Predicting a life-threatening disease and death among ambulance-transported patients with chest pain or other symptoms raising suspicion of an acute coronary syndrome Johan Herlitz, Elisabeth Hansson, Eva Ringvall, Mia Starke, Lisbeth Waagstein, Björn W. Karlson
DOI: http://dx.doi.org/10.1053/ajem.2002.35461
The American Journal of Emergency Medicine , Vol. 20 , Issue 7 ,
Published in issue: November 2002
x The purpose of this study was to evaluate the possibility to predict in the prehospital phase the occurrence of a life-threatening disease or death among ambulance transported patients with acute chest pain or other symptoms raising any suspicion of an acute coronary syndrome. All patients transported by ambulance during 3 months in the community of Göteborg because of symptoms raising any suspicion of an acute coronary syndrome were included in the study. In all, 930 transports (of 859 patients) fulfilled the inclusion criteria, of which 235 (25.3%) fulfilled the critera for a life-threatening disease.
Routine biological tests in self-poisoning patients: Results from an observational prospective multicenter study Thomas Reydel, Jean-Christophe Callahan, Laurent Verley, Christelle Teiten, Christophe Andreotti, Yann Erick Claessens, David Missud, Erwan L'Her, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2016.04.002
Publication stage: In Press Accepted Manuscript
The American Journal of Emergency Medicine
Published online: April 5 2016
x Routine biological tests are frequently ordered in self-poisoning patients, but their clinical relevance is poorly studied.
Acidosis is a life-threatening condition regardless of the underlying condition Cenker Eken
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.038
The American Journal of Emergency Medicine , Vol. 26 , Issue 6 ,
Published in issue: July 2008
x Firstly, thanks to Liu et al [1] for their article about the effect of acidosis on mortality in organophosphate poisonings. However, I have some concerns on the hypothesis of the article.
Non-life-threatening blunt chest trauma: Appropriate investigation and treatment Isser Dubinsky, Aaron Low
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90004-8
The American Journal of Emergency Medicine , Vol. 15 , Issue 3 ,
Published in issue: May 1997
x Non-life-threatening blunt chest trauma is a commonly occurring phenomenon. No clear guidelines exist in the literature regarding the appropriate investigation and treatment, and most clinicians' practice patterns are based on anecdote, individual experience, and the theoretical risk of complications. A prospective study was undertaken of all patients with non-life-threatening blunt chest trauma presenting to a high-volume, community-based teaching hospital emergency department. No clinical features were found to have a high enough positive predictive value for rib fracture or any other injury to warrant their use as a screening tool for further investigations.
Prevalence of life-threatening arrhythmias in ED patients transported to the radiology suite while monitored by telemetry Selin Caglar, Stephen Leffler
DOI: http://dx.doi.org/10.1016/j.ajem.2006.01.028
The American Journal of Emergency Medicine , Vol. 24 , Issue 6 ,
Published in issue: October 2006
x The aim of this study was to determine the prevalence of life-threatening arrhythmias in monitored ED patients while in the radiology suite.
Erratum Shih-Hua Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.019
The American Journal of Emergency Medicine , Vol. 27 , Issue 4 ,
Published in issue: May 2009
x In the article “In-flight Valsalva maneuver induced life-threatening Wünderlich syndrome,” published in Am J Emerg Med 2008 ;26(6):732.e5-6 listed the authors out of order. The correct byline is below.
Transarterial embolization in the management of life-threatening hemorrhage after maxillofacial trauma: a case report and review of literature Wei-Hsiu Liu, Yuan-Hao Chen, Cheng-Ta Hsieh, En-Yuan Lin, Tzu-Tsao Chung, Da-Tong Ju
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.036
The American Journal of Emergency Medicine , Vol. 26 , Issue 4 ,
Published in issue: May 2008
x There are many reasons for hypotension in trauma patients. Life-threatening hemorrhage associated with maxillofacial trauma is considered rare. Here, we present a 25-year-old patient with maxillofacial trauma complicated by life-threatening hemorrhage after a traffic accident. At the emergency department, massive epistaxis was noted. Nasal packing and blood transfusion were performed, but vital signs of the patient were still unstable. Cerebral angiography revealed contrast extravasation from the left superficial temporal and internal maxillary arteries of the left external carotid artery.
Transarterial embolization in the treatment of life-threatening maxillofacial bleeding Chih-Yuan Lee, Ming-Hong Chen, Tzu-Hsin Lin, Shyr-Chyr Chen
DOI: http://dx.doi.org/10.1053/ajem.2002.33773
The American Journal of Emergency Medicine , Vol. 20 , Issue 4 ,
Published in issue: July 2002
x —Traffic accidents are an important cause of facial trauma because the drivers usually have little facial protection. Those patients suffering facial trauma seldom die without airway problems, massive bleeding, or aspiration of blood into the lungs. However, facial trauma associated with life-threatening hemorrhage is rare. We present a patient with exsanguinating epistaxis after maxillofacial trauma caused by a traffic accident. Epistaxis was finally controlled by angiographic embolization.
Initial serum glucose level and white blood cell predict ventricular arrhythmia after first acute myocardial infarction Jiann-Hwa Chen, Chiu-Liang Tseng, Shin-Han Tsai, Wen-Ta Chiu
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.036
The American Journal of Emergency Medicine , Vol. 28 , Issue 4 ,
Published online: February 8 2010
x The aims of this study are to analyze the factors that predispose the occurrence of ventricular arrhythmia (VA) in young patients with a first acute myocardial infarction (AMI) in the emergency department (ED) and to establish predictive implications.
Angioembolization as an effective alternative for hemostasis in intractable life-threatening maxillofacial trauma hemorrhage: case study Shih-Chi Wu, Ray-Jade Chen, Kwo-Whei Lee, Cheng-Cheng Tung, Wen-Pei Lin, Poon Yi
DOI: http://dx.doi.org/10.1016/j.ajem.2007.02.039
The American Journal of Emergency Medicine , Vol. 25 , Issue 8 ,
Published in issue: October 2007
x Life-threatening maxillofacial trauma hemorrhage is not common; oronasal hemorrhage from maxillofacial trauma can often be managed with manual compression or efficient tight packing. Surgery is reserved for cases where failure of tight packing occurs. However, the use of angioembolization might decrease the need for blood transfusion and provide an effective alternative for early hemostasis after packing failure. We report 7 cases wherein angioembolization was successfully performed for hemostasis of life-threatening maxillofacial trauma hemorrhage.
Serious conditions for emergency department elderly fall patients: a secondary analysis of the Basel Nonspecific Complaints study Shan W. Liu, Jiraporn Sri-On, Gregory Philip Tirrell, Christian Nickel, Roland Bingisser
DOI: http://dx.doi.org/10.1016/j.ajem.2016.04.007
Publication stage: In Press Accepted Manuscript
The American Journal of Emergency Medicine
Published online: April 9 2016
x Falls among older adults are a public health problem and are multi-factorial. We sought to determine whether falls predict more serious conditions in older adult patients presenting to the emergency department (ED) with a nonspecific complaint (NSC). A secondary objective was to examine what factors predicted serious conditions among older adult patients with a fall.
Case of infective endocarditis with initial presentation of visual disturbances Fong-Pu Chang, Cheng-Yu Chien, Chung-Hsien Chaou, Ching-Hsing Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2016.03.013
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: March 7 2016
x Infective endocarditis (IE) is not uncommonly treated in daily emergency department (ED) practice, but can sometimes be life-threatening. The diagnosis of IE may pose a challenge to ED physicians because of its possible vague or atypical presenting symptoms. We present herein a previously healthy 23-year-old woman who visited the hospital after having progressively blurred vision in the prior 3 days. During the medical history inquiry, she mentioned mild and intermittent low grade fevers but no other specific discomfort.
Clinical profile of injection drug users presenting to the ED Daniel R. Kievlan, Meri Gukasyan, Julie Gesch, Robert M. Rodriguez
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.020
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: February 19 2015
x Injection drug users (IDUs) commonly use the emergency department (ED) as their primary health care access point.
