Propafenone-induced cardiac arrest: full recovery with insulin, is it possible? Basak Bayram, Erhan Dedeoglu, Nil Hocaoglu, Emine Gazi
DOI: http://dx.doi.org/10.1016/j.ajem.2012.08.003
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: October 19 2012
x Propafenone may cause mental depression, mania, convulsion, metabolic acidosis, hypotension, prolonged QRS, atrioventricular block, and cardiac arrest if it is taken at a dose greater than recommended. There is no standard specific treatment or antidote for a propafenone overdose, and life-supporting treatments are applied in these cases. In this case report, we report a case of a 15-year-old female patient who experienced cardiac arrest after an oral propafenone overdose. She was successfully treated using cardiopulmonary resuscitation, which took approximately 1.5 hours.
The author replies Alan C. Schwartz
DOI: http://dx.doi.org/10.1016/0735-6757(85)90217-7
The American Journal of Emergency Medicine , Vol. 3 , Issue 5 ,
Published in issue: September 1985
Influence of activated charcoal on the pharmacokinetics and the clinical features of carbamazepine poisoning Nozha Brahmi, Nadia Kouraichi, Hafedh Thabet, Mouldi Amamou
DOI: http://dx.doi.org/10.1016/j.ajem.2005.12.025
The American Journal of Emergency Medicine , Vol. 24 , Issue 4 ,
Published in issue: July 2006
x Carbamazepine (CBZ) poisoning has been associated with cases of severe toxicity and death. Multiple-dose activated charcoal was proposed to enhance the clearance of CBZ elimination, but there are no prospective controlled studies that demonstrated a change in clinical outcome after the use of multiple-dose activated charcoal. The aim of this study was to determine the CBZ elimination kinetics and the evolution of clinical features according to the dose of activated charcoal in acute poisoning patients.
A comparison of the frequency and severity of poisoning cases for ingestion of acetaminophen, aspirin, and ibuprofen Joseph C. Veltri, Douglas E. Rollins
DOI: http://dx.doi.org/10.1016/0735-6757(88)90044-7
The American Journal of Emergency Medicine , Vol. 6 , Issue 2 ,
Published in issue: March 1988
x During 1984, 62,837 cases of human exposure to analgesics were reported to the National Data Collection System of the American Association of Poison Control Centers. We undertook a comparative study of 10,134 cases of human exposure to adult formulations of aspirin, acetaminophen, and ibuprofen from which we found that human exposures to analgesics are a common problem reported to poison control centers. All three analgesics studied appear to have minimal toxicity in children who accidentally ingest the product and report the exposure to a poison control center.
Treatment of yew leaf intoxication with extracorporeal circulation Nathalie Soumagne, Stéphane Chauvet, Delphine Chatellier, René Robert, Jean-Mathias Charrière, Paul Menu
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.017
The American Journal of Emergency Medicine , Vol. 29 , Issue 3 ,
Published online: May 3 2010
x Taxine, a yew tree toxin, is highly cardiotoxic. We report the case of a patient who developed severe cardiac failure and ventricular fibrillation after consuming yew leaves and who made a full recovery after extracorporeal life support. Yew poisoning can be added to the list of potential indications of extracorporeal life support for refractory toxic cardiogenic shock.
What else could be done for management of cancer patients in ED? Challenges and suggestions (cancer patients and emergency service) Birdal Yıldirim, Emine Nese Yeniçeri, Ozgur Tanrıverdi, Mehmet Ünaldı, Özcan Başaran, Ömer Doğan Alataş, Ethem Acar
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.046
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 28 2015
x Cancer treatment often involves multiple specialties, and a multidisciplinary approach is needed in management of cancer patients through the disease trajectory [1]. Primary care physicians (PCPs) and emergency physicians have the most probability to encounter cancer patients apart from oncologists. Emergency physicians in particular are encountering a growing number of cancer patients, often near the end of life, and their presentation to the ED often involves palliative care.
EMT-D fibrillation: More shocks for the future Bruce M. Thompson
DOI: http://dx.doi.org/10.1016/S0735-6757(86)80027-4
The American Journal of Emergency Medicine , Vol. 4 , Issue 6 ,
Published in issue: November 1986
Emergency department presentation of pituitary apoplexy Christopher C Lee, Andrew S Cho, Wallace A Carter
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90130-X
The American Journal of Emergency Medicine , Vol. 18 , Issue 3 ,
Published in issue: May 2000
x Pituitary apoplexy is an acute infarction of pituitary gland, and potentially life-threatening condition that may be highly variable in its clinical presentation. We report a 54-year-old man presenting to the emergency department with an isolated oculomotor nerve palsy. Computed tomography (CT) scan revealed an isodense mass within sellar region and subsequently, magnetic resonance imaging (MRI) revealed a pituitary apoplexy causing a compression of right oculomotor nerve. The patient received hydrocortisone immediately, and did well with medical management.
