Elderly fall patients triaged to the trauma bay: age, injury patterns, and mortality risk Daniel Evans, Jonathan Pester, Luis Vera, Donald Jeanmonod, Rebecca Jeanmonod
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.044
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: July 28 2015
x Falls in the elderly are a significant cause of morbidity and mortality. We sought to better categorize this patient population and describe factors contributing to their falls.
Bleeding sites in elderly trauma patients who required massive transfusion: a comparison with younger patients Takao Ohmori, Taisuke Kitamura, Kimiaki Tanaka, Yuichi Saisaka, Junko Ishihara, Hirokazu Onishi, Tsuyoshi Nojima, Kotaro Yamamoto, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.047
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 2 2015
x Among elderly patients with severe trauma, the sites of massive hemorrhage and their clinical characteristics are not well understood. Therefore, we investigated the sites of massive hemorrhage in patients with severe trauma, and compared the results for younger and elderly patients.
Respiratory depression in the intoxicated trauma patient: are opioids to blame? Eleni Shenk, Cassie A. Barton, Nathan D. Mah, Ran Ran, Robert G. Hendrickson, Jennifer Watters
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.053
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: November 3 2015
x Providing effective pain management to acutely intoxicated trauma patients represents a challenge of balancing appropriate pain management with the risk of potential respiratory depression from opioid administration. The objective of this study was to quantify the incidence of respiratory depression in trauma patients acutely intoxicated with ethanol who received opioids as compared with those who did not and identify potential risk factors for respiratory depression in this population. Retrospective medical record review was conducted for subjects identified via the trauma registry who were admitted as a trauma activation and had a detectable serum ethanol level upon admission.
Myocardial injury through serum troponin I and echocardiography in anaphylaxis: Takotsubo cardiomyopathy and the Kounis hypersensitivity–associated acute coronary syndrome Nicholas G. Kounis, Andreas Mazarakis, Constantinos Bardousis
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.019
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 17 2015
x Measuring of high-sensitivity cardiac troponin levels is essential in the diagnosis of acute myocardial infarction. Acute myocardial infarction is defined as myocardial cell death due to prolonged myocardial ischemia. Indeed, in the third universal definition of myocardial infarction [1], detection of rise and/or fall of cardiac troponin above the 99th percentile of the upper reference limit together with ischemic symptoms, electrocardiographic changes of new ischemia, development of pathologic Q-waves in the electrocardiogram, or imaging evidence of new loss of viable myocardium or new regional wall motion abnormality is essential for defining myocardial infarction.
Zipline-related injuries treated in US EDs, 1997-2012 Rachael M. Billock, Jonathan J. Anderegg, Tracy J. Mehan, Thiphalak Chounthirath, Gary A. Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.022
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: August 14 2015
x To investigate the epidemiology of zipline-related injuries in the United States.
Novel technique to diagnose parotid duct injuries at the bedside using fluorescein David T. Montag, Ashok R. Jethwa, Rick M. Odland
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.017
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 15 2015
x Deep penetrating facial soft tissue trauma can potentially involve the parotid duct. This injury requires a high degree of suspicion as it is not readily evident on physical examination, although buccal branch injury may accompany it. Unrecognized parotid duct injury could lead to sialocele, salivary fistula, parotitis, wound dehiscence, or abscess [1]. There are multiple methods of detecting parotid duct injury at the bedside. The most frequently utilized method is cannulation of the papilla with identification of the cannulating object in the wound [2].
Inpatient admissions from the ED for adults with injuries: the role of clinical and nonclinical factors William D. Spector, Rhona Limcangco, Ryan L. Mutter, Jesse M. Pines, Pamela Owens
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.045
The American Journal of Emergency Medicine , Vol. 33 , Issue 6 ,
Published online: March 6 2015
x Inpatient hospital costs represent nearly a third of heath care spending. The proportion of inpatients visits that originate in the emergency department (ED) has been growing, approaching half of all inpatient admissions. Injury is the most common reason for adult ED visits, representing nearly one-quarter of all ED visits.
Characteristics of trauma patients overimmobilized by prehospital providers Elizabeth Paterek, Derek L. Isenberg, Ellie Salinski, Herbert Schiffer, Bruce Nisbet
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.034
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: October 25 2014
x Previous studies have shown that prehospital providers, both emergency medical technicians (EMTs) and paramedics, can accurately apply selective spinal immobilization (SSI) to trauma patients [1–9]. However, no studies have examined why emergency medical services (EMS) providers overimmobilize trauma patients. Our study aimed to examine the reasons why prehospital providers in our system overimmobilized trauma patients.
Is arterial base deficit still a useful prognostic marker in trauma? A systematic review I. Ibrahim, W.P. Chor, K.M. Chue, C.S. Tan, H.L. Tan, F.J. Siddiqui, M. Hartman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.012
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 14 2015
x Arterial base deficit (BD) has been widely used in trauma patients since 1960. However, trauma management has also evolved significantly in the last 2 decades. The first objective of this study was to systematically review the literature on the relationship between arterial BD as a prognostic marker for trauma outcomes (mortality, significant injuries, and major complications) in the acute setting. The second objective was to evaluate arterial BD as a prognosis marker, specifically, in the elderly and in patients with positive blood alcohol levels.
Fiberoptic intubation or video tube for trauma patient intubation—which method to choose? Randomized crossover manikin trial Lukasz Szarpak, Zenon Truszewski, Marcin Madziała, Lukasz Czyzewski
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.030
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: January 27 2016
x We read with interest the article of Bilge et al [1] concerning on endotracheal intubation (ETI) with tactical fiberoptic imaging systems. Under the conditions of cervical spine suspected damage and to limit the movements of the spine, direct laryngoscopy using laryngoscope with Macintosh or Miller blade may be difficult [1–3]. In such cases, we should use alternative methods of ETI, including videolaryngoscopes or fiberoptic intubation (FOB).
Pediatric craniomaxillofacial injuries after road traffic crashes: characteristics of injuries and protective equipment use Siti Salmiah Mohd Yunus, Wei Cheong Ngeow, Roszalina Ramli
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.009
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: May 15 2015
x A cross-sectional study to determine the pattern of craniomaxillofacial (CMF) injuries among children involved in road traffic crashes was performed. The association of protective equipment use with the CMF injuries was evaluated.
Softball injuries treated in US EDs, 1994 to 2010 John C. Birchak, Lynne M. Rochette, Gary A. Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.039
The American Journal of Emergency Medicine , Vol. 31 , Issue 6 ,
Published online: April 19 2013
x Softball is a popular participant sport in the United States. This study investigated the epidemiology of softball injuries with comparisons between children and adults.
Swimming injuries treated in US EDs: 1990 to 2008 Katherine A. Pollard, Bethany L. Gottesman, Lynne M. Rochette, Gary A. Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.028
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: March 13 2013
x Swimming is one of the most popular recreational activities in the United States. The objective of this study was to investigate the epidemiology of the complete spectrum of injuries associated with swimming and swimming pools treated in US hospital emergency departments.
