Questions Regarding the Utility of the 30-Degree Test in Measuring Optic Nerve Sheath Diameters in ED Patients Terrell S. Caffery, Mandi W. Musso
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.039
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: January 30 2015
x We thank the authors for their interest in our paper. The authors recommend using a 30-degree test to detect increased subarachnoid fluid in the optic nerve, citing Ossoinig et al
[1]. Although this test is beyond the scope of our study
[2], we offer several considerations to physicians. First, Ossoinig et al
[1] focus primarily on differentiating various solid optic nerve tumors, optic nerve sheath enlargement, or separation of the optic nerve and sheath by increased fluid in the subarachnoid space.
Re: Pericardial effusion impending tamponade: a look beyond Beck's triad Graeme McNeill, Darragh Halpenny, Aisling Snow, William C. Torreggiani
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.034
The American Journal of Emergency Medicine , Vol. 27 , Issue 5 ,
Published in issue: June 2009
x We read the excellent article by Jacob et al [1] entitled “Pericardial effusion impending tamponade: a look beyond Beck's triad” in the recent edition of The American Journal of Emergency Medicine with great interest.
Pheochromocytoma in pediatric age: a surgical urgency? Aurelio Mazzei, Giuseppe Stranieri, Renato Rubino, Antonella Centonze, Ilaria Prosperi Porta, Andrea Siani, Emanuele Baldassarre
DOI: http://dx.doi.org/10.1016/j.ajem.2009.07.001
The American Journal of Emergency Medicine , Vol. 27 , Issue 9 ,
Published in issue: November 2009
x We read with great interest the article recently published in your journal by Yoshida et al [Am J Emerg Med . 2009;27(5):626]. It is an interesting update on pheochromocytoma causing a life-threatening medical emergency. The authors analyzed all the clinical and laboratory aspects of this pathology, highlighting the great diagnostic and therapeutic difficulties of similar cases.
Benign persistent T-wave inversion mimicking ischemia after left bundle-branch block—cardiac memory Richard Byrne, Lisa Filippone
DOI: http://dx.doi.org/10.1016/j.ajem.2009.10.003
The American Journal of Emergency Medicine , Vol. 28 , Issue 6 ,
Published online: March 26 2010
x The electrocardiographic presence of deep T-wave inversions in a patient presenting with chest pain is highly concerning for cardiac ischemia. There are certain situations, however, when this finding may represent a benign phenomenon. In this report, we illustrate a case of non–ischemia-related T-wave inversion after resolution of a rate-related left bundle-branch block pattern—a case of cardiac memory. This poorly understood process occurs when the heart resumes a sinus rhythm after a period of abnormal depolarization, typically a bundle-branch block or ventricular pacing.
Contents
DOI: http://dx.doi.org/10.1016/S0735-6757(07)00274-4
The American Journal of Emergency Medicine , Vol. 25 , Issue 5 ,
Published in issue: June 2007
Acute gastrointestinal vasculitis as the initial presentationof SLE Luis R. Rodriguez, Gabriel Carpo, Melvin Gertner
DOI: http://dx.doi.org/10.1053/ajem.2001.19984
The American Journal of Emergency Medicine , Vol. 19 , Issue 1 ,
Published in issue: January 2001
x Systemic lupus erythematosus (SLE) is a multisystemic disorder characterized by deposition of autoantibodies and immune complexes in tissues and cells. Musculoskeletal, hematologic, cutaneous, cardiopulmonary, and neurologic manifestations are common. Gastrointestinal (GI) symptoms occur in about 30% of SLE patients,1 of which approximately 75% have findings suggestive of vasculitis.2 Acute, severe abdominal pain was the presenting symptom in an adolescent with SLE.
Use of baseline ST-vector magnitude to identify electrocardiographic injury in patients with suspected acute myocardial infarction Francis M. Fesmire, Sven V. Eriksson, Paul K. Stout, James F. Wojcik, David R. Wharton
DOI: http://dx.doi.org/10.1053/ajem.2002.34801
The American Journal of Emergency Medicine , Vol. 20 , Issue 6 ,
Published in issue: October 2002
x No information is currently available regarding optimal cut-off values of the ST-vector magnitude (ST-VM) for predicting acute myocardial infarction (AMI) in emergency department (ED) chest pain patients undergoing vectorcardiographic (VCG) monitoring. A prospective observational study was performed in 1,722 chest pain patients with suspected acute coronary syndrome and absence of bundle branch block (BBB) and left ventricular hypertrophy (LVH) on initial ECG who underwent continuous VCG ST-segment monitoring during the initial ED evaluation.
