Prospective, 10-year evaluation of the impact of Hispanic ethnicity on pain management practices in the ED Philip Craven, Orhan Cinar, David Fosnocht, Jessica Carey, Adrienne Carey, LeGrand Rogers, Kajsa Vlasic, Troy Madsen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.026
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: July 1 2014
x Hispanic ethnicity has been reported as an independent risk factor for oligoanalgesia in the emergency department (ED).
Upper extremity fractures among hospitalized pediatric road traffic accident victims Guy Rubin, Kobi Peleg, Adi Givon, Israel Trauma Group, Nimrod Rozen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.017
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: February 17 2015
x Upper extremity fractures (UEFs) associated with road traffic accidents (RTAs) may result in long-term disability. Previous studies have examined UEF profiles with small patient populations. The objective of this study was to examine the injury profiles of UEFs in all mechanisms of injury related to RTAs in the pediatric population.
Streamlined focused assessment with sonography for mass casualty prehospital triage of blunt torso trauma patients Hai Hu, Yarong He, Shu Zhang, Yu Cao
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.014
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: March 20 2014
x Without prompt medical attention and often expedient emergency surgery, earthquake victims having blunt torso trauma will experience increased mortality [1]. Rapid identification of necessary emergent medical vs surgical interventions is critically important. Accurate triage is a necessity, particularly with limited medical resources in the chaos after a mass casualty event. The Simple Triage and Rapid Treatment (START) triage method [2] sorts patients into 4 colored tag categories, dependent upon respiratory rate, perfusion (presence of radial pulse and capillary refill time), and mental status (response to commands): red (critically ill patients requiring immediate medical care), yellow (patients in urgent condition, which may receive delayed medical care), green (patients having minor injuries), and black (patients deceased or expectantly soon to be deceased) (Fig. 1).
Leg and Abdominal Impalement With Rebar John P. Sarwark, Danielle M. McCarthy, Charles Pearce, Akhil Seth, Nabil Issa
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.006
The American Journal of Emergency Medicine , Vol. 33 , Issue 8 ,
Published online: January 16 2015
x Although abdominal impalement injuries are less common than other types of penetrating trauma (eg, gunshot wounds), these injuries present providers with a unique set of challenges.
Comparative study of ED mortality risk of US trauma patients treated at level I and level II vs nontrauma centers Brian P. Vickers, Junxin Shi, Bo Lu, Krista K. Wheeler, Jin Peng, Jonathan I. Groner, Kathryn J. Haley, Huiyun Xiang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.010
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: May 15 2015
x Prior studies of undertriage have not made comparisons across multiple trauma levels.
Acute kidney injury after cardiac arrest of ventricular fibrillation and asphyxiation swine model Chen-Chen Hang, Chun-Sheng Li, Cai-Jun Wu, Jun Yang
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.043
The American Journal of Emergency Medicine , Vol. 32 , Issue 3 ,
Published online: November 6 2013
x The purposes of the study are to investigate the renal function in ventricular fibrillation (VF) and asphyxiation cardiac arrest in a swine model and to estimate the value of novel biomarkers in the acute kidney injury (AKI) after cardiac arrest.
The diminishing role of pelvic x-rays in the management of patients with major torso injuries Chih-Yuan Fu, Shang-Yu Wang, Yu-Pao Hsu, Chien-Hung Liao, Being-Chuan Lin, Shih-Ching Kang, Kuo-Ching Yuan, I-Ming Kuo, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.011
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: October 24 2013
x A pelvic x-ray (PXR) can be used as an effective screening tool to evaluate pelvic fractures and stability. However, associated intra-abdominal/retroperitoneal organ injuries and hemorrhage should also be considered and evaluated in patients with major torso injuries. An abdominal/pelvic computed tomographic (CT) scan may provide higher resolution and more information than a PXR. The role of conventional PXRs was delineated in the current study in the context of the development of the CT scan.
