Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography Peiman Nazerian, Giovanni Volpicelli, Simone Vanni, Chiara Gigli, Laura Betti, Maurizio Bartolucci, Maurizio Zanobetti, Francesca Romana Ermini, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.035
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: January 27 2015
x Despite emerging evidences on the clinical usefulness of lung ultrasound (LUS), international guidelines still do not recommend the use of sonography for the diagnosis of pneumonia. Our study assesses the accuracy of LUS for the diagnosis of lung consolidations when compared to chest computed tomography (CT).
High total carbon dioxide predicts 1-year readmission and death in patients with acute dyspnea Nathalie Lund, Anders Rohlén, Per Simonsson, Sofia Enhörning, Torgny Wessman, Klas Gränsbo, Olle Melander
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.079
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 29 2015
Open Access x Patients with acute dyspnea are a large heterogeneous patient group where initial management is important for outcome.
Use of capnographs to assess quality of pediatric ventilation with 3 different airway modalities Julia Fuzak Freeman, Christopher Ciarallo, Lara Rappaport, Maria Mandt, Lalit Bajaj
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.012
The American Journal of Emergency Medicine , Vol. 34 , Issue 1 ,
Published online: September 19 2015
x Prehospital pediatric airway management is difficult and controversial. Options include bag-mask ventilation (BMV), endotracheal tube (ETT), and laryngeal mask airway (LMA). Emergency Medical Services personnel report difficulty assessing adequacy of BMV during transport. Capnography, and capnograph tracings in particular, provide a measure of real-time ventilation currently used in prehospital medicine but have not been well studied in pediatric patients or with BMV. Our objective was to compare pediatric capnographs created with 3 airway modalities.
Double-lung point sign in traumatic pneumothorax Anne Aspler, Emanuele Pivetta, Michael B. Stone
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.059
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: January 10 2014
x Lung ultrasound has emerged as a rapid and accurate screening tool for pneumothorax. The lung point sign, a sonographic representation of the point on the chest wall where the pleural layers re-adhere, is 100% specific to confirm the diagnosis. Double lung point sign for a single pneumothorax is extremely unusual and has only been reported twice in the literature.
Misdiagnosed rare subglottic lesions with bronchial asthma as the initial symptom Ya-Feng Yu, Hong-Yang Ling, Gen-Sheng Xiao, Peng Sun, Man-Yi Li, Wen-Ying Wu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.023
The American Journal of Emergency Medicine , Vol. 31 , Issue 8 ,
Published online: May 22 2013
x Early-stage subglottic lesions are easily misdiagnosed as bronchial asthma. We report on 4 cases of rare subglottic lesions. Our aim is to provide insights for the accurate diagnosis of subglottic lesions.
Central extracorporeal membrane oxygenation requiring pulmonary arterial venting after near-drowning Mitsutoshi Kimura, Osamu Kinoshita, Yoshifumi Fujimoto, Arata Murakami, Takahiro Shindo, Koichi Kashiwa, Minoru Ono
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.031
The American Journal of Emergency Medicine , Vol. 32 , Issue 2 ,
Published online: October 30 2013
x Extracorporeal membrane oxygenation (ECMO) is an effective respiratory and circulatory support in patients in refractory cardiogenic shock or cardiac arrest. Peripheral ECMO sometimes requires left heart drainage; however, few reports state that pulmonary arterial (PA) venting is required during ECMO support. We present a case of a 14-year-old boy who required PA venting during ECMO support after resuscitation from near-drowning in freshwater. A biventricular assist device with an oxygenator implantation was intended on day 1; however, we were unable to proceed because of increasing of pulmonary vascular resistance from the acute lung injury.
Emergency management of community-acquired bacterial pneumonia: what is new since the 2007 Infectious Diseases Society of America/American Thoracic Society guidelines Gregory J. Moran, Richard E. Rothman, Gregory A. Volturo
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.002
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: February 4 2013
x Community-acquired pneumonia (CAP) is a major health problem in the United States and is associated with substantial morbidity, mortality, and health care costs. Patients with CAP commonly present to emergency departments where physicians must make critical decisions regarding diagnosis and management of pneumonia in a timely fashion, with emphasis on efficient and cost-effective diagnostic choices, consideration of emerging antimicrobial resistance, timely initiation of antibiotics, and appropriate site-of-care decisions.
The role of inferior vena cava diameter in the differential diagnosis of dyspneic patients; best sonographic measurement method? Adnan Yamanoğlu, Nalan G. Çelebi Yamanoğlu, İsmet Parlak, Pelin Pınar, Ali Tosun, Burak Erkuran, Alper Akgür, Neslihan Satılmış Siliv
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.032
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: December 26 2014
x We aimed to determine the role of inferior vena cava (IVC) diameter in making a differentiation between dyspnea of cardiac (acute heart failure [AHF]) and pulmonary origin. We also attempted to determine the best sonographic method for the measurement of IVC diameter.
Diagnostic performance of cardiopulmonary ultrasound performed by the emergency physician in the management of acute dyspnea Emeric Gallard, Jean-Philippe Redonnet, Jean-Eudes Bourcier, Dominique Deshaies, Nicolas Largeteau, Jeanne-Marie Amalric, Fouad Chedaddi, Jean-Marie Bourgeois, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.003
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: December 11 2014
x The etiologic diagnosis of acute dyspnea in the emergency department (ED) remains difficult, especially for elderly patients or those with previous cardiorespiratory medical history. This may lead to inappropriate treatment and potentially a higher mortality rate. Our objective was to evaluate the performance of cardiopulmonary ultrasound compared with usual care for the etiologic diagnosis of acute dyspnea in the ED.
A woman with cough: gastrobronchial fistula as a delayed complication of bariatric surgery. Case report and literature review Sofiya Greenberg, Nalini Kanth, Anil Kanth
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.022
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: November 18 2013
x Bariatric surgery has become the treatment of choice for morbid obesity. This case report aims to increase awareness of the emergency physician of a possible presentation of a gastrobronchial fistula after bariatric surgery. Similar presentation may occur after esophageal or other upper abdominal surgery. Appropriate studies for diagnosis are contrast-enhanced abdominal computed tomography and upper gastrointestinal studies.
Diffuse idiopathic skeletal hyperostosis as an acute airway presentation requiring urgent tracheostomy Jonathan H. Bird, Timothy C. Biggs, Petros D. Karkos, Costa Repanos
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.050
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: November 8 2014
x Diffuse idiopathic skeletal hyperostosis is an idiopathic disorder characterized by intervertebral bridges of ossification along the anterior and lateral aspects of the spine. This case report describes an 87-year-old man presenting with an acute onset of stridor. Computed tomography revealed a large osteophyte originating from the cervical spine requiring tracheostomy due to a critical narrowing of the laryngeal inlet. Diffuse idiopathic skeletal hyperostosis is a common cause of dysphagia but rarely results in critical airway obstruction.
Cardiac disease in pediatric patients presenting to a pediatric ED with chest pain David M. Drossner, Daniel A. Hirsh, Jesse J. Sturm, William T. Mahle, David J. Goo, Robert Massey, Harold K. Simon
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.011
The American Journal of Emergency Medicine , Vol. 29 , Issue 6 ,
Published online: July 14 2010
x Chest pain is a frequent chief complaint among the pediatric population. To date, limited data exist on the full spectrum of emergent cardiac disease among such patients; and existing data have been limited to relatively small cohorts.
Sevoflurane administration initiated out of the ED for life-threatening status asthmaticus Daniel Ng, Jahan Fahimi, H. Gene Hern
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.005
The American Journal of Emergency Medicine , Vol. 33 , Issue 8 ,
Published online: January 16 2015
x Status asthmaticus is both a common and dangerous cause of acute dyspnea in the emergency department (ED) setting. Although most cases respond favorably to standard treatment, there are rare cases in which therapy beyond traditional treatment is needed. One of these treatment modalities includes inhalational anesthesia. We present a case in which inhaled sevoflurane was initiated out of the ED for a life-threatening asthma exacerbation refractory to conventional treatment. To our knowledge, this is only the second case to report the use of inhaled anesthetics initiated out of the ED for status asthmaticus and is the first report of its kind to thoroughly detail the respiratory response noted while inhalation anesthesia was being implemented.