Diagnostic laparoscopy for pneumatosis intestinalis: To do or not to do? T. Karabuga, O. Yoldas, I. Ozsan, U.M. Yıldırım, U. Aydin
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.042
The American Journal of Emergency Medicine , Vol. 32 , Issue 12 ,
Published online: April 28 2014
x Pneumatosis intestinalis (PI) is a rare clinical condition, which is commonly associated with mesenteric vascular ischemia, bowel obstruction, and chemotherapy. Although the pathophysiology of PI remains unclear, 2 theories, one mechanical and the other bacterial, have been proposed. Nonoperative medical treatment and observation should be considered in mild cases, but occasionally, the situation requires emergency surgical intervention. In cases of suspectful complicated PI, the clinician should not avoid performing diagnostic laparoscopy to rule out bowel ischemia and perforation.
Primary care orthopedics: Lewis RC. New York, Churchill Livingston, 1987, 298 pages. ISBN 0-443-08356-8, $32.00 (paperback) Michael Pietrzak
DOI: http://dx.doi.org/10.1016/0735-6757(88)90130-1
The American Journal of Emergency Medicine , Vol. 6 , Issue 6 ,
Published in issue: November 1988
Prior authorization for child and adolescent psychiatric patients deemed to be in need of inpatient admission Amy Funkenstein, Stephanie Hartselle, J. Wesley Boyd
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.027
The American Journal of Emergency Medicine , Vol. 34 , Issue 5 ,
Published online: February 12 2016
x Four million children and adolescents in the US suffer from a serious mental disorder that causes significant functional impairments at home, at school and with peers [1]. In any given year, only 20% of children with mental disorders are identified and receive mental health services [2]. In youth, many of these disorders can have life-long deleterious effects.
Recognition and management of digitalis intoxication: Implications for emergency medicine Marc J. Bayer
DOI: http://dx.doi.org/10.1016/0735-6757(91)90165-G
The American Journal of Emergency Medicine , Vol. 9 , Issue 2 ,
Published in issue: March 1991
x Digitalis intoxication is among the most common serious adverse drug reactions in clinical medicine. While the recent development of a radioimmunoassay to accurately measure serum concentrations of digoxin has been of assistance, digitalis intoxication remains a difficult diagnosis to make with certainty. The difficulty in diagnosing digitalis intoxication arises from the nonspecificity of its associated signs and symptoms. The most common symptoms include fatigue, weakness, nausea, and anorexia.
Massive atelectasis with acute respiratory failure in postpartum misdiagnosed as pulmonary embolism Roxana C. Sisu, Gabriela Bicescu, Dragos Vinereanu
DOI: http://dx.doi.org/10.1016/j.ajem.2009.11.012
The American Journal of Emergency Medicine , Vol. 28 , Issue 7 ,
Published online: April 5 2010
x Acute life-threatening complications can arise during early postpartum period and result in maternal morbidity and mortality. Prompt recognition of life-threatening conditions and early effective management are essential to ensure optimal maternal outcome. Thus, peripartum acute respiratory failure is an important cause of mortality, accounting for 30% of maternal deaths. We report a rare case of complete left lung atelectasis, due to a massive fresh intrabronchial clot, with respiratory failure, occurring in early postpartum after cesarean delivery.
Immune reconstitution syndrome–induced hypercalcemic crisis Yu-Tzu Tsao, Chia-Chao Wu, Pauling Chu
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.013
The American Journal of Emergency Medicine , Vol. 29 , Issue 2 ,
Published online: May 3 2010
x Hypercalcemic crisis, a life-threatening decompensation of mineral homeostasis, carries a high risk of mortality. A wide variety of causes have been implicated in different types of hypercalcemia; however, hypercalcemic crisis stemming from tuberculosis-associated immune reconstitution syndrome has been less recognized. This report profiled a case with mediastinal tuberculous lymphadenitis-associated immune reconstitution syndrome heralded by near-fatal hypercalcemic crisis. Calcium-free hemodialysis effectively corrected the life-threatening catastrophe.
Presentation of an adolescent with delayed-onset massive hemorrhage and shock from a tongue piercing Michael W. Sauer, Christopher J. Siano, Harold K. Simon
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.018
The American Journal of Emergency Medicine , Vol. 29 , Issue 9 ,
Published online: October 22 2010
x Tongue piercing is becoming increasingly common among adolescents in the United States. These piercings come with several known complications such as pain, local infection, and minor bleeding. We present the case as well as management strategy of a 16-year-old adolescent girl with insulin-dependent diabetes mellitus who developed a significant hemorrhage following tongue piercing with subsequent clinical shock and diabetic ketoacidosis. Practitioners and patients alike should be aware that this routine procedure may lead to significant, even life-threatening, consequences.
