Interaction of the diabetes mellitus and cardiac diseases on survival outcomes in out-of-hospital cardiac arrest Dayea Beatrice Jang, Sang Do Shin, Young Sun Ro, Kyoung Jun Song, Ki Ok Ahn, Seung Sik Hwang, Young Taek Kim, Sung Ok Hong, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.076
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: December 29 2015
x Diabetes mellitus (DM) and cardiac disease (CD) both likely effect out-of-hospital cardiac arrest (OHCA) survival, but the effect of their relationship on survival outcomes is unclear. This study aims to investigate whether the association of DM and OHCA outcomes differ in patients with and without CD.
Possible association between Takotsubo cardiomyopathy, sepsis, and diabetes mellitus: a still open question Fabio Fabbian, Alfredo De Giorgi, Ruana Tiseo, Benedetta Boari, Raffaella Salmi, Fulvia Signani, Beatrice Zucchi, Roberto Manfredini
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.042
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 23 2015
x We appreciated the comments by Dr Madias [1], raising some interesting key points. On one hand, we quite agree that emotional and physical stressors are not strictly separated entities and, in most cases, may overlap as triggering factors of Takotsubo cardiomyopathy (TTC). However, this definition is widely used [2,3]. The association between diabetes mellitus (DM) and TTC has been matter of several investigations. Pelliccia et al [3], evaluating a series of 19 studies (1109 patients), after a contact with corresponding authors, asked to provide additional quantitative details, concluded that patients with TTC have a relevant prevalence of cardiovascular risk factors and associated comorbidities.
Trends in diabetes-related visits to US EDs from 1997 to 2007 Michael D. Menchine, Warren Wiechmann, Anne L. Peters, Sanjay Arora
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.028
The American Journal of Emergency Medicine , Vol. 30 , Issue 5 ,
Published online: May 13 2011
x The aims of the study were to describe temporal trends in the number, proportion, and per capita use of diabetes-related emergency department (ED) visits and to examine any racial/ethnic disparity in ED use for diabetes-related reasons.
Comparison of coronary calcification of the culprit lesion between diabetic and non-diabetic patients with acute coronary syndrome Dimitrios Barmperis, Konstantina Bouki, Thomas Apostolou, Athanasios Chalkias, Theodoros Xanthos
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.057
The American Journal of Emergency Medicine , Vol. 32 , Issue 5 ,
Published online: February 10 2014
x The risk of myocardial infarction or death in diabetic patients is similar to that of patients with a history of heart attack with coronary artery calcification being an independent predictor of mortality [1,2]. Optical coherence tomography (OCT) is one of the most precise tools in the description of the morphology of the culprit lesion, allowing for the in vivo characterization of the atherosclerotic plaques [3,4]. The purpose of this study was to compare the calcification of the culprit lesion between diabetic and non-diabetic patients who present with acute coronary syndrome (ACS).
Using a single cut-off for stress hyperglycemia in myocardial infarction decreases its prognostic value particularly in diabetes Goran P. Koracevic
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.027
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: November 11 2013
x High admission blood glycemia (ABG), that is, stress hyperglycemia (SH), is an important prognostic indicator in a variety of diseases, including acute myocardial infarction (AMI) [1]. Although this has been known for decades [2], there is, to date, no universal consensus about ABG concentration(s) required for SH in AMI patients [1,3-5]. Indeed, it is intrinsically difficult to define SH in patients with diabetes mellitus (DM) because basal glycemia is not known and could vary significantly in this patient population [6].
Clopidogrel resistance in diabetic patient with acute myocardial infarction due to stent thrombosis Matej Samoš, Radoslava Šimonová, Frantisek Kovář, Lukas Duraj, Jana Fedorová, Peter Galajda, Jan Staško, Marian Fedor, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.006
The American Journal of Emergency Medicine , Vol. 32 , Issue 5 ,
Published online: January 21 2014
x Stent thrombosis is a morbid complication after percutaneous coronary intervention. Dual antiplatelet therapy significantly reduces stent thrombosis risk and forms currently the basis in acute ST elevation myocardial infarction pharmacologic treatment. The introduction of clopidogrel has made a major advance in the acute coronary syndrome treatment. However, there is growing evidence about failure in antiplatelet response after clopidogrel, which may lead to subsequent risk of future thrombotic events.
Prevalence of diabetes mellitus in patients with sepsis-triggered Takotsubo syndrome John E. Madias
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.041
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 23 2015
x The article by Fabbian et al [1] published on line ahead of print on June 18, 2015 in the journal about the concurrence of infections/sepsis and Takotsubo syndrome (TTS) is of interest from the pathogenetic point of view, that a physical stress like sepsis can trigger TTS, and that male patients afflicted with this combinations have worse in-hospital mortality than do their female counterpart. It is conceivable that we are in error when we think that we can separate physical and emotional stresses, and it is possible to consider an emotional overlay over the physical stress of sepsis, as a trigger of TTS.
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
Positive predictive value of an elevated cardiac troponin for type I myocardial infarction in ED patients based on the chief complaint Ronald Maag, Susie Sun, Michael Hannon, Rhian Davies, Peter Alagona, Andrew Foy
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.003
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: February 10 2015
x Cardiac troponin testing is used to aid the diagnosis of myocardial infarction (MI) in the emergency department (ED) for patients who present with a range of symptoms. From a clinical perspective, the distinction between MI due to acute coronary artery thrombosis (type I MI) and other forms of direct and secondary myocardial injury (type II MI) is very important. However, the positive predictive value (PPV) of an elevated troponin for diagnosing type I MI, based on clinical history, has not been described.
Coronary atherosclerosis and adverse outcomes in patients with recent-onset atrial fibrillation and troponin rise Alberto Conti, Elena Angeli, Margherita Scorpiniti, Andrea Alesi, Federica Trausi, Delia Lazzeretti, Luigi Padeletti, Gian Franco Gensini
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.013
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 16 2015
x The relationship between troponin and atrial fibrillation (AF) without acute coronary syndrome is still unclear. We sought to investigate the presence of coronary atherosclerosis and adverse outcomes in patients with AF.
The impact of body mass index on patient survival after therapeutic hypothermia after resuscitation Khadijah Breathett, Nishaki Mehta, Vedat Yildiz, Erik Abel, Ruchika Husa
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.077
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: December 29 2015
x Therapeutic hypothermia improves survival in patients after cardiac arrest, yet the impact of body mass index (BMI) on survival is lesser known. We hypothesized that nonobese patients would have greater survival post–therapeutic hypothermia than obese patients.
Validation of the use of B-type natriuretic peptide point-of-care test platform in preliminary recognition of cardioembolic stroke patients in the ED Zhixin Wu, Mingming Zhao, Mingfeng He, Hongke Zeng, Feng Tan, Kuangyi Li, Shenglong Chen, Qianpeng Han, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.013
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: January 16 2015
x The aim of the study is to validate of the use of plasma B-type natriuretic peptide (BNP) point-of-care test platform in preliminary recognition of cardioembolic stroke patients in the emergency department (ED).
Various admission glucose cut-offs for prognostication and for therapeutic threshold in acute myocardial infarction Goran P. Koracevic
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.046
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: October 2 2014
x Glycemia is a crucial laboratory parameter; and from a “therapeutic” point of view, it is essential to avoid/correct both hypoglycemia and hyperglycemia, particularly if they are pronounced. This also holds true for patients with acute myocardial infarction (AMI). Indeed, in addition to general principles, one of the reasons why correction of high/low glycemia is important in AMI comes from precise investigations of prognostic impact of dysglycemia in this diasease.
Catamenial diabetic ketoacidosis—a diagnostic dilemma in ED Nayer Jamshed, Bharatraj Banavaliker, Praveen Aggarwal
DOI: http://dx.doi.org/10.1016/j.ajem.2012.08.038
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: October 29 2012
x Diabetic ketoacidosis (DKA) is a frequent medical emergency. The most common precipitating events are absolute or relative deficiency of insulin, infection, and noncompliance with medication. We describe a 32-year-old lady with type 1 diabetes mellitus in whom DKA was precipitated 1 to 2 days before her menstrual periods resulting in repeated admissions to hospital. Menstruation may precipitate DKA. Emergency physicians must keep this in mind if no other precipitating event can be found in a patient with DKA.