Anaphylaxis from administration of intravenous thiamine James M. Stephen, Robert Grant, Charlotte S. Yeh
DOI: http://dx.doi.org/10.1016/0735-6757(92)90129-L
The American Journal of Emergency Medicine , Vol. 10 , Issue 1 ,
Published in issue: January 1992
x The routine administration of intravenous thiamine in the emergency department has become widespread. Although anaphylaxis from intravenous thiamine is felt to be uncommon, it can be life threatening. The authors present such a case and review the literature regarding this clinical entity. This case of anaphylactic reaction appears to be the first instance reported since 1946 in the US literature. However a review revealed that cases of anaphylaxis from thiamine have been reported with some regularity in the non-US literature.
Severe explosive headache: a sole presentation of acute myocardial infarction in a young man Vei-Ken Seow, Chee-Fah Chong, Tzong-Luen Wang, Jiann-Ruey Ong
DOI: http://dx.doi.org/10.1016/j.ajem.2006.11.014
The American Journal of Emergency Medicine , Vol. 25 , Issue 2 ,
Published in issue: February 2007
x Acute myocardial infarction is a potentially life-threatening disease that must be diagnosed early and accurately at the emergency department. Its diagnosis may be difficult if manifested solely as a severe explosive headache in a young, nondiabetic, and nonobese man. We report a case of ST-elevation myocardial infarction that was initially misdiagnosed as a case of headache until routine electrocardiography was obtained.
Validation of a 6-hour observation period for cocaine body stuffers Zhanna Livshits, Delbert Clark, Miguel Gutierrez, Robert S. Hoffman
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.016
The American Journal of Emergency Medicine , Vol. 29 , Issue 5 ,
Published online: April 29 2011
x The recent article by Heard et al [1] heightened awareness of the challenges faced by physicians evaluating “body stuffers.” Although serious complications after cocaine body stuffing, such as seizures, typically occur rapidly after ingestion, there is at least 1 report of delayed seizures in a crack cocaine body stuffer, occurring at 10 to 24 hours postingestion [2]. This presents a controversy in defining an appropriate time for observation under medical supervision.
Acid-base interpretation as a predictor of outcome in acute organophosphate poisoning Ya-Fei Yang
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.039
The American Journal of Emergency Medicine , Vol. 26 , Issue 6 ,
Published in issue: July 2008
x We really appreciate Dr Eken's inspiring feedback about our article entitled “Acid-base interpretation can be the predictor of outcome among patients with acute organophosphate poisoning before hospitalization.” In regard to the null hypothesis, H1, that acidosis is associated with mortality regardless of the underlying condition, we agreed with Dr Eken's opinion that acidosis is a life-threatening condition. However, quite a few studies have shown that acidosis may not be associated with mortality in certain groups of patients[1-4], suggesting the need to study the influence of acidosis in patients with difference underlying conditions.
Triage flowchart to rule out acute coronary syndrome Miquel Sánchez, Beatriz López, Ernest Bragulat, Elisenda Gómez-Angelats, Sònia Jiménez, Mar Ortega, Blanca Coll-Vinent, Josep R. Alonso, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2006.12.025
The American Journal of Emergency Medicine , Vol. 25 , Issue 8 ,
Published in issue: October 2007
x The aim of the study was to establish a triage flowchart to rule out acute coronary syndrome (ACS) among patients with chest pain (CP) arriving on an Emergency Department (ED).
Prehospital seizure management: Triage criteria for the advanced life support rescue team Neal Robert Abarbanell
DOI: http://dx.doi.org/10.1016/0735-6757(93)90126-V
The American Journal of Emergency Medicine , Vol. 11 , Issue 3 ,
Published in issue: May 1993
x The present study was completed to establish advanced life support (ALS) versus non-ALS triage criteria for use by ALS prehospital personnel when faced with the seizure patient, in the hope of more efficient use of ALS rescue teams. Preselected triage criteria for acuity of care based on neurological condition, vital signs, and concomitant illness/injury were tested against retrospective data (paramedic run reports) collected on 230 patients. Triage criteria sensitivity (SENS), specificity (SPEC), positive predictive value (PPV), and negative predictive value (NPV) were determined with a 95% confidence interval (CI).
How well do General EMS 911 dispatch protocols predict ED resource utilization for pediatric patients? Stephanie J. Fessler, Harold K. Simon, Arthur H. Yancey II, Michael Colman, Daniel A. Hirsh
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.018
The American Journal of Emergency Medicine , Vol. 32 , Issue 3 ,
Published online: December 26 2013
x The use of Emergency Medical Services (EMS) for low-acuity pediatric problems is well documented. Attempts have been made to curb potentially unnecessary transports, including using EMS dispatch protocols, shown to predict acuity and needs of adults. However, there are limited data about this in children. The primary objective of this study is to determine the pediatric emergency department (PED) resource utilization (surrogate of acuity level) for pediatric patients categorized as “low-acuity” by initial EMS protocols.
Mass smallpox immunization program in a deployed military setting William A Gibson
DOI: http://dx.doi.org/10.1016/j.ajem.2004.04.008
The American Journal of Emergency Medicine , Vol. 22 , Issue 4 ,
Published in issue: July 2004
x A prospective, observational study of immunizing over 6,000 active-duty troops against smallpox in a 4-week time period was conducted. It focused on the complications of the vaccine and lost workdays. Comparison is made to the complication rates of earlier smallpox immunization programs. In direct response to elevated bioterrorism concerns, the United States military and civilian first-responders have begun a mass smallpox immunization program. This article reviews the experience with implementing such a program in a forward-deployed location while maintaining military readiness.
A prediction model to identify patients without a concerning intra abdominal diagnosis Emily Aaronson, Yuchiao Chang, Pierre Borczuk
DOI: http://dx.doi.org/10.1016/j.ajem.2016.03.063
Publication stage: In Press Accepted Manuscript
The American Journal of Emergency Medicine
Published online: April 3 2016
x Patients with abdominal diagnoses constitute 5 to 10% of all ED presentations. The goal of this study is to identify which of these patients will have a non-concerning diagnosis based on demographic, physical exam and basic laboratory testing.
Hypophosphatemia in the emergency department therapeutics David W. Miller, Corey M. Slovis
DOI: http://dx.doi.org/10.1053/ajem.2000.7347
The American Journal of Emergency Medicine , Vol. 18 , Issue 4 ,
Published in issue: July 2000
x Although hypophosphatemia is relatively uncommon, it may be seen in anywhere from 20% to 80% of patients who present to the ED with alcoholic emergencies, diabetic ketoacidosis (DKA), and sepsis. Severe hypophosphatemia, as defined by a serum level below 1.0 mg/dL, may cause acute respiratory failure, myocardial depression, or seizures. Because hypophosphatemia is not as often treated by ED physicians, becoming familiar with a single intravenous phosphate solution and specific guidelines for phosphate repletion are essential.
Hyper-use of the ED Joseph R. Shiber, Michael B. Longley, Kori L. Brewer
DOI: http://dx.doi.org/10.1016/j.ajem.2008.05.006
The American Journal of Emergency Medicine , Vol. 27 , Issue 5 ,
Published in issue: June 2009
x This study aims to describe the population that averages one or more emergency department (ED) visits per month and compare them to the general ED population to determine if there are associated characteristics.
Implication of cardiac marker elevation in patients who resuscitated from out-of-hospital cardiac arrest Sang Hoon Oh, Young Min Kim, Han Joon Kim, Chun Song Youn, Seung Pill Choi, Jung Hee Wee, Soo Hyun Kim, Won Jung Jeong, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.022
The American Journal of Emergency Medicine , Vol. 30 , Issue 3 ,
Published online: February 7 2011
x It is often difficult to diagnose acute myocardial infarction (AMI) in patients who resuscitated after out-of-hospital cardiac arrest (OHCA) and had a delayed elevation in cardiac marker. This study explored whether elevations in cardiac marker were due to coronary artery occlusion or resulted from other causes.
