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.
