Human Carbon Monoxide Factory Karin Howe, David Griffen, Cassie Jaeger
DOI: http://dx.doi.org/10.1016/j.ajem.2016.04.008
Publication stage: In Press Accepted Manuscript
The American Journal of Emergency Medicine
Published online: April 8 2016
x Methylene chloride is a common occupational exposure. A metabolic product of methylene chloride is carbon monoxide (CO) and toxicity can lead to increased carboxyhemoglobin (COHb) levels. The half-life of COHb is prolonged in methylene chloride toxicity as the conversion to CO can last several hours beyond the exposure. In addition, methylene chloride can be stored in tissues, particularly adipose tissue, and converted to CO over time. The following case demonstrates that patients exposed to methylene chloride can essentially become CO factories with the production of CO within the body continuing long after exposure to the toxin.
Validation of the bacterial meningitis score in adults presenting to the emergency department with meningitis Robert McArthur, Jonathan A. Edlow, Lise E. Nigrovic
DOI: http://dx.doi.org/10.1016/j.ajem.2016.04.003
Publication stage: In Press Accepted Manuscript
The American Journal of Emergency Medicine
Published online: April 7 2016
x The Bacterial Meningitis Score classifies children with meningitis and none of the following high-risk predictors at very low risk for bacterial meningitis: Positive cerebrospinal fluid (CSF) Gram Stain, CSF protein ≥3 , peripheral ANC ≥ 10,000 cells/mm3 and seizure at or prior to presentation. Although extensively validated in children, the Bacterial Meningitis Score has not been rigorously evaluated in adults.
Table of Contents
DOI: http://dx.doi.org/10.1016/S0735-6757(16)00142-X
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published in issue: April 2016
Syncope and Collapse in acute Pulmonary Embolism Karsten Keller, Johannes Beule, Jörn Oliver Balzer, Wolfgang Dippold
DOI: http://dx.doi.org/10.1016/j.ajem.2016.03.061
Publication stage: In Press Accepted Manuscript
The American Journal of Emergency Medicine
Published online: March 31 2016
x Syncope and collapse (=
Succinylcholine in an ED patient with unanticipated hyperkalemia: a case report and brief review of the relevant literature Gabrielle Jacknin, Michael C. Overbeck
DOI: http://dx.doi.org/10.1016/j.ajem.2016.03.009
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: March 8 2016
x Succinylcholine is a depolarizing neuromuscular blocker commonly used for paralysis in the setting of rapid sequence intubation. Despite the favorable pharmacokinetic profile of succinylcholine, the safety profile of this agent remains controversial. Concerns among clinicians reg arding hyperkalemia remain persistent despite demonstrated safety in the vast majority of patients.
Cerebral hyperperfusion syndrome: a rare postoperative complication of carotid endarterectomy Mina Guirgis, Kishore Sieunarine
DOI: http://dx.doi.org/10.1016/j.ajem.2016.03.010
Publication stage: In Press Accepted Manuscript
The American Journal of Emergency Medicine
Published online: March 5 2016
x Acute neurological deficits are common presentations to the emergency department. Cerebral hyperperfusion syndrome, a rare phenomenon which can occur within one month following carotid surgical revascularization, may be challenging for the emergency physician to diagnose in the setting of an acute neurological presentation. Carotid arterial disease contributes 15-20% of ischemic cerebrovascular accidents and surgical revascularization is the commonest intervention for preventing stroke in patients with significant carotid disease.
Cerebral oximetry with blood volume index and capnography in intubated and hyperventilated patients Taylor A. Bagwell, Thomas J. Abramo, Gregory W. Albert, Jonathan W. Orsborn, Elizabeth A. Storm, Nicolas W. Hobart-Porter, Tonya M. Thompson, Eylem Ocal, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2016.03.005
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: March 4 2016
x Hyperventilation-induced hypocapnia leads to cerebral vasoconstriction and hypoperfusion. Intubated patients are often inadvertently hyperventilated during resuscitations, causing theoretical risk for ischemic brain injury. Current emergency department monitoring systems do not detect these changes. The purpose of this study was to determine if cerebral oximetry (rc So 2 ) with blood volume index (CBVI) would detect hypocapnia-induced cerebral tissue hypoxia and hypoperfusion.
