An unusual complication of cardiopulmonary resuscitation: Stomach perforation Mustafa Ahmet Afacan, Sahin Colak, Harun Gunes, Hayati Kandis, Ayhan Saritas, Mustafa Cortuk, Ismet Ozaydin
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.027
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: February 26 2014
x Stomach perforation is an unusual complication of cardiopulmonary resuscitation. It generally occurs while providing an advanced airway. Stomach perforation may develop as a consequence of chest compressions in a patient with stomach distention caused by long periods of bag-valve mask ventilation. We presented this case to emphasize that stomach perforation may develop during cardiopulmonary resuscitation, and early diagnosis and surgical treatment may be lifesaving.
Bleeding complications of central venous catheterization in septic patients with abnormal hemostasis David R. Vinson, Dustin W. Ballard, Luke G. Hance, YunYi Hung, Adina S. Rauchwerger, Mary E. Reed, Mamata V. Kene, Uli K. Chettipally, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.004
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: March 20 2014
x Central venous catheterization (CVC) is thought to be relatively contraindicated in patients with thrombocytopenia or coagulopathy. We measured the 24-hour incidence of bleeding in septic emergency department (ED) patients undergoing CVC.
Acute pancreatitis due to extracorporeal shock wave lithotripsy: a rare complication Onder Limon, Funda Ugur Kantar, Erkan Şahin, Murat Arslan, Aslı Aydınoglu Ugurhan
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.026
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: April 17 2014
x Extracorporeal shock wave lithotripsy (ESWL) is considered the treatment of choice for most renal and upper ureteral stones. Although extensive data have documented its safety, serious complications have been reported in 1% of patients, including acute pancreatitis, perirenal hematoma, urosepsis, venous thrombosis, biliary obstruction, bowel perforation, lung injury, and rupture of aortic aneurysms. Here, we report a 41-year-old woman who underwent ESWL for a calculus at the right renal pelvis and immediately developed acute pancreatitis after the procedure.
Aortic intramural hematoma and hepatic artery pseudoaneurysm: unusual complication following resuscitation Yu-Hsiang Juan, Sachin S. Saboo, Naman S. Desai, Kanika Khandelwal, Ashish Khandelwal
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.012
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: September 23 2013
x We present a case of a 71-year-old woman with an unusual complication of aortic intramural hematoma and hepatic artery pseudoaneurysm following cardiopulmonary resuscitation and thrombolysis done for sudden cardiopulmonary arrest and pulmonary embolism. Patient was on Warfarin treatment for a prior history of pulmonary embolism and experienced recurrent cardiac arrests, which finally resolved after intravenous administration of thrombolytic agents. However, follow-up computed tomographic angiography revealed descending aortic intramural hematoma with intramural blood pool and concomitant liver laceration with hepatic artery pseudoaneurysm.
A life-threatening complication of warfarin therapy in ED: diffuse alveolar hemorrhage Emin Uysal, Erdem Çevik, Süleyman Solak, Yahya Ayhan Acar, Mustafa Yalimol
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.022
The American Journal of Emergency Medicine , Vol. 32 , Issue 6 ,
Published online: December 16 2013
x Warfarin have some serious adverse effects, and bleeding is one of the most serious and frequent of them. In this case report, we present the diffuse alveolar hemorrhage case as a rare and life-threatening complication of warfarin.
Acute complications of tattooing presenting in the ED Nicolas Kluger
DOI: http://dx.doi.org/10.1016/j.ajem.2012.06.014
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: September 3 2012
x Permanent decorative tattooing involves the introduction of exogenous pigments and/or dyes into the dermis to produce the permanent design. Despite improved hygiene in the tattoo parlors of Western countries, this procedure still carries risk. Various complications may occur right after tattooing, from benign complications such as transient limb edema, palpable lymph nodes, and contact eczema, to more severe ones such as the inoculation of virulent microorganisms into the dermis, potentially life-threatening cellulitis, and necrotizing fasciitis or cutaneous vasculitis.
