How reliable are electrolyte and metabolite results measured by a blood gas analyzer in the ED? Emin Uysal, Yahya Ayhan Acar, Ahmet Kutur, Erdem Cevik, Necati Salman, Onur Tezel
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.025
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: November 16 2015
x Blood gas analysis is a frequently ordered test in emergency departments for many indications. It is a rapid technique that can analyze electrolyte and metabolites in addition to pH and blood gases. The aim of this study was to investigate the correlation of electrolyte and metabolite results measured by blood gas and core laboratory analyzers.
Is heart rate variability better than routine vital signs for prehospital identification of major hemorrhage? Shwetha Edla, Andrew T. Reisner, Jianbo Liu, Victor A. Convertino, Robert Carter III, Jaques Reifman
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.046
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: December 2 2014
Open Access x During initial assessment of trauma patients, metrics of heart rate variability (HRV) have been associated with high-risk clinical conditions. Yet, despite numerous studies, the potential of HRV to improve clinical outcomes remains unclear. Our objective was to evaluate whether HRV metrics provide additional diagnostic information, beyond routine vital signs, for making a specific clinical assessment: identification of hemorrhaging patients who receive packed red blood cell (PRBC) transfusion.
Comparison of oral oxycodone and naproxen in soft tissue injury pain control: a double-blind randomized clinical trial Marzieh Fathi, Mohammad Amin Zare, Hamid Reza Bahmani, Shahriar Zehtabchi
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.021
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: May 29 2015
x This randomized clinical trial compares the efficacy and safety of oral oxycodone (an oral opioid) with naproxen (a nonsteroidal anti-inflammatory drug) in acute pain control in patients with soft tissue injury. It also evaluates the need for additional doses of analgesics in the first 24 hours of discharge from emergency department (ED).
Tension pneumoperitoneum during routine colonoscopy Jennifer L. Carey, Anthony M. Napoli
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.010
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: December 27 2010
x Colonoscopy is generally a safe and effective means to detect, diagnose, and treat colonic abnormalities. Although the overall complication rate is low, the morbidity and mortality following perforation approach 50%. Here we present a case of a 49-year-old woman undergoing routine colonoscopy when she suffered bowel perforation and tension pneumoperitoneum. This is a seldom occurrence and may result following bowel perforation with the rapid accumulation of free air into the peritoneal cavity. It is a life-threatening complication and a surgical emergency.
Epinephrine use and outcomes in anaphylaxis patients transported by emergency medical services Veena Manivannan, Robert J. Hyde, Daniel G. Hankins, M. Fernanda Bellolio, Martin G. Fedko, Wyatt W. Decker, Ronna L. Campbell
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.014
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: May 19 2014
x Anaphylaxis is a potentially life-threatening allergic reaction that may require emergency medical system (EMS) transport. Fatal anaphylaxis is associated with delayed epinephrine administration. Patient outcome data to assess appropriateness of EMS epinephrine administration are sparse.
Effective analgesia with low-dose ketamine and reduced dose hydromorphone in ED patients with severe pain Terence L. Ahern, Andrew A. Herring, Michael B. Stone, Bradley W. Frazee
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.008
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: April 22 2013
x We assessed the analgesic effect and feasibility of low-dose ketamine combined with a reduced dose of hydromorphone for emergency department (ED) patients with severe pain.
Clinical outcomes of ED patients with bandemia Eileen Shi, Gary M. Vilke, Christopher J. Coyne, Leslie C. Oyama, Edward M. Castillo
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.035
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: March 19 2015
x Although an elevated white blood cell count is a widely utilized measure for evidence of infection and an important criterion for evaluation of systemic inflammatory response syndrome, its component band count occupies a more contested position within clinical emergency medicine. Recent studies indicate that bandemia is highly predictive of a serious infection, suggesting that clinicians who do not appreciate the value of band counts may delay diagnosis or overlook severe infections.
Recombinant tissue plasminogen activator for both pulmonary and cerebral embolism Jean Michel Yeguiayan, Isabelle Benatru, Boris Guiu, Jamal Abou Taam, Serge Albertini, Marc Freysz, Maurice Giroud
DOI: http://dx.doi.org/10.1016/j.ajem.2010.08.020
The American Journal of Emergency Medicine , Vol. 29 , Issue 8 ,
Published online: October 28 2010
x We report a case of massive pulmonary embolism (PE) associated with ischemic stroke due to paradoxical embolism. The patient presented with coma, severe hypoxemia, and hemodynamic instability due to the severity of the PE. Initial neurologic evaluation, in particular, scoring the National Institutes of Health Stroke Scale, was impossible because of coma. Imaging showed a PE and an occlusion of the left middle cerebral artery. Transesophageal echocardiography showed a patent foramen ovale and a right-to-left shunt suggesting stroke with paradoxical embolism.
