Withdrawal Seizures Seen In the Setting of Synthetic Cannabinoid Abuse Christopher S. Sampson, Starr-Mar’ee Bedy, Terry Carlisle
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.025
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: March 15 2015
x The recent rise in the abuse of synthetic cannabinoid receptor agonists (Spice, K2) has led to an increase of patients presenting to emergency departments (EDs) with complications stemming from their abuse. We present a case of withdrawal seizures seen in a chronic abuser of these herbal mixtures who stopped using them abruptly. Seizures have been reported in the literature in the setting of abuse, but not during withdrawal [1].
When a seizure is not a real seizure! Soheila Talebi, Farzaneh Ghobadi, Sameer Chaudhari, Ely Gracia, Ola Olatunde, Gerald Pekler, Ferdinand Visco, Getaw Worku Hassen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.077
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: August 7 2015
x We report here 2 cases of methadone induced Torsades de Pointes with a clinical presentation mimicking convulsive seizures in a substance abuser These cases highlight the importance of being aware of methadone-induced Torsades de Pointes and the occasional atypical clinical presentations of this condition.
Electroencephalography findings in patients presenting to the ED for evaluation of seizures Pooja Kadambi, Kimberly W. Hart, Opeolu M. Adeoye, Christopher J. Lindsell, William A. Knight IV
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.041
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: October 29 2014
x Status epilepticus is a life-threatening, time-sensitive emergency. Acquiring an electroencephalogram (EEG) in the emergency department (ED) could impact therapeutic and disposition decisions for patients with suspected status epilepticus.
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.
Emergent diagnostic testing for pediatric nonfebrile seizures Ashley M. Strobel, Vikramjit S. Gill, Michael D. Witting, Getachew Teshome
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.004
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: June 6 2015
x Guidelines from the American Academy of Neurology recommend laboratory studies or computed tomography (CT) for children who experience a nonfebrile seizure if anything in their history suggests a clinically significant abnormality.
A patient with altered mental status and possible seizure reveals an atypical aortic dissection upon workup Olufolahan J. Lawal, Harinder S. Dhindsa, Joshua W. Loyd
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.010
The American Journal of Emergency Medicine , Vol. 32 , Issue 5 ,
Published online: November 18 2013
x Aortic dissection occurs when a tear occurs in the inner muscle wall lining of the aorta, allowing blood to split the muscle layers of the aortic wall apart. It is classically characterized by pain that starts in the upper chest, which then radiates to the upper back and is tearing or ripping in quality. Our objective is to present a case followed by a brief literature review of aortic dissection and uncommon but important features that may be demonstrated. In this report, we present the case of a 57-year-old woman who was transported to the emergency department with an acute episode of altered mental status, presenting as a possible stroke with possible seizures.
Clinical assessment of children with first-attack seizures admitted to the ED Chun-Yu Chen, Wen-Chieh Yang, Kang-Hsi Wu, Han-Ping Wu
DOI: http://dx.doi.org/10.1016/j.ajem.2011.07.008
The American Journal of Emergency Medicine , Vol. 30 , Issue 7 ,
Published online: October 26 2011
x This study aims to evaluate clinical values and determine the function of a pediatric observation unit (POU) as an alternative to inpatient unit admission for children with newly onset seizures.
The Denver Seizure Score: anion gap metabolic acidosis predicts generalized seizure Katherine M. Bakes, Jeff Faragher, Vince J. Markovchick, Kevin Donahoe, Jason S. Haukoos
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.014
The American Journal of Emergency Medicine , Vol. 29 , Issue 9 ,
Published online: October 18 2010
x Anion gap (AG) and serum bicarbonate concentration (BICARB) may help confirm a diagnosis of seizure in an unwitnessed collapse; however, little data exist to support this practice. Our objective was to assess the association between AG metabolic acidosis and generalized seizure and to derive a simple score to predict seizure.
Ischemia-modified albumin in patients with seizure Sevket Balta, Mustafa Aparci, Mustafa Demir, Cengiz Ozturk, Turgay Celik
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.028
The American Journal of Emergency Medicine , Vol. 32 , Issue 10 ,
Published online: July 1 2014
x We read the article “Novel biochemical marker for differential diagnosis of seizure: Ischemia modified albumin� by Uzel et al [1]. They aimed to evaluate and investigate the diagnostic value of ischemia-modified albumin (IMA) in adult patients presented to emergency department with seizures. They demonstrated that blood IMA level and IMA/albumin ratio significantly increase in adult patients who experienced seizures. Ischemia-modified albumin may be considered as a useful biomarker in the differential diagnosis of seizure.
Electrocardiographic manifestations of tramadol toxicity with special reference to their ability for prediction of seizures Mohammadali Emamhadi, Hossein Sanaei-Zadeh, Masoumeh Nikniya, Nasim Zamani, Richard C. Dart
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.009
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: February 10 2012
x The aims of this study are to determine the electrocardiographic (ECG) manifestations of the symptomatic patients with isolated tramadol toxicity and to predict seizures based on ECG parameters.
Clinical predictors for delirium tremens in patients with alcohol withdrawal seizures Dong Wook Kim, Hyun Kyung Kim, Eun-Kee Bae, So-Hee Park, Kwang Ki Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.030
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: February 23 2015
x Delirium tremens (DT) is the severest form of alcohol withdrawal syndrome, frequently after alcohol withdrawal seizures. Delirium tremens occurs in a small proportion of patients with alcohol withdrawal seizures; nevertheless, early identification of high-risk patients is important for intensive preventive management of unexpected episodes due to agitation and its associated increased mortality. However, there are limited studies on clinical predictors of the development of DT in patients with alcohol withdrawal seizures.
Cerebral oximetry with cerebral blood volume index in detecting pediatric stroke in a pediatric ED Thomas J. Abramo, Z. Leah Harris, Mark Meredith, Kristen Crossman, Rawle Seupaul, Abby Williams, Sheila McMorrow, Jennifer Dindo, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.037
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: July 22 2015
x Despite pediatric stroke awareness and pediatric stroke activation systems, recognition and imaging delays along with activation inconsistency still occur. Reliable objective pediatric stroke detection tools are needed to improve detection and activations. Regional cerebral oxygen saturation (rc so 2 ) with cerebral blood volume index (CBVI) can detect abnormal cerebral physiology.
Subject Index
DOI: http://dx.doi.org/10.1016/S0735-6757(15)00997-3
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published in issue: December 2015
Prevalence of non-convulsive seizure and other electroencephalographic abnormalities in ED patients with altered mental status Shahriar Zehtabchi, Samah G. Abdel Baki, Ahmet Omurtag, Richard Sinert, Geetha Chari, Shweta Malhotra, Jeremy Weedon, André A. Fenton, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.002
The American Journal of Emergency Medicine , Vol. 31 , Issue 11 ,
Published online: September 25 2013
x Four to ten percent of patients evaluated in emergency departments (ED) present with altered mental status (AMS). The prevalence of non-convulsive seizure (NCS) and other electroencephalographic (EEG) abnormalities in this population is unknown.
