Electrocardiographic T-wave inversion: Differential diagnosis in the chest pain patient Geoffrey E. Hayden, William J. Brady, Andrew D. Perron, Michael P. Somers, Amal Mattu
DOI: http://dx.doi.org/10.1053/ajem.2002.32629
The American Journal of Emergency Medicine , Vol. 20 , Issue 3 ,
Published in issue: May 2002
x Inverted T waves produced by myocardial ischemia are classically narrow and symmetric. T-wave inversion (TWI) associated with an acute coronary syndrome (ACS) is morphologically characterized by an isoelectric ST segment that is usually bowed upward (ie, concave) and followed by a sharp symmetric downstroke. The terms coronary T wave and coved T wave have been used to describe these ischemic TWIs. Prominent, deeply inverted, and widely splayed T waves are more characteristic of non-ACS conditions such as juvenile T-wave patterns, left ventricular hypertrophy, acute myocarditis, Wolff-Parkinson-White syndrome, acute pulmonary embolism, cerebrovascular accident, bundle branch block, and later stages of pericarditis.
Meticulous blood pressure control is mandatory for symptomatic primitive trigeminal artery Meng-Rui Lee, Yu-Ming Chuang, Wen-Jone Chen, Ching-Po Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.034
The American Journal of Emergency Medicine , Vol. 27 , Issue 5 ,
Published in issue: June 2009
x One 57-year-old lady with uncontrolled hypertension and right-side pupil-sparing oculomotor palsy visited our emergency department. Computed tomographic angiography revealed right-side persistent primitive trigeminal artery. Her symptoms dramatically improved after her blood pressure went under control. To our knowledge, this is the first case report that describes the relation between blood pressure control and symptomatic improvement of oculomotor palsy due to primitive trigeminal artery. Diagnostic approach, image modalities, and treatment options for oculomotor palsy are also reviewed.
A new marker for myocardial injury in carbon monoxide poisoning: T peak–T end Nazire Belgin Akilli, Emine Akinci, Hakan Akilli, Zerrin Defne Dundar, Ramazan Koylu, Mustafa Polat, Basar Cander
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.049
The American Journal of Emergency Medicine , Vol. 31 , Issue 12 ,
Published online: October 2 2013
x Carbon monoxide (CO) poisoning frequently affects repolarization, resulting in abnormal electrocardiography findings. The goal of this study was to examine the effect of CO poisoning on the novel transmyocardial repolarization parameters T peak–T end (Tp-e), Tp-e dispersion, and Tp-e/QT and the relationship of these parameters to myocardial injury (MI).
Airbag injury and bilateral globe rupture Tahrina Salam, Panagiotis Stavrakas, Louisa Wickham, James Bainbridge
DOI: http://dx.doi.org/10.1016/j.ajem.2009.12.015
The American Journal of Emergency Medicine , Vol. 28 , Issue 8 ,
Published online: March 29 2010
x Airbags protect against serious head injury but can cause ocular injury. Here we describe bilateral simultaneous globe ruptures associated with airbag deployment in a motor vehicle incident.
Epinephrine shot in kiwi anaphylaxis—yes but not yet Subramanian Senthilkumaran, Ritesh G. Menezes, Srinivasan Jayaraman, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.006
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: February 4 2013
x We read the case report of Zhu et al [1] with great interest. Kiwi is an exotic fruit and has gained popularity in domestic markets of many countries now. Because of its wide availability, various forms of allergic reactions to kiwifruit ranging from localized oral allergy syndrome to life-threatening anaphylaxis were reported. Three allergens have been described in green kiwifruit so far, and several more await discovery. Moreover, it is also recognized as part of the “latex-fruit syndrome,” and cross-reactivity has been confirmed [2].
Response of headaches to nonnarcotic analgesics resulting in missed intracranial hemorrhage Jeffrey J Seymour, Ronald M Moscati, Dietrich V Jehle
DOI: http://dx.doi.org/10.1016/0735-6757(95)90240-6
The American Journal of Emergency Medicine , Vol. 13 , Issue 1 ,
Published in issue: January 1995
x The differential diagnosis of headache is broad, ranging from immediately life-threatening to benign etiologies. Currently, headaches can be treated successfully with various nonnarcotic analgesics. Three cases are presented in which patients with headaches were treated in an emergency department with nonnarcotic analgesics which relieved their headaches; subsequently, these patients returned to be diagnosed with intracranial hemorrhage. Some nonnarcotic analgesics may relieve symptoms of intracranial hemorrhage through their recognized mechanisms of action.
