emergency Medicine , Vol. 7 , Issue 3 ,
Published in issue: May 1989
x Freezing point depression osmometry is preferred over vapor pressure with ingestions of volatile substances. Sixty-six laboratories nationwide (23 teaching hospital, 22 nonteaching hospital, and 21 commercial facillities) were surveyed to determine the availability and use of these techniques. Overall, 80% conducted serum osmometry (teaching, 100%; nonteaching, 82%; commercial, 57%). Freezing point depression was the most common method used by all laboratories; however, 33% of commercial laboratories and 11% of nonteaching laboratories used vapor pressure exclusively.
Perpetrators of intimate partner violence use significantly more methamphetamine, cocaine, and alcohol than victims: a report by victims Amy A. Ernst, Steven J. Weiss, Shannon Enright-Smith, Elizabeth Hilton, Emily C. Byrd
DOI: http://dx.doi.org/10.1016/j.ajem.2007.09.015
The American Journal of Emergency Medicine , Vol. 26 , Issue 5 ,
Published in issue: June 2008
x Our objectives were (1) to determine demographic characteristics of intimate partner violence (IPV) victims and perpetrators, as reported by victims in a Victim Assistance Unit where police are called to the scene for IPV, and (2) to compare the relative risk of methamphetamine, cocaine, and alcohol use in perpetrators vs victims of IPV, as reported by victims.
Traumatic train injuries Marc J. Shapiro, William B. Luchtefeld, Rodney M. Durham, John E. Mazuski
DOI: http://dx.doi.org/10.1016/0735-6757(94)90210-0
The American Journal of Emergency Medicine , Vol. 12 , Issue 1 ,
Published in issue: January 1994
x Train accidents involving motor vehicles and pedestrians can be devastating. Approximately 1,234 fatalities were recorded in the United States in 1989. The literature from the United States is sparse, prompling a 7-year review of 23 consecutive train accident victims. Twenty (87%) were male, with an average age of 30.6 years. Sixteen (70%) were intoxicated at the time of the accident, and the average Injury Severity Score was 21.4. There was a total of eight traumatic amputations occuring in the 11 (48%) patients involved as pedestrians.
Population-based study of police-reported sexual assault in Baltimore, Maryland Kathleen M. Read, Joseph A. Kufera, M. Christine Jackson, Patricia C. Dischinger
DOI: http://dx.doi.org/10.1016/j.ajem.2005.01.002
The American Journal of Emergency Medicine , Vol. 23 , Issue 3 ,
Published in issue: May 2005
x To document the population-based incidence of sexual assault in Baltimore, Md, victims' alcohol/drug use, and pre-event circumstances.
Lactic acidosis and acute ethanol intoxication Lawrence MacDonald, James A. Kruse, David B. Levy, Shivaprasad Marulendra, Padraic J. Sweeny
DOI: http://dx.doi.org/10.1016/0735-6757(94)90193-7
The American Journal of Emergency Medicine , Vol. 12 , Issue 1 ,
Published in issue: January 1994
x Ethanol intoxication has been widely reported as a cause of lactic acidosis. To determine the frequency and severity of ethanol-induced lactic acidosis, patients who presented to an emergency department with a clinical diagnosis of acute ethanol intoxication and a serum ethanol concentration of at least 100 mg/dL were studied. Arterial blood was sampled for lactate and blood gas determinations. A total of 60 patients (mean age, 41 years) were studied. Twenty-two patients sustained minor trauma. Ethanol concentrations ranged from 100 to 667 mg/dL (mean, 287 mg/dL).
Traumatic injuries caused by hazing practices Michelle A. Finkel
DOI: http://dx.doi.org/10.1053/ajem.2002.32649
The American Journal of Emergency Medicine , Vol. 20 , Issue 3 ,
Published in issue: May 2002
x Hazing is defined as committing acts against an individual or forcing an individual into committing an act that creates a risk for harm in order for the individual to be initiated into or affiliated with an organization. Hazing is an enduring activity with roots that date back to the ancient and medieval eras. It has become increasingly prevalent in fraternities and sororities, high school and college athletic organizations, the military, professional sports teams, and street gangs. Scant information is available in the medical literature regarding hazing.
