An observational case series of dabigatran and rivaroxaban exposures reported to a poison control system John W. Stevenson, Alicia B. Minns, Craig Smollin, Timothy E. Albertson, F. Lee Cantrell, Christian Tomaszewski, Richard F. Clark
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.031
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: April 30 2014
x Characterize clinical presentations and outcomes of dabigatran and rivaroxaban exposures reported to a poison control system.
Early embolization without external fixation in pelvic trauma Shinsuke Tanizaki, Shigenobu Maeda, Hiroyuki Hayashi, Hideyuki Matano, Hiroshi Ishida, Jun Yoshikawa, Toru Yamamoto
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.032
The American Journal of Emergency Medicine , Vol. 30 , Issue 2 ,
Published online: January 31 2011
x In this retrospective study, we reviewed our protocol consisting of early embolization without acute external fixation in patients with pelvic fracture.
Use of intra-aortic balloon pump support for oozing-type cardiac rupture after acute myocardial infarction Zhi-Ping Zhang, Xi Su, Cheng-Wei Liu, Dan Song, Jian Peng, Ming-Xiang Wu, Yu-Chun Yang, Bo Liu, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.054
The American Journal of Emergency Medicine , Vol. 34 , Issue 1 ,
Published online: June 13 2015
x Left ventricular free wall rupture usually leads to acute hemopericardium and sudden cardiac death resulting in cardiac tamponade. Rarely, only a few patients with subacute free wall rupture such as oozing-type ventricular rupture or left ventricular false aneurysm may permit time for pericardiocentesis and surgery. We report a 63-year-old man with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention about 12 hours from the onset, and cardiac tamponade occurred on the second day.
The value of prehospital echocardiography in shock management Pierre-Marie Brun, Hichem Chenaitia, Jonathan Gonzva, Jacques Bessereau, Xavier Bobbia, Michael Peyrol, WINFOCUS (World Interactive Network Focused On Critical UltraSound) Group France
DOI: http://dx.doi.org/10.1016/j.ajem.2012.05.021
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: August 6 2012
x Establishing the cause is a key part of prehospital management of shock. It is essential to determine whether the condition is of cardiac or noncardiac origin. Herein, we discuss the case of a patient undergoing prehospital management of acute dyspnea associated with shock. Transthoracic echocardiography (TTE) at the bedside allowed early diagnosis of tamponade due to hemopericardium resulting from overdose of vitamin K antagonists (VKAs). Prehospital TTE, which can be performed at the bedside for patients with unstable hemodynamic status, constitutes a precious tool in establishing the diagnosis, adjusting therapy, and directing patients quickly toward the appropriate hospital department.
Early left ventricular free-wall rupture in non-STEMI never to be neglected Yen-Ting Yeh, Chun-Yang Huang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.038
The American Journal of Emergency Medicine , Vol. 34 , Issue 1 ,
Published online: April 24 2015
x As the most dramatic and fatal complication, left ventricular free-wall rupture (LVFWR) used to present in approximately 3% of patients with acute myocardial infarction. After the introduction of primary percutaneous coronary intervention, the incidence of LVFWR decreased but remained approximately 1.7% [1]. Left ventricular free-wall rupture occurs in patients with transmural myocardial infarction, which is almost exclusively ST-elevation myocardial infarction (STEMI) [2]. This condition carries a high mortality as a result of hemopericardium and cardiac tamponade.
Anaphylactic shock associated with intravenous thrombolytics Amna Zarar, Asif A. Khan, Malik M. Adil, Adnan I. Qureshi
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.046
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: October 2 2013
x Adverse events including intracerebral hemorrhage and reperfusion arrhythmias are well known to occur with thrombolytic therapy. We report a case report of anaphylactic reaction directly attributable to intravenous (IV) recombinant tissue plasminogen activator and identify additional cases through review of the Food and Drug Administration Adverse Event Reporting System. A systematic review of Adverse Event Reporting System was performed for allergic adverse events occurring in conjunction with IV thrombolytics.