Management of postpartum hemorrhagic shock and disseminated intravascular coagulation with damage control resuscitation Xiaoyan Xue, Lina Liu, Zhiguo Rao
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.051
The American Journal of Emergency Medicine , Vol. 31 , Issue 8 ,
Published online: May 22 2013
x Damage control resuscitation (DCR) that addresses all aspects of the lethal triad (ie, acidosis, hypothermia, and coagulopathy) is a resuscitation strategy originally developed for combat casualties and subsequently used for civilian trauma patients. However, its survival benefits in obstetric emergencies have yet to be evaluated. Here, we report successful management of a life-threatening case of postpartum hemorrhagic shock associated with disseminated intravascular coagulation (DIC) with DCR.
Determination of a predictive cutoff value of NT-proBNP testing for long-term survival in ED patients with acute heart failure Yalcin Velibey, Yalcin Golcuk, Burcu Golcuk, Deniz Oray, Ozge Duman Atilla, Ayfer Colak, Yusuf Kurtulmus, Ali Rıza Erbay, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.033
The American Journal of Emergency Medicine , Vol. 31 , Issue 12 ,
Published online: September 20 2013
x The main objective of this study was to determine a predictive cutoff value for plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) that could successfully predict the long-term (4-year) survival of patients with acute heart failure (HF) at the time of admission to the emergency department (ED). To our best knowledge, our study is the first research done to identify a predictive cutoff value for admission NT-proBNP to the prescriptive 4-year survival of patients admitted to ED with acute HF diagnosis.
Retropharyngeal space infections in a community hospital Jeremy D. Gradon, Larry I. Lutwick
DOI: http://dx.doi.org/10.1016/0735-6757(91)90023-D
The American Journal of Emergency Medicine , Vol. 9 , Issue 1 ,
Published in issue: January 1991
x The emergency physician often has to deal with infectious disease emergencies. The authors have seen four cases of retropharyngeal infection of potentially life-threatening severity in less than 1 year, all were admitted through the emergency department (ED). Reporting these cases is important to increase awareness among emergency physicians of this classic disease entity. The characteristics of the patients are discussed including initial diagnostic approaches and the use of computed tomography (CT) scanning of the neck and mediastinum.
Outpatient surgery, 2nd ed: Edited by GJ Hill. 1457 pages. WB Saunders, Philadelphia, 1980. $70.00 Glenn C. Hamilton
DOI: http://dx.doi.org/10.1016/0735-6757(83)90050-5
The American Journal of Emergency Medicine , Vol. 1 , Issue 1 ,
Published in issue: July 1983
Which chest pain patients potentially benefit from continuous 12-lead ST-segment monitoring with automated serial ECG? Francis M. Fesmire
DOI: http://dx.doi.org/10.1053/ajem.2000.18036
The American Journal of Emergency Medicine , Vol. 18 , Issue 7 ,
Published in issue: November 2000
x A prospective observational study was performed in 678 chest pain patients with suspected acute coronary ischemic syndrome (ACS) and absence of clinical and ECG criteria for emergent reperfusion therapy on presentation to determine how often continuous 12-lead ST-segment monitoring with automated serial ECG (SECG) results in a significant change in therapy during the initial emergency department (ED) evaluation in typical high- and low-risk chest pain patients. After initial history, physical, and ECG were obtained, patients were grouped into high and low risk subgroups based on ED physician's assessment of likelihood of ACS.
Triage success in disasters: Dynamic victim-tracking cards Paul M. Paris, Ronald D. Stewart, Gregory H. Pelton, Gregory Porter, Anthony Sanzo
DOI: http://dx.doi.org/10.1016/0735-6757(85)90057-9
The American Journal of Emergency Medicine , Vol. 3 , Issue 4 ,
Published in issue: July 1985
x A dynamic victim-tracking card developed for use in community or hospital disaster exercises was tested during two hospital and two airport disaster drills. Use of the card in 375 “patients” allowed testing of the ability to evaluate the decisions of triage, the early medical intervention for “victims,” and the ongoing treatment of patients with a changing medical status. The card was successful in simulating realistic changes that may occur in critically ill and injured patients. Of the 126 “patients” evaluated in an actual exercise, 55 (43.6%) were placed in the proper triage category.
Low plasma C-reactive protein level as an early diagnostic tool for heatstroke vs central nervous system–associated infection in the ED Esther Dahan, Sara Dichtwald, Eyal Amar, Patrick Sorkine, Avi A. Weinbroum
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.030
The American Journal of Emergency Medicine , Vol. 31 , Issue 8 ,
Published online: June 3 2013
x Heatstroke (HS) is a life-threatening condition, manifested by systemic inflammation and multiorgan failure. Rapid recognition and treatment are life saving. We report a laboratory-oriented characterization of HS by low plasma C-reactive protein (CRP) level and propose its usefulness in distinguishing this type of hyperpyrexia from central nervous system–associated high core temperature.