Extracorporeal membrane oxygenation for refractory, life-threatening, and herpes simplex virus 1–induced acute respiratory distress syndrome. Our experience and literature review Massimo Bonacchi, Gabriella Di Lascio, Guy Harmelin, Andrea Pasquini, Adriano Peris, Guido Sani
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.011
The American Journal of Emergency Medicine , Vol. 30 , Issue 6 ,
Published online: June 13 2011
x We report our first experience of treating an immunocompetent adult patient with acute respiratory distress syndrome (ARDS) due to type 1 herpes simplex (HSV1) pneumonitis, using extracorporeal membrane oxygenation (ECMO). Similar cases reported in literature are reviewed as well. The therapeutic options for this particular complication are discussed. Pneumonia caused by HSV1 is a rare finding in immunocompetent individuals; it occurs more often in immunosuppressed and ventilated patients. It is a severe illness; therefore, early diagnosis and initiation of treatment are imperative.
Cytokine markers as predictors of type of respiratory infection in patients during the influenza season John Patrick Haran, Rachel Buglione-Corbett, Shan Lu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.030
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: March 7 2013
x The objective of this study is to characterize the cytokine response among patients presenting with an influenza-like illness who are infected with the influenza virus, a bacterial pneumonia, or another viral infection. We hypothesize that there are differences in proinflammatory and anti-inflammatory cytokines in relation to cytokines associated with the humoral response during viral and bacterial respiratory infections.
Adult asthma exacerbations and environmental triggers: a retrospective review of ED visits using an electronic medical record Larissa May, Marianne Carim, Kabir Yadav
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.034
The American Journal of Emergency Medicine , Vol. 29 , Issue 9 ,
Published online: August 16 2010
x Despite familiarity with triggers for asthma, there is little recent study on the association of triggers with the emergency department (ED) presentation of adult asthma exacerbation.
Severe dengue with massive pleural effusion requiring urgent intercostal chest tube drainage: a case report Afzal Azim, Jyoti N. Sahoo, Arvind K. Baronia, Mohan Gurjar, Ratendra K. Singh, Banani Poddar, Armin Ahmed, Piyush Garg, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.024
The American Journal of Emergency Medicine , Vol. 30 , Issue 2 ,
Published online: February 28 2011
x Dengue is one of the most common mosquito-borne infection affecting more than 50 million people worldwide annually. Most common causes for dengue-associated mortality are shock, bleeding, and respiratory failure.
A comparison of different diagnostic tests in the bedside evaluation of pleuritic pain in the ED Giovanni Volpicelli, Luciano Cardinale, Paola Berchialla, Alessandro Mussa, Fabrizio Bar, Mauro F. Frascisco
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.035
The American Journal of Emergency Medicine , Vol. 30 , Issue 2 ,
Published online: January 31 2011
x Bedside lung ultrasound (LUS) is useful in detecting radio-occult pleural-pulmonary lesions. The aim of our study is to compare the value of LUS with other conventional routine diagnostic tools in the emergency department (ED) evaluation of patients with pleuritic pain and silent chest radiography (CXR).
Sonographic evidence of spontaneous pneumomediastinum Lorraine Ng, Turandot Saul, Resa E. Lewiss
DOI: http://dx.doi.org/10.1016/j.ajem.2012.08.019
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: November 19 2012
x Spontaneous pneumomediastinum (SPM) is defined as a non-traumatic air leak from alveolar, bronchial or esophageal rupture along vascular sheaths and tissue planes into the mediastinum due to increased pressure in the trachea, bronchi, alveoli or esophagus [1]. SPM is rare in children, with a bimodal incidence peaking in children less than 7 years of age and then again in adolescence [1]. Historically, the diagnosis of SPM is made with physical examination findings and chest radiography.
Endogenous carboxyhemoglobin concentrations in the assessment of severity in patients with community-acquired pneumonia Seref Kerem Corbacioglu, Isa Kilicaslan, Fikret Bildik, Atacan Guleryuz, Burak Bekgoz, Ayca Ozel, Ayfer Keles, Ahmet Demircan
DOI: http://dx.doi.org/10.1016/j.ajem.2012.10.005
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: December 7 2012
x Previous studies have shown that carbon monoxide, which is endogenously produced, is increased in community-acquired pneumonia (CAP). However, it has not been studied enough whether severity of pneumonia is correlated with increased carboxyhemoglobin (COHb) concentrations in CAP. The aim of this study was to determine whether endogenous carbon monoxide levels in patients with CAP were higher compared with the control group and, if so, to determine whether COHb concentrations could predict severity in CAP.
Frequent attenders to the ED: patients who present with repeated asthma exacerbations Shu Fen Lim, Win Wah, Yogeswary Pasupathi, Susan Yap, Mariko Siyue Koh, Keng Leong Tan, Cass Jwee Cheong Chay, Marcus Eng Hock Ong
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.052
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: May 12 2014
x Asthma has been reported as one of the main causes of frequent attendance to the emergency department (ED), and many of those visits are potentially preventable. Understanding the characteristics of frequent attender (FA) patients with asthmatic exacerbations will help to identify factors associated with frequent attendance and improve case management. The aim of this study is to describe the characteristics of FA who present multiple times to the ED for asthma exacerbations.
A rare cause of dyspnea in emergency medicine: transfusion-related acute lung injury Pınar Yeşim Akyol, Erden Erol Ünlüer, Pelin Elibol, Arif Karagöz, Fatih Esad Topal
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.035
The American Journal of Emergency Medicine , Vol. 31 , Issue 11 ,
Published online: September 25 2013
x The earliest definition of transfusion-related acute lung injury (TRALI) included all patients who developed acute respiratory distress, moderate to severe hypoxemia, rapid onset of pulmonary edema, mild to moderate hypotension, and fever within 6 hours of receiving a plasma containing blood transfusion. The definition excluded patients if they had underlying cardiac or respiratory disease. The mechanism is not known exactly but it causes morbidity and mortality. Incidence of TRALI changes between 0.08% and 15% of patients receiving a blood transfusion.
Brain natriuretic peptide: the reason of respiratory distress is heart disease or lung disease? Taylan Sahingozlu, Ulaş Karadas, Kayi Eliacik, Ali Rahmi Bakiler, Nihal Ozdemir Karadas, Muhammed Ali Kanik, Masaallah Baran
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.005
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: February 5 2015
x The aim of this study was to determine whether plasma levels of amino-terminal brain natriuretic peptide (BNP) could differentiate between heart failure and lung disease among infants with acute bronchiolitis.
Benign acute childhood myositis—a rare cause of abnormal gait Gregory Hall, Craig I. Schranz
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.057
The American Journal of Emergency Medicine , Vol. 32 , Issue 2 ,
Published online: October 14 2013
x Benign acute childhood myositis is a rare postviral myositis seen in school-aged children after a common upper respiratory infection (URI), most commonly caused by influenza [J Microbiol Immunol Infect 2004;37:95-98]. Predominantly seen in boys, this condition causes bilateral calf tenderness and pain with ambulation, often presenting as a refusal to bear weight. To avoid activation within the gastroc-soleus complex, the child will frequently compensate with a “Frankenstein gait,” described as a stiff-legged posture with shuffling gait [CMAJ 2009;181:711-713].
Inferior vena cava assessment in the bedside diagnosis of acute heart failure Joseph B. Miller, Ayan Sen, Seth R. Strote, Aaron J. Hegg, Sarah Farris, Abigail Brackney, David Amponsah, Usamah Mossallam
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.008
The American Journal of Emergency Medicine , Vol. 30 , Issue 5 ,
Published online: June 13 2011
x The objective of this study was to determine the test characteristics of the caval index and caval-aortic ratio in predicting the diagnosis of acute heart failure in patients with undifferentiated dyspnea in the emergency department (ED).