Blood glucose levels as an adjunct for prehospital field triage Elon Glassberg, Ari M. Lipsky, Gadi Lending, Ilia Sergeev, Avishai Elbaz, Alexander Morose, Udi Katzenell, Nachman Ash
DOI: http://dx.doi.org/10.1016/j.ajem.2012.10.038
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: February 4 2013
x Elevated blood glucose levels (BGL) are known to be part of the physiologic response to stress following physical trauma. We aimed to study whether a measured BGL might help improve accuracy of field triage.
Spontaneous reduction of ileoileal adult intussusception after blunt abdominal injury Mucahit Emet, Abdullah Osman Kocak, Ilker Akbas, Adem Karaman, Sukru Arslan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.053
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 28 2015
x This is the first case report of an adult who had spontaneous reduction of ileoileal intussusception occurred after punching to the abdomen. A 40-year-old man was brought to our emergency department by ground ambulance due to pounding and punching a few hours ago. Physical examination showed multiple dermabrasions on his face, abdomen, and lower extremities. All other examinations were unremarkable except that of mild abdominal pain. Laboratory results gave no clues. On abdominal x-ray, paucity of intestinal gas, pseudomass and surrounding gas appearances were visible.
Spotted lipid sign floating on the blood to differentiate obscured open fractures from simple wound lacerations Mucahit Emet, Kenan Atac, Ali Aydın, Nasuhi Altay, Murat Saritemur
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.009
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: August 7 2014
x Open fractures are not so obvious sometimes, and in the case of multiorgan injuries, they may be misdiagnosed in emergency department. Here, we report a 48-year old man with motor vehicle crash injury. There were ominous facial, vertebral, thoracic, and abdominal injuries as well as distal femoral shaft fracture and multiple skin lacerations in different parts of the body in the initial examination. On the tertiary examination, we incidentally caught an important finding showing an open fracture: oily (greasy) bleeding from the wound (Video 1, Fig. 1 and 2).
Epistaxis complicated by rivaroxaban managed with topical tranexamic acid Mark D. Utkewicz, Luigi Brunetti, Nadia I. Awad
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.049
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: March 6 2015
x The use of topical tranexamic acid has been evaluated in the literature for the management of epistaxis, both uncomplicated and secondary to coagulation disorders. Although it has been proposed to have a role in the treatment of bleeding secondary to target specific oral anticoagulants, there is minimal experience described in the literature related to its utility in the clinical setting. We present the first known case report of epistaxis complicated by outpatient rivaroxaban therapy in an elderly patient that was managed with topical tranexamic acid.
The pathophysiologies of asphyxial vs dysrhythmic cardiac arrest: implications for resuscitation and post-event management Dimitrios Varvarousis, Giolanda Varvarousi, Nicoletta Iacovidou, Ernesto D'Aloja, Anil Gulati, Theodoros Xanthos
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.066
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: July 6 2015
x Cardiac arrest is not a uniform condition and significant heterogeneity exists within all victims with regard to the cause of cardiac arrest. Primary cardiac (dysrhythmic) and asphyxial causes together are responsible for most cases of cardiac arrest at all age groups. The purpose of this article is to review the pathophysiologic differences between dysrhythmic and asphyxial cardiac arrest in the prearrest period, during the no-flow state, and after successful cardiopulmonary resuscitation.
Rotational thromboelastometry along with thromboelastography plays a critical role in the management of traumatic bleeding Miroslav Durila, Martin Malošek
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.038
The American Journal of Emergency Medicine , Vol. 32 , Issue 3 ,
Published online: November 27 2013
x Massive posttraumatic bleeding is the leading cause of potentially preventable death among patients with severe trauma. Immediate diagnosis and treatment of traumatic coagulopathy and its differentiation from surgical bleeding after major trauma are critical in the management of such patients. In this case report, we present a 33-year-old woman who had multiple injuries to the head and trunk in motor vehicle collision, resulting in severe bleeding and necessitating emergency surgery. We demonstrate how repeated rotational thromboelastometry and thromboelastography analyses were used to direct the choice of therapy to stabilize her circulatory system for surgery and to differentiate surgical bleed from coagulopathy.
