Pectus excavatum: a cause of serious cardiac dysfunction and dysrhythmia Terry Li, Evan Bishop-Rimmer, Mason Shieh, Paul Kreiger, Marc Felberbaum, Michael Heller
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.017
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: March 17 2015
x A 24-year-old woman presented to the emergency department (ED) with new onset of palpitations. The patient was found to have pectus excavatum on examination and atrial fibrillation with rapid ventricular response and a right bundle branch block on electrocardiogram; she underwent synchronized cardioversion, which restored normal sinus rhythm. All laboratories were negative. Transthoracic echocardiogram and cardiac magnetic resonance imaging revealed that the sternum was compressing the right ventricular wall causing a decreased right ventricular ejection fraction.
Life-threatening cervical necrotizing fasciitis after a common dental extraction Pascal Bilbault, Vincent Castelain, Malika Schenck-Dhif, Francis Schneider, Anne Charpiot
DOI: http://dx.doi.org/10.1016/j.ajem.2008.01.053
The American Journal of Emergency Medicine , Vol. 26 , Issue 8 ,
Published in issue: October 2008
x We report a case of cervical necrotizing fasciitis (NF) with severe sepsis occurring 8 hours after a banal dental extraction in a healthy adult. A 44-year-old man was admitted for cervical NF and severe sepsis in the emergency department. An early diagnosis was based on clinical examination (violent pain, swelling of face, and crepitation), confirmed by computed tomography scan, which showed subcutaneous gas and a fracture of the maxillary sinus in regard of the extracted tooth. Broad spectrum antibiotherapy was started quickly followed by surgical debridement.
Acute aortic dissection presenting as case of accidental falling with flaccidity of left lower extremity Bao-Fang Lin, Yi-Shan Chen, Hsiao-Fen Weng, Wei-Tso Chia
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.051
The American Journal of Emergency Medicine , Vol. 27 , Issue 1 ,
Published in issue: January 2009
x Aortic dissection is often a catastrophic, life-threatening condition that may not always present with symptoms. Without intensive treatment, the mortality within the first 2 weeks of onset is reportedly as high as 80%. Acute aortic dissection classically presents with the symptoms of abrupt chest pain that sometimes radiates to the back, abdominal pain, or back pain alone. The patient may be cool and clammy, which is indicative of a shock syndrome. It can be associated with neurologic sequelae in as many as one third of all patients.
Colonic necrosis due to sodium polystyrene sulfate (Kayexalate) Andrew S. Bomback, John T. Woosley, Abhijit V. Kshirsagar
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.002
The American Journal of Emergency Medicine , Vol. 27 , Issue 6 ,
Published in issue: July 2009
x The rising prevalence of chronic and end-stage kidney disease is accompanied by a concomitant rising risk of hyperkalemia in these patients. Sodium polystyrene sulfonate (Kayexalate, sanofi-aventis, Bridgemater, NJ) is a commonly used treatment of hyperkalemia. We present a case of Kayexalate-induced colonic necrosis as a reminder of this rare, but potentially avoidable, toxicity of a commonly used medication.
Rupture of splenic artery aneurysm during early pregnancy: a rare and catastrophic event Julien Chookun, Vincent Bounes, Jean Louis Ducassé, Olivier Fourcade
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.039
The American Journal of Emergency Medicine , Vol. 27 , Issue 7 ,
Published in issue: September 2009
x Spontaneous rupture of splenic artery aneurysm during pregnancy is a rare, life-threatening event with a catastrophic prognosis. Splenic artery aneurysm, known to be more frequent in women, especially among multiparous ones, is generally asymptomatic until rupture. Because of increased blood flow and hormonal modifications, this rupture occurs frequently during pregnancy, most often at the end of the third trimester. We present the case of a second parous woman in early pregnancy with a rupture of splenic artery aneurysm initially diagnosed as a complicated ectopic pregnancy, which profoundly modifies surgical treatment.
Spontaneous diaphragmatic rupture complicated with perforation of the stomach during Pilates Young Mo Yang, Hee Bum Yang, Jung Soo Park, Hoon Kim, Suk Woo Lee, Jeong Hee Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2009.06.012
The American Journal of Emergency Medicine , Vol. 28 , Issue 2 ,
Published in issue: February 2010
x Diaphragmatic rupture (DR) is most commonly seen after a blunt trauma. It rarely occurs spontaneously. Many cases of spontaneous DR followed by strenuous sports activity have been reported in the medical literature. However, there has been no previous report on a case of spontaneous DR after a static sport activity. We report the case of a 29-year-old woman who presented to the emergency department (ED) with pain in the epigastric area that started 1 day before visiting the ED during deep breathing in Pilates.