Acute iterative bronchospasm and “do not re-intubate” orders: sedation by an alpha-2 agonist combined with noninvasive ventilation C. Galland, B. Sergent, C. Pichot, M. Ghignone, L. Quintin
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.053
The American Journal of Emergency Medicine , Vol. 33 , Issue 6 ,
Published online: December 4 2014
x A male patient presented with bronchospasm and acute respiratory distress. The patient had presented 2 previous episodes of severe bronchospasm following abdominal surgery, leading twice to intubation, mechanical ventilation, and conventional sedation. As the patient positively rejected a third episode of intubation + mechanical ventilation, noninvasive ventilation (pressure support = 8 cm H2 0, positive end-expiratory pressure = 10 cm H2 0), inhaled therapy, and clonidine orally (≈μ g/kg) were combined.
Elderly man with dysphagia and esophageal perforation from an anterior cervical osteoarthritic osteophyte Daniel Evans, Anthony Luizza, Thomas Zanders, Rebecca Jeanmonod
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.025
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: November 25 2013
x An 85-year-old man with multiple comorbidities presented with dysphagia and developed stridor and respiratory distress, ultimately resulting in intubation due to an anterior, cervical osteoarthritic osteophyte. The osteophyte had eroded into his esophagus and compromised his airway. To our knowledge, this is the only documented case of stridor and respiratory failure in this etiologic situation. We review the common risk factors and presenting symptom patterns for this disease and cite recommendations for diagnosis, management, and disposition in the emergency department and critical care setting.
A centrally acting antihypertensive, clonidine, combined to a venous dilator, nitroglycerin, to handle severe pulmonary edema Philippe Schraub, M. Vecchi, Marc Matthys, Bernard Lecomte, Nicolas Ferrara, Marco Ghignone, Luc Quintin
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.037
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: June 18 2015
x A patient, with known left ventricular failure presented with severe pulmonary edema, an ejection fraction of 10% to 15%, knee mottling, and lactates of 7 mM L− . He was treated with unusually high-dose nitroglycerin (NTG) intravenously (IV; NTG ≈− .
i-gel as alternative airway tool for difficult airway in severely injured patients David Häske, Benjamin Schempf, Christoph Niederberger, Gernot Gaier
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.008
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: June 8 2015
x Supraglottic airway tools (SGAs) are beneficial for airway management or as a backup in “cannot intubate” situations. Recent studies have described laryngeal tubes as being critical because of tongue swelling that results in life-threatening situations, malposition, and bleeding from soft tissue injuries. Unlike other SGAs, supraglottic i-gel is a noninflatable gel-like cuff with an inner gastric channel.
Prehospital ultrasound thoracic examination to improve decision making, triage, and care in blunt trauma Pierre-Marie Brun, Jacques Bessereau, Daniel Levy, Xavier Billeres, Nathalie Fournier, Francois Kerbaul
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.063
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: January 9 2014
x Prehospital acute blunt thoracic trauma care remains difficult. Among then, diagnosis of atelectasis with ultrasound remains rare and unusual.
Redefinition of diagnostic role of inferior vena cava ultrasonography in the identification of acute heart failure A. Gianstefani, F. Savelli, A. Gramenzi, E. Zucconi, N. Di Battista, R. Francesconi, M. Cavazza
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.016
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: April 18 2014
x We have read with great interest the report of Yavasi et al [1] entitled “Monitoring the response to treatment of acute heart failure patients by ultrasonographic inferior vena cava collapsibility index,” in which the authors explore the role of sonographic measurements of inferior vena caval (IVC) diameters and inferior vena caval–collapsibility index (IVC-CI) (ie, measurement of respiratory variation of IVC diameter) in the monitoring of acute heart failure (AHF) therapy in the emergency department.
Clinical diagnosis of influenza in the ED Andrea F. Dugas, Alexandra Valsamakis, Mihir R. Atreya, Komal Thind, Peter Alarcon Manchego, Annum Faisal, Charlotte A. Gaydos, Richard E. Rothman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.008
The American Journal of Emergency Medicine , Vol. 33 , Issue 6 ,
Published online: March 14 2015
x Timely and accurate diagnosis of influenza remains a challenge but is critical for patients who may benefit from antiviral therapy. This study determined the test characteristics of provider diagnosis of influenza, final ED electronic medical record (EMR) diagnosis of influenza, and influenza-like illness (ILI) in patients recommended to receive antiviral treatment according to Centers for Disease Control and Prevention (CDC) guidelines. In addition, we evaluated the compliance with CDC antiviral guidelines.
Head position angles to open the upper airway differ less with the head positioned on a support Thomas Mitterlechner, Peter Paal, Lukas Kuehnelt-Leddhin, Alexander M. Strasak, Günther Putz, Nikolaus Gravenstein, Achim von Goedecke, Volker Wenzel
DOI: http://dx.doi.org/10.1016/j.ajem.2012.06.007
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: September 3 2012
x The aim of the study was to assess the effects of positioning the head on a support on “head position angles” to optimally open the upper airway during bag-valve mask ventilation.
Successful fluid resuscitation in a patient with high extravascular lung water index by restricted fluid infusion strategy under pulse indicator continuous cardiac output monitoring Haiting Xie, Haitao Sun, Zhongli Li, Ping Chang, Duobin Wu
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.057
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: February 17 2015
x Extravascular lung water index (EVLWI) is a measure of the interstitial, alveolar, and lymphatic fluid content of the lungs. A number of animal and clinical studies demonstrated an association of EVLWI to mortality. In this report, we describe successful fluid resuscitation in a patient with high EVLWI by restricted fluid infusion strategy under pulse indicator continuous cardiac output monitoring.
Three-view bedside ultrasound to differentiate acute decompensated heart failure from chronic obstructive pulmonary disease Daniel Mantuani, Arun Nagdev
DOI: http://dx.doi.org/10.1016/j.ajem.2012.11.028
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 4 2013
x Identifying the cause of acute dyspnea in the emergency department is often challenging, even for the most experienced provider. Distinguishing chronic obstructive pulmonary disease from acute decompensated heart failure in the acutely dyspneic patient who presents in respiratory distress is often difficult. Patients are often unable to give a detailed history when in extremis, yet primary management needs to be initiated before further testing can be completed. Bedside diagnostic ultrasound has emerged as a tool for emergency physicians to rapidly evaluate the cardiopulmonary status in patients presenting with undifferentiated shortness of breath [1-3].
A pig model for blunt chest trauma: no pulmonary edema in the early phase David Couret, Sophie de Bourmont, Nicolas Prat, Pierre-Yves Cordier, Jean-Baptiste Soureau, Dominique Lambert, Bertrand Prunet, Pierre Michelet
DOI: http://dx.doi.org/10.1016/j.ajem.2013.05.028
The American Journal of Emergency Medicine , Vol. 31 , Issue 8 ,
Published online: June 27 2013
x Chest trauma remains a leading cause of trauma-death. Since lung contusion is one of the most important lesions implicated, the aim of this experimental study was to evaluate the cardiorespiratory consequences of an isolated lung contusion model.
Combining transtracheal catheter oxygenation and needle-based Seldinger cricothyrotomy into a single, sequential procedure Eric Boccio, Rashmeet Gujral, Michael Cassara, Teresa Amato, Benjamin Wie, Mary Frances Ward, Jason D'Amore
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.048
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: March 6 2015
x Needle-based cricothyrotomy is a common procedure for emergency department patients requiring an emergent surgical airway. Percutaneous transtracheal jet ventilation is well studied to provide oxygenation. We propose to combine these procedures into a novel, single, and sequential procedure.