Diabetic ketoacidosis as the initial presentation of hyperthyroidism Chao-Yen Huang, Wei-Lung Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.065
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 29 2015
x Abdominal pain is a common chief complaint that encompasses a broad differential diagnosis at emergency department (ED), ranging from general discomfort to life-threatening disease. Abdominal pain induced by a metabolic disorder should also be considered. Diabetic ketoacidosis (DKA) is a common complication of new-onset type 1 diabetes mellitus in young patients. Although DKA that presented to the ED with complaint of abdominal pain is not uncommon, it is precipitated by hyperthyroidism, which is rare and more complicated.
Serum procalcitonin level for the prediction of severity in women with acute pyelonephritis in the ED: value of procalcitonin in acute pyelonephritis Jeong Ho Park, Jung Hee Wee, Seung Pill Choi, Kyu Nam Park
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.012
The American Journal of Emergency Medicine , Vol. 31 , Issue 7 ,
Published online: May 22 2013
x Predicting medical outcomes for acute pyelonephritis (APN) in women is difficult. Delay in diagnosis and treatment often results in rapid progression to circulatory collapse, multiple-organ failure, and death. The aim of this study was to investigate the value of procalcitonin (PCT) level in women with APN at ED.
The pregnant heart: cardiac emergencies during pregnancy Alyson J. McGregor, Rebecca Barron, Karen Rosene-Montella
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.046
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: March 6 2015
x Cardiovascular emergencies in pregnant patients are often considered a rare event; however, heart disease as a cause of maternal mortality is steadily increasing.
Transient ischemic attack (TIA): the initial diagnostic and therapeutic dilemma Peter D. Panagos
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.004
The American Journal of Emergency Medicine , Vol. 30 , Issue 5 ,
Published online: May 13 2011
x Many patients with transient ischemic attacks (TIA) are at high risk of stroke within the first few days of onset of symptoms. Emergency physicians and primary care physicians need to assess these patients quickly and initiate appropriate secondary stroke prevention strategies. Recent refinements in diagnostic imaging have produced valuable insight into risk stratification of patients with TIA. Clinical data regarding urgent initiation of antiplatelet therapy specifically in this patient population with non-cardioembolic TIA are limited but promising.
Thoracic spine fracture in the course of severe nocturnal hypoglycemia in young patients with type 1 diabetes mellitus—the role of low bone mineral density Liliana Majkowska, Ewa Waliłko, Piotr Molęda, Andrzej Bohatyrewicz
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.055
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: January 6 2014
x Thus far, only a few spine fracture cases related to severe nocturnal hypoglycemia in type 1 diabetes patients have been reported. Due to the relatively young age of these subjects, osteoporosis was not taken into consideration and bone mineral density was not assessed.
A risk stratification model of acute pyelonephritis to indicate hospital admission from the ED Changwoo Kang, Kyuseok Kim, Soo Hoon Lee, Chanjong Park, Joonghee Kim, Jae Hyuk Lee, You Hwan Jo, Joong Eui Rhee, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.048
The American Journal of Emergency Medicine , Vol. 31 , Issue 7 ,
Published online: April 29 2013
x There are no guidelines regarding the hospitalization of female patients with acute pyelonephritis (APN); therefore, we performed a retrospective analysis to construct a clinical prediction model for hospital admission.
Cardiac risk factors and risk scores vs cardiac computed tomography angiography: a prospective cohort study for triage of ED patients with acute chest pain Ethan J. Halpern, Jacob P. Deutsch, Maria M. Hannaway, Adrian T. Estepa, Anand S. Kenia, Kenneth J. Neuburger, David C. Levin
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.001
The American Journal of Emergency Medicine , Vol. 31 , Issue 10 ,
Published online: September 12 2013
x The objective of the study is to evaluate cardiac risk factors and risk scores for prediction of coronary artery disease (CAD) and adverse outcomes in an emergency department (ED) population judged to be at low to intermediate risk for acute coronary syndrome.
Identifying patients with cellulitis who are likely to require inpatient admission after a stay in an ED observation unit Kathryn A. Volz, Louisa Canham, Emily Kaplan, Leon D. Sanchez, Nathan I. Shapiro, Shamai A. Grossman
DOI: http://dx.doi.org/10.1016/j.ajem.2012.09.005
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: November 19 2012
x Emergency department observation units (EDOU) are often used for patients with cellulitis to provide intravenous antibiotics followed by a transition to an oral regimen for discharge. Because institutional regulations typically limit EDOU stays to 24 hours, patients lacking a clinical response within this period will often be subsequently admitted to the hospital for further treatment.
Is there a potential role for echocardiography in adult patients with CAP? Birdal Yıldırım, Funda Sungur Biteker, Özcan Başaran, Ömer Doğan Alataş, Ethem Acar, Hamdi Sözen, Volkan Doğan, Halil Beydilli, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.036
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: June 18 2015
x The role of echocardiography in adult patients with community-acquired pneumonia (CAP) has not been tested in a clinical trial. The aim of the study was to assess the cardiac changes secondary to CAP by echocardiography and to find out the correlation between echocardiographic findings and the severity of CAP.
Resource utilization and health care charges associated with the most frequent ED users Cory Ondler, G.G. Hegde, Jestin N. Carlson
DOI: http://dx.doi.org/10.1016/j.ajem.2014.07.013
The American Journal of Emergency Medicine , Vol. 32 , Issue 10 ,
Published online: July 29 2014
x Emergency department (ED) visits have continued to rise, and frequent ED users account for up to 8% of all ED visits. Reducing visits by frequent ED users may be one way to help reduce health care costs. We hypothesize that frequent users have unique ED utilization patterns resulting in differences in health care charges.
Association of blood glucose at admission with outcomes in patients treated with therapeutic hypothermia after cardiac arrest Soo Hyun Kim, Seung Pill Choi, Kyu Nam Park, Seung Joon Lee, Kyung Won Lee, Tae O. Jeong, Chun Song Youn, for the Korean Hypothermia Network Investigators
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.004
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: May 12 2014
x It is well known that hyperglycemia is associated with poor outcomes in critically ill patients. We investigated the association between blood glucose level at admission and the outcomes of patients treated with therapeutic hypothermia (TH) after cardiac arrest.
Are there symptom differences in patients with coronary artery disease presenting to the ED ultimately diagnosed with or without ACS? Michele M. Pelter, Barbara Riegel, Sharon McKinley, Debra K. Moser, Lynn V. Doering, Hendrika Meischke, Patricia Davidson, Heather Baker, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.002
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: May 25 2012
x Symptoms are compared among patients with coronary artery disease (CAD) admitted to the emergency department with or without acute coronary syndrome (ACS). Sex and age are also assessed.
Diabetic ketoacidosis in toddler with a diaper rash Mark D. Williams, Don Sallee, Matthew Robinson
DOI: http://dx.doi.org/10.1016/j.ajem.2008.01.018
The American Journal of Emergency Medicine , Vol. 26 , Issue 7 ,
Published in issue: September 2008
x The term diabetes does not denote a single disease entity but rather a clinical syndrome. Fundamental to all types of diabetes is impairment of insulin secretion by the pancreatic beta cells. Diabetes is divided into (1) diabetes associated with certain syndromes or conditions, (2) gestational diabetes, (3) non–insulin-dependent diabetes or type 2 diabetes, and (4) insulin-dependent diabetes (IDDM) or type 1 diabetes. The impairment of insulin secretion seen in diabetes is due to progressive loss of pancreatic beta-cell function secondary to an autoimmune-mediated process.
Gas gangrene, diabetes, and cholecystitis Gabriel Mayer, Rodney Kang
DOI: http://dx.doi.org/10.1016/0735-6757(85)90011-7
The American Journal of Emergency Medicine , Vol. 3 , Issue 1 ,
Published in issue: January 1985
Diabetic ketoacidosis with alkalemia David Jerrard, Jeahan Hanna
DOI: http://dx.doi.org/10.1053/ajem.2001.27167
The American Journal of Emergency Medicine , Vol. 19 , Issue 6 ,
Published in issue: October 2001
x —A common complication of diabetes mellitus is ketoacidosis which results from the accumulation of acetoacetic and B-Hydroxybutyric acids. A less often seen and recognized metabolic alteration is diabetic ketoacidosis with alkalemia This disorder is a mixed acid-base disorder in which diabetic ketoacidosis exists alongside a state of metabolic alkalosis. Blood pH will be determined by which disorder predominates. Diuretic use, vomiting, alkali ingestion, and hypercortisolism have all been implicated as causes of this disorder.
