Cord sign facilitates the early diagnosis of deep cerebral vein thrombosis Hsun-Chang Lin, Chun-Hung Chen, Gim-Thean Khor, Poyin Huang
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.038
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: November 15 2010
x The diagnosis of deep cerebral vein thrombosis is challenging. Brain computed tomography only has limited information. Brain magnetic resonance imaging and venography can make the diagnosis by revealing venous thrombosis. In this case report, we will introduce the unique image findings in brain computed tomography, which may facilitate early diagnosis and result in a better prognosis.
Human intravenous injection of β -cyfluthrin with minimal toxic effects Michael A. Miller, Michael Menowsky
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.045
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: September 30 2013
x A 28-year-old man presented to the emergency department (ED) 20 minutes after injecting 20 mL of an insecticide containing 0.05% β -cyfluthrin. Upon presentation, he had no complaints; and vital signs demonstrated a sinus tachycardia of 150 beats per minute, blood pressure of 140/65 mm Hg, no fever, and a normal respiratory rate. Further physical examination was notable only for the lack of tremor and the presence of a left antecubital recent injection site. The patient denied use of other drugs that day, but admitted to recent use of methamphetamine.
Heatstroke model for desert dry-heat environment and observed organ damage Ren ou Zhou, Jiang Wei Liu, Dong Zhang, Qiong Zhang
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.017
The American Journal of Emergency Medicine , Vol. 32 , Issue 6 ,
Published online: February 26 2014
x Heatstroke is one of the most common clinical emergencies. Heatstroke that occurred in a dry-heat environment such as desert is usually more seriously effective and often leads to death. However, the report of the pathophysiologic mechanisms about heatstroke in dry-heat environment of desert has not been seen.
Triage of children with headache at the ED: a guideline implementation study Veronica Balossini, Anna Zanin, Corinne Alberti, Yonathan Freund, Marion Decobert, Antonella Tarantino, Maria La Rocca, Laurence Lacroix, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2012.11.027
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 4 2013
x We present a multicenter validation of a modified Manchester Triage System (MTS) flowchart for pediatric patients who present with headache to the emergency department. A prospective observational study was conducted across 5 European pediatric emergency departments. The standard MTS headache flowchart and a modified MTS headache flowchart were tested in the participating centers, and results were compared with triage categories identified by either the physician at the end of the clinical examination or the reference classification matrix (RCM).
Peripheral nervous system involvement in lightning strike—the devil in disguise Subramanian Senthilkumaran, Namasivayam Balamurugan, Srinivasan Jayaraman, Sambathkumar Sasikumar, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.016
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: August 10 2015
x We read the report on neurologic complications of central origin by Rahman et al [1] with great interest. We would like to share our observations on isolated peripheral nervous system involvement after lightning strike being an extremely rare event and certain aspects related to the clinical practice.
A new facial expression to botox! Aakash Aggarwal, Viren Kaul, Gurmeen Kaur, Emerald Banas, Praveen Sampath, Ajoy K. Roy
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.017
The American Journal of Emergency Medicine , Vol. 32 , Issue 3 ,
Published online: November 11 2013
x Botulinum toxin (Botox) injection into the lower esophageal sphincter (LES) has been used for the treatment of achlasia cardia since the 1990s. Currently it is indicated for patients who are not candidates for definitive therapy like Heller's myotomy or pneumatic dilation and in those who have recurrence of symptoms after definitive treatments. We present a case of severe anaphylaxix due to Botox.
Safety of β -blockers in the acute management of cocaine-associated chest pain Morhaf Ibrahim, Diego Jose Maselli, Reham Hasan, Andrew Hamilton
DOI: http://dx.doi.org/10.1016/j.ajem.2012.09.027
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: November 1 2012
x Cocaine is the most commonly abused illegal drug in patients presenting to emergency departments (EDs) because of chest pain and accounts for almost 40% of all drug-related visits. It is not known whether all β -blockers (BB) and β 1-selective agents or mixed α 1/β -adrenergic antagonists (α 1/β -BB) are safe in the acute management of cocaine-associated chest pain, due to concerns of unopposed α -receptor activity resulting in coronary artery spasm and hypertensive urgency.
A case of rivastigmine toxicity caused by transdermal patch Duk Hee Lee, Yoon Hee Choi, Kwang Hyun Cho, Soon Young Yun, Hyung Min Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2010.05.024
The American Journal of Emergency Medicine , Vol. 29 , Issue 6 ,
Published online: August 16 2010
x Rivastigmine is a carbamate cholinesterase inhibitor used in the treatment of dementia. Toxicity is expected to resemble poisoning from other carbamates and organophosphates with features of both muscarinic (salivation, lacrimation, urination, defecation, miosis, bronchorrhea, and bradycardia) and nicotinic (muscle weakness, fasciculations, and paralysis) stimulation. We present a case of rivastigmine toxicity caused by transdermal patch. After removal of patches, the patient's symptoms and signs were spontaneous recovery without atropine and oxime therapy.