Takotsubo cardiomyopathy and torsade de pointes in myasthenic crisis: be aware of QT prolongation Alberto Valbusa, Stella Ingrassia, Gian Marco Rosa, Maria Teresa Infante, Angelo Schenone, Fabrizio Montecucco, Christian Cordano
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.030
The American Journal of Emergency Medicine , Vol. 31 , Issue 12 ,
Published online: October 25 2013
x Cardiac complications in myasthenia gravis (MG) represent a hot topic issue for current research and clinical care of the patients. For instance, a “guilty” association of anti-Kv1.4 antibodies have been recently demonstrated in MG, potentially associated with myocarditis and long-QT syndrome [1]. In addition, during the myasthenic crisis, catecholamine excess might trigger apical ballooning syndrome (ABS) [2]. Although QT interval prolongation is prevalent among patients with ABS and might precede torsade de pointes (TdP), life-threatening arrhythmias remain very rare [2,3].
Severe recurrent coagulopathy following crotaline envenomation refractory to maintenance dosing of antivenom Richard F. Clark, Charles W. O’Connell, Janna H. Villano, Andrew Kim, Binh T. Ly, Alicia B. Minns
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.047
The American Journal of Emergency Medicine , Vol. 33 , Issue 6 ,
Published online: December 2 2014
x Introduction: Effects in crotaline snake envenomation include tissue destruction and hemotoxicity. The only available antivenom for treatment in this country is Crotalidae Polyvalent Immune Fab (CPIF) ([Ovine] CroFab; BTG, West Conshohocken, PA). Recurrence is a delayed appearance of coagulopathy and other symptoms in envenomated individuals after stabilization with CPIF. When recurrence was first observed, treatment protocols added extra or “maintenance” doses of antivenom in an attempt to decrease the rate of recurrent symptoms.
Effect of total fluid volume administered on plasma lidocaine levels with endotracheal drug therapy : Sharon E. Mace. Mt. Sinai Medical Center, Cleveland, OH 44106
DOI: http://dx.doi.org/10.1016/0735-6757(86)90206-8
The American Journal of Emergency Medicine , Vol. 4 , Issue 5 ,
Published in issue: September 1986
Unwitnessed ventricular fibrillation: Defibrillation or drug therapy first? : Thomas G. Martin, Nancy S. Hawkins, Dale Rider, Jesse A. Weigel, Barry D. Buckingham. Milton S. Hershey Medical Center, Hershey, PA 17033
DOI: http://dx.doi.org/10.1016/0735-6757(86)90207-X
The American Journal of Emergency Medicine , Vol. 4 , Issue 5 ,
Published in issue: September 1986
The authors reply: Following the patient's best interest — Uncontrolled donation after circulatory determination of death Iván Ortega-Deballon, David Rodríguez-Arias, Edurne De la Plaza-Horche
DOI: http://dx.doi.org/10.1016/j.ajem.2012.08.023
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: November 16 2012
x We appreciate the publication of divergent opinions on a topic as controversial as donation after circulatory determination of death (DCDD).
Gastric dilatation and circulatory collapse due to eating disorder Xavier Repessé, Laurent Bodson, Siu-Ming Au, Cyril Charron, Antoine Vieillard-Baron
DOI: http://dx.doi.org/10.1016/j.ajem.2012.10.018
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: November 30 2012
x Anorexia-bulimia is a frequent psychiatric affection in adolescent female populations [1]. Such eating disorders may have a higher morbi-mortality than usually described in literature. Among frequently encountered complications of this disease, major gastric dilatation can dramatically evolve to death. We present the case of a young woman which presented a rare cause of acute abdominal compartment syndrome.
Inappropriate use of qualitative, point-of-care urine human chorionic gonadotropin test David G. Grenache, Ann M. Gronowski, Corinne R. Fantz
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.041
The American Journal of Emergency Medicine , Vol. 31 , Issue 6 ,
Published online: April 3 2013
x We read with interest the case report by Habboushe and Walker [1] that described the use of whole blood instead of urine or serum for the qualitative detection of human chorionic gonadotropin (hCG) in a patient with a ruptured ectopic pregnancy.
Use of tissue oxygenation (StO2) monitor in the ED Sadiye Yolcu, Bulent Erdur
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.037
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: April 28 2014
x Standard techniques for monitoring low cardiac output and the systemic circulation such as cardiac index and mixed venous saturation are time-consuming and require indwelling pulmonary catheters. However, these catheters can cause complications during application and follow-up and generally may not provide continuous data [1]. Monitoring of early regional ischemia may be more helpful in providing early intervention given that an ischemic injury is reversible. Continuous and noninvasive techniques for ischemia monitoring have been researched recently, but there is limited data in literature [2,3].
