Clinical profile of injection drug users presenting to the ED Daniel R. Kievlan, Meri Gukasyan, Julie Gesch, Robert M. Rodriguez
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.020
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: February 19 2015
x Injection drug users (IDUs) commonly use the emergency department (ED) as their primary health care access point.
Procalcitonin and interleukin 6 for predicting blood culture positivity in sepsis Mohammad Naffaa, Badira F. Makhoul, Amjad Tobia, Marielle Kaplan, Doron Aronson, Zaher S. Azzam, Walid Saliba
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.058
The American Journal of Emergency Medicine , Vol. 32 , Issue 5 ,
Published online: January 6 2014
x Procalcitonin and interleukin 6 (IL-6) are well-known predictors of blood culture positivity in patients with sepsis. However, the association of procalcitonin and IL-6 with blood culture positivity was assessed separately in previous studies. This study aims to examine and compare the performance of procalcitonin and IL-6, measured concomitantly, in predicting blood culture positivity in patients with sepsis.
Seeks, finds, threats: Lyme disease! Xavier Muschart, Dominique Blommaert
DOI: http://dx.doi.org/10.1016/j.ajem.2014.07.019
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: July 30 2014
x Lyme borreliosis is a disease commonly found in humans. Here we report the case of a young, healthy girl presenting with symptomatic first- and second-degree atrioventricular blocks secondary to cardiac myocarditis. The disappearance of the conduction anomaly after antibiotic treatment confirmed Lyme disease before the results from the serology. Therefore, when a healthy, young person suddenly presents with an atrioventricular conduction block, physicians should consider a diagnosis of Lyme disease.
High rates of quinolone resistance among urinary tract infections in the ED Thana Khawcharoenporn, Shawn Vasoo, Edward Ward, Kamaljit Singh
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.030
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: November 15 2010
x The objectives of this study are to examine antibiotic resistance rates and to determine appropriate empiric oral antibiotic for patients with urinary tract infections (UTIs) evaluated and discharged from the ED.
A fish-stunning wound infection with acute cardiac injury Khee-Siang Chan, Kuo-Chen Cheng, Mei-Feng Lee, Wen-Liang Yu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.040
The American Journal of Emergency Medicine , Vol. 32 , Issue 3 ,
Published online: October 31 2013
x Vibrio vulnificus typically causes septicemia and necrotic wound infection. Among V vulnificus– related complications, acute nonthrombotic myocardial damage has not been reported. The most effective antibiotic treatment of V vulnificus infection includes combination of a third-generation cephalosporin and a tetracycline or its analogue. However, recommendations of a fourth-generation cephalosporin-based regimen for treating the disease are not established. A 67-year-old diabetic man acquired V vulnificus infection via a fish-stunning wound on the right foot.
Interleukin-6 at discharge predicts all-cause mortality in patients with sepsis Mohammad Naffaa, Badira F. Makhoul, Amjad Tobia, Marielle Kaplan, Doron Aronson, Walid Saliba, Zaher S. Azzam
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.011
The American Journal of Emergency Medicine , Vol. 31 , Issue 9 ,
Published online: July 29 2013
x Interleukin-6 (IL-6) is a proinflammatory cytokine that plays a central role in the pathogenesis of sepsis. We aim to investigate the association between IL-6 and all-cause mortality in patients with sepsis.
Rhabdomyolysis caused by peripheral T-cell lymphoma in skeletal muscle Koichi Sasaki, Masaya Yamato, Keiko Yasuda, Hiromi Rakugi, Yoshitaka Isaka
DOI: http://dx.doi.org/10.1016/j.ajem.2013.05.034
The American Journal of Emergency Medicine , Vol. 31 , Issue 10 ,
Published online: June 28 2013
x We report a rare case of rhabdomyolysis caused by peripheral T-cell lymphoma (PTCL) in skeletal muscle. A 62-year-old man was admitted with complaints of sudden muscle weakness. Laboratory abnormalities were identified including markedly elevated creatinine-phosphokinase, peaking at 62,640 IU/L and serum creatinine (Cr) at 5.0 mg/dL. Computed tomography scans revealed tumorous swelling of the right psoas major muscle and the obturator internus muscles. Consequently, he was diagnosed with acute renal failure caused by rhabdomyolysis and was treated with hydration and continuous hemodiafiltration, which resulted in significant improvement in renal function (Cr 1.79 mg/dL).
The critical care literature 2010 Michael E. Winters, Tsuyoshi Mitarai, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2011.08.014
The American Journal of Emergency Medicine , Vol. 30 , Issue 7 ,
Published online: November 21 2011
x Jones AE, Shapiro NI, Trzeciak S, Arnold RC, Claremont HA, Kline JA. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy. JAMA 2010;303(8):739-746.
Clinical outcomes of ED patients with bandemia Eileen Shi, Gary M. Vilke, Christopher J. Coyne, Leslie C. Oyama, Edward M. Castillo
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.035
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: March 19 2015
x Although an elevated white blood cell count is a widely utilized measure for evidence of infection and an important criterion for evaluation of systemic inflammatory response syndrome, its component band count occupies a more contested position within clinical emergency medicine. Recent studies indicate that bandemia is highly predictive of a serious infection, suggesting that clinicians who do not appreciate the value of band counts may delay diagnosis or overlook severe infections.
