Validating a pragmatic definition of shock in adult patients presenting to the ED Yan-ling Li, Cangel Pui-yee Chan, King-keung Sin, Stewart S.W. Chan, Pei-yi Lin, Xiao-hui Chen, Brendan E. Smith, Gavin M. Joynt, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.029
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: August 22 2014
x The importance of the early recognition of shock in patients presenting to emergency departments is well recognized, but at present, there is no agreed practical definition for undifferentiated shock. The main aim of this study was to validate an a priori clinical definition of shock against 28-day mortality.
The effects of 3 different compression methods on intrathoracic pressure in a swine model of ventricular fibrillation Wei Yuan, Shuo Wang, Chun-Sheng Li
DOI: http://dx.doi.org/10.1016/j.ajem.2012.06.010
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: September 3 2012
x The aim of this study was to provide a realistic comparison of 3 different extracorporeal compression methods during cardiopulmonary resuscitation on intrathoracic pressure (ITP), hemodynamics, and oxygen metabolism in a swine model of ventricular fibrillation (VF).
Use and efficacy of nebulized naloxone in patients with suspected opioid intoxication Brigitte M. Baumann, Rachel A. Patterson, Dominic A. Parone, Molly K. Jones, Lindsey J. Glaspey, Nicole M. Thompson, Mary P. Stauss, Rachel Haroz
DOI: http://dx.doi.org/10.1016/j.ajem.2012.10.004
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: January 23 2013
x To describe the use and efficacy of nebulized naloxone in patients with suspected opioid intoxication.
Prospective, 10-year evaluation of the impact of Hispanic ethnicity on pain management practices in the ED Philip Craven, Orhan Cinar, David Fosnocht, Jessica Carey, Adrienne Carey, LeGrand Rogers, Kajsa Vlasic, Troy Madsen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.026
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: July 1 2014
x Hispanic ethnicity has been reported as an independent risk factor for oligoanalgesia in the emergency department (ED).
Acute urinary retention as the initial manifestation of Guillain-Barré syndrome Shih-Hao Wu, Jiun-Jen Lynn, Yi-Ling Chan, Te-Fa Chiu, Jih-Chang Chen, Yu-Che Chang
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.013
The American Journal of Emergency Medicine , Vol. 29 , Issue 6 ,
Published online: August 5 2010
x Guillain-Barré syndrome is a leading cause of acute weakness in young and middle-aged people [1,2], but it can affect patients of all ages. The main features of Guillain-Barré syndrome are ascending limb weakness which is relatively symmetric and progresses rapidly, with or without involvement of respiratory or cranial nerve-innervated muscles. In typical cases, possible initial symptoms include pain, numbness, paraesthesia, or weakness of the limbs [3,4]. Guillain-Barré syndrome also has a significant mortality in the first month [5,6]; however, this condition is often initially misdiagnosed [7], because the initial symptoms are often nonspecific, and many clinical variants may present [8].
Ranolazine overdose–induced seizures Nour Akil, Edward Bottei, Sameer Kamath
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.062
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: April 30 2015
x Ranolazine is a new anti-anginal medication that was approved by the US Food and Drug Administration (FDA) in 2006 for patients with symptomatic chronic angina despite optimized therapy. This paper presents a case report of a fifteen year old male patient admitted to the pediatric intensive care unit after ranolazine overdose ingestion. He had recurrent new onset seizures that are most likely due to ranolazine overdose. Seizures have never been reported with ranolazine use or abuse.
An analysis of ED utilization by adults with intellectual disability Arvind Venkat, Rene B. Pastin, Gajanan G. Hegde, John M. Shea, Jeffrey T. Cook, Carl Culig
DOI: http://dx.doi.org/10.1016/j.ajem.2009.11.009
The American Journal of Emergency Medicine , Vol. 29 , Issue 4 ,
Published online: April 26 2010
x We sought to identify factors increasing the odds of ED utilization among intellectually disabled (ID) adults and differentiate their discharge diagnoses from the general adult ED population.
Emergency Medical Services and 9-1-1 pandemic influenza preparedness: a national assessment Anthony L. Oliver, Gerald S. Poplin, Christopher A. Kahn
DOI: http://dx.doi.org/10.1016/j.ajem.2011.11.014
The American Journal of Emergency Medicine , Vol. 30 , Issue 3 ,
Published online: February 10 2012
x The likelihood of an influenza pandemic places public agencies under pressure to ensure readiness for local outbreaks. Emergency Medical Services (EMS) is a critical infrastructure that needs to be part of preparedness and response planning for a severe pandemic. Legal and regulatory frameworks should recognize prehospital capabilities as lawmakers attempt to facilitate capacity-building collaboration, which is critical to disaster response. The prehospital system's lack of surge capacity has been detailed [1-5], and agencies seek direction regarding preparedness planning from state agencies [6,7].