Appropriate use of epinephrine in anaphylaxis Jessica Anchor, Russell A. Settipane
DOI: http://dx.doi.org/10.1016/j.ajem.2004.07.016
The American Journal of Emergency Medicine , Vol. 22 , Issue 6 ,
Published in issue: October 2004
x We are submitting a case-based presentation illustrating medical errors in the use of epinephrine for the treatment of anaphylaxis. Readers will learn from mistakes made by other emergency caregivers in treating anaphylaxis. The article will specifically review the recommended use of epinephrine in the management of anaphylaxis. Four patients are presented who were seen in consultation by our outpatient allergy service. In all 4 cases, the history was suggestive of an episode of anaphylaxis in which emergency care providers mismanaged treatment.
Anaphylaxis to topical bacitracin ointment Karen Greenberg, James Espinosa, Victor Scali
DOI: http://dx.doi.org/10.1016/j.ajem.2006.04.010
The American Journal of Emergency Medicine , Vol. 25 , Issue 1 ,
Published in issue: January 2007
x Bacitracin is used on a daily basis for treatment of local infections and is a popular topical antibiotic for wound prophylaxis because of its low cost and presumed low toxicity [1]. Historically, bacitracin has been thought to rarely cause allergic reactions. In fact, most physicians are not aware of any side effects of the drug. However, in 2003, bacitracin was awarded “Allergen of the Year” by the North American Contact Dermatology Group because its incidence of allergic reactions increased from 1.5% in 1989 to 1990 to 9.2% in 1998 to 2000 [1].
A new full body low-dose x-ray technique is an alternative to conventional “shunt series” in patients with ventriculoperitoneal shunt dysfunction Benoit B. Schaller, Aristomenis K. Exadaktylos, Robert H. Andres, Harald M. Bonel
DOI: http://dx.doi.org/10.1016/j.ajem.2007.03.009
The American Journal of Emergency Medicine , Vol. 25 , Issue 6 ,
Published in issue: July 2007
x Ventriculoperitoneal (VP) shunts are regularly implanted in patients with hydrocephalus. A regular and sometimes life-threatening complication after shunt implantation is disconnection at junction or a break at any point of the descending catheter [1]. In case of such malfunction, a “shunt series” consisting of 2-dimensional plain x-rays of the skull, chest, and/or abdomen has to be performed. To follow the path of the catheter, overlapping at radiologic exposures is unavoidable.
Recognition of pneumoperitoneum using bedside ultrasound in critically ill patients presenting with acute abdominal pain Robert Jones
DOI: http://dx.doi.org/10.1016/j.ajem.2007.02.004
The American Journal of Emergency Medicine , Vol. 25 , Issue 7 ,
Published in issue: September 2007
x Bedside ultrasound examinations performed by emergency physicians are goal-directed studies meant to answer specific questions. These studies are frequently performed in critically ill patients with undifferentiated abdominal pain who are suspected of having intra-abdominal hemorrhage or a ruptured abdominal aortic aneurysm. Patients presenting with a perforated hollow viscus may have a similar clinical presentation. Although detection of the sonographic findings associated with a perforated hollow viscus is not a current study goal, these findings may be readily apparent during the performance of examinations to detect an abdominal aortic aneurysm or intra-abdominal hemorrhage.
Laryngotracheal disruption after blunt neck trauma Rony Aouad, Homere Moutran, Simon Rassi
DOI: http://dx.doi.org/10.1016/j.ajem.2007.02.048
The American Journal of Emergency Medicine , Vol. 25 , Issue 9 ,
Published in issue: November 2007
x Laryngotracheal injuries after motor vehicle accidents are rare. They are mostly confined to the cervical trachea, resulting from direct blunt injury to the anterior neck. In addition, complete laryngotracheal separation carries a high mortality rate immediately, and its early diagnosis is very difficult because of nonspecific signs in the settings of acute trauma. We present a case of a 27-year-old man who experienced a high-energy blunt trauma to the neck, and we discuss the clinical signs and symptoms in laryngotracheal injuries, the importance of imaging features and management in this kind of injury.
Coronary aneurysms in patients with systemic lupus erythematosus Giuseppe Famularo, Andrea Vallone, Margherita Pizzicannella, Laura Gasbarrone, Giovanni Minisola
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.035
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: October 20 2014
x Chen and colleagues [1] report “”on 8 patients presenting with cardiac symptoms who were subsequently diagnosed to have systemic lupus erythematosus (SLE). None of them had an acute coronary syndrome nor an SLE-related coronary vasculitis was ultimately disclosed upon an extensive clinical, laboratory, and imaging workup.
