Venous lactate in predicting the need for intensive care unit and mortality among nonelderly sepsis patients with stable hemodynamic Khrongwong Musikatavorn, Saranpat Thepnimitra, Atthasit Komindr, Patima Puttaphaisan, Dhanadol Rojanasarntikul
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.010
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: April 9 2015
x Our study aims to investigate the role of initial venous lactate in predicting the probability of clinical deterioration and 30-day mortality in nonelderly sepsis patients with acute infections, without hemodynamic shock.
False positivity of monospot test in an immunocompetent elderly woman with acute cytomegalovirus infection Natanong Thamcharoen, Suthanya Sornprom, Nitipong Permpalung, Charles L. Hyman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.028
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 21 2015
x A 75-year-old woman presented with altered mental status, septic picture, and influenza-like symptoms. Initial investigations revealed atypical lymphocytosis, thrombocytopenia, elevated liver enzymes, and a positive monospot test result. Further investigation showed the Epstein-Barr virus viral capsid antibody IgM/IgG and Epstein-Barr virus DNA by polymerase chain reaction to be negative; however, interestingly her cytomegalovirus (CMV) IgM and IgG were positive, suggesting that her mononucleosis-like syndrome was due to acute CMV infection.
Prognostic factors of Streptococcus pneumoniae infection in adults Toru Hifumi, Seitaro Fujishima, Takayuki Abe, Nobuaki Kiriu, Junichi Inoue, Hiroshi Kato, Yuichi Koido, Kenya Kawakita, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.025
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 15 2015
x The mortality of severe sepsis has markedly decreased since the implementation of the Surviving Sepsis Campaign guidelines. The next logical step is to examine the necessity of individualized management guidelines for targeted therapy against specific bacteria. Streptococcus pneumoniae is the leading cause of community-acquired severe sepsis; however, little is known regarding the prognostic factors in adult patients with S pneumoniae sepsis. We aimed to identify prognostic factors in patients with S pneumoniae sepsis and to explore a subgroup of patients at high risk for death with detailed Sequential Organ Failure Assessment (SOFA) score analysis.
A comparison of routine, opt-out HIV screening with the expected yield from physician-directed HIV testing in the ED Matthew E. Prekker, Brandi M. Gary, Roma Patel, Travis Olives, Brian Driver, Stephen J. Dunlop, James R. Miner, Sarah Gordon, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.057
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: January 2 2015
x The Centers for Disease Control and Prevention recommends routine opt-out HIV screening in health care settings. Our goal was to evaluate the feasibility and yield of this strategy in the emergency department (ED) and to compare it to the expected yield of physician-directed testing.
Hepatitis C virus infection in the 1945-1965 birth cohort (baby boomers) in a large urban ED Waridibo E. Allison, William Chiang, Ada Rubin, Lauren O'Donnell, Miguel A. Saldivar, Michael Maurantonio, Jeffrey Dela Cruz, Svetlana Duvidovich, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.072
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: December 28 2015
x The US Preventive Services Task Force recommends one-time screening of the 1945-1965 birth cohort (baby boomers) for hepatitis C (HCV) infection. New York State legislation mandates screening of baby boomers for HCV in most patient care settings except the emergency department (ED). This cross-sectional study explores baby boomer knowledge of HCV, prevalence of HCV infection, and linkage to care from a large urban ED.
Subject Index
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00518-9
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published in issue: November 2012
Spontaneous septic arthritis in a patient without trauma, coinfection, or immunosuppression Peter L. Griffin, Gregory D. Griffin, Erin L. Simon
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.029
The American Journal of Emergency Medicine , Vol. 31 , Issue 11 ,
Published online: September 23 2013
x Septic arthritis is a rare infection, most often affecting the knee and hip [1]. Infections are often secondary to joint repair or replacement surgery, systemic infection, or intravenous recreational drug use [1,2]. Diabetes, rheumatoid arthritis, hepatic dysfunction, and immunosuppression are common risk factors [1,2]. Although septic arthritis can occur spontaneously, such occurrences are rare. We report a case of a previously healthy 54-year-old woman with no known risk factors presenting to a freestanding emergency department with 5 days of shoulder pain.
Factors associated with pneumonia in post–cardiac arrest patients receiving therapeutic hypothermia Jae-Hyug Woo, Yong Su Lim, Hyuk Jun Yang, Won Bin Park, Jin Seong Cho, Jin Joo Kim, Sung Youl Hyun, Gun Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.035
The American Journal of Emergency Medicine , Vol. 32 , Issue 2 ,
Published online: November 22 2013
x The aim of this study is to investigate risk factors associated with the development of pneumonia during the first 7 days of admission in survivors of cardiac arrest receiving therapeutic hypothermia.
Lower mortality in sepsis patients admitted through the ED vs direct admission Emilie S. Powell, Rahul K. Khare, D. Mark Courtney, Joe Feinglass
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.011
The American Journal of Emergency Medicine , Vol. 30 , Issue 3 ,
Published online: February 28 2011
x Early aggressive resuscitation in patients with severe sepsis decreases mortality but requires extensive time and resources. This study analyzes if patients with sepsis admitted through the emergency department (ED) have lower inpatient mortality than do patients admitted directly to the hospital.
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.
Extracorporeal membrane oxygenation for refractory, life-threatening, and herpes simplex virus 1–induced acute respiratory distress syndrome. Our experience and literature review Massimo Bonacchi, Gabriella Di Lascio, Guy Harmelin, Andrea Pasquini, Adriano Peris, Guido Sani
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.011
The American Journal of Emergency Medicine , Vol. 30 , Issue 6 ,
Published online: June 13 2011
x We report our first experience of treating an immunocompetent adult patient with acute respiratory distress syndrome (ARDS) due to type 1 herpes simplex (HSV1) pneumonitis, using extracorporeal membrane oxygenation (ECMO). Similar cases reported in literature are reviewed as well. The therapeutic options for this particular complication are discussed. Pneumonia caused by HSV1 is a rare finding in immunocompetent individuals; it occurs more often in immunosuppressed and ventilated patients. It is a severe illness; therefore, early diagnosis and initiation of treatment are imperative.