Identification of painless aortic dissection before thrombolytic treatment for acute ischemic stroke Chen-Hsiung Huang, Hui-Chun Huang, Kang-Hsu Lin, Wei-Kung Chen, Chon-Haw Tsai
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.027
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 11 2013
x Early detection of acute ischemic stroke secondary to painless aortic dissection is a challenge for emergency physicians, especially when under the stress of the 3-hour golden time window for thrombolytic therapy. We reported a 57-year-old man with acute right hemisphere watershed ischemic stroke caused by painless type A aortic dissection was diagnosed in time with computed tomographic (CT) angiography. The possible detrimental impact which may have been incurred by thrombolytic therapy was avoided.
Penetrating atherosclerotic aortic ulcer rupture causing a right hemothorax; a rare presentation of acute aortic syndrome Yoel Siegel
DOI: http://dx.doi.org/10.1016/j.ajem.2012.11.009
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 11 2013
x Acute aortic syndrome is a spectrum of diseases that have similar presentation and clinical background and include aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. Presented here is an 82-year-old woman with a medical history of diabetes, hypertension, nephrectomy, and chronic renal failure who complained of sudden abdominal pain radiating to epigastrium and back. At presentation, the patient was hemodynamically stable with a hemoglobin level of 10.2 and white blood cell count of 12.
Emergent CT findings of impending cardiac arrest: a report of 4 cases Sun Hwa Hong, Eun-Young Kang, Sik Huh, Hwan-Seok Yong, Yoon Kyung Kim, Ok Hee Woo, Tae-Seok Seo
DOI: http://dx.doi.org/10.1016/j.ajem.2012.10.028
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: January 24 2013
x We report CT findings of 4 patients who experienced sudden cardiac arrest. The CT features documented in our cases include dense opacification of the right heart and major systemic veins, venous layering of contrast material and blood, densely opacified parenchyma in the right hepatic lobe, decreased enhancement of the abdominal organ, dense pulmonary artery, contrast pooling in dependent lungs, and contrast stasis in pulmonary veins. Familiarity with characteristic CT findings of impending cardiac arrest is essential for immediate cardiopulmonary resuscitation.
Blunt hemopericardium detected by surgeon-performed sonography: Carrillo EH, Schirmer TP, Siderman MJ, et al. J Trauma 2000;48:971–974
DOI: http://dx.doi.org/10.1016/S0735-6757(01)80114-5
The American Journal of Emergency Medicine , Vol. 19 , Issue 5 ,
Published in issue: September 2001
The effect of different relieving methods on the outcome of out-of-hospital cardiac arrest patients with nontraumatic hemopericardium in the ED Ruei-Fang Wang, Chun-Chieh Chao, Tzong-Luen Wang, Kuo-Chih Chen, Chee-Fah Chong, Kuo-Hung Huang, Chien-Chih Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.010
The American Journal of Emergency Medicine , Vol. 26 , Issue 4 ,
Published in issue: May 2008
x This study aimed to assess the impact of different methods of draining nontraumatic hemopericardium on outcome from patients with out-of-hospital cardiac arrest (OHCA), identify independent predictors of return of spontaneous circulation (ROSC), and examine the ineffective rate of decompression based on subxiphoid pericardiotomy (SP) and percutaneous pericardial catheter drainage (PCD).
Posttraumatic tension pneumopericardium L Hernández-Luyando, E.González De Las Heras, J Calvo, C López, H De La Puente
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90186-8
The American Journal of Emergency Medicine , Vol. 15 , Issue 7 ,
Published in issue: November 1997
Clinical characteristics of aortic aneurysm and dissection as a cause of sudden death in outpatients Lauren C. Pierce, D. Mark Courtney
DOI: http://dx.doi.org/10.1016/j.ajem.2007.12.014
The American Journal of Emergency Medicine , Vol. 26 , Issue 9 ,
Published in issue: November 2008
x To describe characteristics of nonhospitalized patients experiencing sudden death from aortic causes and compare with characteristics of patients experiencing nontraumatic, unexpected, outpatient death from other causes.
