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).