Urinalysis is an inadequate screen for rhabdomyolysis Sameir A. Alhadi, Rawnica Ruegner, Brandy Snowden, Gregory W. Hendey
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.045
The American Journal of Emergency Medicine , Vol. 32 , Issue 3 ,
Published online: November 6 2013
x Hematuria by urine dipstick with absent red blood cells (RBCs) on microscopy is indicative of rhabdomyolysis. We determined the sensitivity of this classic urinalysis (UA) finding in the diagnosis of rhabdomyolysis.
Severe dengue with massive pleural effusion requiring urgent intercostal chest tube drainage: a case report Afzal Azim, Jyoti N. Sahoo, Arvind K. Baronia, Mohan Gurjar, Ratendra K. Singh, Banani Poddar, Armin Ahmed, Piyush Garg, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.024
The American Journal of Emergency Medicine , Vol. 30 , Issue 2 ,
Published online: February 28 2011
x Dengue is one of the most common mosquito-borne infection affecting more than 50 million people worldwide annually. Most common causes for dengue-associated mortality are shock, bleeding, and respiratory failure.
Catamenial diabetic ketoacidosis—a diagnostic dilemma in ED Nayer Jamshed, Bharatraj Banavaliker, Praveen Aggarwal
DOI: http://dx.doi.org/10.1016/j.ajem.2012.08.038
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: October 29 2012
x Diabetic ketoacidosis (DKA) is a frequent medical emergency. The most common precipitating events are absolute or relative deficiency of insulin, infection, and noncompliance with medication. We describe a 32-year-old lady with type 1 diabetes mellitus in whom DKA was precipitated 1 to 2 days before her menstrual periods resulting in repeated admissions to hospital. Menstruation may precipitate DKA. Emergency physicians must keep this in mind if no other precipitating event can be found in a patient with DKA.
Evaluation of hidden HIV infections in an urban ED with a rapid HIV screening program Yu-Hsiang Hsieh, Gabor D. Kelen, Kaylin J. Beck, Chadd K. Kraus, Judy B. Shahan, Oliver B. Laeyendecker, Thomas C. Quinn, Richard E. Rothman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.002
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 8 2015
x To investigate the prevalence of undiagnosed HIV infections in an emergency department (ED) with an established screening program.
Combined intraaortic balloon counterpulsation and extracorporeal membrane oxygenation in 2 patients with fulminant myocarditis Weihang Hu, Changwen Liu, Lan Chen, Wei Hu, Jun Lu, Yin Zhu, Jianrong Wang, Bingwei Liu
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.043
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: October 29 2014
x Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an effective treatment for fulminant myocarditis (FM). However, VA-ECMO has a limited ability to facilitate left ventricular unloading. Therefore, increased afterload is still a significant concern, especially for those with diffuse myocardial damage and serious left ventricular dysfunction. To our knowledge, there is no report concerning the use of these therapies to treat FM in China. This study investigates the efficacy of using intraaortic balloon counterpulsation to facilitate left ventricular unloading in patients treated with VA-ECMO.
Author’s reply re: Sepsis mortality at Kaiser Permanente Northern California William Durston
DOI: http://dx.doi.org/10.1016/j.ajem.2014.07.023
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: August 1 2014
x I appreciate the opportunity to respond to Morehouse et al criticisms of my correspondence
[1] in which I presented data showing that the sharp reduction in sepsis mortality claimed by Kaiser Permanente (KP) after adoption of a regional early goal-directed therapy (EGDT) sepsis protocol
[2-5], modeled after the protocol published by Rivers et al
[6], was more likely to be due to a change in the definition of sepsis than to real improvements in sepsis care. I noted that adoption of the protocol was actually associated with an increase in the number of patients dying of sepsis per 1000 hospital admissions for all causes, suggesting possible harm from some elements of the protocol.
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).
Synthetic cannabinoid hyperemesis resulting in rhabdomyolysis and acute renal failure Jacqueline R. Argamany, Kelly R. Reveles, Bryson Duhon
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.051
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: September 7 2015
x Synthetic cannabinoid usage has increased in the past decade. Concurrently, emergency management of associated adverse effects due to synthetic cannabinoid usage has also risen. Reported toxicities include psychosis, seizures, cardiotoxicity, acute kidney injury, and death. While cannabis was first described as a cause of acute hyperemesis in 2004, a more recent case series also describes the association between cannabinoid hyperemesis and risk of acute renal failure. Synthetic cannabinoids have also been reported to cause acute hyperemesis and acute renal failure; however, the risk of rhabdomyolysis-induced renal failure has yet to be elucidated.
Emergency management of community-acquired bacterial pneumonia: what is new since the 2007 Infectious Diseases Society of America/American Thoracic Society guidelines Gregory J. Moran, Richard E. Rothman, Gregory A. Volturo
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.002
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: February 4 2013
x Community-acquired pneumonia (CAP) is a major health problem in the United States and is associated with substantial morbidity, mortality, and health care costs. Patients with CAP commonly present to emergency departments where physicians must make critical decisions regarding diagnosis and management of pneumonia in a timely fashion, with emphasis on efficient and cost-effective diagnostic choices, consideration of emerging antimicrobial resistance, timely initiation of antibiotics, and appropriate site-of-care decisions.
