Spontaneous hemothorax following thrombolytic and anticoagulant therapy for massive pulmonary embolism Chung-Cheng Wang, Chip-Jin Ng, Chen-Ken Seak, Chen-June Seak
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.037
The American Journal of Emergency Medicine , Vol. 31 , Issue 6 ,
Published online: March 4 2013
x Massive spontaneous hemothorax following combined thrombolytic and anticoagulant therapy for pulmonary embolism (PE) is a rare event that is little documented in the literature. Here, we describe a rare case of spontaneous hemothorax in a 23-year-old woman with underlying systemic lupus erythematosus following combined administration of tissue plasminogen activator and low-molecular-weight heparin for massive PE. This report of our successful treatment of this case by video-assisted thoracoscopic thoracotomy demonstrates that although the occurrence is rare, massive hemothorax following anticoagulant and/or thrombolytic therapy for PE should be suspected if patients experience chest pain, dyspnea, or signs of anemia, and follow-up physical examination and hemogram should be performed to facilitate diagnosis of this life-threatening complication.
Spontaneous rupture of spleen masquerading as acute pancreatitis Jyotindu Debnath, Samrat Sonkar, Vivek Sharma, Samar Chatterjee, Vikash Srivastava, Shiv Pankaj Khanna
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.036
The American Journal of Emergency Medicine , Vol. 32 , Issue 4 ,
Published online: November 25 2013
x Splenic rupture most commonly follows blunt abdominal trauma. Nontraumatic rupture of the spleen is rare. Nontraumatic rupture of the spleen has been described in a variety of pathologic conditions, which include neoplastic, infectious, and hematologic diseases affecting the spleen. Spontaneous rupture of nondiseased spleen is extremely rare. We report a case of spontaneous rupture of spleen in a chronic alcoholic clinically simulating acute pancreatitis.
The use of adjunctive anticoagulants in patients with acute coronary syndrome transitioning to percutaneous coronary intervention Marc Cohen, James Hoekstra
DOI: http://dx.doi.org/10.1016/j.ajem.2007.11.031
The American Journal of Emergency Medicine , Vol. 26 , Issue 8 ,
Published in issue: October 2008
x Patients presenting to the Emergency Department (ED) need to be quickly diagnosed, risk-stratified, and treated accordingly. Anticoagulants used in the ED should be easy to use and suitable for all patients with acute coronary syndromes, regardless of treatment strategy. In patients with ST-segment myocardial infarction, current guidelines recommend unfractionated heparin regardless of reperfusion strategy or low-molecular-weight heparin (LMWH) as an alternative in patients undergoing percutaneous coronary intervention (PCI).
Does ambulance use differ between geographic areas? A survey of ambulance use in sparsely and densely populated areas Lena Marie Beillon, Björn-Ove Suserud, Ingvar Karlberg, Johan Herlitz
DOI: http://dx.doi.org/10.1016/j.ajem.2008.01.012
The American Journal of Emergency Medicine , Vol. 27 , Issue 2 ,
Published in issue: February 2009
x The aim of this study was to analyze possible differences in the use of ambulance service between densely and sparsely populated areas.
Risk of thromboembolic events after protocolized warfarin reversal with 3-factor PCC and factor VIIa Cassie A. Barton, Nathan B. Johnson, Jon Case, Bruce Warden, Darrel Hughes, Jason Zimmerman, Gregory Roberti, Wesley D. McMillian, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.010
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: June 13 2015
x Bleeding events and life-threatening hemorrhage are the most feared complications of warfarin therapy. Prompt anticoagulant reversal aimed at replacement of vitamin K–dependent clotting factors is essential to promote hemostasis. A retrospective cohort study of warfarin-treated patients experiencing a life-threatening hemorrhage treated with an institution-specific warfarin reversal protocol (postimplementation group) and those who received the prior standard of care (preimplementation group) was performed.
Exercise-associated hyponatremia Ruth E Uphold
DOI: http://dx.doi.org/10.1016/0735-6757(95)90281-3
The American Journal of Emergency Medicine , Vol. 13 , Issue 1 ,
Published in issue: January 1995
Comment on “Lipid 20% emulsion ameliorates the symptoms of olanzapine toxicity in a 4-year-old” Gheshlaghi Farzad
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.015
The American Journal of Emergency Medicine , Vol. 30 , Issue 6 ,
Published online: May 25 2012
x I read with interest the study conducted by McAllister et al [1] titled “Lipid 20% emulsion ameliorates the symptoms of olanzapine toxicity in a 4-year-old,” which is in press in your journal. In the article, the authors mentioned that because of the low morbidity associated with lipid therapy, early consideration of lipid therapy should be considered in adults and children who have toxicity of lipid-soluble medications.