Adolescent pneumopericardium and pneumomediastinum after motor vehicle crash and ejection Mark K. Markarian, David A. MacIntyre, Benjamin J. Cousins, Alexander Malone, John J. Fildes
DOI: http://dx.doi.org/10.1016/j.ajem.2007.08.008
The American Journal of Emergency Medicine , Vol. 26 , Issue 4 ,
Published in issue: May 2008
x A 15 year old male was an unrestrained passenger in a high speed motor vehicle crash followed by ejection. The patient was noted to have evidence of bilateral pneumothorax upon arrival in the Emergency Department. Bilateral chest tubes were placed under sterile conditions; however, the left pneumothorax remained, and a second left chest tube was placed. Repeat chest radiographs revealed extensive subcutaneous emphysema, pneumomediastinum, and pneumopericardium. Needle aspiration of the pericardium returned significant quantities of air, an immediate improvement in blood pressures followed.
When stroke is more than stroke Shing Ching, Soo Moi Ting
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.033
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: November 18 2015
x “Time is brain” captures the essence of treating acute stroke. The diagnosis must be confidently established, whereas contraindications for thrombolysis must be excluded in a timely manner. However, stroke mimics always pose a challenge. We describe a case of aortic dissection presenting as right middle cerebral artery syndrome who received intravenous thrombolysis complicated by aortic rupture with a fatal outcome. A Medline search shows that this is the first report of aortic rupture since the inception of thrombolysis for acute stroke.
Pericarditis as initial manifestation of proximal aortic dissection in young patients Suchdeep Raj Bains, Anita Kedia, Carlos A. Roldan
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.018
The American Journal of Emergency Medicine , Vol. 26 , Issue 3 ,
Published in issue: March 2008
x Pericarditis was the primary manifestation of aortic dissection in these 2 young men. Both patients had no phenotypic characteristics of Marfan or Ehlers-Danlos syndrome. These patients had pleuritic chest pain and characteristic electrocardiographic changes consistent with pericarditis. However, timely performed transthoracic echocardiograms revealed proximal aortic dissection with hemopericardium noted at surgery in both cases. Although the sensitivity of transthoracic echocardiogram for proximal aortic dissection is approximately 60%, certain findings can alert the physician to the possibility of aortic dissection.
Acute ischemic stroke, aortic dissection, and thrombolytic therapy Antonio Villa, Marina Molgora, Stefania Licari, Ezio Omboni
DOI: http://dx.doi.org/10.1053/ajem.2003.50070
The American Journal of Emergency Medicine , Vol. 21 , Issue 2 ,
Published in issue: March 2003
x —A 60-year-old woman was admitted to the ED 30 minutes after the onset of aphasia and the inability to move her right side. The patient's husband reported that she had had a transient loss of consciousness with uncontrolled movements of her right limbs. She had not experienced chest or back pain and she had a history of thyroidectomy for neoplasm (approximately 30 years before), obesity, and high blood pressure.
Hypersensitivity reaction after administration of rivaroxaban (Xarelto) Hampton M. Vernon, Andrew K. Nielsen, Edward C. O'Bryan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.021
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: December 17 2015
x Little has been documented regarding hypersensitivity reactions with rivaroxaban or other factor Xa inhibitors. We report the development of a hypersensitivity reaction to rivaroxaban in a 64-year-old African American male patient who presented to the emergency department and was subsequently evaluated in dermatology consultation and follow-up. This case highlights the vigilance required by health care workers in recognizing potential adverse effects of newer anticoagulation therapy and in making medication changes where necessary.
Ultrasound identification of traumatic pneumobilia Jennifer Huang, Michael B. Stone
DOI: http://dx.doi.org/10.1016/j.ajem.2009.05.007
The American Journal of Emergency Medicine , Vol. 28 , Issue 2 ,
Published in issue: February 2010
x A 65-year-old woman presented to the emergency department with low back pain after being hit by a truck at low speed. Although her abdominal examination showed benign results, an extended Focused Assessment With Sonography in Trauma ultrasound examination was performed and incidentally demonstrated evidence of pneumobilia. There were no additional intra-abdominal injuries noted. Subsequent computed tomography and magnetic resonance cholangiopancreatography confirmed these findings. The etiology of traumatic pneumobilia is discussed with a brief review of the literature on the subject.
Open-chest cardiac massage esophageal trauma Burton L. Herz
DOI: http://dx.doi.org/10.1016/0735-6757(87)90120-3
The American Journal of Emergency Medicine , Vol. 5 , Issue 2 ,
Published in issue: March 1987
