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.
