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.