Adenosine-induced severe bronchospasm in a patient without pulmonary disease Stefano Coli, Francesco Mantovani, Jayme Ferro, Gianluca Gonzi, Marco Zardini, Diego Ardissino
DOI: http://dx.doi.org/10.1016/j.ajem.2011.11.005
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: December 16 2011
x Adenosine is widely used for the treatment of supraventricular tachycardias for its efficacy and excellent safety, but it has been reported to precipitate severe bronchospasm in patients with pulmonary disease. The drug is therefore contraindicated in asthmatic subjects and should be used with caution in patients with chronic obstructive pulmonary disease. Nevertheless, true bronchospasm is rare and should be distinguished from the much more common occurrence of dyspnea, only as a symptom and without respiratory compromise, which is benign and transient.
Subject Index
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00516-X
The American Journal of Emergency Medicine , Vol. 29 , Issue 9 ,
Published in issue: November 2011
A modified paravertebral block to reduce risk of mortality in a patient with multiple rib fractures Hitoshi Yoshida, Shinya Yaguchi, Atsufumi Matsumoto, Hiroyuki Hanada, Hidetomo Niwa, Masatou Kitayama
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.032
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: October 25 2014
x The risk of mortality due to multiple rib fractures elevates with increasing age or severity of injury. Although sufficient pain relief with thoracic epidural block or paravertebral block has been recommended for prevention of critical pneumonia that causes late death, their indications are limited in patients with coagulation disorder. We tested a new modified ultrasound-guided paravertebral block, retrolaminar block (RB)/costovertebral canal block (CVCB), instead of the recommended regional analgesic techniques in a 79-year-old multiple-injured man with routine antiplatelet therapy.
One-hand chest compression and hands-off time in single-lay rescuer CPR—a manikin study Athanasios Chalkias, Nikolaos Vogiatzakis, Konstantinos Tampakis, Maria Kalafati, Lila Papadimitriou, Theodoros Xanthos
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.030
The American Journal of Emergency Medicine , Vol. 31 , Issue 10 ,
Published online: September 12 2013
x To evaluate the effect of one-hand chest compression while continuously maintaining an open airway (OCOA) on rescue breath-associated hands-off time (RAHO) during single-lay rescuer cardiopulmonary resuscitation (CPR).
Early identification of an atypical case of type A dissection by transthoracic echocardiography by the emergency physician Scott Edward Sparks, Michael Kurz, Doug Franzen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.024
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: December 20 2014
x Thoracic aortic dissection is a lethal disease, and emergency department diagnosis is limited by imperfect diagnostic testing and limited resources; however, this case report illustrates the nonspecific presentation of thoracic aortic dissection and the use of emergency physician use of transthoracic echocardiography with the addition of suprasternal notch views to help differentiate all-cause chest pain and aid in accurate diagnosis, as well as earlier surgical correction for best patient outcomes in cases of thoracic aortic dissection.
Evaluation of myocardial injury through serum troponin I and echocardiography in anaphylaxis Yong Sung Cha, Hyun Kim, Min Hyuk Bang, Oh Hyun Kim, Hyung Il Kim, KyoungChul Cha, Kang Hyun Lee, Sung Oh Hwang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.038
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 2 2015
x Anaphylaxis is an acute, lethal, multisystem syndrome that results from the sudden release of mast cell- and basophil-derived mediators. Although anaphylaxis can cause cardiac complications, the incidence of myocardial injury using troponin I (TnI) has not been characterized. In addition, patterns of cardiomyopathy have not been evaluated in patients with elevated TnI. Therefore, we studied the occurrence and patterns of myocardial injury with TnI and echocardiography in anaphylaxis.
C-reactive protein as predictor of bacterial infection among patients with an influenza-like illness John Patrick Haran, Francesca Lynn Beaudoin, Selim Suner, Shan Lu
DOI: http://dx.doi.org/10.1016/j.ajem.2012.06.026
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: September 3 2012
x During the influenza season patients are labeled as having an influenza-like illness (ILI) which may be either a viral or bacterial infection. We hypothesize that C-reactive protein (CRP) levels among patients with ILI diagnosed with a bacterial infection will be higher than patients diagnosed with an influenza or another viral infection.
Intravenous ketamine to facilitate noninvasive ventilation in a patient with a severe asthma exacerbation Emeen Kiureghian, J. Michael Kowalski
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.066
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: April 6 2015
x Despite advances in outpatient treatment and an improved understanding of the pathophysiology, asthma continues to be a significant source of morbidity and mortality in the United States. Although there is certainly a component of chronic inflammation, the majority of the symptoms in acute asthma exacerbations can be reversed with proper medications and management. Reversing bronchoconstriction and avoiding mechanical ventilation should be the goals of the emergency physician and the intensivist to avoid intubation and to view this intervention as a last resort.
Airway compromise in children exposed to single-use laundry detergent pods: a poison center observational case series Paul E. Stromberg, Michele H. Burt, S. Rutherfoord Rose, Kirk L. Cumpston, Michael P. Emswiler, Brandon K. Wills
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.044
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: December 2 2014
x Single-use laundry detergent pods (LDPs) were introduced to the United States in 2010 but had been available in Europe as early as 2001. Case reports of unintentional exposures noted vomiting, ocular injuries, respiratory depression, and central nervous system depression. We summarize clinical effects from unintentional LDP exposures reported to a single poison center over 15 months.
The cardiac literature 2010 Amal Mattu, Michael C. Bond, Semhar Z. Tewelde, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.023
The American Journal of Emergency Medicine , Vol. 30 , Issue 4 ,
Published online: May 2 2011
x A. Pokorna M, Necas E, Kratochvil J, et al. A sudden increase in partial pressure end-tidal carbon dioxide (PET CO2 ) at the moment of return of spontaneous circulation. J Emerg Med 2010;38:614-621 .
The utility of inferior vena cava diameter and the degree of inspiratory collapse in patients with systolic heart failure Feyzullah Besli, Mesut Kecebas, Serhat Caliskan, Seckin Dereli, Ibrahim Baran, Yasin Turker
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.006
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: February 9 2015
x Both inferior vena cava (IVC) diameter and the degree of inspiratory collapse are used in the estimation of right atrial pressure.
Tracheal diverticulum masquerading as pneumomediastinum in a trauma victim Diane L. Gorgas, Brian Miller
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.014
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: August 7 2014
x Background: The differential diagnosis for a paratracheal air collection includes Zenker diverticulum, tracheal diverticulum, apical herniation of the lung, and pneumomediastinum. In the setting of trauma, pneumomediastinum is traditionally regarded as an alarm sign that warrants investigation for tracheal or esophageal rupture, both highly morbid conditions.
A dangerous exercise lessons from food-dependent anaphylaxis for the physician Thomas Medveczky
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.032
The American Journal of Emergency Medicine , Vol. 32 , Issue 10 ,
Published online: March 28 2014
x Exercise-induced anaphylaxis (EIA) and its subtype, food-dependent exercise-induced anaphylaxis are uncommon and therefore underdiagnosed forms of physical allergy. Triggers include various degrees of exercise in combination with ingestion of specific food products. Treatment remains identical to that of IgE-mediated allergic reactions. The presentation is commonly underdiagnosed and caries significant fatality risk, and this case should raise the awareness of the attending physician.
Upper cervical spine movement during intubation with different airway devices Taylan Kılıç, Erkan Goksu, Dilek Durmaz, Günay Yıldız
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.029
The American Journal of Emergency Medicine , Vol. 31 , Issue 7 ,
Published online: May 22 2013
x Prevention of secondary neurologic injury is critical during the airway management of a trauma patient. Trauma patients are assumed to have an unstable cervical spine (C-spine) until proven otherwise: orotracheal intubation during airway management may result in a certain amount of C-spine movement. This study, therefore, aimed to compare C-spine movement within different advanced airway devices (Macintosh blade, McCoy Blade, LMA, I-LMA, and Combitube) during airway management.
Bilateral lower extremity swelling: black pearl Clinton C. Smithson III, Jared C. Ham, Andrew L. Juergens II
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.036
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: April 24 2015
x Iatrogenic pneumothorax secondary to thoracentesis is relatively uncommon but does present to the emergency department (ED). Iatrogenic pneumothoraces developing tension physiology are rare. We report a case of an elderly female patient presenting to the ED with an isolated chief complaint of bilateral leg swelling, beginning the day after a thoracentesis, which was performed 3 days prior for pleural effusions secondary to lung cancer. Given that the patient was hemodynamically stable, not hypoxic, and had a history of chronic obstructive pulmonary disease and recent history of pleural effusions with diminished lung sounds throughout, this was a radiologic diagnosis.