Life-threatening anaphylactoid shock caused by recombinant tissue plasminogen activator Chen-Ting Wang, Feng-Cheng Lin, Gim-Thean Khor, Chun-Hung Chen, Poyin Huang
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.005
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: November 26 2010
x Recombinant tissue plasminogen activator (rt-PA) is currently the only approved agent for treating acute ischemic stroke. However, rt-PA may cause fatal symptomatic intracranial hemorrhage and other adverse effects like bleeding complications and allergic reactions. Patients taking angiotensin-converting enzyme (ACE) inhibitors have increased risk of allergic reactions. This report is about a patient with a history of ACE inhibitor intake who experienced life-threatening anaphylactoid shock during rt-PA administration.
Masked subdural empyema secondary to frontal sinusitis Mustafa Calik, Akin Iscan, Mahmut Abuhandan, Ilhan Yetkin, Ferhat Bozkuş, M. Fuat Torun
DOI: http://dx.doi.org/10.1016/j.ajem.2011.08.003
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: October 26 2011
x Intracranial complications of pediatric sinusitis are rare but potentially life threatening. These complications include cavernous sinus thrombosis, orbital infection, meningitis, and subdural empyema. Children with these complications may experience significant morbidity from their infection. In such cases, delay in diagnosis and treatment may lead to severe brain damage or death. Emergency physicians, pediatricians, and otolaryngologists should maintain a high index of suspicion for this complication of disease when treating patients with sinusitis in the emergency department or outpatient clinic.
Surviving a crisis of HIV-associated immune reconstitution syndrome Yu-Tzu Tsao, Shih-Wei Lee, Jin-Chyr Hsu, Feng-Ming Ho, Wei-Jie Wang
DOI: http://dx.doi.org/10.1016/j.ajem.2011.09.003
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: October 28 2011
x The management of life-threatening complications in HIV-associated immune reconstitution syndrome is becoming a challenging scenario in emergency practice, especially in the era of highly active antiretroviral therapy paralleled by increased worldwide incidence of HIV infection. Here, we described a 37-year-old woman with acute hypoxic respiratory failure, acute renal failure, and hypercalcemic crisis as the presenting features of HIV-associated immune reconstitution syndrome. In this patient, the restored granulomatous host response toward isolated pulmonary Mycobacterium avium complex infection led to a near-fatal catastrophe.
Unilateral paralysis associated with profound hypokalemia Wen-Fang Chiang, Fu-Chiang Yeh, Shih-Hua Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2012.02.007
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: March 30 2012
x Unilateral paralysis is rarely reported to be primary presentation of severe hypokalemia. We describe a 24-year-old woman who presented to the emergency department with sudden onset of right-sided weakness. Neurologic examination revealed diminished muscle strength and tendon reflexes over the right limbs. Computed tomography of the brain showed no organic brain lesion. However, laboratory data showed hypokalemia (K+ 2.0 mmol/L) with metabolic acidosis (HCO3− 19 mmol/L). She needed a total of 260 mmol K+ to achieve complete recovery of muscle strength at a serum K+ level of 3.2 mmol/L and was proved to have distal renal tubular acidosis.
Torsade de pointes indicates early neurologic damage in acute ischemic stroke Li-Yen Huang, Wei-Shiang Lin, Wen-Yu Lin, Cheng-Chung Cheng, Shu-Meng Cheng, Tsung-Neng Tsai
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.007
The American Journal of Emergency Medicine , Vol. 31 , Issue 12 ,
Published online: September 25 2013
x Torsade de pointes (TdP) is a life-threatening polymorphic ventricular tachycardia that is related to QT prolongation. Although QT prolongation is commonly seen in acute stroke, TdP is rare. We report the case of a 78-year-old woman with ischemic stroke who presented with TdP as the initial manifestation of early neurologic deterioration. We hypothesized that an increase in intracranial pressure may result in neurohormonal activation, QT prolongation, and then myocardial damage, leading to TdP. We highlight that new onset of TdP in a patient with stroke may reflect neurologic deterioration, requiring further evaluation and specific intervention.
Isolated splenic peliosis with spontaneous rupture after a viperine bite Anupam Lal, Manphool Singhal, Navneet Sharma, Ashish Bhalla, Niranjan Khandelwal
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.021
The American Journal of Emergency Medicine , Vol. 32 , Issue 2 ,
Published online: November 27 2013
x Isolated splenic peliosis is an extremely uncommon condition that can present with atraumatic rupture and potential fatal outcome. We here report 1 such case that developed after a viperine bite in a 21-year-old woman. The case highlights the diagnostic findings on computed tomographic (CT) scan and its potential complications.