Bowel in the pericardium: Spontaneous herniation mimicking acute aortic dissection Daniel S. Frank, Michael Heller, Jennifer Sedor, Namita Kedia, Adina Shulman, Elias E. Wan
DOI: http://dx.doi.org/10.1016/j.ajem.2016.03.012
Publication stage: In Press Accepted Manuscript
The American Journal of Emergency Medicine
Published online: March 8 2016
x Intra-pericardial herniation of abdominal contents is rarely encountered in emergency practice. The entity is most often the result of blunt or penetrating trauma and also may occur post-operatively. Spontaneous herniation through a Morgagni hernia is even rarer but presents the opportunity for lifesaving diagnosis and treatment. We present the case of an octogenarian presenting with the acute onset of symptoms suggestive of aortic dissection. She was found to have herniated transverse colon within the pericardial sac concerning for strangulated bowel.
Early use of glycoprotein IIb/IIIa inhibitors in the ED treatment of non-ST-segment elevation acute coronary syndromes: a local quality improvement initiative Francis M Fesmire, Eric D Peterson, Matthew T Roe, James F Wojcik
DOI: http://dx.doi.org/10.1016/S0735-6757(03)00027-5
The American Journal of Emergency Medicine , Vol. 21 , Issue 4 ,
Published in issue: July 2003
x A prospective observational study was conducted in 2,007 patients experiencing chest pain to determine impact of local quality improvement (QI) measures on the use of glycoprotein (GP) IIb/IIIa inhibitors in the ED treatment of high-risk patients with non-ST-segment elevation acute coronary syndromes (ACS). Patients with injury on the initial ECG or new sustained injury on continuous ECG were excluded. QI interventions were as follows: control (0-4 mo): no interventions (standardized protocols and prewritten orders in place 4 months prior); phase I (5-8 mo): simple education/awareness program with posted drug information pamphlets and eligibility criteria; phase II (9-12 mo): mandated QI form with real-time feedback and focused one-on-one physician education championed by an ED physician QI advocate.
Fatal QT interval Jérôme Fichet, Olivier Genee, Bertand Pierre, Dominique Babuty
DOI: http://dx.doi.org/10.1016/j.ajem.2007.11.039
The American Journal of Emergency Medicine , Vol. 26 , Issue 6 ,
Published in issue: July 2008
x A 21-year-old woman, without medical history, was admitted after cardiac arrest. Cardiopulmonary resuscitation and use of semiautomatic defibrillator quickly restored sinus rhythm. Clinical examination was normal with no cardiac murmur or abnormal heart sound. Electrocardiogram revealed sinus rhythm with short QT interval. Serum electrolytes and arterial blood gazes were normal. One hour after admission, lethal ventricular fibrillation occurred. Factors that shorten QT interval including increase in heart rate, hyperthermia, increased calcium, or potassium plasma levels and acidosis were excluded.
Angioedema in the emergency department: The impact of angiotensin-converting enzyme inhibitors Edwin C. Pigman, James L. Scott
DOI: http://dx.doi.org/10.1016/0735-6757(93)90166-9
The American Journal of Emergency Medicine , Vol. 11 , Issue 4 ,
Published in issue: July 1993
x Angiotensin-converting enzyme (ACE) inhibitors have been reported to cause angioedema. The purpose of this study was to establish what proportion of patients who present to the emergency department (ED) with angioedema were concomitantly taking any of the ACE inhibitors and to show how this group differed in presentation and response to treatment from the larger population of patients with non-ACE inhibitor-related angioedema. An 8-year retrospective chart review of all patients with the diagnosis of angioedema observed from January 1, 1984 to December 31, 1991 was undertaken in the ED of an urban teaching hospital.
d -Dimer in patients with suspected acute mesenteric ischemiaYu-Hui Chiu, Ming-Kun Huang, Chorng-Kuang How, Teh-Fu Hsu, Jen-Dar Chen, Chii-Hwa Chern, David Hung-Tsang Yen, Chun-I Huang
DOI: http://dx.doi.org/10.1016/j.ajem.2009.06.006
The American Journal of Emergency Medicine , Vol. 27 , Issue 8 ,
Published in issue: October 2009
x The aims of this study were to assess the diagnostic value of d -dimer in patients with suspected acute mesenteric ischemia (AMI) and to evaluate the correlation between d -dimer levels and the severity of bowel necrosis.
A simple and rapid approach to hypokalemic paralysis Shih-Hua Lin, Jainn-Shiun Chiu, Chin-Wang Hsu, Tom Chau
DOI: http://dx.doi.org/10.1016/S0735-6757(03)00159-1
The American Journal of Emergency Medicine , Vol. 21 , Issue 6 ,
Published in issue: October 2003
x Hypokalemia with paralysis (HP) is a potentially reversible medical emergency. It is primarily the result of either hypokalemic periodic paralysis (HPP) caused by an enhanced shift of potassium (K+ ) into cells or non-HPP resulting from excessive K+ loss. Failure to make a distinction between HPP and non-HPP could lead to improper management. The use of spot urine for K+ excretion rate and evaluation of blood acid-base status could be clinically beneficial in the diagnosis and management. A very low rate of K+ excretion coupled with the absence of a metabolic acid-base disorder suggests HPP, whereas a high rate of K+ excretion accompanied by either metabolic alkalosis or metabolic acidosis favors non-HPP.
Interhospital patient transfer: A quality improvement indicator for prehospital triage in mass casualties Dan Leibovici, Ofer N Gofrit, Raphael J Heruti, Shmuel C Shapira, Joshua Shemer, Michael Stein
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90120-0
The American Journal of Emergency Medicine , Vol. 15 , Issue 4 ,
Published in issue: July 1997
x The need for interhospital patient transfer after mass casualties may be a consequence of triage errors. Indications for interhospital patient transfer following seven suicidal bus bombings in Israel were reviewed to identify possible errors in triage at the scene. Medical records of victims arriving to hospitals were analyzed for age, injury description, Injury Severity Score (ISS), and indication and destination of interhospital transfer. A total of 473 victims were involved, 74 of whom died at the scene (15.6%).
Suggestion of a meta-analysis: unfractionated heparin vs low-molecular-weight heparin in patients with compromised left ventricular function Goran P. Koracevic
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.036
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 6 2013
x Clinical experience teaches us to use intravenous (IV) infusions wisely and not to forget the possibility of sudden worsening of heart function following the infusion, especially in older individuals and patients with known heart disease. It is particularly true for rapid IV infusion given to older women and patients with heart failure (HF) with preserved left ventricular (LV) ejection fraction (LVEF) [1].
The utility of the presence or absence of chest pain in patients with suspected acute myocardial infarction Francis M. Fesmire, Robert L. Wears
DOI: http://dx.doi.org/10.1016/0735-6757(89)90041-7
The American Journal of Emergency Medicine , Vol. 7 , Issue 4 ,
Published in issue: July 1989
x In 422 patients admitted from the emergency department (ED) for suspected acute myocardial infarction, the hypothesis that chest pain that persists on arrival in the ED or recurs during the initial ED evaluation is a useful predictor of acute myocardial infarction (AMI) and complications of coronary ischemia was tested. Compared with patients whose chest pain spontaneously ceased before arrival in the ED, patients whose chest pain persisted or recurred during the initial ED evaluation had a 2.3 times greater risk of interventions (P < .001), a 1.7 times greater risk of complications (P = .045), a 3.8 times greater risk of life-threatening complications (P = .04), and a 2.4 times greater risk of AMI (P = .005).
Emergency Medical Services (EMS) versus non-EMS transport of critically injured patients: Cornell EE, Belzberg H, Hennigan K, et al. JAMA 2000;135:315–319
DOI: http://dx.doi.org/10.1016/S0735-6757(01)80092-9
The American Journal of Emergency Medicine , Vol. 19 , Issue 5 ,
Published in issue: September 2001
Rapture of the large intestine caused by severe oral glyphosate-surfactant intoxication Eleni Palli, Demosthenes Makris, Chrysi Diakaki, Grigorios Garoufalis, Epaminondas Zakynthinos
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.002
The American Journal of Emergency Medicine , Vol. 29 , Issue 4 ,
Published online: February 7 2011
x Glyphosate surfactant (GlySH)—an agricultural chemical agent, herbicide—has been used for suicide attempts [1]. Intoxication by GlySH may involve many organs and systems such as the lungs, the kidneys, the liver, and the cardiovascular and nervous systems and, in some cases, may be fatal [2,3]. In contrast, gastrointestinal disorders associated with GlySH intoxication are considered to be moderate, usually limited to local irritation and dysphagia, mainly of the upper tract. We, therefore, wish to report a case of intoxication with a commercial herbicide agent containing GlySH, which apart from the usual multiorgan failure was also associated with extensive corrosive injuries of the large intestine.