Sleep quantity and quality as a predictor of injuries in a rural population Seong-Woo Choi, Corinne Peek-Asa, Nancy L. Sprince, Risto H. Rautiainen, Gregory A. Flamme, Paul S. Whitten, Craig Zwerling
DOI: http://dx.doi.org/10.1016/j.ajem.2005.09.002
The American Journal of Emergency Medicine , Vol. 24 , Issue 2 ,
Published in issue: March 2006
x This study aimed to assess the association of sleep disturbance and injuries in a rural population of Iowa. Study participants were 1345 adults who were enrolled in the KCRHS. Sleep problems were assessed based on self-reports at the beginning of the study. Injury information was collected by telephone interviews an average of every 6 months from August 1999 to June 2004. Sleeping for less than 7.5 hours increased the risk for injuries by 61% (rate ratio, 1.61; 95% confidence interval, 1.21-2.15) compared with sleeping for 7.5 to 8.5 hours (reference).
Unrecognized medical emergencies admitted to psychiatric units Roy R. Reeves, Eric J. Pendarvis, Ray Kimble
DOI: http://dx.doi.org/10.1053/ajem.2000.7318
The American Journal of Emergency Medicine , Vol. 18 , Issue 4 ,
Published in issue: July 2000
x Alteration of mental status secondary to medical illness may occasionally be incorrectly attributed to a psychiatric problem. The cases of 64 patients with unrecognized medical emergencies inappropriately admitted to psychiatric units from emergency departments were reviewed to determine the cause of the misdiagnoses. Medical diagnoses most often missed included severe intoxication with alcohol or other illicit substance (34.4%), drug or alcohol withdrawal or delirium tremens (12.5%), and prescription drug overdose (12.5%).
Health promotion practices of emergency physicians Janet M Williams, Ann C Chinnis, Daniel Gutman
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90041-X
The American Journal of Emergency Medicine , Vol. 18 , Issue 1 ,
Published in issue: January 2000
x In this article we describe health promotion practices of emergency physicians (EPs). A survey was mailed to members of the West Virginia American College of Emergency Physicians. Main outcomes included the EP's beliefs regarding health promotion, perceived roles in health promotion, and perceived effectiveness in modifying the behavior of patients. Over 90% of respondents routinely asked about cigarette smoking and half about alcohol use. A minority routinely asked about illicit drug use, diet, exercise, domestic violence, or stress.
Severe ethanol intoxication in an adolescent David L Morgan, Mark H Durso, Brian K Rich, Thomas L Kurt
DOI: http://dx.doi.org/10.1016/0735-6757(95)90127-2
The American Journal of Emergency Medicine , Vol. 13 , Issue 4 ,
Published in issue: July 1995
x A 15-year-old boy presented to the emergency department with status epilepticus and a blood ethanol concentration of 757 mg/dL. Mechanical ventilation and substantial amounts of benzodiazepines were required. His hospital course was complicated by aspiration pneumonia, but he had no episodes of hypoglycemia. He received 2.8 hours of hemodialysis, which increased the rate of ethanol elimination, but there is no evidence that hemodialysis improved his clinical outcome. To our knowledge, this is the highest blood ethanol level reported in a child or adolescent who survived.
Diagnosing psychiatric emergencies in the elderly Michael J. Tueth
DOI: http://dx.doi.org/10.1016/0735-6757(94)90162-7
The American Journal of Emergency Medicine , Vol. 12 , Issue 3 ,
Published in issue: May 1994
x Psychiatric emergencies in the elderly form a small percent of all elderly patients treated in emergency departments. However, accurately diagnosing and understanding behavioral emergencies in the elderly is difficult. Emergency behavioral syndromes in the elderly include confusion, agitation, psychosis, and behavioral regression. Causes of these syndromes in the elderly include delirium, dementia, medication side effects, physical illnesses, depression, and alcohol intoxication/dependency. Emergency physicians should consider each of these diagnostic possibilities when evaluating elderly behavioral emergencies to properly diagnose and treat elderly patients.