Serial monitoring of sedation scores in benzodiazepine overdose Yeon Young Kyong, Jeng Tak Park, Kyoung Ho Choi
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.004
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: April 14 2014
x Benzodiazepines are widely used for many diseases, and benzodiazepine overdose is globally increasing in proportion to its prescriptions. Although most benzodiazepine overdoses are known to be safe and nonfatal without coingestions, morbidity or mortality after benzodiazepine overdose is closely related with the duration of unconsciousness or depth of compromised airway. Proper use of flumazenil, a potent antidote of benzodiazepine, seems to accelerate the recovery from the toxicity after benzodiazepine overdose.
Red cell distribution width as a predictor of mortality in organophosphate insecticide poisoning Changwoo Kang, In Sung Park, Dong Hoon Kim, Seong Chun Kim, Jin Hee Jeong, Soo Hoon Lee, Sang Bong Lee, Sang Min Jung, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.048
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: March 7 2014
x Suicide by organophosphate insecticide (OPI) poisoning is a major clinical concern (predominantly in developing countries), and 200
Cysticercotic encephalitis: a life threatening form of neurocysicercosis Rajendra Singh Jain, Rahul Handa, Arvind Vyas, Swayam Prakash, Kadam Nagpal, Indu Bhana, Mahendra S. Sisodiya, Pankaj Kumar Gupta
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.048
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: April 28 2014
x Neurocysticercosis is the most frequent neuroparasitosis and is caused by Taenia solium larvae (cysticerci). Its most common presenting feature is seizure, although it may present as headache, focal deficits, hydrocephalous, or as features of raised intracranial pressure. We herein report a case of 40-year-old male who presented with features of acute encephalitis and raised intracranial pressure with magnetic resonance imaging suggestive of multiple neurocysticerci with diffuse cerebral edema. A diagnosis of cysticercotic encephalitis was made, which is a syndrome of encephalitis with clinical and radiologic evidences of diffuse cerebral edema caused by parenchymal cysticercosis.
Psychiatric drug–induced fatal abdominal compartment syndrome Sophie Jambet, Boris Guiu, Pierre Olive-Abergel, Aurélie Grandvuillemin, Jean-Michel Yeguiayan, Pablo Ortega-Deballon
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.005
The American Journal of Emergency Medicine , Vol. 30 , Issue 3 ,
Published online: February 28 2011
x Several drugs used in psychiatry may induce constipation, paralytic ileus, or acute megacolon (Ogilvie's syndrome). We report here 2 cases of patients presenting with fatal abdominal compartment syndrome related to the absorption of antidepressants and benzodiazepines. Two patients (a 27-year-old man and a 57-year-old woman) with a previous psychiatric history and treatment with psychiatric drugs were admitted to the emergency department for coma. Both presented hypothermia; a hard, distended abdomen; and ischemia of the lower limbs.
Fluid balance in sepsis and septic shock as a determining factor of mortality Josep-Maria Sirvent, Cristina Ferri, Anna Baró, Cristina Murcia, Carolina Lorencio
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.016
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: November 19 2014
x The objective was to assess whether fluid balance had a determinant impact on mortality rate in a cohort of critically ill patients with severe sepsis or septic shock.
Is inadequate human immunodeficiency virus care associated with increased ED and hospital utilization? A prospective study in human immunodeficiency virus–positive ED patients T. Rinda Soong, Julianna J. Jung, Gabor D. Kelen, Richard E. Rothman, Avanthi Burah, Judy B. Shahan, Yu-Hsiang Hsieh
DOI: http://dx.doi.org/10.1016/j.ajem.2011.11.020
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: January 13 2012
x There is a lack of data on the effect(s) of suboptimal human immunodeficiency virus (HIV) care on subsequent health care utilization among emergency department (ED) patients with HIV. Findings on their ED and inpatient care utilization patterns will provide information on service provision for those who have suboptimal access to HIV-related care.