An observational case series of dabigatran and rivaroxaban exposures reported to a poison control system John W. Stevenson, Alicia B. Minns, Craig Smollin, Timothy E. Albertson, F. Lee Cantrell, Christian Tomaszewski, Richard F. Clark
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.031
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: April 30 2014
x Characterize clinical presentations and outcomes of dabigatran and rivaroxaban exposures reported to a poison control system.
Acute transient hemiparesis induced by lightning strike Seyed Hesam Rahmani, Gholamreza Faridaalaee, Samira Jahangard
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.031
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: December 18 2014
x According to data from the National Oceanic and Atmospheric Administration, in the years from 1959 to 1994, lightning was responsible for more than 3000 deaths and nearly 10,000 casualties. The most important characteristic features of lightning injuries are multisystem involvement and widely variable severity. Lightning strikes are primarily a neurologic injury that affects all 3 components of the nervous system: central, autonomic, and peripheral. Neurologic complications of lightning strikes vary from transient benign symptoms to permanent disability.
Major hemorrhage from hepatic laceration after cardiopulmonary resuscitation GregoryS. Zahn, MargaretG. Hauck, DavidA. Pearson, John M. Green, Alan C. Heffner
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.048
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: January 6 2015
x Visceral injury from cardiac arrest resuscitation is a rare but potentially life-threatening complication. We describe and review 2 cases of hepatic laceration complicated by major abdominal hemorrhage manifested as delayed shock following cardiopulmonary resuscitation after cardiac arrest. Two patients enrolled in our institutional postcardiac arrest resuscitation clinical pathway had evidence of major liver laceration presenting as delayed shock due to massive hemoperitoneum. Case analysis revealed coagulopathy due to systemic anticoagulation as a risk factor for major hemorrhage.
Neck collar used in treatment of victims of urban motorcycle accidents: over- or underprotection? Hsing-Lin Lin, Wei-Che Lee, Chao-Wen Chen, Tsung-Ying Lin, Yuan-Chia Cheng, Yung-Sung Yeh, Yen-Ko Lin, Liang-Chi Kuo
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.003
The American Journal of Emergency Medicine , Vol. 29 , Issue 9 ,
Published online: October 18 2010
x Cervical collar brace protection of the cervical spine at the scene of the incident is the first priority for emergency medical technicians treating patients who have sustained trauma. However, there is still controversy between over- or underprotection. The objective of this study was to survey the cervical spine injury of lightweight motorcycle accident victims and further evaluate the neck collar protection policy.
Evaluation of geriatric patients with trauma scores after motor vehicle trauma Yunsur Çevik, Nurettin Özgür Doğan, Murat Daş, Onur Karakayalı, Orhan Delice, Cemil Kavalcı
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.021
The American Journal of Emergency Medicine , Vol. 31 , Issue 10 ,
Published online: September 9 2013
x The aim of this study was to investigate the factors affecting in-hospital mortality among geriatric trauma patients who presented to the emergency department (ED) following a motor vehicle collision.
Prehospital endotracheal intubation vs extraglottic airway device in blunt trauma James Kempema, Marc D. Trust, Sadia Ali, Jose G. Cabanas, Paul R. Hinchey, Lawrence H. Brown, Carlos V.R. Brown
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.046
The American Journal of Emergency Medicine , Vol. 33 , Issue 8 ,
Published online: April 29 2015
x The objective of the study is to compare outcomes in blunt trauma patients managed with prehospital insertion of an extraglottic airway device (EGD) vs endotracheal intubation (ETI). The null hypothesis was that there would be no difference in mortality for the 2 groups.
ED crowding is associated with inpatient mortality among critically ill patients admitted via the ED: post hoc analysis from a retrospective study Sion Jo, Taeoh Jeong, Young Ho Jin, Jae Baek Lee, Jaechol Yoon, Boyoung Park
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.004
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: August 6 2015
x Adverse effects of emergency department (ED) crowding among critically ill patients are not well known.
