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.