The John Doe syndrome: Diagnosis and outcome of patients unidentified at the time of emergency department admission Pamela J. Claps, William A. Berk
DOI: http://dx.doi.org/10.1016/0735-6757(92)90212-G
The American Journal of Emergency Medicine , Vol. 10 , Issue 3 ,
Published in issue: May 1992
x Patients unidentified at the time of admission to urban emergency departments are a group about whom little is known. To determine the medical diagnoses and outcomes of these “John” and “Mary Does”, we reviewed emergency department charts for these patients admitted from January 1 to December 31, 1988. During this period there were 344 initially unidentifiable patients, for 0.44% of all visits. Age was 36.9 ± 15.6 years (mean ± SD); 71% were male. All patients had one or more of the following diagnoses, with mortality highest for cardiopulmonary arrest (n = 42, mortality = 100%), followed by major trauma (163, 68%), drug overdose (27, 41%), miscellaneous medical conditions (11, 18%), neuropsychiatric disorders (59, 12%), acute alcohol intoxication (62, 0%), and seizures (13, 0%).
The febrile alcoholic in the emergency department Keith D. Wrenn, Steve Larson
DOI: http://dx.doi.org/10.1016/0735-6757(91)90018-F
The American Journal of Emergency Medicine , Vol. 9 , Issue 1 ,
Published in issue: January 1991
x The authors retrospectively reviewed the charts of 31 alcoholic patients admitted with fever without a defined source. In our population 58% of patients were subsequently found to have an infectious cause for their fever. Pneumonia was the most common infection, but occult urinary tract infections were seen surprisingly offen. Noninfectious but serious disorders, such as delirium tremens, prolonged postictal state, and subarachnoid hemorrhage, were also common. Infectious and noninfectious causes commonly coexisted.
The association of a decreased level of awareness and blood alcohol concentration with both agitation and sedation in intoxicated patients in the ED James R. Miner, Andrea Gaetz, Michelle H. Biros
DOI: http://dx.doi.org/10.1016/j.ajem.2006.12.002
The American Journal of Emergency Medicine , Vol. 25 , Issue 7 ,
Published in issue: September 2007
x This study was conducted to compare the level of awareness as determined by serial bispectral index (BIS) electroencephalogram scores to a standardized Altered Mental Status (AMS) scale used to define a patient's clinical level of agitation or sedation, and the patient's concurrent breath/blood alcohol concentration (BAC).
Traumatic asphyxia in New Mexico: A five-year experience David P. Skalar, Bret Baack, Patricia McFeeley, Turner Osler, Ellen Marder, Gerald Demarest
DOI: http://dx.doi.org/10.1016/0735-6757(88)90003-4
The American Journal of Emergency Medicine , Vol. 6 , Issue 3 ,
Published in issue: May 1988
x Compression of the chest causing facial petechiae, violaceous facial hue, subconjunctival hemorrhages, and frequent mental status abnormalities has been termed traumatic asphyxia. We identified 35 such cases occurring in the State of New Mexico from 1980 to 1985 from records of the Office of the Medical Investigator (n = 30) and from cases presenting to the University of New Mexico Trauma Center (n = 5). Among those found at highest risk for traumatic asphyxia were people ejected from motor vehicles, men working under cars that were inadequately supported and fell onto the victims, children under the age of 5 years who were crushed under household furniture, and people involved in construction activities.
Adult first generalized seizure: Etiology, biological tests, EEG, CT scan, in an ED B Tardy, P Lafond, P Convers, Y Page, F Zeni, A Viallon, B Laurent, F.G Barral, and others
DOI: http://dx.doi.org/10.1016/0735-6757(95)90229-5
The American Journal of Emergency Medicine , Vol. 13 , Issue 1 ,
Published in issue: January 1995
x The purpose of this study was to evaluate adult first seizures in an emergency department by analyzing etiologic and epidemiological data and studying the usefulness of biological screening, electroencephalogram (EEG), and cerebral computed tomography (CT) scan. This was a retrospective study of a 3-year period during which 247 patients were admitted to an emergency department for a first generalized seizure. A CT scan had been performed in 247 patients and an EEG in 209. Etiologies were found to be (1) unknown, (2) alcohol abuse, (3) stroke, and (4) tumor.
