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