Synthetic cannabinoid hyperemesis resulting in rhabdomyolysis and acute renal failure Jacqueline R. Argamany, Kelly R. Reveles, Bryson Duhon
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.051
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: September 7 2015
x Synthetic cannabinoid usage has increased in the past decade. Concurrently, emergency management of associated adverse effects due to synthetic cannabinoid usage has also risen. Reported toxicities include psychosis, seizures, cardiotoxicity, acute kidney injury, and death. While cannabis was first described as a cause of acute hyperemesis in 2004, a more recent case series also describes the association between cannabinoid hyperemesis and risk of acute renal failure. Synthetic cannabinoids have also been reported to cause acute hyperemesis and acute renal failure; however, the risk of rhabdomyolysis-induced renal failure has yet to be elucidated.
Small subdural hemorrhages: is routine intensive care unit admission necessary? Paul Albertine, Samuel Borofsky, Derek Brown, Smita Patel, Woojin Lee, Anthony Caputy, M. Reza Taheri
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.035
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 18 2015
x With advancing technology, the sensitivity of computed tomography (CT) for the detection of subdural hematoma (SDH) continues to improve. In some cases, the finding is limited to one or 2 images of the CT examination. At our institution, all patients with an SDH require intensive care unit (ICU) admission, regardless of size. In this report, we tested the hypothesis that patients with a small traumatic SDH on their presenting CT examination do not require the intensive monitoring offered in the ICU and can instead be managed on a hospital unit with a lower level of monitoring.
Comparison of quantitative EEG to current clinical decision rules for head CT use in acute mild traumatic brain injury in the ED Syed Imran Ayaz, Craig Thomas, Andrew Kulek, Rosa Tolomello, Valerie Mika, Duane Robinson, Patrick Medado, Claire Pearson, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.015
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: November 19 2014
x We compared the performance of a handheld quantitative electroencephalogram (QEEG) acquisition device to New Orleans Criteria (NOC), Canadian CT Head Rule (CCHR), and National Emergency X-Radiography Utilization Study II (NEXUS II) Rule in predicting intracranial lesions on head computed tomography (CT) in acute mild traumatic brain injury in the emergency department (ED).
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.
Clinical factors in predicting acute renal failure caused by rhabdomyolysis in the ED Chun-Yu Chen, Yan-Ren Lin, Lu-Lu Zhao, Wen-Chieh Yang, Yu-Jun Chang, Han-Ping Wu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.047
The American Journal of Emergency Medicine , Vol. 31 , Issue 7 ,
Published online: May 22 2013
x This study aimed to determine the clinical factors in predicting acute renal failure (ARF) in rhabdomyolysis and investigate the potential risk of renal replacement therapy (RRT).
Lack of efficacy of phenytoin in children presenting with febrile status epilepticus Salima Ismail, Arielle Lévy, Helena Tikkanen, Marcel Sévère, Franciscus Johannes Wolters, Lionel Carmant
DOI: http://dx.doi.org/10.1016/j.ajem.2011.11.007
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: March 2 2012
x Fever is the most common precipitant of status epilepticus in children. Animal models suggest that only γ -aminobutyric acidic drugs are effective in the treatment of febrile seizures, but there is limited clinical evidence to support this.
The worst amnesia of your life Muneer Hameer, Aashish Valvani, Hossein Kalantari, Getaw Worku Hassen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.069
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: April 6 2015
x Subarachnoid hemorrhage (SAH) is a medical emergency that can be life threatening or lead to severe disability even if recognized and managed early. Majority of spontaneous SAHs arise from a ruptured saccular aneurysm. However, up to 15% of SAHs do not have a bleeding source and are termed nonaneurysmal SAHs. Although sudden, severe headache is classically associated with aneurysmal SAHs, nonaneurysmal SAHs tend to have a more gradual onset headache and can even present with transient amnesia in about one-third of patients.
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).
Novel biochemical marker for differential diagnosis of seizure: ischemia-modified albumin Muzeyyen Uzel, Nese Colak Oray, Basak Bayram, Tuncay Kume, Mehmet Can Girgin, Ozgur Doylan, Ercument Saritabak, Sedat Yanturali
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.003
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: May 12 2014
x Differential diagnosis of seizure is critical in patients presented to emergency department (ED) with altered mental status or loss of consciousness. Although electroencephalogram is important for the diagnosis of seizures, its use in EDs is limited. The level of ischemia-modified albumin (IMA) increases in conditions of ischemic distress such as acute coronary syndrome, pulmonary embolism, and mesenteric ischemia. No studies exist in literature regarding the increase of IMA levels parallel to increased seizure activity in adults.
Hyperammonemia in idiopathic epileptic seizure Kensuke Nakamura, Kiyomi Yamane, Kazuaki Shinohara, Kent Doi, Ryota Inokuchi, Takahiro Hiruma, Susumu Nakajima, Eisei Noiri, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.003
The American Journal of Emergency Medicine , Vol. 31 , Issue 10 ,
Published online: September 4 2013
x It is known that patients with convulsion often present hyperammonemia. The elevation of ammonia levels in convulsion is considered to occur along with extensive muscle contractions, but the details remain unclear. In emergency pathologies, such as cardiopulmonary arrest or hemorrhagic shock without muscle contraction, red blood cells are known to produce ammonia through acidosis, leading to hyperammonemia. A similar effect would be considered to be involved in idiopathic epileptic seizure patients as well.
A patient with demyelination, laminar cortical necrosis, and rhabdomyolysis associated with hypernatremia Youichi Yanagawa, Takayuki Jo, Tomoyuki Yoshihara, Hiroshi Kato
DOI: http://dx.doi.org/10.1016/j.ajem.2012.04.036
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: July 16 2012
x A 60-year-old man with renal failure and intraabdominal abscess formation probably due to perforation of the colon underwent laparotomy on the sixth hospital day. He developed respiratory infection, deterioration of renal failure, and heart failure resulting in severe respiratory insufficiency after laparotomy. He was placed on mechanical ventilation using sedatives and muscle relaxant and was treated with antibiotics, steroids, and a diuretic. The value of serum sodium jumped from 146 to 164 mEq/L in 2 days.
Factors associated with pneumonia in post–cardiac arrest patients receiving therapeutic hypothermia Jae-Hyug Woo, Yong Su Lim, Hyuk Jun Yang, Won Bin Park, Jin Seong Cho, Jin Joo Kim, Sung Youl Hyun, Gun Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.035
The American Journal of Emergency Medicine , Vol. 32 , Issue 2 ,
Published online: November 22 2013
x The aim of this study is to investigate risk factors associated with the development of pneumonia during the first 7 days of admission in survivors of cardiac arrest receiving therapeutic hypothermia.