Delayed presentation of hypovolemic shock after a simple pubic ramus fracture Wai-Ming Kong, Cheuk-Kwan Sun, I-Ting Tsai
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.030
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: March 19 2012
x Although trauma-induced simple pubic ramus fracture is common in the emergency department (ED), it can result in life-threatening hemorrhagic shock. We describe a 58-year-old woman with closed minimally displaced simple pubic ramus fracture. Hemodynamic instability became apparent 2 hours later. She was successfully treated with transarterial embolization and discharged uneventfully 10 days later. Literature review showed involvement of the superior pubic ramus in all reported cases probably because of hemorrhage from “corona mortis” with delay in shock presentation mostly within 6 hours, suggesting at least an equivalent observation period for these patients, particularly those at high risk for hemorrhage.
Korsakoff's syndrome is preventable Erik Oudman, Jan W. Wijnia
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.017
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: August 7 2014
x Wernicke-Korsakoff syndrome (WKS) is a life-threatening neuropsychiatric disorder caused by thiamine (vitamin B1) deficiency. Wernicke-Korsakoff syndrome is associated with mammillary body edema and small vessel ischemia. Many patients who develop WKS have a history of serious alcoholism and self-neglect. It is a common condition as around 15% of the alcoholics show specific WKS neuropathology. Originally, the syndrome was described as a triad of ataxia, eye movement disorders, and mental status change, but recent studies have suggested that patients frequently only show the mental status change [1].
Catecholaminergic polymorphic ventricular tachycardia as a cause of sudden death in athletes Miguel A. Arias, Juan Carlos Fernández-Guerrero, Juan Herrador, Carlos Pagola
DOI: http://dx.doi.org/10.1016/j.ajem.2005.09.006
The American Journal of Emergency Medicine , Vol. 24 , Issue 2 ,
Published in issue: March 2006
x We read with great interest the paper by Germann and Perron [1] who reviewed in detail the causes of sudden cardiac death in athletes. However, the authors did not mention catecholaminergic polymorphic ventricular tachycardia as a cause of sudden death among this patient population. Although rare, this condition is a form of arrhythmogenic disease occurring in children and young people with a structurally normal heart and can be fatal [2]. The disease is characterized by the occurrence of life-threatening ventricular tachycardia or ventricular fibrillation occurring during emotional or physical stress in the absence of structural heart disease or identifiable precipitating factors.
Unrecognized periorbital penetrating nail in the brain: case report Federico Bilotta, Giovanni Rosa, Roberto Delfini, Raffaella Pinto, Brenno Fiorani
DOI: http://dx.doi.org/10.1016/j.ajem.2006.05.029
The American Journal of Emergency Medicine , Vol. 25 , Issue 2 ,
Published in issue: February 2007
x A periorbital penetrating wound can be complicated by intracranial foreign body displacement even in the presence of a small orifice and in asymptomatic patients [1-3]. We recently treated an asymptomatic patient with a periorbital penetrating wound that was complicated by intracranial nail penetration.
Partial resuscitative endovascular balloon occlusion of the aorta as a hemorrhagic shock adjunct for ectopic pregnancy Eitaro Okumura, Junya Tsurukiri, Taishi Oomura, Yosuke Tanaka, Ryoko Oomura
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.026
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: February 12 2016
x Intractable hemorrhage is a main cause of death in the emergency department (ED). Acute care physicians also encounter various causes of life-threatening hemorrhagic shock, including trauma, ruptured abdominal aortic aneurysms, and postpartum bleeding secondary to placenta previa or placenta abruption. In a recent systematic review, resuscitative endovascular balloon occlusion of the aorta (REBOA) in various clinical settings was found to successfully elevate central blood pressure and control hemodynamic status as an adjunct for surgical hemostasis in life-threatening hemorrhagic shock.
Peritoneal dialysis and potassium: pains and gains in ED—the authors' reply Daniel A. Roseman, Elissa M. Schechter-Perkins, Jasvinder S. Bhatia
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.027
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: April 23 2015
x We thank the readers for their interest in our case report and for highlighting their own experiences using peritoneal dialysis (PD) in the emergency department (ED) for treatment of severe hyperkalemia. They offer a brief review of potassium exchange rates in PD that providers must consider when writing dialysis orders; we acknowledge that potassium clearance rates using PD have important limitations when compared to alternatives such as hemodialysis. However, our patient was already dialysis dependent with a functioning in-dwelling PD catheter as noted in the original report [1].
