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.