Diagnostic performance of the BinaxNow Influenza A&B rapid antigen test in ED patients Wesley H. Self, Candace D. McNaughton, Carlos G. Grijalva, Yuwei Zhu, James D. Chappell, John V. Williams, H. Keipp Talbot, David K. Shay, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2012.04.018
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: July 16 2012
x The objective of this study is to evaluate the diagnostic performance of the BinaxNow Influenza A&B rapid antigen test (RAT) in emergency department (ED) patients.
Evidence-based diagnosis and thrombolytic treatment of cardiac arrest or periarrest due to suspected pulmonary embolism Jill K. Logan, Hardin Pantle, Paul Huiras, Edward Bessman, Leah Bright
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.032
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: April 24 2014
x When a previously healthy adult experiences atraumatic cardiac arrest, providers must quickly identify the etiology and implement potentially lifesaving interventions such as advanced cardiac life support. A subset of these patients develop cardiac arrest or periarrest due to pulmonary embolism (PE). For these patients, an early, presumptive diagnosis of PE is critical in this patient population because administration of thrombolytic therapy may significantly improve outcomes. This article reviews thrombolysis as a potential treatment option for patients in cardiac arrest or periarrest due to presumed PE, identifies features associated with a high incidence of PE, evaluates thrombolytic agents, and systemically reviews trials evaluating thrombolytics in cardiac arrest or periarrest.
Intra-abdominal hypertension: a potent silent killer of cardiac arrest survivors Athanasios Chalkias, Theodoros Xanthos
DOI: http://dx.doi.org/10.1016/j.ajem.2011.11.001
The American Journal of Emergency Medicine , Vol. 30 , Issue 3 ,
Published online: December 29 2011
x Cardiac arrest is a daunting emergency and a leading cause of death worldwide. Despite the progress in cardiopulmonary resuscitation (CPR) as well as in the diagnosis and treatment of postcardiac arrest syndrome, survival rates remain disappointing low. Restoration of spontaneous circulation is just the first step toward complete recovery, and many patients will require multiple organ support during the postresuscitation period. Characteristically, of those patients admitted to intensive care units, only 25% to 56% will survive to hospital discharge [1].
Depressed sympathovagal balance predicts mortality in patients with subarachnoid hemorrhage Te-Fa Chiu, Chien-Cheng Huang, Jiann-Hwa Chen, Wei-Lung Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.037
The American Journal of Emergency Medicine , Vol. 30 , Issue 5 ,
Published online: May 13 2011
x The objective of this study is to investigate the role of sympathovagal balance in predicting inhospital mortality by assessing power spectral analysis of heart rate variability (HRV) among patients with nontraumatic subarachnoid hemorrhage (SAH) in an emergency department (ED).
Acute carbamazepine poisoning treated with resin hemoperfusion successfully Tie Gang Li, Yong Yan, Na Na Wang, Min Zhao
DOI: http://dx.doi.org/10.1016/j.ajem.2009.12.006
The American Journal of Emergency Medicine , Vol. 29 , Issue 5 ,
Published online: April 5 2010
x Carbamazepine (CBZ) poisoning has been occurring more frequently. We describe the use of synthesized resin–absorbed hemoperfusion in the therapy of a 48-year-old man who developed carotic, cardiovascular shock and multiorgan dysfunction due to a CBZ overdose (the highest concentration of drug >20 mg/L; therapeutic range, 8-12 mg/L). The treatment was very successful; and the patient eventually was discharged with a full recovery and no complications, although his diagnosis and treatment had been delayed for 56 hours.
Free phenytoin toxicity Syed Haider Imam, Kristen Landry, Viren Kaul, Harvir Gambhir, Dinesh John, Brian Kloss
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.036
The American Journal of Emergency Medicine , Vol. 32 , Issue 10 ,
Published online: April 2 2014
x Phenytoin has a narrow therapeutic window, and when managing cases of toxicity, clinicians are very wary of this fact. Typically, if patient presents with symptoms suggestive of phenytoin toxicity, total serum phenytoin is promptly ordered. That could be falsely low especially in elderly or critically ill patients, which may lead to a low albumin level resulting in this discrepancy. The free phenytoin can be best estimated using the Sheiner-Tozer equation. Herein, we describe a case of an elderly male patient who presented with drowsiness, gait changes, and elevated liver enzymes and a normal total serum phenytoin level of 18 ng/dL (normal, 10-20 ng/dL).
