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].