Role of autonomic disturbances in the development of accidental hypothermia in diabetic patients : Aibiki M, Ogura S, Shirakawa Y, Uefufi T, Honda K, Yokono A, Yokono S, Oguli K. Jpn J Acute Med 1987;11:1935–1939
DOI: http://dx.doi.org/10.1016/0735-6757(88)90168-4
The American Journal of Emergency Medicine , Vol. 6 , Issue 4 ,
Published in issue: July 1988
Diabetic mastopathy Zara Cooper, Mary Pat McKay
DOI: http://dx.doi.org/10.1016/j.ajem.2004.07.007
The American Journal of Emergency Medicine , Vol. 22 , Issue 6 ,
Published in issue: October 2004
Bedside ultrasound for the detection of diabetic myonecrosis Arun Nagdev, Michael Murphy, Craig Sisson
DOI: http://dx.doi.org/10.1016/j.ajem.2008.02.017
The American Journal of Emergency Medicine , Vol. 26 , Issue 8 ,
Published in issue: October 2008
x Diabetic myonecrosis is an uncommon complication of diabetes mellitus. There are fewer than 50 cases reported in the general medical literature. Patients classically complain of the abrupt onset of diffuse anterior thigh pain with no signs of overlying infection or signs of systemic toxicity. Because of the difficulty in diagnosis, most patients endure multiple medical visits until appropriate imaging modalities are obtained. Currently, magnetic resonance imaging (MRI) or tissue biopsy is considered the gold standard for diagnosis.
Presentation and symptom predictors of coronary heart disease in patients with and without diabetes Marjorie Funk, Janice B. Naum, Kerry A. Milner, Deborah Chyun
DOI: http://dx.doi.org/10.1053/ajem.2001.27135
The American Journal of Emergency Medicine , Vol. 19 , Issue 6 ,
Published in issue: October 2001
x The aims of this prospective, observational study were to compare: (1) symptom presentation of coronary heart disease (CHD) between patients with and without diabetes and (2) symptom predictors of CHD in patients with and without diabetes. We directly observed 528 patients with symptoms suggestive of CHD as they presented to the ED of a 900-bed cardiac referral center in the northeastern United States. There were no significant differences in symptom presentation of CHD between patients with and without diabetes, although patients with diabetes were slightly more likely to present with shortness of breath (P =.056).
Potassium status should be evaluated also when diabetic ketoacidosis is complicated by heart failure Oscar M.P. Jolobe
DOI: http://dx.doi.org/10.1016/j.ajem.2011.05.004
The American Journal of Emergency Medicine , Vol. 29 , Issue 8 ,
Published online: June 13 2011
x The prevalence of hypokalemia quoted in the recent study [1] may not necessarily be a reflection of the state of affairs when diabetic ketoacidosis (DKA) coexists with hypervolemia attributable to heart failure. Documentation of potassium status in all body compartments is relevant to the management of these patients because unlike their hypovolemic counterparts who can tolerate the large volumes of intravenous fluids required to deliver appropriate doses of potassium replacement therapy [2], patients with DKA with coexisting heart failure and, hence, hypervolaemia incur the risk of worsening of heart failure with such treatment.
Cerebral edema in an adult patient with diabetic ketoacidosis Katherine M. Hiller, Stephen J. Wolf
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.009
The American Journal of Emergency Medicine , Vol. 23 , Issue 3 ,
Published in issue: May 2005
x A 31-year-old man without prior medical history presented to the emergency department with 2 days of nausea, vomiting, dyspnea, and abdominal pain. The patient was in moderate respiratory distress with Kussmaul's breathing. He was tachycardic but was not febrile, hypotensive, or hypoxemic. Physical examination was unremarkable except for evidence of dehydration and the abnormal breathing pattern. He was alert and oriented with a normal neurological examination.
Simultaneous presentation of thyroid storm and diabetic ketoacidosis Hsin-Ling Lee, Eugene Yu, How-Ran Guo
DOI: http://dx.doi.org/10.1053/ajem.2001.28043
The American Journal of Emergency Medicine , Vol. 19 , Issue 7 ,
Published in issue: November 2001
x —Thyroid storm and diabetic ketoacidosis (DKA) are both endocrine emergencies. The combination of diabetes mellitus (DM) with thyrotoxicosis is well known, and one condition usually precedes the other1,2 but the coexistence of DKA and thyrotoxic crisis is rare.3,4 We report a case of thyroid storm in a woman, previously diagnosed with hyperthyroidism, who also presented with DKA.
Anaphylaxis-induced diabetic ketoacidosis Gregory Greenbaum, John D. Riley
DOI: http://dx.doi.org/10.1016/0735-6757(94)90152-X
The American Journal of Emergency Medicine , Vol. 12 , Issue 3 ,
Published in issue: May 1994
x Allergic reactions and complications of diabetes mellitus are commonly seen in emergency departments and primary care settings. Although stress is a known contributor to the development of diabetic ketoacidosis (DKA), anaphylaxis-induced DKA has not previously been described. The case of a type 1 diabetic woman who presented with anaphylaxis secondary to seafood ingestion and subsequently developed DKA is reported. It was concluded that stress and counter-regulatory hormones released during anaphylaxis, as well as the treatment with epinephrine and glucocorticolds, precipitated DKA in this patient despite ongoing insulin and fluid therapy.
Effects of diabetes on the ED presentation of acute intermittent porphyria Huan-Wen Chen, Deng-Huang Su, Tzuu-Shuh Jou, Jia-Horng Kao
DOI: http://dx.doi.org/10.1016/j.ajem.2004.12.003
The American Journal of Emergency Medicine , Vol. 23 , Issue 4 ,
Published in issue: July 2005
x Whether diabetes could prevent attacks of acute intermittent porphyria (AIP) remains incompletely understood. Lithner described 16 AIP patients who had complete remission of AIP attacks after onset of diabetes [1]; however, a correlation between blood glucose level and frequency/severity of AIP attacks was not mentioned. Can AIP be excluded in a diabetic patient who visits ED for severe abdominal pain? AIP is a very rare hereditary metabolic disorder in Taiwan; herein, we reported a patient who had diabetes antedated AIP.
Venoarterial extracorporeal membrane oxygenation resuscitation in diabetic ketoacidosis with hypothermic cardiocirculatory instability Lin Ming-hsien, Ko Wen-Je, Shih Shyang-rong, Wang Chih-hsien
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.003
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: December 27 2010
x Diabetic ketoacidosis with hypothermia is underrecognized, and the mortality rate is high at between 30% and 60%. The cause of hypothermia in diabetic ketoacidosis patients is speculative and has multiple factors. Insulin deficit is the most important factor that leads to a lack of substrate for cellular heat production [4]. Water depletion and low environment temperature may also be contributing factors, especially in patients with a severe diabetic coma. Hypothermia may also aggravate uncontrolled diabetes mellitus and complicate treatment because insulin secretion is impaired and exogenous administered insulin is less effective at low temperatures.
Takotsubo cardiomyopathy associated with sepsis in type 2 diabetes mellitusSawako Ohigashi-Suzuki, Yasushi Saito, Ichiro Tatsuno
DOI: http://dx.doi.org/10.1016/j.ajem.2006.11.003
The American Journal of Emergency Medicine , Vol. 25 , Issue 2 ,
Published in issue: February 2007
x Takotsubo cardiomyopathy (TC)—ampullar cardiomyopathy—is a novel cardiac syndrome that has acute onset of chest pain, electrocardiographic change, and minimal elevation of cardiac enzymes resembling acute myocardial infarction without any evidence of myocardial ischemia or injury. Its characteristic image in angiography is a transient left ventricular (LV) apical ballooning having the appearance of takotsubo , Japanese for octopus trap [1-3]. We report here a rare case of a 69-year-old woman with type 2 diabetes mellitus (DM) who exhibited myocardial depression with the typical wall motion abnormality seen in TC during a period of sepsis.
