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.