Spontaneous lingual abscess in an immunocompromised patient Nick Kettaneh, Kelly Williamson
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.027
The American Journal of Emergency Medicine , Vol. 32 , Issue 5 ,
Published online: November 25 2013
x Acute lingual abscess is a rare yet life-threatening clinical entity. Lingual abscess must be appropriately diagnosed and treated in the emergency department to avoid acute airway compromise. A 68-year-old woman on immunomodulatory medication for rheumatoid arthritis presented to the emergency department with left facial pain and swelling. An anterior lingual abscess was diagnosed on computed tomographic scan. The most common cause of lingual abscess is direct trauma, although immunocompromised state is a predisposing risk factor.
Ischemia-reperfusion injury in an aortic dissection patient Zhuo Yin, J.R. Yang, Y.S. Wei, B.L. Liang, Y.B. Wei, K.Q. Zhou, Z. Wang, B. Yan, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.045
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: December 30 2014
x Aortic dissection is a life-threatening emergency. Well-established risk factors include systemic hypertension, hereditary connective tissue diseases (Marfan syndrome and Ehlers-Danlos syndrome), coarctation of the aorta, bicuspid aortic valve, aortitis, and arch hypoplasia. Ischemia of the viscera, the kidneys, the spinal cord, or the lower extremities due to malperfusion constitutes life-threatening complications that have to be considered in the treatment strategy. We report a rare case of symptomatic ischemia of the lower extremities due to aortic dissection.
Authors' response to “Peripartum cardiomyopathy in the ED” Alyson J. McGregor, Rebecca Barron, Karen Rosene-Montella
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.044
The American Journal of Emergency Medicine , Vol. 33 , Issue 8 ,
Published online: April 29 2015
x We thank the writers of the correspondence regarding the recently published review article “The pregnancy heart: cardiac emergencies during pregnancy” for their interest and comments [1]. The main purpose of this article was to summarize diagnostic and clinical management recommendations essential for acute care clinicians to consider for 3 common cardiovascular emergencies in the pregnant patient: peripartum/postpartum cardiomyopathy (PPCM), acute myocardial infarction, and cardiac resuscitation.
A surgical emergency due to an incarcerated paraesophageal hernia Chi-Chung Chang, Chiu-Liang Tseng, Yu-Che Chang
DOI: http://dx.doi.org/10.1016/j.ajem.2008.05.009
The American Journal of Emergency Medicine , Vol. 27 , Issue 1 ,
Published in issue: January 2009
x Paraesophageal hernias (PEHs) are hernias in which the gastroesophageal junction stays where it belongs (attached at the level of the diaphragm), but part of the stomach passes or bulges into the chest beside the esophagus. It represents a small proportion of all hiatal hernias. It can lead to severe complications like incarceration, volvulus, or strangulation, which are true emergencies in the emergent department (ED). Paraesophageal hernia rarely features on a list of differential diagnoses of acute chest or epigastric pain.
Concurrent ovarian hyperstimulation syndrome with perforated appendicitis following induction ovulation with HMG and HCG Zinatossadat Bouzari, Shahla Yazdani, Toktam Sadeghi
DOI: http://dx.doi.org/10.1016/j.ajem.2016.03.015
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: March 5 2016
x Ovarian hyperstimulation syndrome (OHSS) of the ovary is a medical complication of the ovulation induction, and it has been shown that OHSS may both mask the typical manifestations of appendicitis and compromise the concurrent intraperitoneal infection.
Screening for anticholinergic abuse in patients with chronic mental illness Richard C. Christensen
DOI: http://dx.doi.org/10.1016/S0735-6757(03)00167-0
The American Journal of Emergency Medicine , Vol. 21 , Issue 6 ,
Published in issue: October 2003
The resilience of the human body Salim Surani, Marlene Morales, Mauricio Rodriguez, Joseph Varon
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.020
The American Journal of Emergency Medicine , Vol. 29 , Issue 7 ,
Published online: June 13 2011
x The human race has evolved over millions of years. This evolution has allowed our bodies to adapt to critical situations, which are otherwise lethal in other species. One example of such adaptation is the human blood pH. This characteristic measurement, by virtue of its compensatory mechanisms, keeps the pH in a range of 7.35 to 7.45 even under adverse circumstances. As clinicians, we have encountered patients with severe hypoxemia and hypercarbia in our emergency departments (EDs), medical and surgical wards, and the intensive care units.
Laceration of the popliteal artery and compartment syndrome resulting from stingray envenomation Charlotte Derr, Barbara J. O'Connor, Sandra L. MacLeod
DOI: http://dx.doi.org/10.1016/j.ajem.2006.04.016
The American Journal of Emergency Medicine , Vol. 25 , Issue 1 ,
Published in issue: January 2007
x A 46-year-old man was releasing a stingray from a fishing line when its tail barb punctured the patient's wader boots and entered his left medial thigh. When the paramedics arrived, the patient was hypotensive and tachycardic. He complained of severe pain surrounding the wound and numbness in his left foot. No pedal pulse could be palpated in the patient's lower extremity.
Methylene blue for refractory anaphylaxis—is it a magic bullet? The authors' response Cindy S. Bauer, Peter Vadas, Kevin J. Kelly
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.031
The American Journal of Emergency Medicine , Vol. 31 , Issue 7 ,
Published online: May 15 2013
x We wish to thank the authors for their comments concerning our report [1] about the use of methylene blue to treat refractory anaphylaxis. We are entirely in agreement with the need to balance the potential risks and benefits of interventions, particularly in life-threatening situations. Given the limited experience with the use of methylene blue as a salvage medication in refractory anaphylaxis, we would emphasize that the decision to use this drug must be deliberated carefully only after other, more conventional, treatment options have been considered [2].
Calcium blockers in neurological recovery after cardiac arrest Larry J. Baraff
DOI: http://dx.doi.org/10.1016/0735-6757(85)90216-5
The American Journal of Emergency Medicine , Vol. 3 , Issue 5 ,
Published in issue: September 1985
The impact of emergency medical services on the ED care of severe sepsis Jonathan R. Studnek, Melanie R. Artho, Craymon L. Garner Jr, Alan E. Jones
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.015
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: October 28 2010
x The identification and treatment of critical illness is often initiated by emergency medical services (EMS) providers. We hypothesized that emergency department (ED) patients with severe sepsis who received EMS care had more rapid recognition and treatment compared to non-EMS patients.
An unusual cause of postcolonoscopy abdominal pain Michael D. April, Joshua R. Simmons, Adam S. Nielson
DOI: http://dx.doi.org/10.1016/j.ajem.2012.05.011
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: July 16 2012
x Colonoscopy is a common procedure used for screening, diagnosis, and treatment of gastrointestinal disease. Life-threatening complications are uncommon (28/10
The role of icatibant—the B2 bradykinin receptor antagonist—in life-threatening laryngeal angioedema in the ED Carmi Bartal, Vladimir Zeldetz, Vered Stavi, Leonid Barski
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.055
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: August 26 2014
x Angioedema is a localized, sudden, transient, and often recurrent swelling of the deeper layers of the skin or mucosa with no epidermal component. It is caused by vasoactive substances that produce a transient increase in endothelial permeability. Angioedema involving the laryngeal components is a life-threatening situation for the patient, and it is a challenge for the emergency medicine physician to rapidly achieve a safety airway. Most cases of laryngeal angioedema are induced by histamine release; but 10% are bradykinin induced, which does not respond to the conventional algorithm of treating allergic-induced angioedema.
Fatal hyperhemolytic delayed transfusion reaction in sickle cell disease: A case report and literature review Amr El-Husseini, Alaa Sabry
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.032
The American Journal of Emergency Medicine , Vol. 28 , Issue 9 ,
Published online: May 3 2010
x Patients with sickle cell disease (SCD) may require repeated red blood cells (RBCs) transfusion, putting them at risk for minor blood group alloimmunization and the development of hyperhemolytic delayed transfusion reactions (HDTR). We recently cared for an adolescent with SCD who was admitted to the hospital with a severe HDTR. The patient had been discharged from the hospital five days previously, and had been transfused while hospitalized. The patient continued to hemolyse, despite the use of antigen compatible blood and end-up by disseminated intravascular coagulopathy (DIC), acute kidney injury (AKI) and he went on to develop cardiac arrest and could not be resuscitated.