Bradycardia and hypotension after synthetic cannabinoid use: a case series Erin M. Kane, Jeremiah S. Hinson, Candice D. Jordan, Karolina Paziana, Nicholas J. Sauber, Richard E. Rothman, Andrew I. Stolbach
DOI: http://dx.doi.org/10.1016/j.ajem.2016.03.007
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: March 4 2016
x Cardiotoxicity secondary to synthetic cannabinoid use has been reported to manifest with tachycardia and hypertension. We present here a case series of three patients who developed bradycardia and hypotension after synthetic cannabinoid use.
Acute lethargy in a young woman due to latent disseminated cancer mimicking bacterial meningitis: a diagnostic pitfall Tsung-Han Ho, Fu-Chi Yang, Hung-Wen Kao, Sy-Jou Chen, Jiunn-Tay Lee, Liang-Wei Wen, Heng-Cheng Chu, Jiann-Chyun Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.065
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: February 29 2016
x Leptomeningeal carcinomatosis is an atypical behavior of cancer as a consequence of infiltration of malignant cells into the leptomeninges. Leptomeningeal carcinomatosis may share similar clinical manifestations with other etiologies involving the leptomeninges such as infectious meningitis or meningoencephalitis. We present a diagnostic pitfall of acute leptomeningeal carcinomatosis from a latent gastric cancer in a 28-year-old woman presenting with being rapidly comatose and an initial misdiagnosis of bacterial meningitis.
Early neurologic examination is not reliable for prognostication in post–cardiac arrest patients who undergo therapeutic hypothermia Michael S. Merrill, Catherine M. Wares, Alan C. Heffner, Kenneth L. Shauger, H. James Norton, Michael S. Runyon, David A. Pearson
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.002
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: February 20 2016
x Recent advances in post–cardiac arrest (CA) care including therapeutic hypothermia (TH) have improved survival and favorable neurologic outcomes for survivors of CA. Survivors often present with deep coma and lack of brainstem reflexes, which are generally associated with adverse outcomes in many disease processes. Little is known regarding the role of initial emergency department (ED) neurological examination and its potential for prognostication.
Hypertensive brainstem encephalopathy mimicking central pontine myelinolysis: a potential pitfall Tsung-Han Ho, Hung-Wen Kao, Sy-Jou Chen, Jiunn-Tay Lee, Yaw-Don Hsu
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.040
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: February 15 2016
x Hypertensive brainstem encephalopathy, an unusual form of hypertensive encephalopathy resulting from failure of autoregulation of the cerebral blood flow causing vasogenic edema of brainstem, is a medical emergency. Hypertensive brainstem encephalopathy may share similar clinical manifestations to other etiologies involving the brainstem such as central pontine myelinolysis or acute pontine infarcts. However, misdiagnosis by the emergency physicians results in an inappropriate treatment and may lead to permanent neurologic deficits or even death.
Hemodynamic challenges in traumatic subarachnoid hemorrhage complicated by cerebral vasospasm John Papanikolaou, Konstantinos Spathoulas, Demosthenes Makris, Triantafillia Koukoubani, Epaminondas Zakynthinos
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.041
The American Journal of Emergency Medicine , Vol. 34 , Issue 5 ,
Published online: February 12 2016
x We have read with great interest the recent review by Varvarousi et al
[1]
on the role of levosimendan in the clinical setting of aneurysmal subarachnoid hemorrhage (SAH). Previous work by us
[2]
and others
[3,4]
proposed depressed cardiac output (CO), mainly attributed to catecholamine-mediated myocardial dysfunction, as a critical determinant of delayed cerebral ischemia (DCI) and poor neurologic outcome. In this respect, rapid hemodynamic augmentation, with either levosimendan
[5]
or other agents
[6]
, has the potential to reverse cerebral ischemia and prevent further brain damage.