A case of severe rhabdomyolysis with minor trauma: Is sickle cell trait to blame? Paul Krieger, Nathan Zapolsky, Stephen J. Lowery
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.035
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: June 18 2015
x A 37-year-old man with a past medical history of sickle cell trait (SCT) presented to our emergency department (ED) complaining of upper abdominal pain and bilateral shoulder pain, following an assault the prior evening. He reported being pinned on his back with knees on his chest, and repeated punching to his stomach. Physical exam revealed mild tachycardia and diffuse tenderness to palpation of the abdomen, without guarding, rebound, induration, or external signs of trauma. Bilaterally his shoulder exam revealed limited range of motion secondary to pain and tenderness over the trapezius muscles.
Evaluation of myocardial injury through serum troponin I and echocardiography in anaphylaxis Yong Sung Cha, Hyun Kim, Min Hyuk Bang, Oh Hyun Kim, Hyung Il Kim, KyoungChul Cha, Kang Hyun Lee, Sung Oh Hwang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.038
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 2 2015
x Anaphylaxis is an acute, lethal, multisystem syndrome that results from the sudden release of mast cell- and basophil-derived mediators. Although anaphylaxis can cause cardiac complications, the incidence of myocardial injury using troponin I (TnI) has not been characterized. In addition, patterns of cardiomyopathy have not been evaluated in patients with elevated TnI. Therefore, we studied the occurrence and patterns of myocardial injury with TnI and echocardiography in anaphylaxis.
Analysis of risk classification for massive transfusion in severe trauma using the gray zone approach Takayuki Ogura, Minoru Nakano, Yoshimitsu Izawa, Mitsunobu Nakamura, Kenji Fujizuka, Alan T. Lefor
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.007
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: May 15 2015
x The Traumatic Bleeding Severity Score (TBSS) was developed to predict the need for massive transfusion (MT). The aim of this study is evaluation of clinical thresholds for activation of a MT protocol using the gray zone approach based on TBSS.
Injury and illness sustained by human competitors in the 2010 Iditarod Sled Dog Race James W. Gallea, George L. Higgins III, Carl A. Germann, Tania D. Strout
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.018
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: February 26 2014
x Alaska's 1049-mile Iditarod Trail Sled Dog Race is the world's longest sled dog race and the flagship event in the sport of sled dog racing. Race conditions are typically harsh. Physicians are not officially enlisted to care for human competitors. Instead, medical needs are met through an informal system of volunteers, local health care providers, and a fleet of bush planes. The goals of this study were to identify the types of human injury and illness experienced and the methods by which these conditions are treated.
Role of interventional radiology in trauma care: retrospective study from single trauma center experience Nam Yeol Yim, Yong Tae Kim, Hyoung Ook Kim, Jae Kyu Kim, Yang Jun Kang, Yun Chul Park, Chan Yong Park
DOI: http://dx.doi.org/10.1016/j.ajem.2014.07.037
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: August 7 2014
x Although interventional management is now regarded as essential in trauma care, the effect on clinical result remains uncertain. We conducted this retrospective study to figure out the role of interventional management in trauma care.
Stove-related injuries treated in EDs in the United States, 1990-2010 Anita Sivam, Lynne M. Rochette, Gary A. Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.034
The American Journal of Emergency Medicine , Vol. 31 , Issue 11 ,
Published online: September 16 2013
x Household stoves are a common source of injury in the United States.
Microwave oven-related injuries treated in hospital EDs in the United States, 1990 to 2010 Dana F. Thambiraj, Thiphalak Chounthirath, Gary A. Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.023
The American Journal of Emergency Medicine , Vol. 31 , Issue 6 ,
Published online: April 22 2013
x The widespread availability of microwave ovens has sparked interest in injuries resulting from their use.
Assessment of the electronic medical record in documenting trauma resuscitations in the pediatric ED Laura E. McLean, Sean Elwell, Andrew DePiero
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.020
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: January 20 2015
x Utilization of electronic medical records (EMRs) has resulted in a corresponding decline in the use of paper records in many patient care areas. Evidence suggests that EMRs improve patient safety, increase information accessibility, increase workflow efficiency, and minimize documentation time
[1]. However, despite the advantages, very few hospitals have implemented the EMR during pediatric trauma resuscitations
[2,3].
The Effect of Ethanol on Lactate and Base Deficit as Predictors of Morbidity and Mortality in Trauma Mark L. Gustafson, Steve Hollosi, Julton Tomanguillo Chumbe, Damayanti Samanta, Asmita Modak, Audis Bethea
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.030
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: January 22 2015
x The objective of this study was to assess the predictive value of lactate and base deficit in determining outcomes in trauma patients who are positive for ethanol.
Hot asphalt burns: a review of injuries and management options George M. Bosse, Shernaz A. Wadia, Pradeep Padmanabhan
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.007
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: January 21 2014
x Hot asphalt burns to human tissue can increase the likelihood of infection and potential conversion of partial thickness to full-thickness injuries. Successful intervention for hot asphalt burns requires immediate and effective cooling of the asphalt on the tissue followed by subsequent gradual removal of the cooled asphalt.
Do-not-resuscitate orders among trauma patients Catherine A. Marco, Scarlett Michael, Jamie Bleyer, Alina Post
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.026
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: August 17 2015
x Do-not-resuscitate (DNR) orders are an important means to communicate end-of-life wishes. Previous studies have demonstrated variable prevalence of DNR orders among hospitalized trauma patients.
Epidemiology of injuries to wildland firefighters Carla Britton, Charles F. Lynch, Marizen Ramirez, James Torner, Christopher Buresh, Corinne Peek-Asa
DOI: http://dx.doi.org/10.1016/j.ajem.2012.08.032
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: November 19 2012
x Wildland fires have significant ecologic and economic impact in the United States. Despite the number of firefighters involved in controlling them, little is known about the injuries that they sustain. We hypothesized that the mechanism of injury would predict injury characteristics and severity of fire-related injuries.
A proposed novel algorithmic approach to the evaluation of the acutely injured trauma patient: should advanced trauma life support incorporate biomarkers? Nicholas D. Caputo, Marc Kanter
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.048
The American Journal of Emergency Medicine , Vol. 32 , Issue 3 ,
Published online: December 9 2013
x The “Golden Hour” is a concept developed by Cowley and taught in advanced trauma life support (ATLS), which states that traumatically injured patients who receive resuscitation within the first hour of injury will have increased chance of survivability [1]. Patients with trauma generally died of injuries because of hemorrhagic shock leading to sepsis, multiorgans dysfunction syndrome, or other physiologic abnormalities that are not correctable in the late stages. To help determine the presence of major injury, ATLS teaches a classification of hemorrhagic shock that is heavily dependent on vital signs and other clinical signs (see Table 1).
Cost savings associated with transfer of trauma patients within an accountable care organization Brian C. Geyer, David A. Peak, George C. Velmahos, Jonathan D. Gates, Yvonne Michaud, Laurie Petrovick, Jarone Lee, Brian J. Yun, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.067
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 4 2015
x The Patient Protection and Affordable Care Act supports the establishment of accountable care organizations (ACOs) as care delivery models designed to save costs. The potential for these cost savings has been demonstrated in the primary care and inpatient populations, but not for patients with emergency conditions or traumatic injuries.