Focal neurological deficits with delayed resolution in a seven-year-old boy with insulin-dependent diabetes Paul J. Allegretti, Meta Carroll
DOI: http://dx.doi.org/10.1053/ajem.2002.35507
The American Journal of Emergency Medicine , Vol. 20 , Issue 6 ,
Published in issue: October 2002
x —A 7 year old boy with diabetes mellitus presented to the emergency department (ED) after he arose from bed in the morning and fell. His parents tried to help him, but he could not stand on his own. His right side appeared weak. The boy's mother said he was feeling normal the night before. His finger stick glucose had been running “high” the past 2 days for which extra insulin had been administered. His blood sugar was down to 179 mg/dL before going to bed. The fire department obtained a rapid glucose of 77mg/dL.
Managing combined critical hypothermia, diabetic ketoacidosis and cocaine intoxication noninvasively Miriam Freundt, Adel Obaji, John K. Hix
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.042
The American Journal of Emergency Medicine , Vol. 32 , Issue 4 ,
Published online: November 4 2013
x Severe hypothermia with a core temperature below 28°C is critical especially in patients with diabetic ketoacidosis (DKA) and carries a high risk of mortality. Our case of a 52-year-old woman presenting with DKA, pH of 6.9, potassium of 7.6 mEq/L, and body temperature of 26°C demonstrates that conservative management can be safe and successful. We used an established cardiac arrest rewarming phase protocol modified to active warming with the Meditherm 3 Machine and the facility-used rigorous DKA protocol to successfully and safely achieve rewarming without hemodialysis or extracorporeal maneuvers.
Spurious laboratory values in diabetic ketoacidosis and hyperlipidemia Elizabeth S. Kaminska, Ghassem Pourmotabbed
DOI: http://dx.doi.org/10.1016/0735-6757(93)90066-K
The American Journal of Emergency Medicine , Vol. 11 , Issue 1 ,
Published in issue: January 1993
Serum glucose changes after administration of 50% dextrose solution: Pre- and in-hospital calculations Paul M. Adler
DOI: http://dx.doi.org/10.1016/S0735-6757(86)80004-3
The American Journal of Emergency Medicine , Vol. 4 , Issue 6 ,
Published in issue: November 1986
x A prospective clinical trial was conducted to estimate the rise in serum glucose level after an intravenous bolus of 50 ml of 50% dextrose solution (D-50) in the emergency department setting. Fifty one subjects with altered levels of consciousness were studied. Of these, 23 patients were known diabetics, and 28 were not diabetic. The change in glucose level for the total study group ranged from a low of 37 mg/dl to a high of 370 mg/dl, with a mean of 166 ± 77 mg/dl. The mean for the diabetic and non-diabetic groups were 177 ± 80 mg/dl and 154 ± 75 mg/dl.
Hyperglycemia in ED patients with no history of diabetes Louise A. Prince, Elliot Rodriquez, James Campagna, Lawrence Brown, Daisy Fischer, William D. Grant
DOI: http://dx.doi.org/10.1016/j.ajem.2007.08.009
The American Journal of Emergency Medicine , Vol. 26 , Issue 5 ,
Published in issue: June 2008
x The purpose of this study was to determine the prevalence of incidentally discovered hyperglycemia in patients with non–glucose-related complaints and to consider the potential care implications.
Acute hematemesis confusing the diagnosis of diabetic ketoacidosis in an infant Samar K. Bhowmick, Sean L. Murphy
DOI: http://dx.doi.org/10.1016/0735-6757(89)90192-7
The American Journal of Emergency Medicine , Vol. 7 , Issue 3 ,
Published in issue: May 1989
Primary gas-containing mediastinal abscess in a diabetic patient Tze-Yu Lee, Sheung-Fat Ko, Yu-Fan Cheng, Yung-Liang Wang, Wen-Yen Chien
DOI: http://dx.doi.org/10.1016/0735-6757(95)90131-0
The American Journal of Emergency Medicine , Vol. 13 , Issue 4 ,
Published in issue: July 1995
x A case of primary gas-containing mediastinal abscess is reported. Mediastinal widening was seen on the chest radiograph of a diabetic patient who presented with nonspecific symptoms of shortness of breath and abdominal pain of 3 days' duration. The diagnosis of primary gas-containing mediastinal abscess was established by the characteristic findings of computed tomography and exclusion of all the etiological possibilities. The patient was treated by closed chest tube drainage and antibiotic therapy with an uneventful outcome.
Seizures in a diabetic patient on monoamine oxidase inhibitors M Albareda, C Udina, A Escartín, R Corcoy
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90035-9
The American Journal of Emergency Medicine , Vol. 17 , Issue 1 ,
Published in issue: January 1999
Poor glycemic control in diabetic patients seeking care in the ED Gary Josephsen, Robert Rusnak
DOI: http://dx.doi.org/10.1016/j.ajem.2006.02.019
The American Journal of Emergency Medicine , Vol. 24 , Issue 6 ,
Published in issue: October 2006
x We hypothesized that diabetic patients in the emergency department (ED) have poorer glycemic control than patients seeking care at primary care clinics. A convenience sample of hemoglobin A1c (HbA1c) values was gathered retrospectively from the ED, Endocrinology, and Family Medicine Clinics. Results were divided into controlled, poorly controlled, and extremely poorly controlled. The only differing pattern of patients (*P < .01) was in the extremely poorly controlled group consisting of 36% of the ED patients (confidence interval [CI], 29.23-42.69; n = 74) vs 18% of the Endocrinology patients (CI, 13.76-22.53; n = 56) and 19% of the Family Medicine patients (CI, 15.98-22.75; n = 105).
Bilateral emphysematous pyelonephritis Terrance P McHugh, Suzanne E Albanna, Nathaniel J Stewart
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90038-9
The American Journal of Emergency Medicine , Vol. 16 , Issue 2 ,
Published in issue: March 1998
x In any diabetic patient being diagnosed or treated for pyelonephritis, it is important to exclude the diagnosis of emphysematous pyelonephritis, which carries a high mortality rate. The authors present an illustrative case of emphysematous pyelonephritis treated with antibiotics and emergency nephrectomy. The signs, symptoms, pathophysiology, diagnosis, and treatment of emphysematous pyelonephritis are discussed.
A case report of emphysematous pyelonephritis secondary to ureteral obstruction in a non-diabetic patient Nicole Suzanne Vetere, James Monti, Deborah Gutman
DOI: http://dx.doi.org/10.1016/j.ajem.2006.02.018
The American Journal of Emergency Medicine , Vol. 24 , Issue 6 ,
Published in issue: October 2006
x A 74-year-old woman was brought to the emergency department after being found by her niece on the floor of her apartment, confused and incontinent of urine and stool. According to her niece, the patient had been complaining of flank pain for several days. The patient's medical history included hypertension; gastric cancer status post resection, radiation, and chemotherapy 3 years prior; and pulmonary embolus. She did not have a history of diabetes mellitus.
Survival after prolonged resuscitation from cardiac arrest due to diabetic ketoacidosis using extracorporeal life support Toru Hifumi, Nobuaki Kiriu, Hiroshi Kato, Junichi Inoue, Yuichi Koido
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.041
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: March 4 2013
x Management of cardiac arrest due to severe diabetic ketoacidosis (DKA) using bicarbonate therapy and extracorporeal life support (ECLS) remains controversial. We report a case of a 24-year-old man with insulin-dependent type 1 diabetes mellitus who survived without any neurologic complications after prolonged ECLS (including fluid resuscitation and insulin but no aggressive bicarbonate) for cardiac arrest due to severe DKA. In post-DKA cardiac arrest, insulin and fluid resuscitation is the mainstay of treatment, but ECLS should be considered when prolonged cardiac arrest is expected.
Pseudonormoglycemia in diabetic ketoacidosis with elevated triglycerides Mark J. Rumbak, Thomas A. Hughes, Abbas E. Kitabchi
DOI: http://dx.doi.org/10.1016/0735-6757(91)90019-G
The American Journal of Emergency Medicine , Vol. 9 , Issue 1 ,
Published in issue: January 1991
x A 24-year-old newly diagnosed male patient with diabetes presented with diabetic ketoacidosis (DKA) (pH 7.16, HCO3 6.0) and extreme hypertriglyceridemia (239.35 mmol/L). The diagnosis of DKA was delayed because of the apparent depression of the true serum glucose (to 11 mmol/L). He was treated with intravenous (IV) insulin and rehydration, which normalized his pH, HCO3 , and triglyceride levels. To the authors' knowledge, this is both the highest triglyceride level recorded and the first report of a high triglyceride level as the apparent cause of a factitiously low glucose level.