Spiral tibal fractures revisited Larry B. Mellick
DOI: http://dx.doi.org/10.1016/0735-6757(91)90042-I
The American Journal of Emergency Medicine , Vol. 9 , Issue 1 ,
Published in issue: January 1991
Acute kidney injury associated with tumor lysis syndrome: a paradigm shift Amr El-Husseini, Alberto Sabucedo, Jorge Lamarche, Craig Courville, Alfredo Peguero
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.029
The American Journal of Emergency Medicine , Vol. 30 , Issue 2 ,
Published online: February 7 2011
x Tumor lysis syndrome (TLS) causes acute kidney injury (AKI) by various pathophysiologies. Herein, we report on a case of recurrent AKI in TLS induced by 2 different mechanisms and highlight the increasing magnitude of acute phosphate nephropathy after wide use of rasburicase.
Herpes simplex virus esophagitis in an immunocompetent teenaged girl Dennis P. McKenna, Wayne Triner, Michelle Tomassi, Anjana Poonthota
DOI: http://dx.doi.org/10.1016/j.ajem.2006.05.010
The American Journal of Emergency Medicine , Vol. 24 , Issue 7 ,
Published in issue: November 2006
x A previously healthy 14-year-old teenaged girl presented to the emergency department (ED) complaining of dysphagia associated with liquids and solids and difficulty swallowing her own saliva. The patient also reported a “pain in the chest” for the previous 2 days that appeared to begin after eating a turkey sandwich. The pain was substernal, sharp, and pleuritic. She reported fever and chills, but denied abdominal pain, vomiting, diarrhea, or hematemesis. She denied any history of gastroesophageal reflux, nonsteroidal anti-inflammatory drug, tobacco or alcohol use, unusual ingestions, trying to induce vomiting, or having ever been sexually active.
Thallium myocardial scanning in the emergency department evaluation of chest pain Sharon E. Mace
DOI: http://dx.doi.org/10.1016/0735-6757(89)90180-0
The American Journal of Emergency Medicine , Vol. 7 , Issue 3 ,
Published in issue: May 1989
x Chest pain is a common complaint of patients seen in the emergency department. The causes are legion, and range from the non-life-threatening to the potentially catastrophic. Thallium heart scanning was done prospectively in 20 patients with a “classic” history for myocardial infarction (eight patients) or atypical chest pain and/or associated symptoms plus an abnormal ECG (12 patients) to discern a subset of patients from whom thallium scintography may be indicated in the emergency department. Although further investigation is needed, our preliminary study suggests that myocardial scanning with thallium can be a safe, fairly rapid, and useful objective parameter in the emergency department detection of suspected myocardial infarction, and in differential diagnosis of chest pain when other data such as the history, physical examination, ECG, or enzymes are inconclusive.
Unrecognized fatal liver injury caused by a bicycle handlebar Daniel J Spitz
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90115-8
The American Journal of Emergency Medicine , Vol. 17 , Issue 3 ,
Published in issue: May 1999
x Patterned injuries often remain unrecognized by emergency department personnel. Immediate recognition of a simple, superficial patterned injury may result in prompt and possibly life-saving treatment. A fall off a bicycle with a patterned abdominal bruise should suggest potentially life-threatening trauma.
The spectrum of emergency admissions for thyroidectomy Paul G Gauger, Ana I Guinea, Thomas S Reeve, Leigh W Delbridge
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90204-8
The American Journal of Emergency Medicine , Vol. 17 , Issue 6 ,
Published in issue: October 1999
x Emergency physicians frequently encounter patients with thyroid disease. However, it is unusual for these thyroid disorders to create acute, life-threatening situations. Critical airway compression attributable to benign or malignant thyroid enlargement may occur suddenly. Similarly, venous obstruction from thyroid tumors or severe physiological compromise from thyrotoxicosis may require urgent treatment. We reviewed a group of patients who were evaluated by emergency physicians for acute thyroid pathology and subsequently admitted for urgent thyroidectomy.
Terlipressin saved the life of a child with severe nonvariceal upper gastrointestinal bleeding Nilgun Erkek, Saliha Senel, Samil Hizli, Can Demir Karacan
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.010
The American Journal of Emergency Medicine , Vol. 29 , Issue 1 ,
Published online: April 29 2010
x Terlipressin is a longer half-life synthetic analogue of vasopressin. Its use is approved in esophageal variceal bleedings as an adjuvant therapy. The beneficial effects of terlipressin use in children with septic shock had also been revealed. We described a 10-month-old boy with massive, life-threatening, nonvariceal upper gastrointestinal bleeding rescued with terlipressin therapy. To our knowledge, this is the first report of terlipressin use in a child with nonvariceal upper gastrointestinal bleeding.