Gastrostomy tube replacement in a pediatric ED: frequency of complications and impact of confirmatory imaging Cory D. Showalter, Benjamin Kerrey, Stephanie Spellman-Kennebeck, Nathan Timm
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.014
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: February 10 2012
x Gastrostomy tube (g-tube) dislodgement is a common problem in special needs children. There are no studies on the frequency of complications after g-tube replacement for children in a pediatric emergency department (ED).
Incidence of tricyclic antidepressant-like complications after cyclobenzaprine overdose Ari Greenwald, Colleen M. Birmingham, Robert S. Hoffman
DOI: http://dx.doi.org/10.1016/j.ajem.2011.09.006
The American Journal of Emergency Medicine , Vol. 30 , Issue 2 ,
Published online: December 28 2011
x Bebarta et al [1] commendably set out to determine whether patients who overdose on cyclobenzaprine are at risk for developing Tricyclic antidepressant (TCA)-like effects (ie, a widened QRS or ventricular dysrhythmia). This topic is of interest as clear evidence that cyclobenzaprine does not cause cardiotoxic effects could save the health care system considerably with regard to bed use. Unfortunately, this retrospective study fails to definitively answer this question. Moreover, misinterpretation of their findings as proof that cyclobenzaprine overdose does not cause TCA-like cardiotoxicity might place patients at risk.
Neurologic complication after a roller coaster ride Davi Sa Leitao, Dercio Mendonca, Harish Iyer, Cheng-Kai Kao
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.026
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: October 27 2010
x Neurologic complications after roller coaster rides are uncommon but potentially catastrophic. Physicians should have a high index of suspicion and prompt appropriate investigation. A 22-year-old healthy African American man presented with a 2-day history of constant occipital headache associated with vertigo, nausea, vomiting, and ambulatory dysfunction. Physical examination showed gait ataxia, slight dysmetria, and vertical nystagmus. Magnetic resonance imaging (MRI) of the brain showed early subacute ischemic infarct in the right cerebellum in the distribution of the right posterior inferior cerebellar artery.
Incidence of tricyclic antidepressant-like complications after cyclobenzaprine overdose Vikhyat S. Bebarta, Joseph Maddry, Doug J. Borys, David L. Morgan
DOI: http://dx.doi.org/10.1016/j.ajem.2011.09.005
The American Journal of Emergency Medicine , Vol. 30 , Issue 2 ,
Published online: November 21 2011
x We thank the authors for their comments of our study. We agree that an ideal study of acute cyclobenzaprine toxicity would be prospective with blood levels, review of electrocardiograms by 2 reviewers, and prospective collection of data from hospital records. Because this type of study is both expensive and it is difficult to find centers with sufficient cases, it is rarely performed. In lieu of this ideal study, we used a retrospective data set to evaluate a large volume of short-term cases as reported to several poison centers, a source of cases used to develop clinical guidelines [1].
Incidence of tricyclic antidepressant-like complications after cyclobenzaprine overdose Vikhyat S. Bebarta, Joseph Maddry, Douglas J. Borys, David L. Morgan
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.014
The American Journal of Emergency Medicine , Vol. 29 , Issue 6 ,
Published online: May 3 2010
x The cyclobenzaprine structure is similar to amitriptyline; however, tricyclic antidepressant (TCA)-like wide complex dysrhythmia has not been reported. Our objective was to determine the incidence of TCA-like effects in cyclobenzaprine overdoses as reported to 6 poison centers for 2 years. We compared the incidence of these effects to amitriptyline overdoses collected during the same period.
Pediatric acute osteomyelitis in the postvaccine, methicillin-resistant Staphylococcus aureus era Kristin Ratnayake, Andrew J. Davis, Lance Brown, Timothy P. Young
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.011
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 16 2015
x We sought to describe the causative organisms, bones involved, and complications in cases of pediatric osteomyelitis in the postvaccine age and in the era of increasing infection with community-associated methicillin-resistant Staphylococcus aureus (MRSA).
The cost-effectiveness analysis of video capsule endoscopy compared to other strategies to manage acute upper gastrointestinal hemorrhage in the ED Andrew C. Meltzer, Michael J. Ward, Ian M. Gralnek, Jesse M. Pines
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.012
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: November 18 2013
x Acute upper gastrointestinal (GI) hemorrhage is a common presentation in hospital-based emergency departments (EDs). A novel diagnostic approach is to use video capsule endoscopy to directly visualize the upper GI tract and identify bleeding. Our objective was to evaluate and compare the relative costs and benefits of video capsule endoscopy compared to other strategies in low- to moderate-risk ED patients with acute upper GI hemorrhage.
