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.