Point-of-care ultrasound diagnoses acute decompensated heart failure in the ED regardless of examination findings Kenton L. Anderson, Katherine Y. Jenq, J. Matthew Fields, Nova L. Panebianco, Anthony J. Dean
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.025
The American Journal of Emergency Medicine , Vol. 32 , Issue 4 ,
Published online: December 20 2013
x We thank Dr Guglielmo M. Trovato for the comments about our article titled “Diagnosing heart failure among acutely dyspneic patients with cardiac, inferior vena cava, and lung ultrasound” [1]. In our article, we demonstrated that point-of-care ultrasound (US) is able to make the diagnosis of acutely decompensated heart failure (ADHF) among dyspneic patients in the emergency department (ED) if all 3 of the following were present: left ventricular ejection fraction (LVEF) less than 45%, inferior vena cava collapsibility index (IVC-CI) less than 20%, and B lines 10 or higher.
Abdominal complaints as a common first presentation of heart failure in adolescents with dilated cardiomyopathy Seth A. Hollander, Linda J. Addonizio, Clifford Chin, Jacqueline M. Lamour, Daphne T. Hsu, Daniel Bernstein, David N. Rosenthal
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.009
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 4 2013
x We hypothesized that isolated gastrointestinal complaints (abdominal pain, nausea, anorexia, weight loss), in the absence of other symptoms, were a common mode of initial presentation in children with congestive heart failure (CHF).
Pulmonary thromboembolism due to paliperidone: report of 2 cases Melike Ceyhan Balcı Şengül, Kemal Kaya, Atakan Yilmaz, Cem Şengül, Mustafa Serinken
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.038
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: December 30 2013
x Venous thromboembolism (VTE) is serious medical condition, which might be caused by psychotropic medications. Previously, antipsychotic-induced VTE due to olanzapine, risperidone, clozapine, and amisulpiride was reported. In this report, we present 2 cases of paliperidone-induced VTE.
Focused cardiac ultrasound diagnosis of right-sided endocarditis Neil J. Pathak, Lorraine Ng, Turandot Saul, Resa E. Lewiss
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.003
The American Journal of Emergency Medicine , Vol. 31 , Issue 6 ,
Published online: March 13 2013
x Endocarditis is a serious infection of the innermost muscle layer of the heart and can lead to significant mortality and morbidity. Echocardiography is instrumental to the timely diagnosis of this disease entity. We discuss the case of a patient presenting to the emergency department (ED) with fever of unclear etiology. The diagnosis of right-sided endocarditis was made using focused cardiac ultrasound. A 46-year-old man with a history of intravenous drug abuse presented to the ED complaining of fevers and headaches.
Could the survival and outcome benefit of adrenaline also be dependent upon the presence of gasping upon arrival of emergency rescuers? Eric M. Rottenberg
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.005
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: June 12 2014
x A recent systematic review and meta-analysis of randomized controlled trials of adrenaline use during resuscitation of out-of-hospital cardiac arrest found no benefit of adrenaline in survival to discharge or neurological outcomes. It did, however, find an advantage of standard dose adrenaline (SDA) over placebo and high dose adrenaline over SDA in overall survival to admission and return of spontaneous circulation (ROSC), which was also consistent with previous reviews. As a result, the question that remains is "Why is there no difference in the rate of survival to discharge when there are increased rates of ROSC and survival to admission in patients who receive adrenaline?" It was suggested that the lack of efficacy and effectiveness of adrenaline may be confounded by the quality of cardiopulmonary resuscitation (CPR) during cardiac arrest, which has been demonstrated in animal models.
The pathophysiologies of asphyxial vs dysrhythmic cardiac arrest: implications for resuscitation and post-event management Dimitrios Varvarousis, Giolanda Varvarousi, Nicoletta Iacovidou, Ernesto D'Aloja, Anil Gulati, Theodoros Xanthos
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.066
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: July 6 2015
x Cardiac arrest is not a uniform condition and significant heterogeneity exists within all victims with regard to the cause of cardiac arrest. Primary cardiac (dysrhythmic) and asphyxial causes together are responsible for most cases of cardiac arrest at all age groups. The purpose of this article is to review the pathophysiologic differences between dysrhythmic and asphyxial cardiac arrest in the prearrest period, during the no-flow state, and after successful cardiopulmonary resuscitation.
Flow resistance, work of breathing of humidifiers, and endotracheal tubes in the hyperbaric chamber Ran Arieli, Yohanan Daskalovic, Ofir Ertracht, Yehuda Arieli, Yohai Adir, Amir Abramovich, Pinchas Halpern
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.003
The American Journal of Emergency Medicine , Vol. 29 , Issue 7 ,
Published online: May 3 2010
x Humidification of inspired gas is critical in ventilated patients, usually achieved by heat and moisture exchange devices (HMEs). HME and the endotracheal tube (ETT) add airflow resistance. Ventilated patients are sometimes treated in hyperbaric chambers. Increased gas density may increase total airway resistance, peak pressures (PPs), and mechanical work of breathing (WOB). We tested the added WOB imposed by HMEs and various sizes of ETT under hyperbaric conditions. We mechanically ventilated 4 types of HMEs and 3 ETTs at 6 minute ventilation volumes (7-19.5 L/min) in a hyperbaric chamber at pressures of 1 to 6 atmospheres absolute (ATA).
Lemierre's syndrome and rapidly deteriorating respiratory failure in the emergency department Annette Dorfman, Hamid Shokoohi, M. Reza Taheri
DOI: http://dx.doi.org/10.1016/j.ajem.2011.08.008
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: October 28 2011
x Rapidly progressive acute respiratory distress along with life-threatening gram-negative anaerobic sepsis in a young, immunocompetent individual should always raise concern for Lemierre's syndrome. Although still rare, the incidence of Lemierre's syndrome has been increasing over the past 20 years. Lemierre's syndrome is characterized by postanginal septicemia and secondary internal jugular vein suppurative thrombophlebitis. In the emergency department (ED), patients often present with evidence of sepsis and secondary septic emboli to different organs, primarily the lungs.
Surviving a crisis of HIV-associated immune reconstitution syndrome Yu-Tzu Tsao, Shih-Wei Lee, Jin-Chyr Hsu, Feng-Ming Ho, Wei-Jie Wang
DOI: http://dx.doi.org/10.1016/j.ajem.2011.09.003
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: October 28 2011
x The management of life-threatening complications in HIV-associated immune reconstitution syndrome is becoming a challenging scenario in emergency practice, especially in the era of highly active antiretroviral therapy paralleled by increased worldwide incidence of HIV infection. Here, we described a 37-year-old woman with acute hypoxic respiratory failure, acute renal failure, and hypercalcemic crisis as the presenting features of HIV-associated immune reconstitution syndrome. In this patient, the restored granulomatous host response toward isolated pulmonary Mycobacterium avium complex infection led to a near-fatal catastrophe.
Considerations for resuscitation at high altitude in elderly and untrained populations and rescuers Takashi Suto, Shigeru Saito
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.007
The American Journal of Emergency Medicine , Vol. 32 , Issue 3 ,
Published online: November 14 2013
x With the development of transportation technologies, elderly people with chronic diseases are increasingly enjoying trekking and tours of nature resorts that include mountain highlands. Because of problems related to circulation, respiration, metabolism, and/or the musculoskeletal system in this population, the impact of high altitude on cardiopulmonary function is increased. Alpine accidents, therefore, tend to be more common in this population, and cases of cardiopulmonary arrest (CPA) at high altitudes seem to be increasing.