A retrospective review of the prehospital use of activated charcoal Joseph Villarreal, Christopher A. Kahn, James V. Dunford, Ekta Patel, Richard F. Clark
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.019
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: October 21 2014
x We studied the complications and timing implications of prehospital activated charcoal (PAC). Appropriateness of PAC administration was also evaluated.
Heart rate variability risk score for prediction of acute cardiac complications in ED patients with chest pain Marcus Eng Hock Ong, Ken Goh, Stephanie Fook-Chong, Benjamin Haaland, Khin Lay Wai, Zhi Xiong Koh, Nur Shahidah, Zhiping Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2013.05.005
The American Journal of Emergency Medicine , Vol. 31 , Issue 8 ,
Published online: June 12 2013
x We aimed to develop a risk score incorporating heart rate variability (HRV) and traditional vital signs for the prediction of early mortality and complications in patients during the initial presentation to the emergency department (ED) with chest pain.
Value of helical computed tomography in the early diagnosis of esophageal foreign bodies in adults Yong-Cai Liu, Shui-Hong Zhou, Ling Ling
DOI: http://dx.doi.org/10.1016/j.ajem.2013.05.049
The American Journal of Emergency Medicine , Vol. 31 , Issue 9 ,
Published online: July 29 2013
x To investigate the relationship between early use of computed tomography (CT) and complications associated with esophageal foreign body impaction in adults.
Risk-benefit analysis of lumbar puncture to evaluate for nontraumatic subarachnoid hemorrhage in adult ED patients Victoria L. Migdal, W. Kelly Wu, Drew Long, Candace D. McNaughton, Michael J. Ward, Wesley H. Self
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.048
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: June 22 2015
x The objective of the study is to compare the risks and benefits of lumbar puncture (LP) to evaluate for subarachnoid hemorrhage (SAH) after a normal head computed tomographic (CT) scan.
Feasibility of sonographic localization of the inferior epigastric artery before ultrasound-guided paracentesis Justin C. Stone, James H. Moak
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.067
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: July 6 2015
x Ultrasound-guided paracentesis is commonly performed in the emergency department (ED) setting. Injury to the inferior epigastric artery (IEA) is an uncommon but potentially life-threatening complication of paracentesis. Use of anatomic landmarks has been recommended to avoid this structure. If feasible, sonographic localization of the IEA before ultrasound-guided paracentesis may provide the operator with anatomic mapping of this vascular structure.
Subarachnoid hemorrhage and pneumocephalus due to epidural anesthesia Murat Güzel, Ömer Salt, Ali K. Erenler, Ahmet Baydın, Mehmet T. Demir, Anil Yalcin, Zahide Doganay
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.029
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: January 30 2014
x Epidural analgesia is an extremely effective and popular treatment for pain during labor. Subarachnoid hemorrhage and pneumocephaly is a serious but rare complication of puncture of the dura mater in epidural anesthesia. To best of our knowledge, intracranial subarachnoid hemorrhage together with pneumocephaly hasn’t been reported as a complication after the lumbar puncture so far. Our purpose is to increase awareness for serious complications such as subarachnoid hemorrhage and pneumocephaly following regional procedures (See Fig.
Risk of thromboembolic events after protocolized warfarin reversal with 3-factor PCC and factor VIIa Cassie A. Barton, Nathan B. Johnson, Jon Case, Bruce Warden, Darrel Hughes, Jason Zimmerman, Gregory Roberti, Wesley D. McMillian, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.010
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: June 13 2015
x Bleeding events and life-threatening hemorrhage are the most feared complications of warfarin therapy. Prompt anticoagulant reversal aimed at replacement of vitamin K–dependent clotting factors is essential to promote hemostasis. A retrospective cohort study of warfarin-treated patients experiencing a life-threatening hemorrhage treated with an institution-specific warfarin reversal protocol (postimplementation group) and those who received the prior standard of care (preimplementation group) was performed.