Prognostic determinants of community-acquired bloodstream infection in type 2 diabetic patients in ED Chia-Hung Yo, Meng-Tse Gabriel Lee, Weng-Tein Gi, Shy-Shin Chang, Kuang-Chau Tsai, Shyr-Chyr Chen, Chien-Chang Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.071
The American Journal of Emergency Medicine , Vol. 32 , Issue 12 ,
Published online: August 29 2014
x The objective of the study is to describe the epidemiology and outcome of community-acquired bloodstream infection (BSI) in type 2 diabetic patients in emergency department (ED).
An unusual presentation of emphysematous cystitis John Weddle, Beth Brunton, David R Rittenhouse
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90170-X
The American Journal of Emergency Medicine , Vol. 16 , Issue 7 ,
Published in issue: November 1998
x Emphysematous cystitis is a rare disorder most commonly seen in women and associated with urinary tract infections and poorly controlled diabetes mellitus. We report the case of a 76-year-old woman who presented with diarrhea and abdominal discomfort, and emphysematous cystitis was revealed on the abdominal X-ray series. This case is unique in that the patient had no evidence of urinary tract infection, diabetes, or recent instrumentation. As the patient was treated for emphysematous cystitis (bladder irrigation and intravenous antibiotics), the diarrhea rapidly resolved and the radiographic abnormalities of the emphysematous cystitis also resolved.
Diabetic ketoacidosis and infection: Leukocyte count and differential as early predictors of serious infection Corey M Slovis, Virginia G.C Mork, Randall J Slovis, Raymond P Bain
DOI: http://dx.doi.org/10.1016/0735-6757(87)90280-4
The American Journal of Emergency Medicine , Vol. 5 , Issue 1 ,
Published in issue: January 1987
x The records of 153 patients who presented to an emergency department with diabetic ketoacidosis were reviewed to determine whether any admission evaluation laboratory data could serve as a predictor of occult or coexisting infection. Ten patients with admission radiographs already demonstrating active infection (pneumonia or tuberculosis) and two patients with wet gangrene of an extremity were not included in subsequent statistical analysis, as their infections were diagnosed on initial evaluation.
Prescriber beware: report of adverse effect of sodium-glucose cotransporter 2 inhibitor use in a patient with contraindication Reginald St Hilaire, Heather Costello
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.039
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: October 2 2014
x Diabetic ketoacidosis (DKA) is well recognized as an endocrine emergency. Diabetic ketoacidosis more commonly occurs in patients with type I diabetes secondary to the absence of endogenous insulin and their general predilection toward ketone production. Emergency medicine physicians are well trained in the prompt recognition and initiation of appropriate treatment needed to stop the rapidly progressive cycle of acidosis and dehydration before it becomes fatal. Traditionally, diagnostic criteria include hyperglycemia (>
Rate and prediction of infection in children with diabetic ketoacidosis Robert G. Flood, Vincent W. Chiang
DOI: http://dx.doi.org/10.1053/ajem.2001.24473
The American Journal of Emergency Medicine , Vol. 19 , Issue 4 ,
Published in issue: July 2001
x The purpose of this retrospective cohort study was to determine the rate and prediction of infection in children, ≤ 21 years, with diabetic ketoacidosis (DKA). Over a 6-year period, 247 admissions were identified. There were 171 (69%) with no infection, 44 (17.8%) with presumed viral infection, and 32 (12.9%) with bacterial infection. The mean WBC for all patients was 17,519 ( ± 9,582). 118 (50%) had leukocytosis as defined by a WBC ≥15,000/mm3. WBC, differential, leukocytosis, as well as sex, temperature and new onset diabetes, were not significant predictors (P >.05) of bacterial infection.
Gender differences in reported symptoms for acute myocardial infarction: Impact on prehospital delay time interval Hendrika Meischke, Mary Pat Larsen, Mickey S Eisenberg
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90128-0
The American Journal of Emergency Medicine , Vol. 16 , Issue 4 ,
Published in issue: July 1998
x A retrospective observational study using database registry of consecutive patients admitted to 16 King County hospital Coronary Care Units (CCU) was conducted to assess gender differences in symptom presentation for acute myocardial infarction (AMI) and investigate how symptom presentation relates to prehospital delay time interval from acute symptom onset to emergency department (ED) presentation. Between January 1991 and February 1993, 4,497 patients were admitted to the CCUs with diagnosed AMI.
Survival after prolonged resuscitation from cardiac arrest in a case of severe diabetic ketoacidosis Huei-Tsair Chen, Jiann-Ruey Ong, Shih-Wen Hung, Li-Wei Lin, Chee-Fah Chong
DOI: http://dx.doi.org/10.1016/j.ajem.2006.01.011
The American Journal of Emergency Medicine , Vol. 24 , Issue 5 ,
Published in issue: September 2006
x The use of bicarbonate in the management of diabetic ketoacidosis (DKA) remains controversial. Previous studies have shown that the use of bicarbonate in patients with severe DKA is not associated with better outcomes [1-3]. However, the use of bicarbonate therapy in patients with complicated DKA has not been addressed adequately, and the dogmatic use of bicarbonate continues in such cases [4].
An unusual case of mesenteric ischemia in a patient with new-onset diabetes mellitus Ghazala Q Sharieff, Javaid A Shad, Gus Garmel
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90016-4
The American Journal of Emergency Medicine , Vol. 15 , Issue 3 ,
Published in issue: May 1997
x The early detection of acute mesenteric ischemia is crucial for the preservation of bowel viability. The emergency physician must have a high index of suspicion to identify mesenteric ischemia when there is a paucity of physical examination findings. We discuss the case of a patient who presented to the emergency department with confusion, hyperglycemia, abdominal tenderness, and metabolic acidosis who also developed mesenteric ischemia.
Polyglandular autoimmune syndrome: A cause of multiple and sequential endocrine emergencies Mark A. Graber, Howard A. Freed
DOI: http://dx.doi.org/10.1016/0735-6757(92)90045-Y
The American Journal of Emergency Medicine , Vol. 10 , Issue 2 ,
Published in issue: March 1992
x The polyglandular autoimmune syndromes are a rare, inherited constellation of disorders characterized by multiple endocrine end-organ failures. Since these individuals have more than one endocrine failure, it is important to recognize these syndromes in clinical practice and be alert to the possibility of a second major endocrine organ failure after one has been diagnosed.
Perionychial infections associated with sculptured nails Raymond J Roberge, Debra Weinstein, Melissa M Thimons
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90201-2
The American Journal of Emergency Medicine , Vol. 17 , Issue 6 ,
Published in issue: October 1999
x Two cases of perionychial infections associated with the use of sculptured fingernails are presented. Both patients developed paroncyhia necessitating incision and drainage. One patient, a diabetic, had a concomitant subungual abscess and felon which required repeat drainage and debridement as well as intravenous antibiotics over an extended period for complete resolution. Sculptured fingernails may be risk factors for the development of digit infections through various mechanisms, and users of these cosmetic devices, especially diabetics and immunocompromised people, should be made aware of their potential for infectious complications.
Prevalence of hypokalemia in ED patients with diabetic ketoacidosis Sanjay Arora, Daniel Cheng, Benjamin Wyler, Michael Menchine
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.002
The American Journal of Emergency Medicine , Vol. 30 , Issue 3 ,
Published online: February 14 2011
x Although patients with diabetic ketoacidosis (DKA) are expected to have total body potassium depletion, measured levels may be normal or elevated due to extracellular shifts of potassium secondary to acidosis. Because insulin therapy decreases serum potassium levels, which creates potential to precipitate a fatal cardiac arrhythmia in a patient with hypokalemia, the American Diabetes Association (ADA) recommends obtaining a serum potassium level before giving insulin. Although the ADA guidelines are clear, the evidence on which they are based is largely anecdotal.