Emergency physician focused cardiac ultrasound improves diagnosis of ascending aortic dissection Joseph R. Pare, Rachel Liu, Christopher L. Moore, Tyler Sherban, Michael S. Kelleher Jr., Sheeja Thomas, R. Andrew Taylor
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.005
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 12 2015
x Ascending aortic dissection (AAD) is an uncommon, time-sensitive, and deadly diagnosis with a nonspecific presentation. Ascending aortic dissection is associated with aortic dilation, which can be determined by emergency physician focused cardiac ultrasound (EP FOCUS). We seek to determine if patients who receive EP FOCUS have reduced time to diagnosis for AAD.
Activated charcoal may not be necessary in all oral overdoses of medication Georgia Orfanidou, Athanasios Chalkias, Anastasios Koutsovasilis, Georgios Loizos, Theodoros Xanthos
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.015
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: November 9 2015
x Acute poisoning constitutes a significant proportion of hospital admissions with varying morbidity and mortality. Activated charcoal (AC) is commonly used to treat poisonings and overdoses following oral ingestion; however, although AC absorbs most drugs and is generally well tolerated with few adverse effects, its administration does not come without risk, and it may not improve clinical outcome [1–8]. The aim of our study was to evaluate the effect of AC administration on outcome of patients having ingested an oral overdose of medication.
Emergency medicine: Definition and direction Hubert S. Mickel
DOI: http://dx.doi.org/10.1016/S0735-6757(84)80016-9
The American Journal of Emergency Medicine , Vol. 2 , Issue 2 ,
Published in issue: March 1984
Medical student attitudes toward life-saving clinical skills Douglas S. Ander, Katherine L. Heilpern, Constance S. Parramore
DOI: http://dx.doi.org/10.1016/j.ajem.2003.09.012
The American Journal of Emergency Medicine , Vol. 22 , Issue 1 ,
Published in issue: January 2004
Emergency ultrasonography for the early diagnosis of necrotizing fasciitis: a case series from the ED Lindsay Oelze, Stanley Wu, Jennifer Carnell
DOI: http://dx.doi.org/10.1016/j.ajem.2012.09.026
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: January 23 2013
x Necrotizing fasciitis is a rapidly progressing and life-threatening bacterial infection of deep subcutaneous tissues. Prompt diagnosis and surgical intervention decrease morbidity and improve patient survival [1]. A paucity of physical examination findings in early disease hinders timely diagnosis contributing to a high mortality rate of 25% to 30% [2]. Emergency department physicians rely on clinical suspicion to make the diagnosis in critically ill patients as advanced imaging modalities such as computed tomography or magnetic resonance imaging may result in an unacceptable delay to surgical intervention.
Subarachnoid hemorrhage and pneumocephalus due to epidural anesthesia Murat Güzel, Ömer Salt, Ali K. Erenler, Ahmet Baydın, Mehmet T. Demir, Anil Yalcin, Zahide Doganay
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.029
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: January 30 2014
x Epidural analgesia is an extremely effective and popular treatment for pain during labor. Subarachnoid hemorrhage and pneumocephaly is a serious but rare complication of puncture of the dura mater in epidural anesthesia. To best of our knowledge, intracranial subarachnoid hemorrhage together with pneumocephaly hasn’t been reported as a complication after the lumbar puncture so far. Our purpose is to increase awareness for serious complications such as subarachnoid hemorrhage and pneumocephaly following regional procedures (See Fig.
Contents
DOI: http://dx.doi.org/10.1016/S0735-6757(08)00388-4
The American Journal of Emergency Medicine , Vol. 26 , Issue 6 ,
Published in issue: July 2008
Attending supervision of nonemergency medicine residents in a university hospital ED C.James Holliman, Richard C Wuerz, Mark J Kimak, Keith K Burkhart, J.Ward Donovan, Howard L Rudnick, Mark A Bates, H.Arnold Muller
DOI: http://dx.doi.org/10.1016/0735-6757(95)90195-7
The American Journal of Emergency Medicine , Vol. 13 , Issue 3 ,
Published in issue: May 1995
x There have been a limited number of studies assessing the impact of attending physician supervision of residents in the emergency department (ED). The objective of this study is to describe the changes in patient care when attending emergency physicians (AEPs) supervise nonemergency medicine residents in a university hospital ED. This was a prospective study including 1,000 patients, 32 second- and third-year nonemergency medicine residents and eight AEPs. The AEPs classified changes in care for each case as major, minor, or none, according to a 40-item data sheet list.
Identification of potential organ donors of advanced age in EDs Philippe Le Conte, David Riochet, Laetitia Labastire, Jean Christophe Auneau, Estelle Legeard, Myriam Van Tricht, Eric Batard, Emmanuel Montassier, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2010.08.012
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: November 1 2010
x In France and in Belgium, as in many countries, there is a shortage of organs for transplantation, which has led to strategies to recruit older potential donors who may die of stroke.
Occult lacerations to the epiglottis and pharynx by glass fragments Ryoko Warabi, Katsutoshi Tanno, Suguru Hirayama, Takehiro Warabi, Noriyuki Sakakibara, Yoshinobu Kimura
DOI: http://dx.doi.org/10.1016/j.ajem.2007.08.024
The American Journal of Emergency Medicine , Vol. 26 , Issue 4 ,
Published in issue: May 2008
x Injury to the epiglottis and pharynx is very rare in neck trauma overall. We experienced such a rare case in which a 43-year-old woman had lacerations to the epiglottis and pharynx. It was difficult to determine the exact site of the damage by observing the cut. We believed there was no damage to the lower respiratory tract because her vital signs were stable and her consciousness was clear. However, initial computed tomography revealed emphysema and showed that fragments from a glass vase had pierced the posterior pharyngeal wall.
Letter regarding rapidly improving, severe acute myocarditis after a scorpion bite Gen-Min Lin, Chih-Lu Han
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.031
The American Journal of Emergency Medicine , Vol. 29 , Issue 3 ,
Published online: December 15 2010
x We appreciate the experience by Sezen et al [1], who described a 12-year-old boy who developed life-threatening, acute toxic myocarditis and heart failure after a scorpion bite, for whom aggressive medical treatment with inotropic agents, diuretics, and parenteral corticosteroids resulted in rapid clinical resolution. To our knowledge, the natural course of fulminant myocarditis is related to the underlying etiologies including severe ischemia, toxic/metabolic agents, infection, and inflammation [2].
Oedipism: bilateral self-enucleation Igal Leibovitch, George Pietris, Robert Casson, Dinesh Selva
DOI: http://dx.doi.org/10.1016/j.ajem.2005.08.019
The American Journal of Emergency Medicine , Vol. 24 , Issue 1 ,
Published in issue: January 2006
x A 35-year-old man was previously diagnosed with a manic depressive disorder leading to a suicide attempt 15 years earlier. He also had a history of substance abuse (marijuana usage and moderate consumption of alcohol) and was treated with diazepam (4 mg/d). Six months before his current presentation, he felt that he was born again as a Christian, and this was associated with increasing religious preoccupations using the bible. On the night before his admission, he had a special religious experience of being able to look into the next life, and there he saw himself as a child molester.
Psychiatric drug–induced fatal abdominal compartment syndrome Sophie Jambet, Boris Guiu, Pierre Olive-Abergel, Aurélie Grandvuillemin, Jean-Michel Yeguiayan, Pablo Ortega-Deballon
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.005
The American Journal of Emergency Medicine , Vol. 30 , Issue 3 ,
Published online: February 28 2011
x Several drugs used in psychiatry may induce constipation, paralytic ileus, or acute megacolon (Ogilvie's syndrome). We report here 2 cases of patients presenting with fatal abdominal compartment syndrome related to the absorption of antidepressants and benzodiazepines. Two patients (a 27-year-old man and a 57-year-old woman) with a previous psychiatric history and treatment with psychiatric drugs were admitted to the emergency department for coma. Both presented hypothermia; a hard, distended abdomen; and ischemia of the lower limbs.