Spontaneous spinal epidural hematoma presenting as Brown-Séquard syndrome Jung-In Ko, Taikwan Kim, Cheol Su Jwa, Ji Yeon Jang, Ki Young Jeong, Gil Jun Suh, Taejin Park
DOI: http://dx.doi.org/10.1016/j.ajem.2012.11.018
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 4 2013
x Spontaneous spinal epidural hematoma (SEH) is a rare disease. Furthermore, Brown-Séquard syndrome due to spontaneous SEH has been rarely reported. Early detection of spontaneous SEH is not easy because early symptoms are often atypical and neurologic findings are often absent in the early stage. Early diagnosis and urgent surgical management are needed to prevent permanent neurologic deficits. We report a case of a 30-year-old patient who presented with Brown-Séquard syndrome due to spontaneous SEH.
A primary cardiac sarcoma presenting with superior vena cava obstruction Manish Thakker, Tracey Keteepe-Arachi, Ausami Abbas, Graham Barker, Neil Ruparelia, Gearoid T. Kingston, Timothy J. Parke
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.030
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: January 31 2011
x Superior vena cava (SVC) obstruction leads to a constellation of symptoms and signs that encompass the SVC syndrome. Today, malignancy accounts for 65% of all cases. The most common neoplastic causes are non–small cell lung cancer (50%), small cell lung cancer (25%), lymphoma, and metastasis. Primary cardiac tumors are an extremely rare cause of SVC obstruction. We describe the case of a 48-year-old man who presented with dyspnea, confusion, and facial swelling with cyanosis. The patient developed life-threatening airway obstruction after administration of anxiolytic.
About ultrasound in pneumothorax Andrew Verniquet, Rafid Kakel
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.015
The American Journal of Emergency Medicine , Vol. 29 , Issue 7 ,
Published online: June 6 2011
x The interesting case report “the double lung point: an unusual sonographic sign of juvenile spontaneous pneumothorax” by Volpicelli and Audino [1] raises several questions.
ED crowding and the outcomes of out-of-hospital cardiac arrest Jiwon Kang, Joonghee Kim, You Hwan Jo, Kyuseok Kim, Jae Hyuk Lee, Taeyun Kim, Jungyoup Lee, Ji Eun Hwang, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.002
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: August 4 2015
x Emergency department (ED) overcrowding is a worldwide problem associated with adverse outcomes. This study was performed to investigate the association between ED overcrowding and the outcomes and quality of cardiopulmonary resuscitation for out-of-hospital cardiac arrest (OHCA).
Timing and appropriateness of initial antibiotic therapy in newly presenting septic patients Antonia L. Vilella, Charles F. Seifert
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.008
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: October 21 2013
x To determine the effectiveness of antibiotic regimens and time to antibiotics in septic patients admitted to an intensive care unit from the emergency department.
Impact of individual characteristics on sonographic IVC diameter and the IVC diameter/aorta diameter index Jianjun Gui, Jiongguang Guo, Fengqiu Nong, Dongxin Jiang, Anding Xu, Fan Yang, Qiaozhu Chen, Youping Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.047
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: June 22 2015
x The inferior vena cava (IVC) parameters, including its diameter and collapsibility index have been evaluated for fluid status for over 30 years, but little is known about the impacts of patient characteristics on IVC parameters. The purpose of this study was to explore the relationships between individual patient characteristics and IVC parameters in healthy Chinese adult volunteers.
Large hiatal hernia at chest radiography in a woman with cardiorespiratory symptoms Daniele Torres, Gaspare Parrinello, Mauro Cardillo, Marina Pomilla, Caterina Trapanese, Bellanca Michele, Umberto Lupo, Caterina Schimmenti, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.009
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: May 25 2012
x Hiatal hernia (HH) is a frequent entity. Rarely, it may exert a wide spectrum of clinical presentations mimicking acute cardiovascular events such as angina-like chest pain until manifestations of cardiac compression that can include postprandial syncope, exercise intolerance, respiratory function, recurrent acute heart failure, and hemodynamic collapse. A 69-year-old woman presented to the emergency department complaining of fatigue on exertion, cough, and episodes of restrosternal pain with less than 1 hour of duration.
Monitoring the response to treatment of acute heart failure patients by ultrasonographic inferior vena cava collapsibility index Özcan Yavaşi, Erden Erol Ünlüer, Kamil Kayayurt, Selim Ekinci, Caner Sağlam, Nebi Sürüm, Mehmet Hicri Köseoğlu, Murat Yeşil
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.046
The American Journal of Emergency Medicine , Vol. 32 , Issue 5 ,
Published online: January 6 2014
x Our aim was to determine if N-terminal pro-brain natriuretic peptide (NT-proBNP) or sonographic measurements of inferior vena caval (IVC) diameters and collapsibility index (IVC-CI) have a role in the monitoring of acute heart failure (AHF) therapy.
Spontaneous tension pneumothorax and CO2 narcosis in a near fatal episode of chronic obstructive pulmonary disease exacerbation Walter Spindelboeck, Adrian Moser
DOI: http://dx.doi.org/10.1016/j.ajem.2011.09.015
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: November 21 2011
x Exacerbation of chronic obstructive pulmonary disease (COPD) is a disease pattern frequently seen in emergency medical services and intensive care units. Usually, exacerbations of COPD are of infectious origin, and an acute vital threat may take several days to develop. Tension pneumothorax in patients with COPD is a rare and often unexpected cause of acute vital threat. To the best of our knowledge, this is a unique case of CO2 narcosis after spontaneous tension pneumothorax in a patient with COPD.
Usefulness of triggering receptor expressed on myeloid cells-1 in differentiating between typical and atypical community-acquired pneumonia Chorng-Kuang How, Sen-Kuang Hou, Hsin-Chin Shih, David Hung-Tsang Yen, Chun-I Huang, Chen-Hsen Lee, Gau-Jun Tang
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.010
The American Journal of Emergency Medicine , Vol. 29 , Issue 6 ,
Published online: May 3 2010
x The purpose of this study is to investigate the clinical use of inflammatory marker triggering receptor expressed on myeloid cells (TREM)-1 at admission for differentiating between typical and atypical bacterial community-acquired pneumonia (CAP).
Acute heart failure diagnosis by ultrasound: new achievements and persisting limitations Daniela Catalano, Guglielmo M. Trovato, Marco Sperandeo
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.026
The American Journal of Emergency Medicine , Vol. 32 , Issue 4 ,
Published online: December 19 2013
x The article by Anderson et al [1] elegantly addresses the problem of misdiagnosis of acutely decompensated heart failure (ADHF). Their approach is very comprehensive and, in our opinion, is an important advancement of the current evidence in emergency medicine, beyond the existing severe limitations of previous studies using lung ultrasound (LUS). Nonetheless, we can agree only partially with the statements, which are the background of this and similar reports and by which the subsequent statistical analysis is severely biased.
Vomiting is not associated with poor outcomes in pediatric victims of unintentional submersions Kimberley M. Farr, Elizabeth A. Camp, Shabana Yusuf, Rohit P. Shenoi
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.055
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: February 4 2015
x The outcome of submersion victims depends on submersion duration and the availability of timely and effective resuscitation. The prognostic implication of vomiting during resuscitation of submersion victims is unclear. The study sought to determine whether vomiting during resuscitation in children treated for unintentional submersion injuries adversely impacts outcome.
Recurrent idiopathic ventricular fibrillation induced by high fever Kazuhiko Omori, Kei Jitsuiki, Hiromichi Ohsaka, Kentaro Mishima, Kouhei Ishikawa, Mariko Obinata, Yasumasa Oode, Youichi Yanagawa
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.021
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: March 17 2015
x A 75-year-old man became unconscious while taking a bath and drowned. His family found him and called an ambulance, and he was transported to our department. On arrival, his consciousness had improved. The results of his physical examination and an electrocardiogram were negative for abnormalities. After starting to eat, he developed a high fever at greater than 39°C, which was followed by pulseless ventricular tachycardia and ventricular fibrillation (Vf). Immediate coronary angiography showed no remarkable findings.