The significance of routine serum magnesium determination in the ED Ruth Stalnikowicz
DOI: http://dx.doi.org/10.1016/S0735-6757(03)00097-4
The American Journal of Emergency Medicine , Vol. 21 , Issue 5 ,
Published in issue: September 2003
x To determine the significance of routine serum magnesium determination in the ED, a retrospective analysis was done on 253 patients in whom serum magnesium levels were examined in the department of EM. Mild, moderate, and severe hypomagnesemia was found in 19.5%, 9.1%, and 2.5% of the study population, respectively. Univariate analysis showed that pregnancy and pregnancy-related conditions, diabetes mellitus, gender, renal function, infectious diseases, and the presence of ischemic heart disease were associated with low serum magnesium levels.
Orthopedic pitfalls in the ED: Osteomyelitis Andrew D. Perron, William J. Brady, Mark D. Miller
DOI: http://dx.doi.org/10.1053/ajem.2003.50013
The American Journal of Emergency Medicine , Vol. 21 , Issue 1 ,
Published in issue: January 2003
x Osteomyelitis can present to the emergency department as an acute, subacute, or chronic orthopedic concern. The presentation can range from subtle, as with acute hematogenous osteomyelitis in the pediatric patient population, to obvious, as with the diabetic patient who presents with a foot ulcer overlying exposed bone. Accurate early diagnosis and prompt treatment, whether with antibiotics, debridement, or both, are important in helping determine the ultimate outcome in this potential orthopedic pitfall.
Mucormycosis: what emergency physicians need to know? Brit Long, Alex Koyfman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.037
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: August 25 2015
x Mucormycosis is a rare presentation for patients in the emergency department (ED), primarily affecting immunocompromised patients. Multiple forms of infection are present, and with poor prognosis, ED diagnosis and treatment of this deadly condition are necessary.
Prognosis of Critically Ill Patients in the ED and Value of Perfusion Index Measurement: A Cross-Sectional Study Alten Oskay, Oktay Eray, Selcan Enver Dinç, Alp Giray Aydın, Cenker Eken
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.033
The American Journal of Emergency Medicine , Vol. 33 , Issue 8 ,
Published online: April 24 2015
x Critically ill patients have high mortality and admission rates requiring early recognition and a rapid management. In the present study, we evaluated the prognostic parameters in these patients and the value of perfusion index measurement as a novel tool for accomplishing emergency department (ED) triage.
Emergency diagnosis of Fournier's gangrene with bedside ultrasound Daniel Morrison, Michael Blaivas, Matthew Lyon
DOI: http://dx.doi.org/10.1016/j.ajem.2004.12.010
The American Journal of Emergency Medicine , Vol. 23 , Issue 4 ,
Published in issue: July 2005
x Fournier gangrene is a life-threatening infection of the scrotal skin. Although originally thought to be an idiopathic process, Fournier gangrene has been shown to have a predilection for patients with diabetes as well as chronic alcohol abuse; however, it can also affect patients with nonobvious immune compromise. Because of potential complications, it is important to diagnose the disease process as early as possible. Ultrasound has been previously described to aid in the diagnosis of Fournier's gangrene.
Hypoglycemia in multiple trauma victims William J Brady, Kathy Butler, Robert Fines, Jeffrey Young
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90002-5
The American Journal of Emergency Medicine , Vol. 17 , Issue 1 ,
Published in issue: January 1999
x The typical presentation of hypoglycemia involves a diaphoretic patient with a history of diabetes mellitus who is found with an altered mental status. The hypoglycemic patient's presentation may lead the physician to believe that the altered mentation may have been caused by some other condition. Hypoglycemia occurs rarely in the traumatic setting, yet is easily and rapidly diagnosed with bedside testing. A retrospective review was conducted in a university hospital emergency department (ED) (level 1 trauma center) of adult trauma patients with a Glasgow Coma Scale (GCS) score of <15 who had presented from July 1995 through August 1996.
Pediatric hyperglycemic hyperosmolar syndrome: diagnostic difficulties and high mortality rate Joel B. Cochran, Scott Walters, Joseph D. Losek
DOI: http://dx.doi.org/10.1016/j.ajem.2005.10.007
The American Journal of Emergency Medicine , Vol. 24 , Issue 3 ,
Published in issue: May 2006
x Childhood obesity has become a pandemic health care problem. A complication of childhood obesity is type 2 diabetes mellitus which has increased 10-fold in the past 20 years. A serious complication of type 2 diabetes mellitus is hyperglycemic hyperosmolar syndrome (HHS). The following case is an obese adolescent boy with a newly diagnosed HHS. The demographic and clinical characteristics of our case and those of 17 other cases from recently published small case series are presented. Of the 18 cases, there were 13 deaths (72%).
Predicting unfavorable outcome in subjects with diagnosis of chest pain of undifferentiated origin Andrea Fabbri, Filippo Ottani, Giulio Marchesini, Marcello Galvani, Alberto Vandelli
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.022
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: November 1 2010
x In subjects with chest pain of undifferentiated origin, the risk of unfavorable outcome cannot be accurately predicted by the selected clinical items.
Case report of factor VII deficiency Alan J. Hirshberg, Ronald L. Fletcher, Curtis Harris Jr, Robert L. Dupper
DOI: http://dx.doi.org/10.1016/0735-6757(93)90010-9
The American Journal of Emergency Medicine , Vol. 11 , Issue 6 ,
Published in issue: November 1993
x The case of a 57-year-old woman with no personal or family history of coagulopathy or blood dyscrasia who was found to be factor VII deficient by routine laboratory testing is reported. The patient was also found to have type 2 diabetes mellitus and adenocarcinoma of the uterus in the course of her hospitalization.
Prognostic value of the Thrombolysis in Myocardial Infarction risk score in a unselected population with chest pain. Construction of a new predictive model Francisco J. García-Almagro, Juan R. Gimeno, Manuel Villegas, Jose Hurtado, Francisca Teruel, Maria C. Cerdán, Josefa González-Carrillo, Domingo Pascual, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.011
The American Journal of Emergency Medicine , Vol. 26 , Issue 4 ,
Published in issue: May 2008
x The Thrombolysis in Myocardial Infarction (TIMI) risk score (TRS) has proven to be a useful and simple tool for risk stratification of patients with chest pain in intermediate- and high-risk populations. There is little information on its applicability in daily clinical routine with unselected populations.
Gas gangrene from subcutaneous insulin administration Rachel L. Chin, Ricardo Martinez, Gus Garmel
DOI: http://dx.doi.org/10.1016/0735-6757(93)90018-7
The American Journal of Emergency Medicine , Vol. 11 , Issue 6 ,
Published in issue: November 1993
x A case of gas gangrene that caused intractable shoulder pain refractory to narcotics in an immunocompromised host is presented. Gas gangrene has been associated with severe trauma involving penetrating wounds, compound fractures, extensive soft-tissue injury, intramuscular injection of epinephrine, and interruption of arterial blood supply. This case describes an elderly insulin-dependent diabetic woman who developed gas gangrene in her arm and leg at the site of her subcutaneous insulin injections.
Acute suppurative parotitis with spread to the deep neck spaces Merrill A Cohen, John W Docktor
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90015-3
The American Journal of Emergency Medicine , Vol. 17 , Issue 1 ,
Published in issue: January 1999
x This report describes the case of an elderly, diabetic woman who became dehydrated and developed acute suppurative parotitis, which caused marked swelling of her left face and neck. The parotid infection also extended by continuity into the lateral pharyngeal space and contiguous deep neck spaces, causing airway-threatening, extensive inflammation and swelling of the epiglottis and parapharyngeal soft tissues. The differential diagnosis and diagnostic rationale is discussed. The anatomy of the stylomandibular area is reviewed to explain how infection of the parotid can spread to the pharynx.
Clinical features, triage, and outcome of patients presenting to the ED with suspected acute coronary syndromes but without pain: A multicenter study Boris E. Coronado, J.Hector Pope, John L. Griffith, Joni R. Beshansky, Harry P. Selker
DOI: http://dx.doi.org/10.1016/j.ajem.2004.09.001
The American Journal of Emergency Medicine , Vol. 22 , Issue 7 ,
Published in issue: November 2004
x We studied the impact on triage and outcome of patients presenting to the emergency department (ED) with symptoms suggestive of an acute coronary syndromes (ACS) but without a complaint of pain. Data from a prospective clinical trial of patients with symptoms suggesting an ACS in the EDs of 10 US hospitals comparing patient demographics, clinical variables, and outcomes was used to perform a secondary analysis. Of 10,783 subjects, a final diagnosis of an ACS was confirmed in 24% of which 35% had acute myocardial infarction (AMI) and 65% unstable angina pectoris (UAP).