Detection of acute myocardial ischemic injury by gender using a novel cardiac electrical biomarker David M. Schreck, Robert D. Fishberg
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.029
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: December 20 2014
x The objective of this study us to stratify by gender a new cardiac electrical biomarker (CEB) diagnostic accuracy for detection of acute myocardial ischemic injury (AMII).
Communication with patients with trauma who were in spinal immobilization Catherine A. Marco, Steven Nelson, Matthew Jolly, Stephanie Ritter, Andrew Rudawsky
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.041
The American Journal of Emergency Medicine , Vol. 32 , Issue 2 ,
Published online: November 27 2013
x Motor vehicle accidents comprise approximately 1.3% of emergency department (ED) visits annually in the United States [1]. A previous study demonstrated that successful communication with patients regarding reasons for hospital admission was correlated with increased patient satisfaction [2]. Emergency department patients have reported a perceived need for improved communication with health care providers [3]. Another recent study demonstrated that the satisfaction of patients with trauma is improved when health care providers provide both instrumental and attentive care [4].
The traditional vs “1:1:1” approach debate on massive transfusion in trauma should not be treated as a dichotomy Anthony M.-H. Ho, John B. Holcomb, Calvin S.H. Ng, Jorge E. Zamora, Manoj K. Karmakar, Peter W. Dion
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.065
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: June 26 2015
x Traditional transfusion guidelines suggest that fresh frozen plasma (FFP) should be given based on laboratory or clinical evidence of coagulopathy or acute loss of 1 blood volume. This approach tends to result in a significant lag time between the first units of erythrocytes and FFP in trauma requiring massive transfusion. In severe trauma, observational studies have found an association between increased survival and aggressive use of FFP and platelets such that FFP:platelet:erythrocyte ratio approaches 1:1:1 to 2 from the first units of erythrocytes given.
Chest tube insertion direction: is it always necessary to insert a chest tube posteriorly in primary trauma care? Shokei Matsumoto, Kazuhiko Sekine, Tomohiro Funabiki, Motoyasu Yamazaki, Tomohiko Orita, Masayuki Shimizu, Kei Hayashida, Masanobu Kishikawa, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.042
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: October 29 2014
x The advanced trauma life support guidelines suggest that, in primary care, the chest tube should be placed posteriorly along the inside of the chest wall. A chest tube located in the posterior pleural cavity is of use in monitoring the volume of hemothoraces. However, posterior chest tubes have a tendency to act as nonfunctional drains for the evacuation of pneumothoraces, and additional chest tube may be required. Thus, it is not always necessary to insert chest tubes posteriorly. The purpose of this study was to determine whether posterior chest tubes are unnecessary in trauma care.
Lumbar Morel-Lavallee lesion after trauma: a report of 2 cases Ayla Buyukkaya, Harun Güneş, Mehmet Ali Özel, Ramazan Buyukkaya, Ömer Onbas, Ayhan Sarıtas
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.043
The American Journal of Emergency Medicine , Vol. 33 , Issue 8 ,
Published online: February 2 2015
x Morel-Lavallee syndrome is a posttraumatic soft tissue injury in which the subcutaneous tissue is broken off from the underlying fascia, creating a cavity filled with hematoma and liquefied fat. It commonly occurs over the greater trochanter and, rarely, may also occur in the lumbal region. Morel-Lavallee syndrome can be often diagnosed late because of ommitted diagnosis in emergency services. The emergency physician and radiologist must keep this syndrome in mind because early diagnosis can enable conservative management, whereas delayed diagnosis may lead to surgical exploration.
Angiographic embolization in chest wall hematoma due to handlebar injury—a rare case report Po-Chin Yu, Tzu-Hsien Yang, Abhishek Katakwar, Yu-Jen Cheng, Po-Chih Chang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.054
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: March 6 2015
x We report a woman presenting with an expanding chest wall hematoma after handlebar injury. Computed tomography identified a right anterior-upper chest wall hematoma with extension to right shoulder and upper extremity. Moreover, an enhancing spot within the hematoma was identified, favoring a pseudoaneurysm. The right axillary arterial angiography revealed a pseudoaneurysm at the branch of right anterior humeral circumflex artery. Patient underwent angiographic embolization with subsequent surgical drainage and made a full recovery.
Right coronary artery dissection and aneurysm presented as acute inferior myocardial infarction from an automobile airbag trauma Chunlai Zeng, Wuming Hu, Ning Zhu, Xuyong Zhao, Jian Xu, Shiyong Ye, Yijia Xiang, Linchun Lv
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.074
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 29 2015
x Coronary artery dissection and aneurysm culminating in acute myocardial infarction are rare after blunt chest trauma. We are reporting a case of a previously healthy 52-year-old man who presented with right inferior lobe contusion, pleural effusion, right interlobar fissure effusion, bone fracture of right fourth rib, and acute inferior wall myocardial infarction and who experienced blunt trauma in his right chest wall by an airbag deployment in a car accident. Coronary angiography showed an aneurysm in the middle of right coronary artery with 70% afferent narrowing just distal to the aneurysm with no visible atherosclerotic lesion.
Does the Venner A.P. Advance video laryngoscope improve success of first intubation attempt of trauma patient? Zenon Truszewski, Łukasz Bogdanski, Andrzej Kurowski, Łukasz Czyzewski, Wieslawa Stepniewska, Iwona Stawicka, Dariusz Timler, Piotr Zasko, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.058
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: November 3 2015
x Out-of-hospital endotracheal intubation (ETI) is still considered as a criterion standard for emergency airway management in severely injured trauma patients in the prehospital setting; moreover, effective ETI is the cornerstone of major trauma management [1]. Endotracheal intubation becomes particularly important in the case of patients with respiratory distress or depressed mentation, or for whom there is concern about protecting the airway [1–3]. During standard nontraumatic patient ETI, we can performed “sniffing position,” which is used for head extension to obtain a line of sight between the intubator's eye and the patient's glottis [4].
Are young physicians prepared to perform focused assessment with sonography in trauma examination? Zenon Truszewski, Lukasz Szarpak, Andrzej Kurowski, Piotr Adamczyk, Silvia Samarin, Lukasz Czyzewski
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.045
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 30 2015
x In a recent article, O'Dochartaigh and Douma [1] present a systematic review of prehospital ultrasound of the abdomen and thorax, which changes trauma patient management. This article prompted us to conduct a study on young physicians preparing for performing focused assessment with sonography for trauma (FAST).
Alcohol and trauma—in every age group Terry Kowalenko, Bradford Burgess, Susanna M. Szpunar, Charlene B. Irvin-Babcock
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.032
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 4 2013
x The purpose was to determine the proportion of alcohol-positive (AlcPos) trauma patients in different age groups and any association with mortality using the National Trauma Data Bank.
Epidemiology of strain/sprain injuries among cheerleaders in the United States Brenda J. Shields, Gary A. Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2010.05.014
The American Journal of Emergency Medicine , Vol. 29 , Issue 9 ,
Published online: August 16 2010
x The aim of this study is to describe the epidemiology of cheerleading-related strain/sprain injuries by type of cheerleading team and type of event.