Evaluation of intramuscular fosphenytoin vs intravenous phenytoin loading in the ED Patrick Michael Aaronson, Bernadette S. Belgado, Joseph P. Spillane, Thomas A. Kunisaki
DOI: http://dx.doi.org/10.1016/j.ajem.2010.05.005
The American Journal of Emergency Medicine , Vol. 29 , Issue 9 ,
Published online: August 5 2010
x A comparison of length of stay in an emergency department (ED) after loading patients at risk for seizures with either intravenous (IV) phenytoin or intramuscular (IM) fosphenytoin was studied.
Mild head injury in pediatrics: algorithms for management in the ED and in young athletes Burkhard Simma, Jürg Lütschg, James M. Callahan
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.007
The American Journal of Emergency Medicine , Vol. 31 , Issue 7 ,
Published online: May 22 2013
x Mild head injury is of interest because of a history of under diagnosis and underestimated clinical importance. Half of the patients with mild head injuries or concussions have sport-related injuries. Knowledge of symptoms and appropriate management can be improved and is a matter of practical interest. Several algorithms exist for discharge, admission or for cranial computed tomography (CT).These employ different risk factors and calculate their sensitivity of correctly identifying children with traumatic brain injury (TBI).
Fatal heat stroke associated with topiramate therapy Stephen W Borron, Robert Woolard, Susan Watts
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.013
The American Journal of Emergency Medicine , Vol. 31 , Issue 12 ,
Published online: September 3 2013
x A 40-year-old man with diabetes and seizure disorder was found at home unresponsive and “very hot to touch� by his father 40 minutes before emergency medical services arrival. His usual medications included topiramate, divalproex sodium, and rosiglitazone/metformin. Paramedics administered oxygen, intravenous fluids, and naloxone. They did not witness or report seizure activity. Upon emergency department arrival, the patient was unresponsive (Glasgow Coma Scale 3), hypotensive (94/50 mm Hg), and tachypneic (32 breaths per minute), with a heart rate of 60 beats per minute and elevated rectal temperature peaking at 43.2°C.
Predictive value of the Cincinnati Prehospital Stroke Scale for identifying thrombolytic candidates in acute ischemic stroke Je Sung You, Sung Phil Chung, Hyun Soo Chung, Hye Sun Lee, Jong Woo Park, Hyun Jong Kim, Shin Ho Lee, Incheol Park, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.029
The American Journal of Emergency Medicine , Vol. 31 , Issue 12 ,
Published online: September 23 2013
x Despite the usefulness of the Cincinnati Prehospital Stroke Scale (CPSS) for rapid recognition of acute stroke, its ability to assess stroke severity is unclear. We investigated the usefulness of CPSS for assessment of stroke severity by comparing CPSS and National Institutes of Health Stroke Scale (NIHSS) scores in patients who were candidates for thrombolytic therapy at hospital admission within 6 hours of symptom onset.
Neurologic complaints in young children in the ED: when is cranial computed tomography helpful? Tarannum M. Lateef, Rebecca Kriss, Karen Carpenter, Karin B. Nelson
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.018
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: March 2 2012
x The objective of this study is to describe the use of emergent head computed tomography (CT) in young children and ask in which circumstances scans contributed to immediate management.
A hair-raising diagnosis: goose bumps as sign of herpes simplex encephalitis Jared Brazg, Brian Gillett
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.030
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: November 28 2014
x Herpes simplex virus (HSV) encephalitis is an infectious disease emergency with potential for significant patient morbidity and mortality. Although lumbar puncture, computed tomography, and magnetic resonance imaging (MRI) remain useful diagnostic modalities in the diagnosis of HSV encephalitis, clinical signs prompting providers to obtain these studies are often nonspecific. The diagnosis requires a high index of suspicion, and the importance of a thorough history and physical examination cannot be overemphasized.
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.
Nonconvulsive status epilepticus masquerading as stroke Christopher Kennel, Andreas Michas-Martin, Brian D. Berman, Sharon Poisson
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.066
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: August 28 2014
x This case describes a patient with multiple stroke risk factors—including prior stroke—who presented to the emergency department with symptoms suggestive of stroke and who received a rapid stroke work up but was later found to be in nonconvulsive status epilepticus (NCSE). This case report highlights the challenge and importance of making an accurate diagnosis in NCSE, and we have included teaching points to help clinicians understand the clinical manifestations and diagnosis of NCSE as well as how it may impact a patient's prognosis.
Subject Index
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00518-9
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published in issue: November 2012
This is your brain on calcium: psychosis as the presentation of isolated hypoparathyroidism Meaghen Finan, Jennifer Axelband
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.032
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: January 30 2014
x We report a case of long-standing isolated hypoparathyroidism that presented with psychosis and ataxia without other signs of hypocalcemia. A 56-year-old man presented to the emergency department with report of abnormal behavior. He had recently stopped attending work and was found moving all his furniture into his basement. Physical exam was remarkable for poor attention and cerebellar ataxia. Head computed tomography was remarkable for extensive and profound calcifications involving all regions of the brain; laboratory studies revealed hypocalcemia, hyperphosphatemia, and low parathyroid.
Caffeine overdose resulting in severe rhabdomyolysis and acute renal failure Christina Campana, Peter L. Griffin, Erin L. Simon
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.042
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: September 30 2013
x Despite the fact that caffeine is the most commonly used stimulant in modern society, cases of caffeine overdose are relatively rare, with fatalities reported from doses of 10 g and higher (Nord J Psychiatry . 2006;60:97-106). Large doses produce symptoms associated with stimulation of the cardiovascular, central nervous, and gastrointestinal symptoms (Associates of the California Poison Control Center, Poisoning and Drug Overdose, pp. 142-143. 5th Ed ). We present the first reported case of a man with delayed presentation to the emergency department after ingesting 24 g of caffeine in a suicide attempt who suffered complications of severe rhabdomyolysis and acute renal failure requiring subsequent hemodialysis.
Imported malaria: an update Eric J. Nilles, Paul M. Arguin
DOI: http://dx.doi.org/10.1016/j.ajem.2011.06.016
The American Journal of Emergency Medicine , Vol. 30 , Issue 6 ,
Published online: September 12 2011
x Evidence suggests that imported malaria is a diagnostic challenge with initial misdiagnosis rates of 40% or greater. Given that prompt diagnosis and appropriate treatment are the only intervention proven to prevent progression to severe malaria and death, these figures are concerning. The purpose of this clinical review is to provide the most up-to-date and practical information on the diagnosis and treatment of imported malaria for the emergency health care provider. We highlight common pitfalls, errors, and mistakes in arriving at the correct diagnosis.
Do energy drinks cause epileptic seizure and ischemic stroke? Suber Dikici, Ayhan Saritas, Fahri Halit Besir, Ahmet Hakan Tasci, Hayati Kandis
DOI: http://dx.doi.org/10.1016/j.ajem.2012.05.018
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: August 6 2012
x Energy drinks are popular among young individuals and marketed to college students, athletes, and active individuals between the ages of 21 and 35 years. We report a case that had ischemic stroke and epileptic seizure after intake of energy drink with alcohol. To the best of our knowledge, the following case is the first report of ischemic stroke after intake of energy drink. A previously healthy 37-year-old man was brought to the emergency department after a witnessed tonic-clonic seizure. According to his wife's testimony, just before loss of consciousness, the patient had been drinking 3 boxes of energy drinks (Redbull, Istanbul, Turkey, 250 mL) with vodka on an empty stomach.