An unusual cause of rhabdomyolysis in emergency setting: challenges of diagnosis Mikhail Petrov, Yan Yatsynovich, Catalina Lionte
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.041
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: June 2 2014
x Rhabdomyolysis is a rare phenomenon that may be challenging to recognize in an emergency setting. Drugs are one of the common causes. Trimethoprim-sulfamethoxazole is a commonly used antibiotic effective in the treatment of upper and lower respiratory tract infections as well as renal, urinary, and gastrointestinal tract infections. It has variable side effects, ranging from mild symptoms of fatigue and insomnia to a potentially life-threatening Steven-Johnson syndrome and renal failure. Rhabdomyolysis is a rare complication of therapy with this drug and is commonly seen in immunocompromised patients or those with an allogenic stem cell transplant.
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.
Surviving a crisis of HIV-associated immune reconstitution syndrome Yu-Tzu Tsao, Shih-Wei Lee, Jin-Chyr Hsu, Feng-Ming Ho, Wei-Jie Wang
DOI: http://dx.doi.org/10.1016/j.ajem.2011.09.003
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: October 28 2011
x The management of life-threatening complications in HIV-associated immune reconstitution syndrome is becoming a challenging scenario in emergency practice, especially in the era of highly active antiretroviral therapy paralleled by increased worldwide incidence of HIV infection. Here, we described a 37-year-old woman with acute hypoxic respiratory failure, acute renal failure, and hypercalcemic crisis as the presenting features of HIV-associated immune reconstitution syndrome. In this patient, the restored granulomatous host response toward isolated pulmonary Mycobacterium avium complex infection led to a near-fatal catastrophe.
Practice patterns and management strategies for purulent skin and soft-tissue infections in an urban academic ED Larissa May, Katherine Harter, Kabir Yadav, Ryan Strauss, Jameel Abualenain, Amy Keim, Gillian Schmitz
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.033
The American Journal of Emergency Medicine , Vol. 30 , Issue 2 ,
Published online: January 31 2011
x Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is the most common cause of purulent skin and soft-tissue infections (SSTIs) in the Unites States. Little is known regarding health care provider management strategies for abscesses in the emergency department (ED). Understanding variability in practice patterns could be an important step in implementing evidence-based guidelines.
Timing and appropriateness of initial antibiotic therapy in newly presenting septic patients Antonia L. Vilella, Charles F. Seifert
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.008
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: October 21 2013
x To determine the effectiveness of antibiotic regimens and time to antibiotics in septic patients admitted to an intensive care unit from the emergency department.
Response to “Protective effect of tetanus antibodies” Kristan E. Vollman, Nicole M. Acquisto, Ryan P. Bodkin
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.049
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: June 4 2014
x We thank Dr Gozdas for opening discussion regarding our recent case report of tetanus infection despite a protective tetanus antibody level [1]. We agree that the increased level of tetanus antibody may be somewhat attributed to the active tetanus infection. However, the accepted level of protective tetanus antibody must also be discussed.
Impact of an antimicrobial stewardship intervention on urinary tract infection treatment in the ED Kelly M. Percival, Kristine M. Valenti, Stacy E. Schmittling, Brandi D. Strader, Rebecka R. Lopez, Scott J. Bergman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.067
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: May 1 2015
x The study objective is to assess changes in treatment of uncomplicated urinary tract infections (UTIs) after implementation of recommendations based on national guidelines and local resistance rates.
End-tidal carbon dioxide as a goal of early sepsis therapy Faheem W. Guirgis, Deborah J. Williams, Colleen J. Kalynych, Mary E. Hardy, Alan E. Jones, Sunita Dodani, Robert L. Wears
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.036
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: August 20 2014
x To determine the use of end-tidal carbon dioxide (etco 2 ) as an end point of sepsis resuscitation.
Mortality in Emergency Department Sepsis score as a prognostic indicator in patients with pyogenic liver abscess Sheng-Hung Kuo, Yuan-Ti Lee, Chi-Rong Li, Chien-Jen Tseng, Wai-Nang Chao, Po-Hui Wang, Ruey-Hong Wong, Chun-Chieh Chen, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.045
The American Journal of Emergency Medicine , Vol. 31 , Issue 6 ,
Published online: April 26 2013
x The purpose of this study was to explore the predictor index of mortality in patients with pyogenic liver abscess (PLA).
Hazards with ordering troponin in patients with low pretest probability of acute coronary syndrome Soheila Talebi, Rosa Maria Ferra, Sara Tedla, Alicia DeRobertis, Adrian C. Garofoli, Ferdinand Visco, Gerald Pekler, Getaw Worku Hassen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.006
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: June 8 2015
x In clinical practice, we progressively rely on biomarkers, without estimating the pretest probability. There is not enough support for the use of cardiac troponin (cTn) I in the management of noncardiac patients. We studied the rate at which this test was ordered, the prevalence of detection of a positive result in noncardiac patients, and the impact of this incidental finding on clinical management.
Diabetic ketoacidosis and infection: Leukocyte count and differential as early predictors of serious infection Corey M Slovis, Virginia G.C Mork, Randall J Slovis, Raymond P Bain
DOI: http://dx.doi.org/10.1016/0735-6757(87)90280-4
The American Journal of Emergency Medicine , Vol. 5 , Issue 1 ,
Published in issue: January 1987
x The records of 153 patients who presented to an emergency department with diabetic ketoacidosis were reviewed to determine whether any admission evaluation laboratory data could serve as a predictor of occult or coexisting infection. Ten patients with admission radiographs already demonstrating active infection (pneumonia or tuberculosis) and two patients with wet gangrene of an extremity were not included in subsequent statistical analysis, as their infections were diagnosed on initial evaluation.