Delayed diagnosis of injuries in pediatric trauma: the role of radiographic ordering practices Emily L. Willner, Hollie A. Jackson, Alan L. Nager
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.033
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: February 7 2011
x We sought to describe the use of radiographic studies in pediatric major trauma patients and determine the extent to which a selective, clinically guided use of imaging contributes to delayed diagnosis of injury (DDI).
Efficacy and safety of nebulized morphine given at 2 different doses compared to IV titrated morphine in trauma pain Mohamed Habib Grissa, Hamdi Boubaker, Asma Zorgati, Kaouthar Beltaïef, Wafa Zhani, Mohamed Amine Msolli, Nasri Bzeouich, Wahid Bouida, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.014
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: June 13 2015
x Our aim was to compare the efficacy and safety of intravenous (IV) titrated morphine with nebulized morphine given at 2 different doses in severe traumatic pain.
Can physician and patient gestalt lead to a shared decision to reduce unnecessary radiography in extremity trauma? Michael Mouw, Tatiana Balatiouk-Lance, Lawrence H. Brown
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.022
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: December 1 2015
x Minor musculoskeletal injury is one of the most common presentations to the emergency department (ED). The majority (85%-90%) of those presenting for minor injury do not have a fracture [1], and presumably, many others never seek medical attention. The need to image patients with obvious signs of fracture is never in question—but it is much less clear who needs imaging when those signs are absent. This leads to considerable practice variability1 and, in the United States, is complicated further by the need to address patient satisfaction.
Can physician and patient gestalt lead to a shared decision to reduce unnecessary radiography in extremity trauma? Michael Mouw, Tatiana Balatiouk-Lance, Lawrence H. Brown
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.027
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: August 18 2015
x Minor musculoskeletal injury is one of the most common presentations to the emergency department (ED). The majority (85%-90%) of those presenting for minor injury do not have a fracture [1], and presumably, many others never seek medical attention. The need to image patients with obvious signs of fracture is never in question—but it is much less clear who needs imaging when those signs are absent. This leads to considerable practice variability1 and, in the United States, is complicated further by the need to address patient satisfaction.
Age effects on case fatality rates of injury patients by mechanism Yong Joo Park, Young Sun Ro, Sang Do Shin, Kyoung Jun Song, Seung Chul Lee, Yu Jin Kim, Joo Yeong Kim, Ki Jeong Hong, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.024
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 16 2015
x Case fatality from injury increases exponentially with age. The objective of this study is to identify age effects on case fatality of injury patients by injury mechanism.
Elongated left lobe of the liver mimicking a subcapsular hematoma of the spleen on the focused assessment with sonography for trauma exam Robert Jones, Matthew Tabbut, Diane Gramer
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.050
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: January 6 2014
x The focused assessment with sonography for trauma examination has assumed the role of initial screening examination for the presence or absence of hemoperitoneum in the patient with blunt abdominal trauma. Sonographic pitfalls associated with the examination have primarily been related to mistaking contained fluid collections with hemoperitoneum. We present a case in which an elongated left lobe of the liver was misdiagnosed as a splenic subcapsular hematoma. It is imperative that emergency physicians and trauma surgeons be familiar with this normal variant of the liver and its associated sonographic appearance on the perisplenic window in order to prevent nontherapeutic laparotomies or embolizations.
In reply to “Utility of shock index calculation in hemorrhagic trauma” Shwetha Edla, Andrew T. Reisner, Jianbo Liu, Victor A. Convertino, Robert Carter III, Jaques Reifman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.002
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: April 6 2015
x We wish to thank the correspondents for their interest and comments regarding our report [1]. We agree that multivariate vital-sign analysis is a powerful tool. The Shock Index (SI), which scales the heart rate (HR) to the systolic blood pressure (SBP), is attractive because it can be computed mentally at the bedside. At least in theory, by examining multiple vital signs, one may better distinguish abnormal vital signs due to psychological distress (typically tachycardia with hypertension) vs blood loss and shock (relative tachycardia with normal or reduced blood pressure).
Significance of the vacuum phenomenon in patients with trauma evaluated by whole-body computed tomography Kazuhiko Omori, Kouhei Ishikawa, Mariko Obinata, Kentaro Mishima, Shin Fukusato, Hiromichi Ohsaka, Yasumasa Oode, Youichi Yanagawa
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.055
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: December 3 2014
x Severely traumatized patients undergo whole-body computed tomography (WCT) to detect lethal anatomical injuries. When checking the images, we have sometimes recognized minute gas (the vacuum phenomenon [VP]) near the traumatized lesions. Accordingly, we investigated the significance of the VP in patients with trauma.
Integration of point-of-care sonography during rapid sequence intubation in trauma resuscitation: will it make a difference? Sanjeev Bhoi, Prakash Ranjan Mishra
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.058
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: November 21 2015
x Airway management plays a critical role in resuscitation of trauma patients in the emergency department. Failure to secure an adequate airway can quickly lead to death or disability [1]. Rapid sequence intubation (RSI) is the cornerstone of emergency airway management [2,3]. Rapid sequence intubation includes 3 phases: preoxygenation, endotracheal intubation, and tube confirmation. It has been seen that airway problems such as tracheal injury, paratracheal hematoma, vocal cord paralysis, abnormal midline vessels, and soft tissue mass in the neck go unnoticed during RSI leading to fatal events in acute trauma patients.
Trivial trauma, lethal outcome: streptococcal toxic shock syndrome presenting to the ED Jiun-Nong Lin, Lin-Li Chang, Chung-Hsu Lai, Hsi-Hsun Lin, Yen-Hsu Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.011
The American Journal of Emergency Medicine , Vol. 31 , Issue 8 ,
Published online: May 22 2013
x Group A Streptococcus , also known as Streptococcus pyogenes , is a common gram-positive bacterium that causes a broad spectrum of human infections ranging from uncomplicated pharyngitis and impetigo to life-threatening necrotizing fasciitis, bacteremia, and streptococcal toxic shock syndrome. Although it is rarely encountered in emergency departments, streptococcal toxic shock syndrome usually leads to a catastrophic outcome. Here we present 2 young patients who experienced trivial traumas before admission, which, nevertheless, finally resulted in lethal streptococcal toxic shock syndrome.
Characteristics and outcomes of injured patients presenting by private vehicle in a state trauma system Nicholas J. Johnson, Brendan G. Carr, Rama Salhi, Daniel N. Holena, Catherine Wolff, Roger A. Band
DOI: http://dx.doi.org/10.1016/j.ajem.2012.07.023
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: September 24 2012
x Previous studies have demonstrated lower mortality among patients transported to single urban trauma centers by private vehicle (PV) compared with Emergency Medical Services (EMS). We sought to describe the characteristics and outcomes of injured patients transported by PV in a state trauma system compared to patients transported by EMS.