“Stuttering� after minor head trauma Stephen Strasberg, Elizabeth J. Johnson, Thomas Parry
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.056
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: July 28 2015
x Traumatic brain injury (TBI) is defined as impairment in brain function as a result of mechanical force. It is classified based on clinical findings using the Glasgow Coma Scale (GCS). Mild TBI is defined as GCS 14-15; moderate, 9-13; and severe, 3-8 [1–6]. Patients with the same TBI classification may have very different underlying pathology. In moderate to severe TBI, the primary pathology may include contusions, hemorrhage, diffuse axonal injury, direct cellular damage, “tearing and shearing of the tissues, loss of the blood-brain barrier, disruption of the neurochemical homeostasis and loss of the electrochemical function� [5].
Lack of efficacy of phenytoin in children presenting with febrile status epilepticus Suresh S. Pujar, Rod C. Scott, Richard F.M. Chin
DOI: http://dx.doi.org/10.1016/j.ajem.2012.07.005
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: September 13 2012
x We read with interest a recently published article by Ismail et al [1] reporting the lack of efficacy of phenytoin in children presenting with febrile status epilepticus (FSE). The authors, by retrospective medical record review, conclude that phenytoin is rarely effective in controlling FSE in children and that exposure to phenytoin results in increased seizure duration and risk of brain injury. We would like to comment on a few issues:
Successful treatment of flecainide-induced cardiac arrest with extracorporeal membrane oxygenation in the ED Joshua C. Reynolds, Bryan S. Judge
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.054
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 28 2015
x Flecainide is a class Ic antidysrhythmic agent used to prevent and treat tachydysrhythmias. Flecainide toxicity primarily causes cardiovascular and neurologic effects through sodium-channel blockade. There is scant evidence to support specific management, and recommended therapies have been extrapolated from management of other sodium-channel blocking drugs. Traditionally, these therapies have consisted of intravenous fluids, sodium bicarbonate, vasopressors, and cardiac pacing. Novel therapies include intravenous fat emulsion and venoarterial extracorporeal membrane oxygenation (VA-ECMO).
Successful Treatment of Metoprolol-Induced Cardiac Arrest With High-Dose Insulin, Lipid Emulsion, and ECMO Jeremiah T. Escajeda, Ken D. Katz, Jon C. Rittenberger
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.012
The American Journal of Emergency Medicine , Vol. 33 , Issue 8 ,
Published online: January 16 2015
x β -Adrenergic antagonist toxicity causes cardiovascular collapse often refractory to standard therapy. Alternative therapies include high-dose insulin, lipid emulsion, and venoarterial extracorporeal membrane oxygenation (VA-ECMO). A 47-year-old man ingested 10 g of metoprolol tartrate in a suicide attempt. Upon emergency department presentation, he was comatose, bradycardic, and hypotensive. Glucagon (14 mg IV) and vasopressor/inotropic support (epinephrine 0.1 μ g/[kg min], dobutamine 10 μ g/[kg min]) were administered.
Outcomes of patients admitted for hanging injuries with decreased consciousness but without cardiac arrest Jung Hee Wee, Jeong Ho Park, Seung Pill Choi, Kyu Nam Park
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.061
The American Journal of Emergency Medicine , Vol. 31 , Issue 12 ,
Published online: October 7 2013
x The objective of this study is to provide appropriate treatment of patients who showed decreased mentality but did not suffer cardiac arrest (CA) from hanging injury, from reviewing the characteristics and analyzing the outcomes in such patients.
National trends in resource utilization associated with ED visits for syncope Marc A. Probst, Hemal K. Kanzaria, Misato Gbedemah, Lynne D. Richardson, Benjamin C. Sun
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.030
The American Journal of Emergency Medicine , Vol. 33 , Issue 8 ,
Published online: April 24 2015
x Over the last 20 years, numerous research articles and clinical guidelines aimed at optimizing resource utilization for emergency department (ED) patients presenting with syncope have been published.
2010: the emergency medical services literature in review Benjamin J. Lawner, Jose Victor Nable, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2011.05.031
The American Journal of Emergency Medicine , Vol. 30 , Issue 6 ,
Published online: December 14 2011
Observation vs admission in syncope: can we predict short length of stays? Margaret Lin, Richard E. Wolfe, Nathan I. Shapiro, Victor Novack, Yotam Lior, Shamai A. Grossman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.010
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: August 10 2015
x Rising health care costs demands justifying prolonged hospitalization for syncope, yet predictors of shorter length of stay (LOS) have not been identified.
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 .
Stroke: prospective evaluation of a prehospital management process based on rescuers under medical direction Laure Alhanati, Stéphane Dubourdieu, Clément Hoffmann, Francis Béguec, Stéphane Travers, Hugues Lefort, Olga Maurin, Daniel Jost, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.034
The American Journal of Emergency Medicine , Vol. 32 , Issue 5 ,
Published online: February 3 2014
x Improving access to thrombolytic therapy for patients with ischemic stroke is challenging. We assessed a prehospital process based on firemen rescuers under strict medical direction, aimed at facilitating thrombolysis of eligible patients.
Outcomes of warfarinized patients with minor head injury and normal initial CT scan Beng Leong Lim, Charmaine Manauis, Marxengel L. Asinas-Tan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.009
The American Journal of Emergency Medicine , Vol. 34 , Issue 1 ,
Published online: September 18 2015
x We investigated delayed outcomes of patients with minor head injury, warfarin, and a normal initial head computer tomographic (CT) scan finding.
Pulmonary embolism as a cause of seizure Kimitoshi Kimura, Hitoshi Mori, Hiroshi Kitaguchi, Fusae Yamao, Katsuro Shindo
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.024
The American Journal of Emergency Medicine , Vol. 31 , Issue 10 ,
Published online: August 12 2013
x Pulmonary embolism (PE) is not rare, with an overall annual incidence of 60 to 70 cases per 100 000 [1]. Pulmonary embolism presents typically with cardiopulmonary symptoms. In some cases, however, patients present with neurologic symptoms such as syncope and a convulsion [2], which makes clinical evaluation compromised and results in delayed diagnosis. There are only a few case reports about seizures related to PE. The clinical characteristics of such cases remain unclear. The objective of this study is to elucidate them.
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 prospective, randomized, trial of phenobarbital versus benzodiazepines for acute alcohol withdrawal Gregory W. Hendey, Robert A. Dery, Randy L. Barnes, Brandy Snowden, Philippe Mentler
DOI: http://dx.doi.org/10.1016/j.ajem.2009.10.010
The American Journal of Emergency Medicine , Vol. 29 , Issue 4 ,
Published online: March 26 2010
x The aim of this study was to compare phenobarbital (PB) versus lorazepam (LZ) in the treatment of alcohol withdrawal in the emergency department (ED) and at 48 hours.