Clinical assessment of children with first-attack seizures admitted to the ED Chun-Yu Chen, Wen-Chieh Yang, Kang-Hsi Wu, Han-Ping Wu
DOI: http://dx.doi.org/10.1016/j.ajem.2011.07.008
The American Journal of Emergency Medicine , Vol. 30 , Issue 7 ,
Published online: October 26 2011
x This study aims to evaluate clinical values and determine the function of a pediatric observation unit (POU) as an alternative to inpatient unit admission for children with newly onset seizures.
The infected heart: ventriculoseptal abscess and intracardiac fistulization Keith Habeeb, Holly Stankewicz, Jennifer Axelband, Scott Melanson
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.053
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: June 29 2015
x Infective endocarditis is a rare but potentially deadly infection of the endocardial layer, which can involve the valves of the heart among other structures. The extraordinarily rare complication seen in this case involves extensive damage manifesting in an aortic root abscess resulting in an abnormal communication between the aorta and the atrium known as an aortocavitary fistula (Eur Heart J 2005;26:288-297; Pediatr Cardiol 2011;32:1057-1059; J Am Coll Cardiol 1991;18:663-667). As the disease progresses, wading through the complex symptoms, which may seem unrelated, represents a key challenge in diagnosis.
Linezolid is a novel and effective treatment for septic pulmonary embolism Maki Yasuda, Ryota Inokuchi, Kazuma Ohshima, Miyuki Yamamoto, Kurato Tokunaga, Tatsuma Fukuda, Kensuke Nakamura
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.035
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: January 6 2015
x Septic pulmonary embolism (SPE) is an uncommon and severe infectious disease that requires early diagnosis and proper antibiotic therapy. We present the case of a healthy 14-year-old girl with a history of atopic dermatitis, who developed SPE caused by Staphylococcus aureus bacteremia. We initially administered intravenous doripenem and vancomycin. Four days after her admission, blood and urine cultures yielded penicillinase nonproducing, methicillin-sensitive S aureus , with a minimum inhibitory concentration less than 0.06 μ g/mL.
Hantavirus infection in North America: a clinical review James Hartline, Chris Mierek, Tristan Knutson, Christopher Kang
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.001
The American Journal of Emergency Medicine , Vol. 31 , Issue 6 ,
Published online: May 15 2013
x The recent outbreak of hantavirus in Yosemite National Park has attracted national attention, with 10 confirmed cases of hantavirus cardiopulmonary syndrome and thousands of more people exposed. This article will review the epidemiology, presentation, workup, and treatment for this rare but potentially lethal illness. The possibility of infection with hantavirus deserves consideration in patients with severe respiratory symptoms with rodent exposure or rural/wilderness travel. Accurate diagnosis requires a high index of suspicion.
Ketamine-propofol combination (ketofol) vs propofol for procedural sedation and analgesia: systematic review and meta-analysis Mohammad Jalili, Maryam Bahreini, Amin Doosti-Irani, Rasoul Masoomi, Mona Arbab, Hadi Mirfazaelian
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.074
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 28 2015
x This meta-analysis of trials was conducted to evaluate the analgesic and side effects of ketamine-propofol combination (ketofol) in comparison to propofol in procedural sedation and analgesia (PSA).
The use of bedside ultrasonography in the evaluation of a neck mass Cindy Chavez, Eitan Dickman, Lawrence Haines
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.026
The American Journal of Emergency Medicine , Vol. 30 , Issue 2 ,
Published online: February 7 2011
x A 53-year-old man presented to the emergency department (ED) with neck swelling, shortness of breath, and a change in the sound of his voice. Physical examination revealed an afebrile man speaking in 2- to 3-word sentences with a firm, nontender, nonerythematous mass on the right side of his neck. A bedside ultrasound demonstrated a homogenous mass with internal vascular flow. This constellation of findings was felt to be most consistent with a malignancy. Nasopharyngoscopy confirmed a near obstructing supraglottic mass, and the patient underwent an emergent tracheostomy.
Prevalence of large and occult pneumothoraces in patients with severe blunt trauma upon hospital admission: experience of 526 cases in a French level 1 trauma center Jonathan Charbit, Ingrid Millet, Camille Maury, Benjamin Conte, Jean-Paul Roustan, Patrice Taourel, Xavier Capdevila
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.057
The American Journal of Emergency Medicine , Vol. 33 , Issue 6 ,
Published online: April 6 2015
x Occult pneumothoraces (PTXs), which are not visible on chest x-ray, may progress to tension PTX. The aim of study was to establish the prevalence of large occult PTXs upon admission of patients with severe blunt trauma, according to prehospital mechanical ventilation.
Fire extinguisher: an imminent threat or an eminent danger? Subramanian Senthilkumaran, Ramachandran Meenakshisundaram, Namasivayam Balamurgan, Krishnanswamy SathyaPrabhu, V Karthikeyan, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.018
The American Journal of Emergency Medicine , Vol. 30 , Issue 3 ,
Published online: March 16 2011
x Acute phosphate toxicity following rectal administration of phosphate-containing preparations was documented earlier. However, acute phosphate toxicity due to inhalation of monoammonium phosphate (MAP) is rarely reported. The present report describes the systemic toxicity following intentional inhalation of MAP, a dry chemical powder present in fire extinguishers, in a 25-year-old healthy man with normal renal function resulting in hyperphosphatemia (11.0 mg/dL), hypocalcemia (ionized calcium, 1.18 mg/dL; total calcium, 3.6 mg/dL), hypomagnesemia (1.2 mg/dL), seizures, and 4 episodes of pulseless polymorphic ventricular tachycardia requiring defibrillation.
Anaphylaxis after intramuscular injection of diclofenac sodium Sahin Colak, Harun Gunes, Mustafa Ahmet Afacan, Hayati Kandis, Mehmet Ozgur Erdogan, Mehmet Ayranci, Ayhan Saritas
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.049
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: January 6 2014
x Diclofenac sodium is a 2-arylacetic acid, nonsteroidal anti-inflammatory drug. It is widely used in pain management. Side effects such as urticaria, asthmatic attack, vasospastic angina, ischemic stroke, and Kounis syndrome may be seen after the use of diclofenac sodium. However, anaphylactic shock is rare. Anaphylactic shock secondary to injection of diclofenac sodium can be treated successfully with intramuscular injection of adrenaline. Because diclofenac sodium is commonly used in analgesic treatment in emergency departments, we present this case report to emphasize that anaphylactic shock may be seen after the use of that drug.
Admission serum lactate predicts mortality in aneurysmal subarachnoid hemorrhage Imo P. Aisiku, Peng Roc Chen, Hanh Truong, Daniel R. Monsivais, Jonathan Edlow
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.079
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: December 30 2015
x Aneurysmal subarachnoid hemorrhage (SAH) is the most devastating form of hemorrhagic stroke. Primary predictors of mortality are based on initial clinical presentation. Initial serum lactic acid levels have been shown to predict mortality and disease severity. Initial serum lactate may be an objective predictor or mortality.
Rates of ED visits and of intubations for congestive heart failure declined from 1996 to 2008 John R. Allegra, Barnet Eskin, Sarah Campeas, Bonnie McGuire Wreschner
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.003
The American Journal of Emergency Medicine , Vol. 31 , Issue 12 ,
Published online: October 16 2013
x Many advances have been made recently in the treatment of congestive heart failure (CHF). We hypothesize that this should have resulted in fewer CHF patients presenting to the emergency department (ED) and fewer being intubated.
Lung ultrasound associated to capnography to verify correct endotracheal tube positioning in prehospital Pierre-Marie Brun, Jacques Bessereau, Nicolas Cazes, Emgan Querellou, Hichem Chenaitia
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.023
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: December 28 2011
x Endotracheal intubation is the “gold standard” of the control of airway patency but is associated with nonnegligible morbidity rates. A rapid detection of esophageal intubation is essential. Capnography is considered the reference technique for correct endotracheal tube (ETT) positioning confirmation. However, capnography can provide false-positive and false-negative results in some situations. Recently, the ultrasound assessment has been studied for confirming ETT placement. Despite of few trials, the ultrasound procedure may enhance physician confidence and decision making in airway management.
