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.