Utilization of ST-segment deviation sum and change scores to identify acute myocardial infarction Francis M. Fesmire
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.004
The American Journal of Emergency Medicine , Vol. 28 , Issue 7 ,
Published online: April 5 2010
x No information is currently available regarding the optimal cutoff values of the baseline ST-segment deviation sum (STDsumbaseline ) and 60-minute ST-segment deviation change (STDchange60min ) for predicting acute myocardial infarction (AMI).
Kiosks as tools for health information sharing: exploratory analysis of a novel ED program Megan S. Orlando, Richard E. Rothman, Alonzo Woodfield, Megan Gauvey-Kern, Stephen Peterson, Peter M. Hill, Charlotte A. Gaydos, Yu-Hsiang Hsieh
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.025
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: April 17 2014
x It is widely recognized that the demand for emergency services is rising. Emergency department (ED) utilization increased from 36.9 visits per 100 persons per year in 1995 to 42.8 in 2010 [1,2]. With increasingly time- and personnel-constrained EDs, self-service kiosks have emerged as one potential solution to perform simple tasks such as registration and information distribution. This process-oriented solution may free up health care providers for more complex duties and is particularly relevant to EDs, whose core mission is to provide emergency care for potentially life-threatening conditions.
Pulmonary embolism in a patient of tetralogy of Fallot: a diagnostic challenge I-Lin Wu, Jo-Chi Tseng
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.061
The American Journal of Emergency Medicine , Vol. 33 , Issue 6 ,
Published online: December 31 2014
x A 46-year-old male patient with tetralogy of Fallot presented to the emergency department with progressive dyspnea for 3 days. The dyspnea was refractory to treatment for tet spells. Pulmonary embolism (PE) was subsequently diagnosed by computed tomography, and the patient was successfully treated with heparinization. Chronic hypoxemia-induced secondary polycythemia and the consequent increase in blood hyperviscosity predisposed this patient to PE. This case reminds us of the similarity in clinical presentation between PE and tet spells.
Theophylline poisoning Wendy Klein-Schwartz
DOI: http://dx.doi.org/10.1016/0735-6757(85)90212-8
The American Journal of Emergency Medicine , Vol. 3 , Issue 5 ,
Published in issue: September 1985
Early onset of cooling catheter–related right atrial thrombus following cardiac arrest Yong Hun Jung, Byung Kook Lee, Hyoung Youn Lee, Kyung Woon Jeung
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.014
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: January 21 2013
x Catheter-related right atrial thrombus (RAT) is an uncommon life-threatening complication. Few cases of endovascular cooling catheter–related complications have been reported. We report the first case of endovascular cooling catheter–related RAT. A 17-year-old adolescent boy was treated with therapeutic hypothermia using an endovascular cooling catheter following ventricular fibrillation cardiac arrest. He became alert, but RAT was found 3 days after the placement of the cooling catheter. Anticoagulation with enoxaparin for 2 weeks completely resolved the RAT, and he was consequently treated with radiofrequency ablation and received an implanted cardiac defibrillator.
Spontaneous splenic artery aneurysm rupture: mimicking acute myocardial infarct Sezgin Zeren, Zülfü Bayhan, Yalcın Sönmez, Metin Mestan, Mehmet Korkmaz, Emine Kadıoglu, Bercis Imge Ucar, Cigdem Devir, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.07.011
The American Journal of Emergency Medicine , Vol. 32 , Issue 12 ,
Published online: July 29 2014
x Spontaneous splenic artery aneurysm (SAA) is a rare but a life-threatening condition. Thus, early diagnoses may increase the chance of survival. A 52-year-old female patient was admitted to the emergency department with a pain that starts from the chest and epigastric region and radiates to back and left arm. The patient prediagnosed as having acute myocardial infarct and was under observation when acute abdomen and hemorrhagic shock developed. After further investigation, the patient was diagnosed as having SAA and has undergone a successful surgery.
