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.