Prospective evaluation of an ED observation unit protocol for trauma activation patients Jessica Holly, Joseph Bledsoe, Kathryn Black, Riann Robbins, Virgil Davis, Philip Bossart, Erik Barton, Troy Madsen
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.012
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: December 28 2011
x The University of Utah emergency department (ED) observation unit (EDOU) cares for over 2500 patients each year, with a significant portion of these patients being trauma activation patients. We evaluated the safety and efficacy of our EDOU trauma protocol and described patient characteristics and outcomes of trauma patients managed in an EDOU.
Point tenderness at 1 of 5 locations and limited elbow extension identify significant injury in children with acute elbow trauma: a study of diagnostic accuracy Alexander Sasha Dubrovsky, Elise Mok, Suk Yee Lau, Mohammad Al Humaidan
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.028
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: November 29 2014
x Our goal was to determine whether the combination of tenderness at 1 of 5 commonly fractured sites and elbow extension accurately predicts the presence of acute elbow fractures or isolated effusions in children.
Prospective correlation of arterial vs venous blood gas measurements in trauma patients Scott E. Rudkin, Christopher A. Kahn, Jennifer A. Oman, Matthew O. Dolich, Shahram Lotfipour, Stephanie Lush, Marla Gain, Charmaine Firme, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2011.09.027
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: December 14 2011
x The objective of this study is to assess if venous blood gas (VBG) results (pH and base excess [BE]) are numerically similar to arterial blood gas (ABG) in acutely ill trauma patients.
Impact of trauma activation on the ED length of stay for nontraumatic patients Rajiv Arya, Frank Dossantos, Pamela Ohman-Strickland, Mark A. Merlin
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.011
The American Journal of Emergency Medicine , Vol. 30 , Issue 2 ,
Published online: February 7 2011
x Trauma activation prioritizes hospital resources for the assessment and treatment of trauma patient over all patients in the emergency department (ED). We hypothesized that length of stay (LOS) is longer for nontrauma patients during a trauma activation.
Utility of shock index calculation in hemorrhagic trauma Marilyn Franchin, Daniel Jost, Hugues Lefort, Stephane Travers, Jean-Pierre Tourtier
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.001
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: April 6 2015
x We read with great interest the article by Edla et al [1] comparing heart rate variability (HRV) metrics vs routine vital signs as diagnostic tests to improve trauma patient management focusing on the identification of trauma patients with major hemorrhage. They conducted a multivariate analysis using routine vital signs (heart rate, respiratory rate, systolic blood pressure, and pulse pressure) as the comparator to test the hypothesis that HRV metrics can improve the identification of patients with major hemorrhage.
Image quality evaluation of a portable handheld ultrasound machine for the focused assessment with sonography for trauma examination Katherine M. Baugher, Brian D. Euerle, Sarah K. Sommerkamp, Michael D. Witting
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.034
The American Journal of Emergency Medicine , Vol. 32 , Issue 4 ,
Published online: December 23 2013
x Benefits of handheld ultrasound devices include ease of portability,1,2 lower cost,3,4 and potentially reduced examination time.5 However, questions have been raised about the quality of images obtained on these devices.4 We hypothesized that the overall image quality of the smaller handheld device would be inferior to that of a larger cart-mounted machine during the focused assessment with sonography for trauma (FAST) examination. For evaluation in this study, we compared the pocket-sized GE Vscan (GE VINGMED, Horten, Norway) to the cart-mounted ZONARE z.one ultra sp ultrasound device (ZONARE Medical Systems, Inc, Mountain View, CA).
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.
A new marker for myocardial injury in carbon monoxide poisoning: T peak–T end Nazire Belgin Akilli, Emine Akinci, Hakan Akilli, Zerrin Defne Dundar, Ramazan Koylu, Mustafa Polat, Basar Cander
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.049
The American Journal of Emergency Medicine , Vol. 31 , Issue 12 ,
Published online: October 2 2013
x Carbon monoxide (CO) poisoning frequently affects repolarization, resulting in abnormal electrocardiography findings. The goal of this study was to examine the effect of CO poisoning on the novel transmyocardial repolarization parameters T peak–T end (Tp-e), Tp-e dispersion, and Tp-e/QT and the relationship of these parameters to myocardial injury (MI).
Ultrasound-assisted triage of ankle trauma can decrease the need for radiographic imaging Henrik Hedelin, Lars-Åke Goksör, Jon Karlsson, Stina Stjernström
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.005
The American Journal of Emergency Medicine , Vol. 31 , Issue 12 ,
Published online: October 23 2013
x An ankle sprain is a common injury, and patients are usually examined with plain radiographs to rule out a fracture despite the fact that only a small minority actually have one.
Utility of point-of-care ultrasound in acute management triage of earthquake injury Shu Zhang, Da Zhu, Zhi Wan, Yu Cao
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.009
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: November 11 2013
x Earthquake could leads to massive casualty and injury in a short period [1-3]. Rapid screening and proper initial management and transfer triage are critical for improving survival during earthquake [1,4,5]. Point-of-care (POC) ultrasound is a newly diagnostic method that has been widely applied during emergency practice [6,7]. Several reports have shown the potential role of POC ultrasound in evaluation earthquake injury [8-10]. In April 20, 2013, a 7.3 magnitude earthquake struck the Sichuan Lu-Shan city (Epicenter location), causing more than 200 deaths and 10 000 injuries.
The accuracy of ultrasound evaluation in foot and ankle trauma Salih Ekinci, Onur Polat, Müge Günalp, Arda Demirkan, Ayça Koca
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.008
The American Journal of Emergency Medicine , Vol. 31 , Issue 11 ,
Published online: August 30 2013
x Foot and ankle injuries that result in sprains or fractures are commonly encountered at the emergency department. The purpose of the present study is to find out the accuracy of ultrasound (US) scanning in injuries in the aforementioned areas.
Outcomes of patients admitted for hanging injuries with decreased consciousness but without cardiac arrest Jung Hee Wee, Jeong Ho Park, Seung Pill Choi, Kyu Nam Park
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.061
The American Journal of Emergency Medicine , Vol. 31 , Issue 12 ,
Published online: October 7 2013
x The objective of this study is to provide appropriate treatment of patients who showed decreased mentality but did not suffer cardiac arrest (CA) from hanging injury, from reviewing the characteristics and analyzing the outcomes in such patients.
Emergency cricothyroidotomies for trauma: further considerations R. Gentry Wilkerson, Kenneth H. Butler, Michael D. Witting
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.032
The American Journal of Emergency Medicine , Vol. 31 , Issue 6 ,
Published online: May 15 2013
x In 2 recent articles, published in this journal [1] and The Scandinavian Journal of Surgery [2], King and colleagues observed that surgeons performed almost all of the 54 cricothyroidotomies documented in the patient records they collected in a retrospective medical record review at 2 trauma centers. Their conclusion caught our attention and prompted this response because we, as emergency physicians, have demonstrated our competency to teach this rare and lifesaving procedure in our emergency medicine training program and are confident that our graduates are proficient in it.