Risk factors associated with difficult venous access in adult ED patients J. Matthew Fields, Nicole E. Piela, Arthur K. Au, Bon S. Ku
DOI: http://dx.doi.org/10.1016/j.ajem.2014.07.008
The American Journal of Emergency Medicine , Vol. 32 , Issue 10 ,
Published online: July 29 2014
x The objective was to determine risk factors associated with difficult venous access (DVA) in the emergency department (ED).
Acute inferior pseudoinfarction pattern in a patient with normokalemia and diabetic ketoacidosis Enbiya Aksakal, Taner Ulus, Ednan Bayram, Hakan Duman
DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.024
The American Journal of Emergency Medicine , Vol. 27 , Issue 2 ,
Published in issue: February 2009
x Diabetic ketoacidosis (DKA) is an important medical emergency and may cause electrocardiogram (ECG) changes mimicking myocardial infarction. In the literature, hyperkalemia-associated ST-segment elevations have been defined in DKA; it has been demonstrated that these changes resolve completely after the treatment of hyperkalemia. We aimed to present a case with DKA in whom ST-segment elevation in inferior derivations was observed, but serum potassium level (4.4 mEq/L) was normal. The patient was admitted to the emergency department with complaints of nausea, bloody vomiting, and epigastric pain.
Acute hypoglycemia masquerading as head trauma: A report of four cases Samuel D Luber, William J Brady, Asher Brand, Jeffrey Young, Andrew T Guertler, Mike Kefer
DOI: http://dx.doi.org/10.1016/S0735-6757(96)90094-7
The American Journal of Emergency Medicine , Vol. 14 , Issue 6 ,
Published in issue: October 1996
x Hypoglycemia, a commonly encountered metabolic emergency, is most often easily diagnosed and rapidly treated with satisfactory patient outcome. If not recognized and treated promptly, hypoglycemia may cause irreversible central nervous system injury; it rarely results in death. The classic presentation of hypoglycemia, a patient with diabetes mellitus on medical therapy (insulin or oral hypoglycemic agents) who presents with an altered sensorium, is frequently seen in the emergency department (ED).
Looking at diabetic ketoacidosis through electrocardiogram window! Soheila Talebi, Farzaneh Ghobadi, Arthur Cacacho, Ola Olatunde, Alicia DeRobertis, Gerald Pekler, Ferdinand Visco, Savi Mushiyev, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.032
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 28 2015
x Initial serum potassium (K
Can paramedics safely treat and discharge hypoglycemic patients in the field? E.Brooke Lerner, Anthony J. Billittier IV, Daniel R. Lance, David M. Janicke, Josette A. Teuscher
DOI: http://dx.doi.org/10.1053/ajem.2003.50014
The American Journal of Emergency Medicine , Vol. 21 , Issue 2 ,
Published in issue: March 2003
x To determine whether paramedics can safely treat and discharge insulin-dependent diabetic patients experiencing uncomplicated hypoglycemic events, we conducted a prospective, observational study with a convenience sample of diabetic patients whose hypoglycemia resolved after intravenous administration of dextrose and before they were transported by paramedics. On-line medical control was contacted to obtain approval and informed consent for participation from interested patients who met all eligibility criteria for the study.
Atypical migraine presenting with meningeal signs Ata Ulhaq, Walid Massarweh
DOI: http://dx.doi.org/10.1016/0735-6757(94)90207-0
The American Journal of Emergency Medicine , Vol. 12 , Issue 1 ,
Published in issue: January 1994
x A case of atypical or complicated migraine is presented with signs and symptoms of meningeal irritation, projectile emesis NS obtundation, and unresponsiveness. The patient is a 19-year-old diabetic on insulin who had a mild episode of upper respiratory tract symptoms with severe headache and was found unresponsive and brought to the emergency department. After a work-up for meningitis was negative (as well as computerized tomography and magnetic resonance imaging) he recovered totally in 3 days with no residual signs or symptoms and was discharged from the hospital.
Resuscitation with balanced electrolyte solution prevents hyperchloremic metabolic acidosis in patients with diabetic ketoacidosis Simon A. Mahler, Steven A. Conrad, Hao Wang, Thomas C. Arnold
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.004
The American Journal of Emergency Medicine , Vol. 29 , Issue 6 ,
Published online: May 3 2010
x The objective of the study was to determine if balanced electrolyte solution (BES) prevents hyperchloremic metabolic acidosis in patients with diabetic ketoacidosis (DKA).
The clinical experience of acute cyanide poisoning David Yen, Jeffrey Tsai, Lee-Min Wang, Wei-Fong Kao, Sheng-Chuan Hu, Chen-Hsen Lee, Jou-Fang Deng
DOI: http://dx.doi.org/10.1016/0735-6757(95)90162-0
The American Journal of Emergency Medicine , Vol. 13 , Issue 5 ,
Published in issue: September 1995
x The authors reviewed the clinical manifestations, complications, and the prognosis affected by Lilly Cyanide Antidote in 21 victims of acute cyanide poisoning over a 10-year period. The clinical signs and symptoms in cyanide poisoning are variable. Among 21 cases, loss of consciousness (15), metabolic acidosis (14), and cardiopulmonary failure (9) were the three leading manifestations of cyanide intoxication. Anoxic encephalopathy (6) was not uncommon in the severely intoxicated victims. Diabetes insipidus (1) or clinical signs and symptoms mimicking diabetes insipidus (3) may be an ominous sign to encephalopathy victims.
Renal abscess: Early diagnosis and treatment David Hung-Tsang Yen, Sheng-Chuan Hu, Jeffrey Tsai, Wei-Fong Kao, Chii-Hwa Chern, Lee-Min Wang, Chen-Hsen Lee
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90060-8
The American Journal of Emergency Medicine , Vol. 17 , Issue 2 ,
Published in issue: March 1999
x The purpose of this study was to identify initial clinical characteristics that can lead to early diagnosis of renal abscess in the emergency department and predict poor prognosis. A retrospective review of 88 renal abscess patients, from April 1979 through January 1996, was conducted. Patients were categorized into two groups. In group 1, renal abscess was diagnosed by an emergency physician, whereas in group 2 renal abscess was not diagnosed by an emergency physician. Clinical characteristics included demographic data, predisposing medical problems, duration of illness before diagnosis, time spent in hospital diagnosis, initial signs and symptoms, laboratory tests, and radiology studies that may have been useful in the early diagnostic regimes.
Obstructive ileus caused by a swallowed foreign body (a “press-through” package) and preexisting adhesions Hitoshi Imaizumi, Masanori Yamauchi, Akiyoshi Namiki, Hiromi Takahashi, Kaneschige Hatakeyama
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90048-6
The American Journal of Emergency Medicine , Vol. 15 , Issue 1 ,
Published in issue: January 1997
x A “press-through” package (PTP), because it is large and square-shaped, tends to be caught in the esophagus when swallowed. A rare case of obstructive ileus induced by a PTP that was swallowed by 54-year-old man with a history of diabetes mellitus and acute appendectomy is reported. The PTP was 19 mm × 18 mm and was lodged in the cecum, which was stenosed because of preexisting intestinal adhesions; consequently, the PTP obstructed the ileus. The PTP was surgically removed.
A clinical score to obviate the need for cardiac stress testing in patients with acute chest pain and negative troponins Alberto Bouzas-Mosquera, Jesús Peteiro, Francisco J. Broullón, Nemesio Álvarez-García, Nicolás Maneiro-Melón, Patricia Pardo-Martinez, Marta Sagastagoitia-Fornie, Dolores Martínez, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2016.04.016
Publication stage: In Press Accepted Manuscript
The American Journal of Emergency Medicine
Published online: April 12 2016
x Although cardiac stress testing may help establish the safety of early discharge in patients with suspected acute coronary syndromes and negative troponins, more cost-effective strategies are necessary. We aimed to develop a clinical prediction rule to safely obviate the need for cardiac stress testing in this setting.