A new facial expression to botox! Aakash Aggarwal, Viren Kaul, Gurmeen Kaur, Emerald Banas, Praveen Sampath, Ajoy K. Roy
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.017
The American Journal of Emergency Medicine , Vol. 32 , Issue 3 ,
Published online: November 11 2013
x Botulinum toxin (Botox) injection into the lower esophageal sphincter (LES) has been used for the treatment of achlasia cardia since the 1990s. Currently it is indicated for patients who are not candidates for definitive therapy like Heller's myotomy or pneumatic dilation and in those who have recurrence of symptoms after definitive treatments. We present a case of severe anaphylaxix due to Botox.
Cerebral oximetry with blood volume index in asystolic pediatric cerebrospinal fluid malfunctioning shunt patients Thomas J. Abramo, Mark Meredith, Mathew Jaeger, Bradford Schneider, Holli Bagwell, Eleym Ocal, Gregory Albert
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.007
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: April 17 2014
x Pediatric cerebrospinal fluid shunt malfunctions can present with varying complaints. The primary cause is elevated intracranial pressure (ICP). Malfunctioning sites are the proximal or distal sites [1-4]. A rare presenting complaint is cardiac arrest. Immediate ICP reduction is the only reversible option for this type of cardiac arrest.
Trivial trauma, lethal outcome: streptococcal toxic shock syndrome presenting to the ED Jiun-Nong Lin, Lin-Li Chang, Chung-Hsu Lai, Hsi-Hsun Lin, Yen-Hsu Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.011
The American Journal of Emergency Medicine , Vol. 31 , Issue 8 ,
Published online: May 22 2013
x Group A Streptococcus , also known as Streptococcus pyogenes , is a common gram-positive bacterium that causes a broad spectrum of human infections ranging from uncomplicated pharyngitis and impetigo to life-threatening necrotizing fasciitis, bacteremia, and streptococcal toxic shock syndrome. Although it is rarely encountered in emergency departments, streptococcal toxic shock syndrome usually leads to a catastrophic outcome. Here we present 2 young patients who experienced trivial traumas before admission, which, nevertheless, finally resulted in lethal streptococcal toxic shock syndrome.
Injury and illness sustained by human competitors in the 2010 Iditarod Sled Dog Race James W. Gallea, George L. Higgins III, Carl A. Germann, Tania D. Strout
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.018
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: February 26 2014
x Alaska's 1049-mile Iditarod Trail Sled Dog Race is the world's longest sled dog race and the flagship event in the sport of sled dog racing. Race conditions are typically harsh. Physicians are not officially enlisted to care for human competitors. Instead, medical needs are met through an informal system of volunteers, local health care providers, and a fleet of bush planes. The goals of this study were to identify the types of human injury and illness experienced and the methods by which these conditions are treated.
Severe hydrogen sulfide intoxication treated with therapeutic hypothermia Shih-Hao Wu, Kuan-Fu Chen, Yi-Ling Chan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.027
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: February 20 2015
x Hydrogen sulfide inhibits mitochondrial cytochrome c oxidase, thereby causing tissue bioenergetic failure and respiratory paralysis. Brain injury that resembles hypoxic ischemic encephalopathy may thus ensue. Therapeutic hypothermia seems capable of reducing the severity of hypoxic ischemic encephalopathy in ventricular arrhythmia–induced cardiac arrest patients. We report a case of hydrogen sulfide poisoning who developed central nervous system manifestations but was successfully treated with therapeutic hypothermia.
An unusual presentation of meningococcal meningitis—timely recognition can save lives! Amil Rafiq
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.012
The American Journal of Emergency Medicine , Vol. 31 , Issue 6 ,
Published online: April 19 2013
x Meningococcal meningitis has been known to have a high fatality rate. A high degree of suspicion is required for early recognition and timely intervention. In this report, a case of a young male is presented who came to the emergency department with predominately lower gastrointestinal symptoms but was diagnosed with meningococcal meningitis and managed accordingly.