Impact of checklists on peri-intubation care in ED trauma patients Mark J. Conroy, Gregory S. Weingart, Jestin N. Carlson
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.006
The American Journal of Emergency Medicine , Vol. 32 , Issue 6 ,
Published online: February 19 2014
x Checklists have successfully been used in intensive care units (ICUs) to improve metrics of critical care. Proper peri-intubation care including use of appropriate induction agents and postintubation sedation is crucial when performing endotracheal intubation (ETI) on critically ill patients, especially in the emergency department (ED). We sought to evaluate the impact of checklists on peri-intubation care in ED trauma patients.
The difference in myocardial injuries and mitochondrial damages between asphyxial and ventricular fibrillation cardiac arrests Min-Shan Tsai, Chien-Hua Huang, Shang-Ho Tsai, Chia-Ying Tsai, Huei-Wen Chen, Hsaio-Ju Cheng, Chiung-Yuan Hsu, Tzung-Dau Wang, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.001
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: March 2 2012
x Ventricular fibrillation (VF) and asphyxia account for most cardiac arrests but differ in cardiac arrest course, neurologic deficit, and myocardial damage. In VF resuscitation, cardiac mitochondria were known to be damaged via excess generation of reactive oxygen species. This study evaluated the difference of cardiac mitochondrial damages between VF and asphyxial cardiac arrests.
Hamate body and capitate fracture in punch injury Jacob A. Goliver, Joshua S. Adamow, Jake Goliver
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.050
The American Journal of Emergency Medicine , Vol. 32 , Issue 10 ,
Published online: April 7 2014
x Hamate fractures represent only 2% to 4% of all carpal bone fractures because they require a large degree of force to the hand or wrist. This is a case report of a patient with hamate and capitate fractures after a punch injury. It details the minute change seen in routine 3-view radiographic imagery and indications for computed tomography.
Traumatic mediastinal hematoma: a potentially fatal condition that may be overlooked by traditional Focused Assessment with Sonography for Trauma Li-wen Hsu, Chee-Fah Chong, Tzong-Luen Wang, Bor-hen Wu
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.022
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: May 25 2012
x Mediastinal hematoma is an uncommon finding in blunt chest trauma. It may be caused by aortic injury, by mediastinal vascular injury such as aortic injury, and by fractures of the sternum and vertebral column. A huge mediastinal hematoma can result in extrapericardial cardiac tamponade by compressing the adjacent organs. Although Focused Assessment with Sonography for Trauma (FAST) can reliably assess the presence of pericardial effusion in the subxiphoid view, it may overlook mediastinal hematoma.
Blunt diaphragmatic rupture - a rare but challenging entity in thoracoabdominal trauma I-Ming Kuo, Chien-Hung Liao, Ming-Che Hsin, Shih-Ching Kang, Shang-Yu Wang, Chun-Hsiang Ooyang, Jen-Feng Fang
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.014
The American Journal of Emergency Medicine , Vol. 30 , Issue 6 ,
Published online: June 6 2011
x Delayed diagnosis of blunt traumatic diaphragmatic rupture (BDR) is not uncommon in the emergency department (ED) despite improvement in investigative techniques. We reviewed a large case series of patients diagnosed with blunt traumatic diaphragmatic rupture in order to report demographics, clinical features, and mechanisms of injury of this important but challenging entity.
A community-based comparison of trauma patient outcomes between d - and l -lactate fluids Kazuaki Kuwabara, Akihito Hagiwara, Shinya Matsuda, Kiyohide Fushimi, Koichi B. Ishikawa, Hiromasa Horiguchi, Kenji Fujimori
DOI: http://dx.doi.org/10.1016/j.ajem.2012.07.013
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: September 24 2012
x Ringer's lactate is used for patient resuscitation. Lactate naturally occurs in 2 stereoisometric forms, d - and l -lactate, that are added to fluid in equal amounts. Animal studies have demonstrated potentially deleterious effects of d -lactate on vital organs. Using an administrative database, we examined whether d - or l -lactate volume was associated with mortality in patients with trauma.
Prehospital neurologic deterioration is independent predictor of outcome in traumatic brain injury: analysis from National Trauma Data Bank Shahram Majidi, Farhan Siddiq, Adnan I. Qureshi
DOI: http://dx.doi.org/10.1016/j.ajem.2013.05.026
The American Journal of Emergency Medicine , Vol. 31 , Issue 8 ,
Published online: June 27 2013
x The prevalence and impact of prehospital neurologic deterioration (PhND) in patients with traumatic brain injury (TBI) have not been investigated. We aimed to determine the prevalence of PhND during emergency medical service (EMS) transportation among patients with TBI and its impact on patient's outcome.
Deep sedation with sevoflurane insufflated via a nasal cannula in uncooperative child undergoing the repair of dental injury Seung-Oh Kim, Young-Jae Kim, Yong-Seo Koo, Teo Jeon Shin
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.008
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: February 11 2013
x Sevoflurane, a potent volatile anesthetic, has been attempted to be used for procedural sedation. Because of lack of a commercially available sedation apparatus for sevoflurane administration, anesthetic gas delivery apparatus should be connected to general anesthetic machine for delivering sevoflurane gas. In this case, deep sedation was maintained during treatment of dental injuries involving the upper lip and incisor by sevoflurane insufflations via a nasal cannula. Especially, this may be advantageous in treating dental injuries involving upper lip and maxillary anterior teeth because the treatment is not disturbed during sevoflurane insufflations via a nasal cannula.
Emergent cricothyroidotomies for trauma: training considerations David R. King, Michael P. Ogilvie, George Velmahos, Hasan B. Alam, Marc A. deMoya, Susan R. Wilcox, Ali Y. Mejaddam, Gwendolyn M. Van Der Wilden, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.026
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: December 28 2011
x Emergent cricothyroidotomy remains an uncommon, but life-saving, core procedural training requirement for emergency medicine (EM) physician training. We hypothesized that although most cricothyroidotomies for trauma occur in the emergency department (ED), they are usually performed by surgeons.
Subject Index
DOI: http://dx.doi.org/10.1016/S0735-6757(15)00997-3
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published in issue: December 2015
Factors associated with law enforcement–related use-of-force injury Edward M. Castillo, Nitin Prabhakar, Bethi Luu
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.017
The American Journal of Emergency Medicine , Vol. 30 , Issue 4 ,
Published online: March 16 2011
x Use-of-force (UOF) techniques are used by law enforcement to gain control of noncompliant subjects. The purpose of this study was to assess factors associated with subject and deputy injuries during law enforcement UOF.
Successful endovascular treatment of subclavian artery dissection after compression trauma Murat Günday, Mehmet Özülkü, Erkan Yıldırım, Aytekin Güven, Özgür Çiftçi
DOI: http://dx.doi.org/10.1016/j.ajem.2012.07.030
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: October 8 2012
x Subclavian artery injury may occur as a result of penetrating or blunt trauma. Surgical or endovascular approaches are 2 treatment options. Previous case reports in the literature have described successful treatment of subclavian artery injury. In our case report, a 31-year-old male patient who had been exposed to blunt thorax trauma was admitted to our hospital complaining of chest pains and shortness of breath. During his examination at the hospital, he also complained of numbness in his right arm.