Prevalence of diabetes mellitus in patients with sepsis-triggered Takotsubo syndrome John E. Madias
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.041
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 23 2015
x The article by Fabbian et al [1] published on line ahead of print on June 18, 2015 in the journal about the concurrence of infections/sepsis and Takotsubo syndrome (TTS) is of interest from the pathogenetic point of view, that a physical stress like sepsis can trigger TTS, and that male patients afflicted with this combinations have worse in-hospital mortality than do their female counterpart. It is conceivable that we are in error when we think that we can separate physical and emotional stresses, and it is possible to consider an emotional overlay over the physical stress of sepsis, as a trigger of TTS.
Methylene blue for refractory anaphylaxis—is it a magic bullet? Subramanian Senthilkumaran, Ritesh G. Menezes, Narendra Nath Jena, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.032
The American Journal of Emergency Medicine , Vol. 31 , Issue 7 ,
Published online: May 24 2013
x The case report by Bauer et al is indeed interesting [1]. Rapid reversal of marked respiratory distress following methylene blue (MB) administration in a normotensive patient is of recent information. However, few aspects of the report require contemplation.
Emergency endoscopy for upper gastrointestinal bleeding in patients with coronary artery disease Ping-Huei Tseng, Jyh-Ming Liou, Yi-Chia Lee, Lian-Yu Lin, Alyssa Yan-Zhen Liu, Dun-Cheng Chang, Han-Mo Chiu, Ming-Shiang Wu, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.018
The American Journal of Emergency Medicine , Vol. 27 , Issue 7 ,
Published in issue: September 2009
x Endoscopy is useful for diagnosis and treatment of upper gastrointestinal bleeding (UGIB). However, both endoscopy and UGIB may compromise the cardiovascular function. The present study is to investigate the cardiovascular responses of emergency endoscopy for patients with UGIB and stable coronary artery disease (CAD).
Extracorporeal membrane oxygenation in maternal arrhythmic cardiogenic shock Shyh-Shyong Sim, Hao-Chang Chou, Juin-Wei Chen, Matthew Huei-Ming Ma
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.030
The American Journal of Emergency Medicine , Vol. 30 , Issue 6 ,
Published online: June 6 2011
x Very few cases of the use of extracorporeal membrane oxygenation (ECMO) in pregnant women have been reported to date. We report the first case of the use of ECMO for the treatment of cardiac arrhythmia with cardiogenic shock in a pregnant woman. A 28-year-old pregnant woman at 26 weeks of gestation presented with supraventricular tachycardia complicated with cardiogenic shock and fetal distress that was refractory to medication and electrical cardioversion. ECMO was applied, and it facilitated successful radiofrequency ablation.
Visual recognition of anatomical structures in a circulated and in a non-circulated airway Erik M. Koopman, Sten Scholtens, Johannes M. Huitink
DOI: http://dx.doi.org/10.1016/j.ajem.2016.03.044
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: March 19 2016
x Pre-hospital airway management is complex and complications occur frequently. Guidelines advice using waveform capnography to confirm correct tube position, but in the emergency setting this is not universally available. Continuous visualization of the airway with a video tube (VivaSight SL™) could serve as an alternative confirmation method, provided that airway structures are properly recognized. With this study we wanted to investigate whether airway management practitioners were able to recognize anatomical structures both in a circulated and in a non-circulated airway.
Pulmonary Embolism Rule-out Criteria vs D-dimer testing in low-risk patients for pulmonary embolism: a retrospective study J. Bokobza, A. Aubry, N. Nakle, C. Vincent-Cassy, D. Pateron, C. Devilliers, B. Riou, P. Ray, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.008
The American Journal of Emergency Medicine , Vol. 32 , Issue 6 ,
Published online: April 14 2014
x The Pulmonary Embolism Rule-out Criteria (PERC) score has shown excellent negative predictive value; however, its use in the European population with high prevalence of PE is controversial. In Europe, PERC is not part of routine practice. For low-risk patients, guidelines recommend D-dimer testing, followed if positive by imaging study. We aimed to study the rate of diagnosis of PE after D-dimer testing in PERC-negative patients that could have been discharged if PERC was applied.
The worst amnesia of your life Muneer Hameer, Aashish Valvani, Hossein Kalantari, Getaw Worku Hassen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.069
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: April 6 2015
x Subarachnoid hemorrhage (SAH) is a medical emergency that can be life threatening or lead to severe disability even if recognized and managed early. Majority of spontaneous SAHs arise from a ruptured saccular aneurysm. However, up to 15% of SAHs do not have a bleeding source and are termed nonaneurysmal SAHs. Although sudden, severe headache is classically associated with aneurysmal SAHs, nonaneurysmal SAHs tend to have a more gradual onset headache and can even present with transient amnesia in about one-third of patients.