Infective rhomboencephalitis and inverted Takotsubo: neurogenic-stunned myocardium or myocarditis? Francesco Ruggieri, Marco Cerri, Luigi Beretta
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.047
The American Journal of Emergency Medicine , Vol. 32 , Issue 2 ,
Published online: September 30 2013
x Here we originally describe the clinical scenario of a young immune-competent patient affected by acute rhomboencephalitis with severe parenchymal edema and acute hydrocephalus who developed sudden life-threatening cardiac derangement. Hemodynamic and perfusion parameters revealed cardiogenic shock, so intensive circulatory support with epinephrine infusion and intra-aortic balloon pump was needed to restore organ perfusion. Transesophageal echocardiographic examination showed severe left ventricular dysfunction (ejection fraction as low as 20%) with wall motion abnormalities resembling a pattern of Takotsubo-inverted cardiomyopathy.
A patient with numerous tablets remaining in the stomach even 5 hours after ingestion Yoshinobu Kimura, Yasuhiro Kamada, Saori Kimura
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.021
The American Journal of Emergency Medicine , Vol. 26 , Issue 1 ,
Published in issue: January 2008
x The current consensus suggests that gastric lavage should not be considered unless a patient has ingested a potentially life-threatening amount of a poison and that the procedure can be undertaken within 60 minutes of ingestion. However, it can be difficult to identify those who might potentially benefit from gastric lavage in some cases because some life-threatening drugs such as tricyclic antidepressants tend to remain in the stomach longer. We report a case that necessitated gastric lavage using abdominal computed tomography (CT).
Pediatric hemoptysis with pulmonary hemorrhage and respiratory failure: A case report Adam P. Dine, Sandra L. Werner
DOI: http://dx.doi.org/10.1016/j.ajem.2007.10.035
The American Journal of Emergency Medicine , Vol. 26 , Issue 5 ,
Published in issue: June 2008
x Hemoptysis is a rare complaint in the pediatric population. It is most commonly of infectious etiology and is rarely life threatening. However, there are rare life-threatening causes of pediatric hemoptysis, which should be included in the differential diagnoses of children presenting to the emergency department (ED) with this complaint.
Cardiac arrest with refractory ventricular fibrillation: a successful resuscitation using extracorporeal membrane oxygenation Chun-Chieh Chiu, Chun-wen Chiu, Ying-Cheng Chen, Fu-Yuan Siao
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.035
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: May 25 2012
x Extracorporeal membrane oxygenation (ECMO) is a form of a mechanical cardiopulmonary life-support system and an adjunct to prolonged cardiac resuscitation. The ECMO results in good outcomes for patients with in-hospital cardiac arrest. We present a case of a 52-year-old man with out-of-hospital cardiac arrest caused by refractory ventricular fibrillation. The patient was referred to our emergency department with suspected acute coronary syndrome. Cardiac arrest with ventricular fibrillation was refractory to conventional cardiopulmonary resuscitation.
Life-threatening “round pneumonia” Ayman O Soubani, Scott K Epstein
DOI: http://dx.doi.org/10.1016/S0735-6757(96)90132-1
The American Journal of Emergency Medicine , Vol. 14 , Issue 2 ,
Published in issue: March 1996
x Round pneumonia is a rare manifestation of lower respiratory tract infection in adults. Previous reports emphasize that this entity is typically a mild, easily treatable illness that often masquerades radiographically as a neoplasm. We present two cases of round pneumonia, in patients with abnormal immunity, that progressed rapidly to life-threatening septic shock and respiratory failure.
Risk tolerance for the exclusion of potentially life-threatening diseases in the ED Jesse M. Pines, Demian Szyld
DOI: http://dx.doi.org/10.1016/j.ajem.2006.10.011
The American Journal of Emergency Medicine , Vol. 25 , Issue 5 ,
Published in issue: June 2007
x Given the same pretest probability (10%) for subarachnoid hemorrhage (SAH), pulmonary embolism (PE), and acute coronary syndrome (ACS), we determined if differences exist in the risk tolerance for disease exclusion according to published guidelines given a negative test result.
A primary cardiac sarcoma presenting with superior vena cava obstruction Manish Thakker, Tracey Keteepe-Arachi, Ausami Abbas, Graham Barker, Neil Ruparelia, Gearoid T. Kingston, Timothy J. Parke
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.030
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: January 31 2011
x Superior vena cava (SVC) obstruction leads to a constellation of symptoms and signs that encompass the SVC syndrome. Today, malignancy accounts for 65% of all cases. The most common neoplastic causes are non–small cell lung cancer (50%), small cell lung cancer (25%), lymphoma, and metastasis. Primary cardiac tumors are an extremely rare cause of SVC obstruction. We describe the case of a 48-year-old man who presented with dyspnea, confusion, and facial swelling with cyanosis. The patient developed life-threatening airway obstruction after administration of anxiolytic.
Nosocomial and community-acquired infection rates of patients treated by prehospital advanced life support compared with other admitted patients Scott M. Alter, Mark A. Merlin
DOI: http://dx.doi.org/10.1016/j.ajem.2009.07.020
The American Journal of Emergency Medicine , Vol. 29 , Issue 1 ,
Published online: March 10 2010
x Nosocomial infections are a large burden to both patients and health care organizations, causing hospitals to take measures in an attempt to reduce microorganism transmission. Patients treated by emergency medical services are one population that has not been studied regarding infection rates. This study examines admitted patients treated by advanced life support (ALS) and their likelihood of having community-acquired and nosocomial infections.
Hyperbaric oxygen and cyanide poisoning Kenneth W. Kizer
DOI: http://dx.doi.org/10.1016/0735-6757(84)90122-0
The American Journal of Emergency Medicine , Vol. 2 , Issue 1 ,
Published in issue: January 1984
Acute life-threatening presentation of unknown lymphatic malformation Thierry Detaille, Ryad Joomye, Catherine Barrea, Philippe Clapuyt, Laurence M. Boon, Stephan Clément de Cléty
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.031
The American Journal of Emergency Medicine , Vol. 28 , Issue 9 ,
Published online: May 3 2010
x Lymphatic malformations (LMs) are rare congenital vascular malformations. Lymphatic malformations include a wide variety of diseases, such as lymphangiomatosis, macro or microcystic lymphatic malformation, and lymphangiectasia. Lymphatic malformations are often first seen at birth, although intrauterine diagnosis is not uncommon. Depending on their size and location, they can be asymptomatic or threaten life by compression of vital structures. We report 2 children admitted to the emergency department with an acute life-threatening presentation of undiagnosed LM.
Lodox/Statscan provides benefits in evaluation of gunshot injuries Chih-Yuan Fu, Yu-Chun Wang, Chi-Hsun Hsieh, Ray-Jade Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.001
The American Journal of Emergency Medicine , Vol. 29 , Issue 7 ,
Published online: June 6 2011
x Gunshot wounds may result in abdominal or extremity injuries, which have a high rate of mortality [1-8]. Multiple films may be needed to survey the injured sites and localize any residual bullet wounds. Therefore, emergency department (ED) physicians frequently face the challenge of deciding which films to take and how many films are needed because of the presence of multiple wounds and the unpredictable paths of projectiles.
Tension pneumoperitoneum during routine colonoscopy Jennifer L. Carey, Anthony M. Napoli
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.010
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: December 27 2010
x Colonoscopy is generally a safe and effective means to detect, diagnose, and treat colonic abnormalities. Although the overall complication rate is low, the morbidity and mortality following perforation approach 50%. Here we present a case of a 49-year-old woman undergoing routine colonoscopy when she suffered bowel perforation and tension pneumoperitoneum. This is a seldom occurrence and may result following bowel perforation with the rapid accumulation of free air into the peritoneal cavity. It is a life-threatening complication and a surgical emergency.