Secondary chordae rupture due to low-tension electricity trauma Hakan Akilli, Alpay Aribas, Nazire Belgin Akilli, Mehmet Kayrak, Hasan Gok
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.012
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: May 25 2012
x The most frequent cardiac pathologies caused by electric shock are arrhythmias with a wide clinical picture ranging from sinus tachycardia to asystole. Cardiac mechanical complications secondary to electric shock have rarely been reported. Despite the use of electrocardiography and cardiac monitorization in evaluating dysrhythmias and in the patients' follow-up, there is still no consensus on how to assess patients against probable mechanical complications and how to follow up these patients. In this study, we have presented the rupture in the secondary chordae of the mitral anterior leaflet caused by low-voltage electrical trauma.
The motor component does not convey all the mortality prediction capacity of the Glasgow Coma Scale in trauma patients Benoît Vivien, Jean-Michel Yeguiayan, Yannick Le Manach, Claire Bonithon-Kopp, Sébastien Mirek, Delphine Garrigue, Marc Freysz, Bruno Riou
DOI: http://dx.doi.org/10.1016/j.ajem.2011.06.022
The American Journal of Emergency Medicine , Vol. 30 , Issue 7 ,
Published online: October 31 2011
x We tested the hypothesis that the motor component of the Glasgow Coma Scale (GCS) conveys most of the predictive information of triage scores (Triage Revised Trauma Score [T-RTS] and the Mechanism, GCS, Age, arterial Pressure score [MGAP]) in trauma patients.
Airway management of adult patients without trauma in an ED led by internists Dominik Roth, Wolfgang Schreiber, Peter Stratil, Katharina Pichler, Christof Havel, Moritz Haugk
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.001
The American Journal of Emergency Medicine , Vol. 31 , Issue 9 ,
Published online: July 11 2013
x Airway management is a key competence in emergency medicine. Patients heavily differ from those in the operating room. They are acutely ill by definition and usually not fasting. Evaluation of risk factors is often impossible. Current literature primarily originates from countries where emergency medicine is an independent specialty. We evaluated intubations in a high-volume emergency department run by internists and comprising its own distinctive intensive care unit.
Relation of signal in mononuclear cell with endotoxin response and clinical outcome after trauma Hsin-Chin Shih, Mu-Shun Huang, Chen-Hsen Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.025
The American Journal of Emergency Medicine , Vol. 30 , Issue 3 ,
Published online: February 7 2011
x We investigated the correlation of proinflammatory transcript nuclear factor κ B (NF-κ B) and antioxidative gene transcript nuclear factor-erythroid 2–related factor 2 (Nrf2) expressions in peripheral blood mononuclear cells (PBMCs) with the tumor necrosis factor α (TNF-α ) response after endotoxin stimulation and the clinical outcome of severely injured patients.
X-ray–negative posterior sternoclavicular dislocation after minor trauma Mary Jacob, Jonathan Snashall, Annette Dorfman, Robert Shesser
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.014
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: May 25 2012
x Posterior sternoclavicular dislocation is a rare injury that must be recognized by the emergency physician because failure to rapidly reduce can lead to serious vascular complications. A high index of suspicion must be maintained in the appropriate setting because these injuries are difficult to detect on physical examination as well as on plain radiography. We present a case of a 19-year-old man with an isolated posterior sternoclavicular dislocation, in the setting of minor blunt trauma. The correct diagnosis required multiple imaging modalities over 2 emergency department visits and was ultimately successfully managed with intraoperative reduction.
Hypothermia is associated with poor outcome in pediatric trauma patients Jennifer Sundberg, Cristina Estrada, Cathy Jenkins, Jacqueline Ray, Thomas Abramo
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.002
The American Journal of Emergency Medicine , Vol. 29 , Issue 9 ,
Published online: August 16 2010
x The objective of the study was to determine if hypothermia in pediatric trauma patients is associated with increased mortality.
Erratum to “Can physician and patient gestalt lead to a shared decision to reduce unnecessary radiography in extremity trauma?” [Am J Emerg Med 33 (2015) 1692–1699] Michael Mouw, Tatiana Balatiouk-Lance, Lawrence H. Brown
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.023
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published in issue: February 2016
The characteristics and correlation between the ischemia-reperfusion and changes of redox status in the early stage of severe burns Lizhu Zhi, Xinlei Hu, Jun Xu, Chaoheng Yu, Huawei Shao, Xuanliang Pan, Hang Hu, Chunmao Han
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.026
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: November 28 2014
x Both the ischemia-reperfusion injury and the abnormal changes of redox status are the important pathologic changes in the burn shock stage for severe burns. The study of clinical dynamic, quantitative relevance about them was performed.
Denver ED Trauma Organ Failure Score outperforms traditional methods of risk stratification in trauma Jody A. Vogel, Nicole Seleno, Emily Hopkins, Christopher B. Colwell, Craig Gravitz, Jason S. Haukoos
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.006
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 6 2015
x Early identification of trauma patients at risk for inhospital mortality may facilitate goal-directed resuscitation and secondary triage to improve outcomes. The objective of this study was to compare prognostic accuracies of the Denver Emergency Department (ED) Trauma Organ Failure (TOF) Score, ED Sequential Organ Failure Assessment (SOFA) score, and ED base deficit and ED lactate for inhospital mortality in adult trauma patients.
Tele-ultrasound and paramedics: real-time remote physician guidance of the Focused Assessment With Sonography for Trauma examination Keith S. Boniface, Hamid Shokoohi, E. Reed Smith, Kari Scantlebury
DOI: http://dx.doi.org/10.1016/j.ajem.2009.12.001
The American Journal of Emergency Medicine , Vol. 29 , Issue 5 ,
Published online: April 14 2010
x The aim of this study was to examine the capability of ultrasound-naïve paramedics to obtain interpretable Focused Assessment With Sonography for Trauma (FAST) images under the remote direction of emergency physicians (EPs).
Outcome analysis of cardiac arrest due to hanging injury Jung Hee Wee, Kyu Nam Park, Sang Hoon Oh, Chun Song Youn, Han Joon Kim, Seung Pill Choi
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.013
The American Journal of Emergency Medicine , Vol. 30 , Issue 5 ,
Published online: June 6 2011
x The aim of this study was to review patient characteristics and analyze the outcomes in patients who have had cardiac arrest from hanging injuries.
Amphetamine use in Rhode Island Hospital trauma patients Jeanine A. Ward, Matthew Zuckerman, Charles A. Adams Jr., Anthony Napoli
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.026
The American Journal of Emergency Medicine , Vol. 29 , Issue 5 ,
Published online: April 25 2011
x Although data indicate 3,4-Methylenedioxymethamphetamine (MDMA) and methamphetamine use in New England, little is known about recent specific MDMA and methamphetamine use in the state of Rhode Island [1,2]. Therefore, given the potential increased burden of these agents in our region, we decided to undertake a study to determine the types of amphetamines used in our local trauma patients. Prior studies have implicated a potential association between amphetamine use and trauma [3,4]. As such, it may also be important to determine the specific patient demographics of those using these substances in Rhode Island from both an epidemiologic and treatment perspective.
