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.