Disulfiram ethanol reaction mimicking anaphylactic, cardiogenic, and septic shock Simon Bourcier, Nicolas Mongardon, Fabrice Daviaud, Laurence Moachon, Marc-Antoine Arnould, Franck Perruche, Frédéric Pène, Alain Cariou
DOI: http://dx.doi.org/10.1016/j.ajem.2012.05.002
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: July 18 2012
x Shock is a common reason for medical intensive care unit admission, with septic and cardiogenic accounting for most of the etiologies. However, the potential severity of adverse side effects of drugs indicates that any medication should be carefully scrutinized for potential pharmacokinetic and pharmacodynamic interactions that may result. We herein report the case of a life-threatening shock mimicking successively anaphylactic, cardiogenic, and septic shock, which was finally related to disulfiram ethanol reaction.
First-aid treatments of crush injuries after earthquake: 2 special cases Xia Zhang, Xiaofeng Bai, Qing Zhou
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.062
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: January 9 2014
x Hyperkalemia and acute renal failure are the life-threatening complications of crush injuries. Vigilant prehospital emergency care is vital to reduce the complications. We report and discuss 2 cases diagnosed as crush syndrome after earthquake, in order to illustrate the value of prehospital application of tourniquets to prevent hyperkalemia accompanying extremity crush injuries. The victim in case 1 died of hyperkalemia shortly after extrication without tourniquet. The prehospital tourniquet had been used to avoid uncontrollable hemorrhage and release of toxic metabolites into the circulation in case 2.
Hemoptysis caused by Hughes-Stovin syndrome Chu-Lin Tsai, Tsung-Chien Lu, Kuang-Chau Tsai, Wen-Jone Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2004.05.009
The American Journal of Emergency Medicine , Vol. 23 , Issue 2 ,
Published in issue: March 2005
x Hemoptysis is a common complaint that emergency physicians encounter. Most cases are minor or self-limited; however, massive hemoptysis occasionally occurs and can be life-threatening. Patients with Hughes-Stovin syndrome can present with massive hemoptysis from pulmonary artery aneurysms and pulmonary embolisms, and specific treatments are required for this potentially lethal condition. Here we report a unique case and discuss the clinical implications for emergency physicians.
Bilateral carotid and vertebral artery dissection: a life-threatening cause of postpartum headache Erin L. Simon, Greg Griffin, Evan Bosman
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.017
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: September 18 2014
x We report a case of a 31-year-old G4P4 woman who was 3-week status post vaginal delivery who presented to the emergency department (ED) with a worsening headache that developed 1 week after delivery. She was initially seen in the ED at 2 weeks postpartum. At that time, a computed tomography (CT) without contrast revealed no significant findings, and she was discharged with hydrocodone/acetaminophen, which provided adequate pain relief. She returned to the ED one week later with an increased headache, left upper and lower extremity numbness, and left facial numbness for 24 hours.
Successful use of ECMO as a bridge to surgical embolectomy in Life-Threatening Pulmonary Embolism Guillaume Lebreton, Nadia Bouabdallaoui, Loïc Gauduchon, Mohamed Ali Mnif, François Roques
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.018
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: March 17 2015
x Massive pulmonary embolism is a life-threatening condition that carries a high mortality rate. Treatment relies on thrombolytic therapy and/or emergency surgical embolectomy. Extra-Corporeal Membrane Oxygenation (ECMO) may be considered in massive pulmonary embolism with hemodynamic compromise as a bridge to specific reperfusion therapy. We here describe the successful use of ECMO as a bridge to surgical embolectomy in a 36-year-old female patient admitted for acute pulmonary embolism in which intravenous thrombolysis was firmly contraindicated.
Sustained ventricular tachycardia caused by anaphylactic reaction Qiang Chen, Tong Liu, Guangping Li
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.034
The American Journal of Emergency Medicine , Vol. 31 , Issue 11 ,
Published online: August 19 2013
x We report a 30-year-old man who developed severe anaphylactic reactions with sustained ventricular tachycardia after eating seafood. This case emphasizes the need for cardiac monitoring in patients with anaphylaxis to identify malignant ventricular arrhythmias early.
Assessment of acute asthma severity in the ED: are heart and respiratory rates relevant? Gustavo J. Rodrigo, Hugo Neffen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.022
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: June 16 2015
x Assessment of acute asthma severity in the emergency department (ED) determines the appropriate initial therapy. The aim of this study was to evaluate the usefulness of heart and respiratory rates as determinants of severity of asthma exacerbations.
Improving risk stratification in patients with chest pain: the Erlanger HEARTS3 score Francis M. Fesmire, Erik J. Martin, Yu Cao, Gregory W. Heath
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.017
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: May 25 2012
x The HEART score uses elements from patient H istory, E lectrocardiogram, A ge, R isk Factors, and T roponin to obtain a risk score on a 0- to 10-point scale for predicting acute coronary syndromes (ACS). This investigation seeks to improve on the HEART score by proposing the HEARTS3 score, which uses likelihood ratio analysis to give appropriate weight to the individual elements of the HEART score as well as incorporating 3 additional “S” variables: S ex, S erial 2-hour electrocardiogram, and S erial 2-hour delta troponin during the initial emergency department valuation.
On-site pharmacists in the ED improve medical errors Amy A. Ernst, Steven J. Weiss, Arthur Sullivan IV, Dusadee Sarangarm, Shannon Rankin, Martha Fees, Preeyaporn Sarangarm
DOI: http://dx.doi.org/10.1016/j.ajem.2011.05.002
The American Journal of Emergency Medicine , Vol. 30 , Issue 5 ,
Published online: June 13 2011
x The objective of the study was to compare errors in the emergency department (ED) with pharmacists present (PPs) for resuscitations and traumas vs with pharmacists absent (PAs). Our hypothesis was that errors would be significantly fewer during PP than PA times. We also hypothesized that times with PP would affect patients greater when disposition was to more critical areas (intensive care unit, or ICUs).
Subconjunctival hemorrhage in a patient on dabigatran (Pradaxa) Tam M. Nguyen, Michael P. Phelan, Xiang Q. Werdich, Paul J. Rychwalski, Christopher M. Huff
DOI: http://dx.doi.org/10.1016/j.ajem.2012.07.021
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: September 24 2012
x Dabigatran is a direct thrombin inhibitor that has gained increasing popularity for prevention of thromboembolic events such as stroke, pulmonary embolism, and myocardial ischemia. Because of the increasing use of this drug, emergency department (ED) physicians are going to be evaluating patients taking this medication. It is important to understand the potential for ocular bleeding complications associated with this class of anticoagulant. Traditionally, patients have been placed on vitamin K antagonists to decrease the risk of thromboembolism.
Caution with naloxone use in asthmatic patients Paul J. Allegretti, Jeff S. Bzdusek, Jim Leonard
DOI: http://dx.doi.org/10.1016/j.ajem.2005.09.008
The American Journal of Emergency Medicine , Vol. 24 , Issue 4 ,
Published in issue: July 2006
x The city of Chicago has a high prevalence of asthma and is currently in the midst of a heroin abuse epidemic. Higher-purity heroin is readily available and can be easily inhaled. As a result, the emerging pattern in heroin administration is changing, with inhalation being the most commonly reported route of use. This has contributed to a growing perception that heroin is not as dangerous or addictive as it used to be. The population of suburban youth inhaling heroin (younger than 25 years) demonstrates the largest increase.
A rare cause of headache: cerebral venous sinus thrombosis due to hyperthyroidism Murat Pekdemir, Serkan Yilmaz, Murat Ersel, Hasan Tahsin Sarisoy
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.029
The American Journal of Emergency Medicine , Vol. 26 , Issue 3 ,
Published in issue: March 2008
x Headache represents up to 4% of all emergency department (ED) visits. Emergency physicians generally are concerned with identifying those patients whose headaches are caused by life-threatening conditions. Cerebral venous sinus thrombosis may be difficult to diagnose clinically because of its various and nonspecific manifestations. The most frequent but least specific symptom of sinus thrombosis is severe headache, which is present in more than 90% of adult patients. In the case report we present, a patient had severe headache and was diagnosed until third ED visit at different hospitals.