Status epilepticus after myelography with iohexol (Omnipaque) Hossein Alimohammadi, Ali Abdalvand, Saeed Safari, Alireza Mazinanian
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.034
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: March 2 2012
x Myelography has been of great use as a diagnostic modality, especially when other modalities were not conclusive. However, considering the invasive nature of myelography, it should receive the attention of medical personnel for them to be aware of its possible complications, especially when newer agents are applied as the contrast media. Myelography could lead to some common adverse effects and complications, but in this case report, we will present one of the most serious and uncommon complications accompanied with myelography using Omnipaque, a nonionic second-generation contrast agent.
Varicella zoster encephalitis mimicking stroke JoaquÃn Valle Alonso, Javier Fonseca, Daniel López, Juan José Ochoa
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.019
The American Journal of Emergency Medicine , Vol. 32 , Issue 6 ,
Published online: December 16 2013
x Physicians need to consider a broad differential diagnosis when evaluating a patient presenting with a suspected stroke. The rates of overdiagnosis of stroke in studies of consecutive patients vary from 19% to 31%. The two most common stroke mimics are hypoglycemia and seizure, but several etiologies have been reported. We reported the case of a 41-year-old patient presenting to the emergency department with aphasia and right-side hemiparesis, initially suspected to have stroke and finally diagnosed of varicella-zoster encephalitis.
Complete atrioventricular block due to overdose of pregabalin Enbiya Aksakal, Eftal Murat Bakirci, Mucahit Emet, Mustafa Uzkeser
DOI: http://dx.doi.org/10.1016/j.ajem.2012.02.008
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: May 25 2012
x Pregabalin, a synthetic derivate of the inhibitory neurotransmitter γ -aminobutyric acid, shows antiepileptic, analgesic, anticonvulsant, anxiolytic, and sleep-modulating activities. The major advantage of pregabalin is its relative reliability, easy use, high tolerance, and lack of negative interaction with other drugs. A 65-year-old woman with medical histories of diabetes mellitus, lumbar spondylosis, diabetic nephropathy, chronic renal failure, and anemia of chronic disease was admitted with the complaint of dizziness and syncope.
Rhabdomyolysis as presenting feature of acute HIV-1 seroconversion in a pediatric patient Jason Gagnon, Harold Katner, S. Brent Core, Jean Dozier, Chintan Patel, Chanty Davis
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.031
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: August 29 2015
x Acute rhabdomyolysis is a rare phenomenon in the emergency setting almost exclusively associated with trauma, drugs, and recent upper respiratory and gastrointestinal infection. Rare reports in the literature have highlighted adult patients presenting with rhabdomyolysis as 1 component in a constellation of symptoms in acute HIV-1 seroconversion; however, there are few reports of rhabdomyolysis as the sole presenting symptom. This case highlights the importance of investigating HIV and other sexually transmitted diseases in pediatric cases of rhabdomyolysis in the emergency care setting.
Urgent neurology consultation from the ED for transient ischemic attack Anthony S. Kim, Stephen Sidney, Allan L. Bernstein, Vanja C. Douglas, S. Claiborne Johnston
DOI: http://dx.doi.org/10.1016/j.ajem.2009.12.025
The American Journal of Emergency Medicine , Vol. 29 , Issue 6 ,
Published online: April 26 2010
x The objective of this study was to evaluate the association between urgent neurology consultation and outcomes for patients with transient ischemic attack (TIA).
Transient splenial diffusion-weighted image restriction mimicking stroke Sharma Bhawna, Handa Rahul, Nagpal Kadam, Prakash Swayam, Pankaj Kumar Gupta, Rakesh Agrawal, Mahendra S. Sisodiya
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.044
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: March 6 2014
x Acute transient diffusion-weighted image (DWI) restriction of the splenium of corpus callosum is reported in various medical conditions (encephalopathy, hypoglycemia, in patients on antiepileptic drugs) and in various infections. In some cases, the cause is unknown. We report a case of a 55-year-old woman who presented with acute-onset disorientation and ataxia, initially diagnosed as a case of stroke but later on found to be a case of transient splenial DWI restriction due to unknown cause. Because of a rich blood supply, stroke of the splenium of corpus callosum occurs only rarely.
Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episode leading to recurrent superior mesenteric artery syndrome Oh Young Kwon, Seong Gwan Lim, Sung Hyuk Park
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.059
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: February 12 2014
x Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like events (MELAS) is a rare neurodegenerative disorder caused by a mitochondrial DNA point mutation. Besides neurologic and metabolic manifestations, patients sometimes present with pseudo-obstruction of the bowel due to vomiting and anorexia. This report describes the case of a 28-year-old female with MELAS who presented with recurrent superior mesenteric artery syndrome (SMAS). She complained of severe vomiting and malaise, and had a past history of congestive heart failure and SMAS.
Lack of adverse effects from flumazenil administration: an ED observational study Tammy T. Nguyen, Michelle Troendle, Kirk Cumpston, S. Rutherfoord Rose, Brandon K. Wills
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.031
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: July 21 2015
x Flumazenil is an effective benzodiazepine (BZD) antagonist. Empiric use of flumazenil in the emergency department (ED) is not widely recommended due to concerns of seizures, which are commonly associated with coingestants and BZD withdrawal.
Combined intraaortic balloon counterpulsation and extracorporeal membrane oxygenation in 2 patients with fulminant myocarditis Weihang Hu, Changwen Liu, Lan Chen, Wei Hu, Jun Lu, Yin Zhu, Jianrong Wang, Bingwei Liu
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.043
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: October 29 2014
x Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an effective treatment for fulminant myocarditis (FM). However, VA-ECMO has a limited ability to facilitate left ventricular unloading. Therefore, increased afterload is still a significant concern, especially for those with diffuse myocardial damage and serious left ventricular dysfunction. To our knowledge, there is no report concerning the use of these therapies to treat FM in China. This study investigates the efficacy of using intraaortic balloon counterpulsation to facilitate left ventricular unloading in patients treated with VA-ECMO.
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.
Outcome and adverse events with 72-hour cooling at 32°C as compared to 24-hour cooling at 33°C in comatose asphyxial arrest survivors Byung Kook Lee, Seung Joon Lee, Kyung Woon Jeung, Hyoung Youn Lee, Tag Heo, Yong Il Min
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.046
The American Journal of Emergency Medicine , Vol. 32 , Issue 4 ,
Published online: December 9 2013
x Studies suggest that the current therapeutic hypothermia (TH) protocol does not improve outcomes in adult asphyxial arrest survivors. We sought to compare the effect of 24-hour cooling at 33°C vs that of 72-hour cooling at 32°C on outcomes and the incidence of adverse events in unconscious asphyxial arrest survivors.