How well do General EMS 911 dispatch protocols predict ED resource utilization for pediatric patients? Stephanie J. Fessler, Harold K. Simon, Arthur H. Yancey II, Michael Colman, Daniel A. Hirsh
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.018
The American Journal of Emergency Medicine , Vol. 32 , Issue 3 ,
Published online: December 26 2013
x The use of Emergency Medical Services (EMS) for low-acuity pediatric problems is well documented. Attempts have been made to curb potentially unnecessary transports, including using EMS dispatch protocols, shown to predict acuity and needs of adults. However, there are limited data about this in children. The primary objective of this study is to determine the pediatric emergency department (PED) resource utilization (surrogate of acuity level) for pediatric patients categorized as “low-acuity” by initial EMS protocols.
A comparison of bilevel and continuous positive airway pressure noninvasive ventilation in acute cardiogenic pulmonary edema Hui Li, Chunlin Hu, Jinming Xia, Xin Li, Hongyan Wei, Xiaoyun Zeng, Xiaoli Jing
DOI: http://dx.doi.org/10.1016/j.ajem.2013.05.043
The American Journal of Emergency Medicine , Vol. 31 , Issue 9 ,
Published online: August 8 2013
x Whether bilevel positive airway pressure (BiPAP) is advantageous compared with continuous positive airway pressure (CPAP) in acute cardiogenic pulmonary edema (ACPO) remains uncertain. The aim of the meta-analysis was to assess potential beneficial and adverse effects of CPAP compared with BiPAP in patients with ACPO.
Morphine consumption is not modified in patients with severe pain and classified by the DN4 score as neuropathic Virginie Lvovschi, Amandine Arhan, Gaëlle Juillien, Viviane Montout, Mouhssine Bendahou, Hélène Goulet, Khaled Saïdi, Bruno Riou
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.037
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: July 16 2012
x Neuropathic pain has been poorly investigated in the emergency department, although it is known to be less sensitive to opioids than other forms of pain. We tested the hypothesis that morphine requirements are increased in patients having severe pain classified as neuropathic using the DN4 score. We included adult patients with acute severe pain (visual analog scale ≥
Hemodynamic rescue and ECG stability during chest compressions using adenosine and lidocaine after 8-minute asphyxial hypoxia in the rat Yulia Djabir, Geoffrey P. Dobson
DOI: http://dx.doi.org/10.1016/j.ajem.2013.05.044
The American Journal of Emergency Medicine , Vol. 31 , Issue 11 ,
Published online: September 23 2013
x Sudden cardiac death generally arises from either ventricular fibrillation or asphyxial hypoxia. In an effort to translate the cardioprotective effects of adenosine and lidocaine (AL) from hemorrhagic shock to cardiopulmonary resuscitation, we examined the effect of AL on hemodynamics and electrocardiogram (ECG) stability in the rat model of asphyxial hypoxia.
Patent foramen ovale appearance with association of left ventricular assist device and mechanical ventilation Philippe Marty, Simon Méjean, Nicolas Boudou, Nicolas Mayeur, Vincent Minville, Michel Galinier
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.034
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: December 15 2010
x We report on a 62-year-old man referred to the cardiac intensive care unit less than 24 hours after anterior ST-segment elevated myocardial infarction. The patient developed cardiogenic shock requiring elective intubation, vasopressor, and inotropic support. Emergency coronary angiography, revascularization, and insertion of an intraaortic balloon pump were performed. Nevertheless, the hemodynamic situation remained unstable, and a left ventricular assist device (LVAD) was inserted. Severe hypoxemia occurred several minutes after initiating the Impella Recover LD/LP 5.0 (Abiomed, Danvers, MA).
Successful management of drug-induced hypercapnic acidosis with naloxone and noninvasive positive pressure ventilation Michalis Agrafiotis, Stavros Tryfon, Demetra Siopi, Georgia Chassapidou, Artemis Galanou, Venetia Tsara
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.006
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: August 7 2014
x A 74-year-old man was referred to our hospital due to deteriorating level of consciousness and desaturation. His Glasgow Coma Scale was 6, and his pupils were constricted but responded to light. Chest radiograph was negative for significant findings. Arterial blood gas evaluation on supplemental oxygen revealed severe acute on chronic respiratory acidosis: pH 7.15; Pco 2 , 133 mm Hg; Po 2 , 64 mm Hg; and Hco 3 , 31 mmol/L. He regained full consciousness (Glasgow Coma Scale, 15) after receiving a 0.4 mg dose of naloxone, but because of persistent severe respiratory acidosis (pH 7.21; Pco 2 , 105 mm Hg), he was immediately commenced on noninvasive positive pressure ventilation (NIV) displaying a remarkable improvement in arterial blood gas values within the next few hours.