Patterns of use of EMS transport Charles McConnel, Rosemary W. Wilson
DOI: http://dx.doi.org/10.1053/ajem.2001.16252
The American Journal of Emergency Medicine , Vol. 19 , Issue 1 ,
Published in issue: January 2001
x My colleague and I were pleased to review Dr Svenson's emergency medical service (EMS) transport study in this Journal 1 and hope that its publication is a sign of a heightened interest in population-based studies that focus on the socioeconomic and demographic factors underlying EMS use. It is a rich study with a variety of important findings that reinforce the view of previous research regarding the necessity for planning the public provision of emergency health resources as our society ages. Nonetheless, having pursued a similar research program over the past decade, we are compelled to quarrel with the investigator's assertion of priority in reporting EMS transport use rates across all age groups.
Treatment strategies for prosthetic valve thrombosis in pregnant patients Mahmut Yesin, Macit Kalçık, Süleyman Karakoyun, Mehmet Ali Astarcıoğlu, Mustafa Ozan Gürsoy, Sabahattin Gündüz, Mehmet Özkan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.055
The American Journal of Emergency Medicine , Vol. 33 , Issue 6 ,
Published online: March 31 2015
x We would like to comment on the recent article reported by Saha et al [1] that was recently published in the American Journal of Emergency Medicine . Thanks to the authors for their contribution of the present report describing thrombolytic therapy (TT) with streptokinase (SK) in a pregnant patient with prosthetic valve thrombosis (PVT). However, we feel that there remain some drawbacks to be addressed regarding the patient management and TT regimens for PVT in pregnancy.
Painless acute aortic dissection presenting as intermittent syncope Ying-Sheng Shen, Wei-Lung Chen, Jiann-hwa Chen, Yung-Lung Wu, Hung-Yi Kuo
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.015
The American Journal of Emergency Medicine , Vol. 28 , Issue 4 ,
Published online: March 26 2010
x Syncope is commonly encountered in emergency department patients. The causes are numerous and include certain life-threatening illnesses that must be rapidly considered and excluded from the differential diagnosis. This article reports on a case of a painless acute aortic dissection and having collapsed 3 times within 1 day. The rupture of the patient's proximal dissection (ascending aorta) into the pericardial space with low cardiac output may have lead to his intermittent syncope (especial during postural change).
Patient treatment in ED hallways and patient perception of clinician-patient communication Bernard P. Chang, Eileen Carter, Edward H. Suh, Ian M. Kronish, Donald Edmondson
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.074
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: March 2 2016
x In the setting of high patient volumes and boarding times across many emergency departments (EDs), clinicians are increasingly tasked with the challenge of managing patients in nonconventional care areas [1]. The use of hallway care areas, locations where patients are in close proximity to one another with little or no structural partitions separating them, has increased [2–3]. Several negative consequences of ED hallway care have been noted, including patient perceptions of compromised care [4] and poor infection prevention practices among staff [5].
Physician-staffed mobile ICUs Bruce M. Thompson
DOI: http://dx.doi.org/10.1016/0735-6757(85)90020-8
The American Journal of Emergency Medicine , Vol. 3 , Issue 1 ,
Published in issue: January 1985
ED management of pediatric syncope Valérie Hue, Odile Noizet-Yvernaux, Guy Vaksmann, François Dubos, Alain Martinot
DOI: http://dx.doi.org/10.1016/j.ajem.2008.05.019
The American Journal of Emergency Medicine , Vol. 26 , Issue 9 ,
Published in issue: November 2008
x We read with interest the article by Goble and colleagues [1] entitled “ED management of pediatric syncope: searching for a rationale.” The authors highlighted 2 findings: “the interpretation of ECGs by a pediatric cardiologist before planning admission may have adverted up to 5 of the 11 admissions”, and “a high rate of non cardiologic testing,” particularly head computed tomography (CT) (58% of patients, all with normal findings). We performed an observational cohort study that confirmed the first and original point and illustrated the second one with a very different pattern of procedures performed in a French multidisciplinary pediatric emergency department (ED) of a university hospital.
Life-threatening flecainide overdose treated with intralipid and extracorporeal membrane oxygenation Emily Brumfield, Kenneth R.L. Bernard, Christopher Kabrhel
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.012
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: April 11 2015
x Flecainide is a Class Ic antiarrythmic agent associated with adverse events due to its pro-arrythmic effects. We report the case of a 33-year-old female presenting in cardiac arrest after a flecainide overdose treated with intravenous fat emulsion (IFE), sodium bicarbonate (NaHCO3 ), and extracorporeal membrane oxygenation (ECMO). This case reviews the pathophysiology and management of flecainide toxicity including novel strategies of IFE and ECMO.
The use of bretylium in prehospital ventricular fibrillation Eric E. Harrison, Brent D. Amey
DOI: http://dx.doi.org/10.1016/0735-6757(83)90029-3
The American Journal of Emergency Medicine , Vol. 1 , Issue 1 ,
Published in issue: July 1983
x Bretylium tosylate is recommended by the American Heart Association Standards for Advanced Cardiac Life Support for refractory ventricular fibrillation after countershock, sodium bicarbonate, and epinephrine. According to this protocol, paramedics gave five to six milligrams per kilogram of intravenous bretylium by bolus in 96 patients with refractory fibrillation over a 24-month period. A positive response was defined as the presence of a palpable pulse following bretylium and countershock. Thirty-five percent of patients () responded following bretylium.
Anticytoplasm neutrophil antibodies–positive vasculitis with diffuse alveolar hemorrhage related to a spider bite Laura-Otilia Damian, Cristina Lenuţ, Dan Sebastian Dîrzu, Anca Cristea, Simona Rednic, Natalia Hagău
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.021
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: June 13 2015
x Diffuse alveolar hemorrhage is a life-threatening complication of anticytoplasm neutrophil antibodies–associated vasculitis. We report the first case of microscopic polyangiitis with pulmonary-renal syndrome triggered by a spider bite and discuss the potential mechanisms involving neutrophil activation in loxoscelism. This expands the list of autoimmune and toxic reactions related to spider bites, as well as the list of vasculitis triggers.
Development of a prehospital vital signs chart sharing system Taka-aki Nakada, Naohisa Masunaga, Shota Nakao, Maiko Narita, Takashi Fuse, Hiroaki Watanabe, Yasuaki Mizushima, Tetsuya Matsuoka
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.048
The American Journal of Emergency Medicine , Vol. 34 , Issue 1 ,
Published online: October 2 2015
x Physiological parameters are crucial for the caring of trauma patients. There is a significant loss of prehospital vital signs data of patients during handover between prehospital and in-hospital teams. Effective strategies for reducing the loss remain a challenging research area. We tested whether the newly developed electronic automated prehospital vital signs chart sharing system would increase the amount of prehospital vital signs data shared with a remote trauma center prior to hospital arrival.
Does timing matter? Upstream or downstream administration of antiplatelet therapy David Slattery, Charles V. Pollack Jr
DOI: http://dx.doi.org/10.1016/j.ajem.2008.01.017
The American Journal of Emergency Medicine , Vol. 27 , Issue 3 ,
Published in issue: March 2009
x Current treatment guidelines recommend an early, aggressive strategy in patients with non–ST-elevation acute coronary syndromes. Administration of antiplatelet therapy—a glycoprotein IIb-IIIa inhibitor with or without clopidogrel—before catheterization in patients with high-risk features confers substantially reduced risk of ischemic events while potentially increasing bleeding risk. Strategies for risk stratification are therefore important in the emergency department, with appropriate pharmacotherapy.
Life-threatening hypophosphatemia and/or phosphate depletion in a patient with acute lymphoblastic leukemia: a rare case report Yasemin Soyoral, Mehmet Aslan, Senar Ebinc, Yaren Dirik, Cengiz Demir
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.011
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: April 17 2014
x Acute severe hypophosphatemia can be life threatening and is associated with mortality and impaired cardiac and respiratory function. Several conditions including decreased absorption or increased urinary phosphate excretion, shifts from the extracellular to intracellular compartments, and phosphate consumption by rapidly proliferating cells are known to induce moderate to severe acute hypophosphatemia. Although hypophosphatemia and/or phosphate depletion in patients with acute or chronic myeloid leukemia have been reported in the literature, hypophosphatemia due to acute lymphoblastic leukemia (ALL) is very rare.
The author replys Raymond J. Roberge
DOI: http://dx.doi.org/10.1016/0735-6757(94)90257-7
The American Journal of Emergency Medicine , Vol. 12 , Issue 2 ,
Published in issue: March 1994