Novel technique in ED: supracondylar ultrasound-guided nerve block for reduction of distal radius fractures Ali Attila Aydin, Sedat Bilge, Murtaza Kaya, Guclu Aydin, Orhan Cinar
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.032
The American Journal of Emergency Medicine , Vol. 34 , Issue 5 ,
Published online: February 12 2016
x Distal radius fractures (DRFs) of the wrist are the most common upper extremity fracture presented to an emergency department (ED). Distal radius fracture, requiring manipulation and reduction, is frequently encountered in the ED. Several methods have been used for pain management during the procedure. These include peripheral nerve block (PNB), hematoma block (HB), intravenous regional anesthesia (IVRA), procedural sedation analgesia (PSA), nitrous oxide and general anesthesia
[1]
. Ultrasound (US)–guided PNBs, performed by emergency physicians, have gradually gained a place in emergency practice.
Posterior reversible encephalopathy syndrome after bevacizumab treatment presenting to the ED as chest pain and headache A.H. Miller, J.A. Monteiro de Oliveira Novaes, P.A. Brock, M. Sandoval
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.033
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: February 12 2016
x Posterior reversible encephalopathy syndrome is a rare but increasingly identifiable clinicoradiologic syndrome typically characterized by the composite of symptoms including headache, altered mental status, visual disturbances, and seizures. On neuroimaging, there is a characteristic pattern of white-gray matter vasogenic edema involving, in most cases, the posterior regions of the central nervous system. As suggested by the name, the clinical and radiologic features are reversible. This syndrome was first described in 1996 by Hinchey et al [1] and was called reversible posterior leukoencephalopathy syndrome .
Quantitative analysis of high plasma lactate concentration in ED patients after alcohol intake Tomohiro Sonoo, Satoshi Iwai, Ryota Inokuchi, Masataka Gunshin, Susumu Nakajima, Naoki Yahagi
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.021
The American Journal of Emergency Medicine , Vol. 34 , Issue 5 ,
Published online: January 22 2016
x Plasma lactate concentration is known to increase after alcohol intake. However, this increase has rarely been analyzed quantitatively in emergency department (ED) settings. Evaluating plasma lactate elevation in ED patients after alcohol intake is important because it can affect patients' evaluation based on the plasma lactate level.
Effect of predischarge blood pressure on follow-up outcomes in patients with severe hypertension in the ED Paisit Nakprasert, Khrongwong Musikatavorn, Dhanadol Rojanasarntikul, Khuansiri Narajeenron, Patima Puttaphaisan, Suthaporn Lumlertgul
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.013
The American Journal of Emergency Medicine , Vol. 34 , Issue 5 ,
Published online: January 20 2016
x Although emergency department (ED) patients with asymptomatic severe hypertension (ASH) generally have no serious short-term hypertension-related adverse events, it is unclear whether persistently high discharge blood pressure (BP) affects the outcome due to the dynamic nature of BP.
Sling and swathe modification for immobilization of posterior glenohumeral dislocations Andrew P. Harris, Steven F. DeFroda, Joseph A. Gil, Gregory R. Waryasz
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.088
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: January 5 2016
x Posterior glenohumeral dislocations occur less frequently compared with anterior glenohumeral dislocations, which are 15.5-21.5 times more common than posterior dislocations [1]. Inadequate physical examination and radiographic evaluation result in missed or delayed diagnosis in up to 79% of patients who present with a posterior glenohumeral dislocation [2–4]. Common reported causes include seizure, trauma, and electric shock. Initial evaluation of a suspected glenohumeral dislocation must include a thorough physical examination and anteroposterior and axillary lateral radiographs [5].
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.
Status epilepticus and type 2 myocardial infarctionGiuseppe Famularo
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.057
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: December 22 2015
x Patients with convulsive seizures are exposed to a wide spectrum of cardiovascular events, and the risk is particularly elevated in patients with refractory epilepsy. I present a patient with refractory status epilepticus who had a type 2 myocardial infarction (MI) during relapsing seizures and ultimately died of multiorgan failure. Type 2 MI happens because of an imbalance between blood supply and myocardial oxygen demand; however, very few cases have been described in patients with convulsive seizures or status epilepticus .
Salicylate toxicity in the absence of anion gap metabolic acidosis Stephanie Bauer, Michael A. Darracq
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.038
Publication stage: In Press Corrected Proof
The American Journal of Emergency Medicine
Published online: December 21 2015
x Salicylates are a common ingredient in many over-the-counter and prescription medications. Classically, salicylate poisoning is associated with an elevated anion gap acidosis; however, the absence of an anion gap does not rule out salicylate toxicity.