Subarachnoid hemorrhage and pneumocephalus due to epidural anesthesia Murat Güzel, Ömer Salt, Ali K. Erenler, Ahmet Baydın, Mehmet T. Demir, Anil Yalcin, Zahide Doganay
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.029
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: January 30 2014
x Epidural analgesia is an extremely effective and popular treatment for pain during labor. Subarachnoid hemorrhage and pneumocephaly is a serious but rare complication of puncture of the dura mater in epidural anesthesia. To best of our knowledge, intracranial subarachnoid hemorrhage together with pneumocephaly hasn’t been reported as a complication after the lumbar puncture so far. Our purpose is to increase awareness for serious complications such as subarachnoid hemorrhage and pneumocephaly following regional procedures (See Fig.
The toxicology literature of 2011: issues impacting the emergency physician Nathan P. Charlton, Peter S. Morse, Heather A. Borek, David T. Lawrence, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2012.10.011
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: February 4 2013
x Annane D, Chadda K, Gajdos P, et al. Hyperbaric oxygen therapy for acute domestic carbon monoxide poisoning: two randomized controlled trials. Intensive Care Med . 2011;37(3):486–492.
Differences in interpretation of cranial computed tomography in ED traumatic brain injury patients by expert neuroradiologists J. Stephen Huff, Sandeep Jahar
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.010
The American Journal of Emergency Medicine , Vol. 32 , Issue 6 ,
Published online: April 14 2014
x Cranial computed tomography (CT) is generally regarded as the standard for evaluation of structural brain injury in patients with traumatic brain injury (TBI) presenting to the emergency department (ED). However, the subjective nature of the visual interpretations of CT scans and the qualitative nature of reporting may lead to poor interrater reliability. This is significant because CT positive scans include a continuum of structural injury with differences in treatment. The purpose of the present study was to evaluate the consistency of readings of head CT scans obtained within 24 hours after mild TBI in the ED, as assessed by an independent adjudication panel of 3 experienced neuroradiologists.
Ischemic stroke presenting as fluctuating focal weakness in an otherwise healthy young man Melanie J. Lippmann, Adam H. Miller
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.019
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: March 13 2013
x A 32-year-old man presented to our emergency department (ED) with no complaints after paramedics responded to a fall. Medics noted left-sided weakness on scene. Symptoms were initially absent in the ED, although later recurred, and included dramatically waxing and waning focal weakness. An acute middle cerebral artery ischemic stroke was diagnosed, and tissue plasminogen activator was administered. Despite a fluctuating course of symptoms, our patient ultimately achieved a complete recovery.
Outcome analysis of cardiac arrest due to hanging injury Jung Hee Wee, Kyu Nam Park, Sang Hoon Oh, Chun Song Youn, Han Joon Kim, Seung Pill Choi
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.013
The American Journal of Emergency Medicine , Vol. 30 , Issue 5 ,
Published online: June 6 2011
x The aim of this study was to review patient characteristics and analyze the outcomes in patients who have had cardiac arrest from hanging injuries.
Acute vertebrobasilar ischemic stroke due to electric injury Rajendra Singh Jain, Sunil Kumar, Desai Tushar Suresh, Rakesh Agarwal
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.068
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: January 6 2015
x Electrical injuries are most commonly due to household accidents. Various factors determine the severity of electric injury, including type of current, amperage, voltage, tissue resistance, pathway of current, and duration of contact with the body. Various types of neurologic damage due to electrical injury have been described in literature. It may manifest as peripheral nerve injury, spinal cord damage, seizures, cerebellar ataxia, hypoxic encephalopathy, and intracerebral hemorrhage. Acute ischemic stroke is an infrequent complication of electrical injury.
Oxcarbazepine-induced resistant ventricular fibrillation in an apparently healthy young man Ayman El-Menyar, Mazhar Khan, Jassim Al Suwaidi, Esam Eljerjawy, Nidal Asaad
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.008
The American Journal of Emergency Medicine , Vol. 29 , Issue 6 ,
Published online: August 16 2010
x We report a 30-year-old man with recurrent loss of consciousness. His resting electrocardiogram revealed Brugada pattern. The patient developed resistant ventricular fibrillation after receiving oral oxcarbazepine. The clinical, echocardiographic, and electrocardiographic features are discussed in brief.
Neuron-specific enolase and S100B protein in children with carbon monoxide poisoning: children are not just small adults Ahmet Zulfikar Akelma, Aydin Celik, Osman Ozdemir, Fatma Kavak Akelma, Ayhan Abaci, Cem Hasan Razi, Fatih Mehmet Kislal, Okhan Akin
DOI: http://dx.doi.org/10.1016/j.ajem.2012.10.009
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: February 4 2013
x The aim of this study was to evaluate the role of S100B protein and neuron-specific enolase (NSE) in children with carbon monoxide (CO) poisoning.
Drinking to near death—acute water intoxication leading to neurogenic stunned myocardium Lia I. Losonczy, Emily Lovallo, C. Daniel Schnorr, Daniel Mantuani
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.055
The American Journal of Emergency Medicine , Vol. 34 , Issue 1 ,
Published online: June 13 2015
x Neurogenic stunned myocardium is a rare disease entity that has been typically described as a consequence of subarachnoid hemorrhage and, less commonly, seizures. Here we describe a case of a healthy young woman who drank excessive free water causing acute hyponatremia complicated by cerebral edema and seizure, leading to cardiogenic shock from neurogenic stunned myocardium. Two days later, she had complete return of her normal cardiac function.
Caffeine-induced rhabdomyolysis Yalcin Golcuk, Murat Ozsarac, Burcu Golcuk, Erkan Gunay
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.016
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: November 11 2013
x To the Editor,
Hypertensive brain stem encephalopathy Pen-Yuan Liao, Chien-Chang Lee, Cheng-Yu Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.032
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: July 1 2014
x A 48-year-old man presented with headache and extreme hypertension. Computed tomography showed diffuse brain stem hypodensity. Magnetic resonance imaging revealed diffuse brain stem vasogenic edema. Hypertensive brain stem encephalopathy is an uncommon manifestation of hypertensive encephalopathy, which classically occurs at parietooccipital white matter. Because of its atypical location, the diagnosis can be challenging. Moreover, the coexistence of hypertension and brain stem edema could also direct clinicians toward a diagnosis of ischemic infarction, leading to a completely contradictory treatment goal.
Electrocardiographic implications of the prolonged QT interval Joshua B. Moskovitz, Bryan D. Hayes, Joseph P. Martinez, Amal Mattu, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.013
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: April 22 2013
x The QT interval measures the time from the start of the QRS complex to the end of the T wave. Prolongation of the QT interval may lead to malignant ventricular tachydysrhythmias, including torsades de pointes. Causes of QT prolongation include congenital abnormalities of the sodium or potassium channel, electrolyte abnormalities, and medications; idiopathic causes have also been identified. Patients can be asymptomatic or present with syncope, palpitations, seizure-like activity, or sudden cardiac death.