Prevalence of large and occult pneumothoraces in patients with severe blunt trauma upon hospital admission: experience of 526 cases in a French level 1 trauma center Jonathan Charbit, Ingrid Millet, Camille Maury, Benjamin Conte, Jean-Paul Roustan, Patrice Taourel, Xavier Capdevila
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.057
The American Journal of Emergency Medicine , Vol. 33 , Issue 6 ,
Published online: April 6 2015
x Occult pneumothoraces (PTXs), which are not visible on chest x-ray, may progress to tension PTX. The aim of study was to establish the prevalence of large occult PTXs upon admission of patients with severe blunt trauma, according to prehospital mechanical ventilation.
Application of National Emergency X-Ray Utilizations Study low-risk c-spine criteria in high-risk geriatric falls Daniel Evans, Luis Vera, Donald Jeanmonod, Jonathan Pester, Rebecca Jeanmonod
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.031
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: June 1 2015
x We sought to validate National Emergency X-Radiography Utilizations Study low-risk cervical spine (C spine) criteria in a geriatric trauma population. We sought to determine whether patients' own baseline mental status (MS) could substitute for Glasgow Coma Scale (GCS) to meet the criteria “normal alertness.” We further sought to refine the definition of “distracting injury.”
Characteristics of intentional fall injuries in the ED Jae Hoon Choi, Sun Hyu Kim, Sun Pyo Kim, Koo Young Jung, Ji Yeong Ryu, Sang Cheon Choi, In Cheol Park
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.053
The American Journal of Emergency Medicine , Vol. 32 , Issue 6 ,
Published online: February 6 2014
x This study was conducted to examine the characteristics of intentional fall injuries and the factors associated with their prognosis.
Does adding low doses of oral naltrexone to morphine alter the subsequent opioid requirements and side effects in trauma patients? Shervin Farahmand, Omid Ahmadi, Ahmadreza Dehpour, Patricia Khashayar
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.031
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: November 15 2010
x The present study aims to assess the influence of ultra-low doses of opioid antagonists on the analgesic properties of opioids and their side effects.
What is the clinical significance of chest CT when the chest x-ray result is normal in patients with blunt trauma? Bory Kea, Ruwan Gamarallage, Hemamalini Vairamuthu,, Jonathan Fortman, Kevin Lunney, Gregory W. Hendey, Robert M. Rodriguez
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.021
The American Journal of Emergency Medicine , Vol. 31 , Issue 8 ,
Published online: June 24 2013
x Computed tomography (CT) has been shown to detect more injuries than plain radiography in patients with blunt trauma, but it is unclear whether these injuries are clinically significant.
Risk factors for ground-level falls differ by sex Takayuki Taira, Seiji Morita, Rimako Umebachi, Naoya Miura, Atsushi Icimura, Shigeaki Inoue, Yoshihide Nakagawa, Sadaki Inokuchi
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.052
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: February 4 2015
x The populations of many developed countries have been aging in recent years, resulting in increasing numbers of elderly-related injuries. Conventionally regarded as minor, injuries from ground-level falls are now associated with a higher risk of death for elderly people.
Cervical spine immobilization may be of value following firearm injury to the head and neck Sebastian D. Schubl, R. Jonathan Robitsek, Christian Sommerhalder, Kimberly J. Wilkins, Taylor R. Klein, Scott Trepeta, Vanessa P. Ho
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.014
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: January 20 2016
x Penetrating injuries to the head and neck may not be able to cause unstable fractures without concomitant spinal cord injury, rendering prehospital spinal immobilization (PHSI) ineffectual, and possibly harmful. However, this premise is based on reports including predominantly chest and abdominal injuries, which are unlikely to cause cervical spine (CS) injuries.
Do you think about traumatic appendicitis in your trauma bay? Hamed Ghoddusi Johari, Shima Eskandari
DOI: http://dx.doi.org/10.1016/j.ajem.2011.07.004
The American Journal of Emergency Medicine , Vol. 29 , Issue 9 ,
Published online: September 12 2011
x We read with great interest the article by Charlotte Derr and D. Eliot Goldner “Posttraumatic appendicitis: further extending the extended focused assessment with sonography in trauma examination,” which states that ultrasonography may have an unrealized potential as a diagnostic tool for traumatic appendicitis in the trauma bay [1].
Clinically meaningful reduction in pain severity in children treated by paramedics: a retrospective cohort study Paul A. Jennings, Bill Lord, Karen Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.026
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: June 17 2015
x Pediatric pain is a common presenting symptom in the prehospital setting; however, there is a lack of data identifying factors associated with effective pain management in this population. We sought to identify the factors associated with clinically meaningful pain reduction in children.
Use of extracorporeal membrane oxygenation in severe traumatic lung injury with respiratory failure Shih-Chi Wu, William Tzu-Liang Chen, Hui-Han Lin, Chih-Yuan Fu, Yu-Chun Wang, Hung-Chieh Lo, Han-Tsung Cheng, Chia-Wei Tzeng
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.007
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: February 7 2015
x The use of extracorporeal membrane oxygenation (ECMO) in managing acute respiratory distress syndrome had been accepted. Severe lung injury with respiratory failure is often encountered in trauma patients. We report our experience with the use of ECMO in severe traumatic lung injury.
Computed tomography is not justified in every pediatric blunt trauma patient with a suspicious mechanism of injury Yehuda Hershkovitz, Itai Zoarets, Albert Stepansky, Eran Kozer, Zahar Shapira, Baruch Klin, Ariel Halevy, Igor Jeroukhimov
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.024
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: April 21 2014
x Computed tomography (CT) has become an important tool for the diagnosis of intra-abdominal and chest injuries in patients with blunt trauma. The role of CT in conscious asymptomatic patients with a suspicious mechanism of injury remains controversial. This controversy intensifies in the management of pediatric blunt trauma patients, who are much more susceptible to radiation exposure. The objective of this study was to evaluate the role of abdominal and chest CT imaging in asymptomatic pediatric patients with a suspicious mechanism of injury.
Femur fractures should not be considered distracting injuries for cervical spine assessment Robert T. Dahlquist, Peter E. Fischer, Harsh Desai, Amelia Rogers, A. Britton Christmas, Michael A. Gibbs, Ronald F. Sing
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.009
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: August 10 2015
x The National Emergency X-Radiography Utilization Study (NEXUS) clinical decision rule is extremely sensitive for clearance of cervical spine (C-spine) injury in blunt trauma patients with distracting injuries.
Prehospital trauma arrival notification associated with more image studies in patients with minor head trauma discharged from ED Shujun Xia, Thomas Perera, Ethan Cowan, Michael P. Jones, Adrienne Birnbaum
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.024
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: February 19 2015
x The objective of this study was to determine whether prehospital trauma arrival notification was associated with more head computed tomography (CT) scans and image studies performed in patients with minor head trauma and discharged from emergency department (ED).
Predictive value of liver transaminases levels in abdominal trauma Ismail Bilgic, Sibel Gelecek, Ali Emre Akgun, M. Mahir Ozmen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.052
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: April 7 2014
x We aimed to evaluate whether hepatic transaminase levels could predict the presence and severity of liver injury following abdominal trauma.