Impact of metformin use on the prognostic value of lactate in sepsis Jeffrey P. Green, Tony Berger, Nidhi Garg, Alison Suarez, Yolanda Hagar, Michael S. Radeos, Edward A. Panacek
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.014
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: March 19 2012
x The objective of this study is to determine if metformin use affects the prevalence and prognostic value of hyperlactatemia to predict mortality in septic adult emergency department (ED) patients.
Prevalence and risk factors for central diabetes insipidus in cardiac arrest survivor treated with targeted temperature management Dong Hun Lee, Byung Kook Lee, Kyoung Hwan Song, Yong Hun Jung, Jung Soo Park, Sung Min Lee, Yong Soo Cho, Jin Woong Kim, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2016.04.005
Publication stage: In Press Accepted Manuscript
The American Journal of Emergency Medicine
Published online: April 8 2016
x Central diabetes insipidus (CDI) is a marker of severe brain injury. Here we aimed to investigate the prevalence and risk factors of CDI in cardiac arrest survivors treated with targeted temperature management (TTM).
Quantitative insulin and C-peptide levels among ED patients with sulfonylurea-induced hypoglycemia—a prospective case series Charles J. Fasano, Adam K. Rowden, Gerald F. O'Malley, Elizabeth Aguilera, Kennon Heard
DOI: http://dx.doi.org/10.1016/j.ajem.2009.08.025
The American Journal of Emergency Medicine , Vol. 28 , Issue 8 ,
Published online: March 26 2010
x The objective of this study was to measure the serum insulin and C-peptide concentrations among diabetic patients known to be taking sulfonylurea agents who presented to the emergency department with hypoglycemia thought to be due to therapeutic usage as opposed to overdose. A recently published systematic review of 22 articles involving 76 patients with sulfonylurea-induced hypoglycemia (glucose <49 mg/dL) resulting from accidental ingestion or intentional overdose found that patients had an average serum insulin concentration of 3.9 μ IU/mL or higher and an average serum C-peptide concentration of 1.4 ng/mL or higher.
A prospective evaluation of glucose reagent teststrips in the prehospital setting Robert F. Lavery, John R. Allegra, Ronald P. Cody, Daniel Zacharias, David M. Schreck
DOI: http://dx.doi.org/10.1016/0735-6757(91)90046-M
The American Journal of Emergency Medicine , Vol. 9 , Issue 4 ,
Published in issue: July 1991
x Reagent teststrip determination of blood glucose has been shown to be accurate for hospital and home testing and is commonly used in prehospital care despite the lack of studies in this arena. This prospective, multicenter study examines the ability of glucose reagent teststrips to detect hypoglycemia when used under field conditions compared with simultaneously drawn control samples for laboratory glucose determination. Also examined was the accuracy of the teststrips in the laboratory glucose range ≤200 mg/dL.
Acute emphysematous cholecystitis with initial normal radiological evaluation: a fatal diagnostic pitfall in the ED Vei-Ken Seow, Chiu-Mei Lin, Tzong-Luen Wang, Chee-Fah Chong, I-Yin Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2006.11.023
The American Journal of Emergency Medicine , Vol. 25 , Issue 4 ,
Published in issue: May 2007
x Acute emphysematous cholecystitis is a relatively rare disease, a severe variant of acute cholecystitis, that predominantly affects elderly diabetic men. The apparently high mortality and morbidity associated with acute emphysematous cholecystitis have previously emphasized the importance of prompt diagnosis and emergent surgical intervention. Radiological evaluation including plain plain abdominal radiograph (KUB), abdominal sonography, and computed tomography of abdomen is the cornerstone of diagnosis of acute emphysematous cholecystitis.
Hypophosphatemia in the emergency department therapeutics David W. Miller, Corey M. Slovis
DOI: http://dx.doi.org/10.1053/ajem.2000.7347
The American Journal of Emergency Medicine , Vol. 18 , Issue 4 ,
Published in issue: July 2000
x Although hypophosphatemia is relatively uncommon, it may be seen in anywhere from 20% to 80% of patients who present to the ED with alcoholic emergencies, diabetic ketoacidosis (DKA), and sepsis. Severe hypophosphatemia, as defined by a serum level below 1.0 mg/dL, may cause acute respiratory failure, myocardial depression, or seizures. Because hypophosphatemia is not as often treated by ED physicians, becoming familiar with a single intravenous phosphate solution and specific guidelines for phosphate repletion are essential.
Improvement of ED prediction of cardiac mortality among patients with symptoms suggestive of acute myocardial infarction Björn W Karlson, Johan Herlitz, Ulf Strömbom, Jonny Lindqvist, Anders Odén, Åke Hjalmarson
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90038-3
The American Journal of Emergency Medicine , Vol. 15 , Issue 1 ,
Published in issue: January 1997
x A study was undertaken to evaluate the 1-year risk of cardiac death for patients with chest pain/suspected acute myocardial infarction in the emergency department (ED) and express the prognosis in a statistical model. Clinical variables and electrocardiogram were correlated to cardiac death during 1 year. Cox regression model was used to estimate the risk of death as a continuous function of a risk score and the time interval. From these, the prognosis for each patient can be calculated. There were 6,794 visits by 5,303 patients followed for 1 year, during which 604 patients died.
Is prehospital blood glucose measurement necessary in suspected cerebrovascular accident patients? Neal Robert Abarbanell
DOI: http://dx.doi.org/10.1016/j.ajem.2005.01.004
The American Journal of Emergency Medicine , Vol. 23 , Issue 7 ,
Published in issue: November 2005
x The present study was completed to establish an epidemiologic database defining prehospital management of suspected cerebrovascular accidents (CVAs) with attention to blood glucose measurement, in the hope of developing recommendations for further treatment protocols. On review of 9495 paramedic run reports for the 24-month period from January 2001 through December 2002, from a low-volume urban emergency medical services system, 185 persons presented with CVA signs and/or symptoms. Data collected included patient chief complaint, neurologic examination, patient age, vital signs, ambulance field times, patient past medical history, and blood glucose measurement with resulting prehospital interventions, efficacy of interventions, and iatrogenic complications.
Predictors of bacteremia in emergency department patients with suspected infection Maureen Chase, Richard S. Klasco, Nina R. Joyce, Michael W. Donnino, Richard E. Wolfe, Nathan I. Shapiro
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.018
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: May 25 2012
x The goal of this study is to identify clinical variables associated with bacteremia. Such data could provide a rational basis for blood culture testing in emergency department (ED) patients with suspected infection.
Balance of older trekkers: data on alpine accidents and performance as assessed using a video game machine Masafumi Kimura, Masaru Tobe, Takashi Suto, Soh Narahara, Makiko Yamada, Chizu Aso, Tomonori Takazawa, Yasuo Baba, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2011.07.022
The American Journal of Emergency Medicine , Vol. 30 , Issue 7 ,
Published online: May 25 2012
x The number of alpine accidents involving older trekkers has increased markedly in developed countries in recent years. More than 76.8% of the trekkers involved in alpine accidents in Japan were older than 40 years, with some experiencing a stroke or myocardial infarction while trekking at altitude. In the present study, we surveyed social trends in trekkers by interview at a popular mountain site, Mt Tanigawa (1963 m in altitude). The total number of trekkers interviewed was 511, and more than 60% of these were older than 40 years.
Prevalence and risk factors for multidrug resistant uropathogens in ED patients Seth W Wright, Keith D Wrenn, Marylou Haynes, David W Haas
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90005-6
The American Journal of Emergency Medicine , Vol. 18 , Issue 2 ,
Published in issue: March 2000
x The purpose of this study was to describe resistance patterns of infecting organisms and determine risk factors for multidrug resistance in patients with urinary tract infections. Retrospective case series of 435 patients age ≥16 with urinary tract infection. Multidrug resistance was defined as resistance to ≥two classes of antibiotics. Demographic, historical, and microbiological data were collected. Univariate analysis and multivariate logistic regression were used to determine risk factors for multidrug resistance.
Predictors of medication refill–seeking behavior in the ED Adam H. Miller, Gregory L. Larkin, Claudie H. Jimenez
DOI: http://dx.doi.org/10.1016/j.ajem.2005.01.009
The American Journal of Emergency Medicine , Vol. 23 , Issue 4 ,
Published in issue: July 2005
x Determine predictors of medication refill–seeking behavior in ED patients with chronic illness.