Intravenous migraine therapy in children with posttraumatic headache in the ED Steven Chan, Brad Kurowski, Terri Byczkowski, Nathan Timm
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.053
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: February 4 2015
x More than 3.8 million children sustain traumatic brain injuries annually. Treatment of posttraumatic headache (PTH) in the emergency department (ED) is variable, and benefits are unclear.
An uncommon cause of alteration of consciousness in a patient with systemic lupus erythematosus Patompong Ungprasert
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.040
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: March 6 2014
x Posterior reversible encephalopathy syndrome, which is commonly encountered in association with various medical conditions including systemic lupus erythematosus, is an uncommon cause of alteration of consciousness. However, failure to diagnose this condition can lead to permanent neurologic deficits. We report a case of 51-year-old woman who presented with altered mental status and was subsequently diagnosed with this syndrome.
Propofol for benzodiazepine-refractory alcohol withdrawal in a non–mechanically ventilated patient Darrel W. Hughes, Elizabeth VanWert, Lauren LePori, Bruce D. Adams
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.044
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: September 27 2013
x Long-term alcohol use confers neurochemical changes in response to alcohol's exogenous inhibitory effects. Downregulation and decreased sensitivity of γ -aminobutyric acid receptors render benzodiazepines less effective at controlling psychomotor agitation. Propofol has been reported to have successfully relieved alcohol withdrawal syndrome (AWS) symptoms in part because of activation of γ -aminobutyric acid channels in combination with antagonism of excitatory amino acids such as N -methyl-d -aspartate.
Association of blood glucose at admission with outcomes in patients treated with therapeutic hypothermia after cardiac arrest Soo Hyun Kim, Seung Pill Choi, Kyu Nam Park, Seung Joon Lee, Kyung Won Lee, Tae O. Jeong, Chun Song Youn, for the Korean Hypothermia Network Investigators
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.004
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: May 12 2014
x It is well known that hyperglycemia is associated with poor outcomes in critically ill patients. We investigated the association between blood glucose level at admission and the outcomes of patients treated with therapeutic hypothermia (TH) after cardiac arrest.
Diagnosing frontal lobe epilepsy in the ED Lara Phillips, Michele Walsh
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.025
The American Journal of Emergency Medicine , Vol. 32 , Issue 10 ,
Published online: March 31 2014
x Frontal lobe seizures are a common form of epilepsy. It has a variable presentation and can often be missed in the emergency department (ED). Missing this diagnosis can lead to a delay in treatment and poor outcome for cognitive function. We hereby present a case of a 14-year-old girl who presented to our ED after the development of abnormal movements. Knowledge of the anatomy behind the development of partial seizures and the best testing modality can aid in the diagnosis. In this review, we attempt to discuss the pathophysiology of frontal lobe epilepsy and what physical examination findings and testing will best lead to a diagnosis.
Simultaneous event of brachial artery occlusion and acute embolic stroke Soo Hoon Lee, Nack-Cheon Choi, In Seok Jang, Tae-Sin Kang, Changwoo Kang, Jin Hee Jeong, Dong Seob Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.049
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: August 26 2014
x Although the rapid and accurate diagnosis of both acute ischemic stroke and extremity ischemia is essential to the timely and appropriate treatment, it is not always easy to differentiate between true stroke and stroke mimics. Although in general, limb ischemia due to extremity embolism is not included in stroke mimics or misdiagnosis, limb arterial embolism should be considered in the differential diagnosis of acute monoparesis because the diagnosis may be missed if the other typical manifestations of this presentation (pain, pallor, pulselessness, sensory loss, and coolness of the arm) are overlooked.
Transient ischemic attack (TIA): the initial diagnostic and therapeutic dilemma Peter D. Panagos
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.004
The American Journal of Emergency Medicine , Vol. 30 , Issue 5 ,
Published online: May 13 2011
x Many patients with transient ischemic attacks (TIA) are at high risk of stroke within the first few days of onset of symptoms. Emergency physicians and primary care physicians need to assess these patients quickly and initiate appropriate secondary stroke prevention strategies. Recent refinements in diagnostic imaging have produced valuable insight into risk stratification of patients with TIA. Clinical data regarding urgent initiation of antiplatelet therapy specifically in this patient population with non-cardioembolic TIA are limited but promising.
The orthopedic literature 2009 Michael C. Bond, Daniel L. Lemkin, William Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.028
The American Journal of Emergency Medicine , Vol. 29 , Issue 8 ,
Published online: October 11 2010
x Green DW, Mogekwu N, Scher DM, et al. A modification of Klein's Line to improve sensitivity of the anterior-posterior radiograph in slipped capital femoral epiphysis. J Pediatr Orthop 2009;29:449-453.
Posterior reversible encephalopathy syndrome as the first presentation of chronic kidney disease Mohammadmahdi Forouzanfar, Pauline Haroutunian, Alireza Baratloo, Behrooz Hashemi
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.013
The American Journal of Emergency Medicine , Vol. 32 , Issue 5 ,
Published online: November 18 2013
x Posterior reversible encephalopathy syndrome is a clinicoradiologic syndrome characterized by seizure, headache, nausea, vomiting, altered mental status, visual disturbance, or visual loss, together with radiologic findings.
Acute pediatric stroke—what’s the hurry? A case for emergency physician-performed echocardiography Christopher D. Thom, Scott E. Sparks
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.023
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: April 18 2014
x Acute ischemic stroke in a pediatric population is uncommon and has a different etiology from the adult population. We describe a case of acute ischemic stroke for which emergent, physician-sonographer–performed transthoracic echocardiography (TTE) changed his outcome. The patient in this case presented with left-sided hemiparesis, with subsequent CT Angiography (CTA) imaging and follow-on neurosurgical embolectomy for a proximal middle cerebral artery occlusion after which showed early recovery of muscular deficit.
Syncopal storm caused by glossopharyngeal neuralgia Babak Kazemi, Fariborz Akbarzadeh
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.003
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: May 25 2012
x We report a rare case presenting with up to 50 episodes of syncopes per day in a 54-year-old man with the ultimate diagnosis of idiopathic glossopharyngeal neuralgia. All episodes were started with a severe pain sensation in the right side of the throat followed by asystole and then very slow ventricular escape beats. The patient was successfully treated with the combination of carbamazepine, gabapentin, and dual-chamber pacemaker implantation.
Paralytic rabies or postvaccination myelitis: a diagnostic dilemma Rajendra Singh Jain, Pankaj Kumar Gupta, Rahul Handa, Shankar Tejwani, Swayam Prakash, Sunil Kumar, Rakesh Agrawal, Mahendra S. Sisodiya
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.026
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: September 26 2014
x Rabies is a serious health hazard in developing countries like India. Paralytic rabies is difficult to diagnose due to lack of classic manifestations. It poses diagnostic dilemma in patients who have received postexposure prophylaxis, as it is difficult to differentiate it from vaccine-induced Guillain-Barre syndrome, postvaccination myelitis, and acute disseminated encephalomyelitis. Early diagnosis of rabies in such cases is very important for adequate infection control and for institution of public health measures.