Adenosine in the treatment of supraventricular tachycardia: 5 years of experience (2002-2006) Alessandro Riccardi, Eleonora Arboscello, Maria Ghinatti, Pierangela Minuto, Roberto Lerza
DOI: http://dx.doi.org/10.1016/j.ajem.2007.11.029
The American Journal of Emergency Medicine , Vol. 26 , Issue 8 ,
Published in issue: October 2008
x We report a retrospective analysis of 5 years of adenosine use in our emergency department (2002-2006). We treated 454 patients with an intravenous bolus of adenosine. The cohort was made up of 40.7% men and 59.3% women, with mean age of 47.32 years, mean heart rate of 162.48 beats per minute. Among them, 73% responded immediately to the 6-mg dose, 15% responded after the second 12-mg dose, and 11% responded to a further 12-mg dose, whereas 11% were unresponsive. We observed minor side effects in a high percentage of patients (ie, chest tightness 83%, flushing 39.4%, sense of impending death 7%).
Dyslipidemia and sternum fracture Cagdas Can, Umut Gulactı, Aydin Sarıhan, Hakan Topacoglu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.036
The American Journal of Emergency Medicine , Vol. 31 , Issue 6 ,
Published online: March 13 2013
x Tenderness over the sternum is a clue for possible sternal fracture. Sternal fractures usually occur at the body or manubrium. Lateral chest radiography could detect a sternum fracture, but the diagnosis is usually made by chest tomography. Traumatic sternum fracture considered as a marker of seriously life-threatening, high-energy injury. In hyperlipidemia, oxidized lipids accumulate in vascular tissues and trigger atherosclerosis. Such lipids also deposit in bone tissues where they may promote osteoporosis.
Severe hyperkalemia with refractory ventricular fibrillation: successful resuscitation using extracorporeal membrane oxygenation Chun-Chieh Chiu, Hsu-Heng Yen, Yao-Li Chen, Fu-Yuan Siao
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.016
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: January 23 2014
x Refractory ventricular fibrillation caused by severe hyperkalemia is a rare condition. We report a case of a 66-year-old man presenting with prolonged cardiac arrest and refractory ventricular fibrillation due to severe hyperkalemia caused by his having taken an unknown herbal medicine and in which cardiac arrest was refractory to prolonged conventional cardiopulmonary resuscitation. Extracorporeal membrane oxygenation was initiated approximately 90 minutes after prolonged cardiopulmonary resuscitation; this provided cardiopulmonary life support for prolonged cardiac arrest and termination of refractory ventricular fibrillation, achieving a sustained return of spontaneous circulation, which permitted adequate time for continuous venovenous hemofiltration with the promotion of potassium excretion and enabled a good recovery with intact cerebral performance.
Critical care provided in an urban emergency department Malcolm Nelson, Ron D Waldrop, John Jones, Zelma Randall
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90066-3
The American Journal of Emergency Medicine , Vol. 16 , Issue 1 ,
Published in issue: January 1998
x The emergency department (ED) provides a substantial amount of critical care. The purpose of this study was to quantitate the critical care provided in an urban ED. The study was performed at a large urban hospital with an annual ED volume of 70,000 patients. All patients requiring critical care in the ED or hospital were prospectively observed between September 1 and November 30, 1993. Patients requiring recovery room care or neonatal intensive care were excluded. Data collected included age, disposition, length of stay, triage acuity assignment in the ED, primary diagnosis, and critical care procedures.
Purpura fulminans caused by community-associated methicillin-resistant Staphylococcus aureus Casimir J. Fitzgerald, Thomas V. Pranikoff, Gregory A. Ross, Steven Mou, Laurence B. Givner, Avinash K. Shetty
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.032
The American Journal of Emergency Medicine , Vol. 30 , Issue 6 ,
Published online: June 6 2011
x Sepsis-induced purpura fulminans is a rare but life-threatening condition characterized by rapidly progressive hemorrhagic infarction of the skin due to dermal vascular thrombosis resulting in tissue loss and severe scarring. Although most commonly related to meningococcal or invasive group A streptococcal disease, it may also be caused by several other bacterial or viral pathogens including Pneumococcus and Varicella . Purpura fulminans associated with Staphylococcus aureus sepsis is rare but has been reported in adults.
Early risk stratification with simple clinical parameters for cirrhotic patients with acute upper gastrointestinal bleeding Yao-Chun Hsu, Jyh-Ming Liou, Chen-Shuan Chung, Cheng-Hao Tseng, Tzu-Ling Lin, Chieh-Chang Chen, Ming-Shiang Wu, Hsiu-Po Wang
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.037
The American Journal of Emergency Medicine , Vol. 28 , Issue 8 ,
Published online: March 29 2010
x This study aimed to identify pre-endoscopic clinical parameters independently associated with 6-week mortality and to develop a prognostic model in cirrhotic patients with acute upper gastrointestinal (UGI) bleeding.