Sonographic evaluation of a paralyzed hemidiaphragm from ultrasound-guided interscalene brachial plexus nerve block Daniel Mantuani, Arun Nagdev
DOI: http://dx.doi.org/10.1016/j.ajem.2012.02.004
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: March 30 2012
x The ultrasound-guided interscalene brachial plexus is becoming increasingly popular for anesthesia in the management of upper-extremity injuries by emergency physicians. Traditional high-volume injections of local anesthesia will also affect the phrenic nerve, leading to temporary paralysis of the ipsilateral hemidiaphragm. With direct ultrasound guidance, more precise needle placement allows for lower-volume injections that reduce inadvertent spread of local anesthetic to the phrenic nerve without decreasing the efficacy of onset of time and quality of the block.
The role of inferior vena cava diameter in volume status monitoring; the best sonographic measurement method? Nalan Gökçe Çelebi Yamanoğlu, Adnan Yamanoğlu, İsmet Parlak, Pelin Pınar, Ali Tosun, Burak Erkuran, Gizem Aydınok, Fatih Torlak
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.014
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: December 18 2014
x This study aims to determine the site of and the best sonographic method for measurement of inferior vena cava (IVC) diameter in volume status monitoring.
A healthy young woman with headache and focal seizures David Barbic
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.040
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: February 5 2014
x A previously healthy 21-year-old woman presented to the emergency department with a history of headache and 3 recent focal seizures. She was otherwise healthy and denied recent head trauma or infective symptoms. She denied pet ownership or foreign travel in the last 5 years. She was HIV negative during a recent prenatal screen. Her head and neck, cardiovascular, respiratory, and neurologic physical examinations were normal. Subsequent computed tomographic scan of the brain with intravenous contrast revealed a lesion consistent with Toxoplasma gondii brain abscess.
Atrial fibrillation related to carbon monoxide poisoning in a female patient Hızır Ufuk Akdemir, Bülent Güngörer, Fatih Çalışkan, Şahin Çolak, Murat Güzel
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.050
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: March 11 2014
x The clinical findings related to carbon monoxide (CO) poisoning, which is one of the most mortal types of poisoning in the world, are associated with different tissues that are more sensitive to hypoxia such as the central nervous system and cardiovascular system. Carbon monoxide causes myocardial damage and arrhythmias by impairing the transport of oxygen. However, there have been few reported cases of CO poisoning–induced atrial fibrillation in the literature. In this article, a case of CO poisoning–induced atrial fibrillation and myocardial damage is presented.
A rational approach to the treatment of alcohol withdrawal in the ED Christine R. Stehman, Mark B. Mycyk
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.029
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 11 2013
x Approximately 7% of the US population abuses or is dependent on alcohol. Patients with alcohol disorders often seek medical attention in Emergency Departments (EDs) for complications directly related to alcohol use or due to other medical issues associated with alcohol use. Because of increasing lengths of stay in EDs, alcohol-dependent patients are at high risk of developing alcohol withdrawal syndrome (AWS) during their ED visit. This article reviews the physiology of alcohol withdrawal as well as the symptoms of this potentially deadly illness for the practicing emergency physician (EP).
Superior vena cava syndrome masquerading as an allergic reaction Jamie S. Johnson, Joseph G. Kotora, Brett F. Bechtel
DOI: http://dx.doi.org/10.1016/j.ajem.2012.02.006
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: March 30 2012
x Patients are often referred to the emergency department for further evaluation, yet the astute physician will maintain a broad differential to avoid anchoring on prior diagnoses. In this case, a 56-year-old man was referred to our emergency department from the radiology suite secondary to concerns for an “allergic reaction” to prior magnetic resonance imaging contrast. Upon presentation, he was noted to have facial swelling with ruddy appearance and vascular congestion extending to the midchest region; no airway compromise or dyspnea was noted.
The difference in myocardial injuries and mitochondrial damages between asphyxial and ventricular fibrillation cardiac arrests Min-Shan Tsai, Chien-Hua Huang, Shang-Ho Tsai, Chia-Ying Tsai, Huei-Wen Chen, Hsaio-Ju Cheng, Chiung-Yuan Hsu, Tzung-Dau Wang, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.001
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: March 2 2012
x Ventricular fibrillation (VF) and asphyxia account for most cardiac arrests but differ in cardiac arrest course, neurologic deficit, and myocardial damage. In VF resuscitation, cardiac mitochondria were known to be damaged via excess generation of reactive oxygen species. This study evaluated the difference of cardiac mitochondrial damages between VF and asphyxial cardiac arrests.
The influence of hemorrhagic shock on ventilation through needle cricothyroidotomy in pigs Ivan Murad, Simone C.V. Abib, Daniela P.A. Lima, Paulo S.V.S. Ferreira, Eduardo Q. dos Santos, Thomas V. Bataglia
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.017
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: March 30 2012
x The aim of this study was to examine the effects of controlled hemorrhage and shock on oxygenation and ventilation using needle cricothyroidotomy and jet ventilation in an animal model.
The role of routine chest radiography in initial evaluation of stable blunt trauma patients Shahram Paydar, Hamed Ghoddusi Johari, Fariborz Ghaffarpasand, Danial Shahidian, Afsaneh Dehbozorgi, Bijan Ziaeian, Shahram Bolandparvaz, Hamid Reza Abbasi, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2010.08.010
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: November 9 2010
x Radiology plays an important role in evaluation of a trauma patient. Although chest radiography is recommended for initial evaluation of the trauma patient by the Advanced Trauma Life Support course, we hypothesized that precise physical examinations and history taking accurately identify those blunt trauma patients at low risk for chest injury, making routine radiographs unnecessary. Thus, this study was performed to investigate the role of chest radiography in initial evaluation of those trauma patients with normal physical examination.
Successful treatment of thyroid crisis accompanied by hypoglycemia, lactic acidosis, and multiple organ failure Yongmei Deng, Weiwei Zheng, Jihong Zhu
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.003
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: March 2 2012
x We describe a case of thyroid crisis with hypoglycemia, lactic acidosis, multiple organ failure, and disseminated intravascular coagulation—rare but severe complications of thyroid crisis. The patient was a 59-year-old Chinese woman who presented with evidence of heart failure and atrial fibrillation. Analysis of a blood sample yielded astonishing results: her blood glucose was 1.7 mmol/L, and lactate greater than 15 mmol/L with the arterial pH as 6.94. Liver enzymes (alanine aminotransferase, 1846 U/L; aspartate aminotransferase, 6242 U/L) and bilirubin elevated rapidly and dramatically.
Questioning the ultrasound diagnosis of pneumothorax Rea Gaetano, Maria D’Amato, Giorgia Ghittoni
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.025
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: August 22 2014
x We 3 MDs (a radiologist, a pneumologist, and an intervention ultrasound internist working also in the emergency department) practice in well-known, very active, and historical European cardiothoracic institutions. In our original letter [1], we very respectfully suggest a different interpretation of the published computed tomography (CT) images and of the ultrasound videoclip by Aspler et al [2]. The elegant answer of Aspler et al [3] to our letter [1] is constructive and contributory to the debate and the readers' understanding.
Pitfalls in using serum C-reactive protein to predict bacteremia in febrile adults in the ED Ching-Chi Lee, Ming-Yuan Hong, Nan-Yao Lee, Po-Lin Chen, Chia-Ming Chang, Wen-Chien Ko
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.012
The American Journal of Emergency Medicine , Vol. 30 , Issue 4 ,
Published online: April 25 2011
x The diagnostic performance of serum C-reactive protein (CRP) in prediction of bacteremia among febrile patients visiting an emergency department (ED) was analyzed.
Factors associated with shock in anaphylaxis Hyun Jun Park, Sun Hyu Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.015
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: March 19 2012
x The aim of this study was to investigate the clinical characteristics of anaphylactic shock and the factors associated with anaphylactic shock in anaphylaxis.