Tramadol-induced apnea Hossein Hassanian-Moghaddam, Hoorvash Farajidana, Saeedeh Sarjami, Hamid Owliaey
DOI: http://dx.doi.org/10.1016/j.ajem.2012.05.013
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: July 18 2012
x In contrast with other opioids, there are few cases of tramadol-related respiratory depression described in the literature, and renal impairment is a proposed risk factor. The aim of this study is to determine the prevalence of and predisposing factors for tramadol-related apnea in patients referred to our center.
Recurrent hypoglycemia in a toddler Marissa Cohen, Sean Zwiebel, Rebecca Jeanmonod
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.074
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: April 30 2015
x Idiopathic ketotic hypoglycemia is the most common cause of hypoglycemia in toddlers. This diagnosis should be considered in any hypoglycemic toddler with no prior history of abnormal growth who is developmentally normal when toxic ingestions and sepsis are inconsistent with the clinical picture. Diagnosis is important in preventing serious long-term sequelae and is made in the setting of hypoglycemia, ketonuria, and ketonemia. Therefore, checking urine and blood ketones is an essential part of the evaluation in any hypoglycemic toddler.
Mimics of subacute subdural hematoma in the ED Marlijn H. de Beer, Ad P. van Gils, Hille Koppen
DOI: http://dx.doi.org/10.1016/j.ajem.2012.10.019
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: February 4 2013
x Diagnosing the true etiology of a subdural fluid collection is challenging in the acute setting of an emergency department (ED). In case of a subdural fluid collection at computed tomographic imaging, the possibility of a subdural hematoma will be considered at once. However, other causes such as subdural empyema and dural metastases with pachymeningitis hemorrhagica must be kept in mind. Especially when there is a medical history of recent sinusitis or malignancy. We describe 3 patients who presented to the ED with a history of progressive headache, aphasia, and a right-sided hemiparesis in whom a isodense subdural fluid collection was demonstrated with computed tomographic imaging.
Automated electroencephalogram identifies abnormalities in the ED Rosanne S. Naunheim, Matthew Treaster, Joy English, Teya Casner
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.010
The American Journal of Emergency Medicine , Vol. 29 , Issue 8 ,
Published online: May 3 2010
x Advances in analysis of electrical signals have now made it possible to create a handheld electroencephalogram (EEG).
A near-fatal case of exercise-associated hyponatremia Mathilde Severac, Jean-Christophe Orban, Thibaut Leplatois, Carole Ichai
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.041
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: December 30 2013
x A 42-year-old woman presented to our emergency department with headache, nausea, and confusion after completing an Ironman triathlon. She performed the race at a slow pace, in hot and dry weather. The first medical examination reported confusion with a Glasgow Coma Scale score of 13. A few minutes later, she presented with seizures. A cerebral computed tomographic (CT) scan showed major cerebral edema. Blood analysis showed severe acute hyponatremia (123 mEq/L) with hypotonicity (255 mEq/L). Her clinical condition quickly worsened, leading to a Glasgow Coma Scale score of 3 with fixed dilated pupils.
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.
Improved door-to-needle times and neurologic outcomes when IV tissue plasminogen activator is administered by emergency physicians with advanced neuroscience training Karen Greenberg, Christina R. Maxwell, Keisha D. Moore, Michael D’Ambrosio, Kenneth Liebman, Erol Veznedaroglu, Geri Sanfillippo, Cynthia Diaz, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.025
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: November 28 2014
x The neurologic emergency department (neuro ED) at our medical center is staffed by emergency medicine physicians who have specialized neuroscience training and give intravenous (IV) tissue plasminogen activator (tPA) independently for acute ischemic stroke patients. Door-to-needle (DTN) times, discharge location, and discharge National Institute of Health Stroke Scale (NIHSS) scores were studied between the neuro ED and main emergency department (ED) with the hypothesis that all measures would be better in the neuro ED group.
Traumatic posterior shoulder dislocation with a large engaging Hill-Sachs lesion: splinting technique Sultan Aldebeyan, Ahmed Aoude, Hans Van Lancker
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.061
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: June 25 2015
x Posterior shoulder dislocations are rare and are often associated with seizures, electrocution, and high-energy trauma. They can be missed and, therefore, left untreated. Early diagnosis and treatment can help avoid future complications and surgical intervention.
Hyperthermia and severe rhabdomyolysis from synthetic cannabinoids Brett Sweeney, Soheila Talebi, David Toro, Kristhiam Gonzalez, Jean-Paul Menoscal, Ronald Shaw, Getaw Worku Hassen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.052
The American Journal of Emergency Medicine , Vol. 34 , Issue 1 ,
Published online: June 13 2015
x Synthetic cannabinoids (SC) have exploded on to the scene. With this rise in SC use, the number of complications and potential adverse effects are also well documented in the literature and is on the rise. The most frequently cited side effects are behavioral in nature and range for severe agitation to psychosis and delirium. We report a case of hyperthermia with severe rhabdomyolysis from SC use.
The associative factors of delayed-onset rhabdomyolysis in patients with doxylamine overdose Han Joon Kim, Sang Hoon Oh, Chun Song Youn, Jung Hee Wee, Ji Hoon Kim, Won Jung Jeong, Soo Hyun Kim, Seung Hee Jeong, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.032
The American Journal of Emergency Medicine , Vol. 29 , Issue 8 ,
Published online: December 15 2010
x The aim of this study was to investigate the associative factors of rhabdomyolysis in patients with doxylamine overdose who had normal creatine phosphokinase levels at admission.
Purple glove syndrome occurring after oral administration of phenytoin in therapeutic doses: mechanism still a dilemma Rajendra Singh Jain, Kadam Nagpal, Sunil Kumar, Swayam Prakash, Rahul Handa
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.039
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: May 31 2014
x Purple glove syndrome is a rare and poorly understood complication of phenytoin use, occurring almost always with its intravenous formulation. This syndrome comprises of pain, purple discoloration, and edema distal to the site of intravenous administration of phenytoin. We hereby report an unusual case, wherein purple glove syndrome was seen on oral formulation of phenytoin in its therapeutic dose.
Pralidoxime inhibits paraoxon-induced depression of rocuronium-neuromuscular block in a time-dependent fashion Eichi Narimatsu, Tomohisa Niiya, Kazunobu Takahashi, Masanori Yamauchi, Michiaki Yamakage
DOI: http://dx.doi.org/10.1016/j.ajem.2011.06.013
The American Journal of Emergency Medicine , Vol. 30 , Issue 6 ,
Published online: August 26 2011
x The composite effects of organophosphorus (OP)–cholinesterase (ChE) inhibitors and oximes on the actions of nondepolarizing neuromuscular blockers in acute OP-ChE inhibitor intoxication have not been evaluated in detail. We investigated the effects of paraoxon (Pox) (an OP-ChE inhibitor) and pralidoxime (PAM) (an oxime) on the nondepolarizing neuromuscular blocking action of rocuronium.