An unlikely culprit—the many guises of thiamine deficiency Ami Schattner, Asaf Kedar
DOI: http://dx.doi.org/10.1016/j.ajem.2012.10.024
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: February 4 2013
x A 59-year-old patient presented with prolonged abdominal pain, vomiting, and anorexia, which were finally found to be caused by an abscess in a previously resected kidney bed. After operation, vomiting continued, and the patient was treated with omeprazole when investigations revealed esophagitis. However, vomiting persisted with associated increasing lassitude, tachycardia, blood pressure lability (hypertension or episodic hypotension/syncope), leg pain, apathy, and somnolence. Nystagmus and areflexia were observed, suggesting thiamine deficiency and Wernicke encephalopathy.
Randomized single-blinded clinical trial on effects of nursery songs for infants and young children’s anxiety before and during head computed tomography Grace Park, Steven J. Weiss, Patricia Repar
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.045
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 28 2015
x The objective of this clinical trial was to determine if an intervention of listening to nursery songs with integrated heartbeat sounds resulted in changes in anxiety levels in infants and children younger than 4 years in an emergent setting.
Ciprofloxacin-induced torsade de pointes Morhaf Ibrahim, Bassam Omar
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.039
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: November 15 2010
x A 65-year-old man with recently diagnosed urinary tract infection treated with ciprofloxacin (Cipro) presented to our institution with recurrent seizure-like activity. His rhythm revealed torsade de pointes, which required defibrillation. Subsequent electrocardiogram revealed severely prolonged QT interval, which near-completely resolved 7 days later off Cipro. This case highlights a rare but potentially fatal side effect of quinolone antibiotics, especially in combination with other QT-prolonging medications.
Inhalant abuse of computer cleaner manifested as angioedema Peter C. Kurniali, Letitia Henry, Rita Kurl, Joseph V. Meharg
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.003
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: February 4 2011
x Inhalant abuse is the intentional inhalation of chemical vapors or volatile substance to achieve a euphoric effect. Although no statistical data are reported yet, inhalant abuse is potentially life-threatening and has resulted in a wide range of toxic effects such as central nervous system depression, seizures, aspiration, cardiac arrhythmia, asphyxiation, hypoxia, metabolic acidosis, and sudden death among others. We are reporting a 25-year-old white man who was brought to the emergency department after inhaling aerosolized computer-cleaning spray composed of difluoroethane.
Vogt-Koyanagi-Harada disease: presentation and implications in undocumented immigrants Fotini Manizate, Farnaz Baksh, Getaw Worku Hassen, Hossein Kalantari
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.029
The American Journal of Emergency Medicine , Vol. 31 , Issue 9 ,
Published online: May 28 2013
x Vogt-Koyanagi-Harada syndrome is an autoimmune disease involving pigmented tissue in the eyes, auditory system, skin, and central nervous system. It often presents as bilateral chronic granulomatous panuveitis. We report the case of a 32-year-old immigrant who presented to the emergency department asking for a second opinion for loss of vision and progressive hearing loss. We also will discuss the issue limited access to health care for a vulnerable population such as undocumented immigrants.
The rise in K2 use with varying clinical symptoms and the potential for ED crowding Asha A. Roy, Lara DeNonno, Ivan Becerra, Roger Chirurgi, Peter McCorkell, Getaw Worku Hassen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.028
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: December 18 2014
x The rise in recreational drug abuse and corresponding increases in the production of newer and more potent synthetic drugs are alarming [1]. Our institution has experienced periodic increases in emergency department (ED) visits from synthetic drug use at music festivals [2,3]. However more recently, daily visits have increased significantly due to synthetic cannabinoid (SC) abuse. The Substance Abuse and Mental Health Services Administration reported 11 406 SC ED visits in 2010 increasing to 28 531 in 2012 [4].
Thyroid storm and arrhythmic storm: a potentially fatal combination Diana Anjo, José Maia, André Couto Carvalho, Heloísa Castro, Irene Aragão, António Pinheiro Vieira, António Hipólito Reis, Fátima Borges, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.026
The American Journal of Emergency Medicine , Vol. 31 , Issue 9 ,
Published online: May 28 2013
x Thyroid storm is a rare clinical emergency with a mortality rate between 20% and 30%. Cardiac arrhythmias associated with thyrotoxicosis are usually supraventricular. Ventricular arrhythmias are rarely associated with this entity and tend to occur in patients with intrinsic cardiac disease. We present a 35-year-old woman with Graves disease and a thyroid storm manifested with multiple malignant dysrhythmic episodes, without underlying cardiac disease. The mechanism for ventricular arrhythmia is not clear but seems to be due to the increased myocardial excitability directly caused by the thyroid hormones.
Hyperammonemic encephalopathy in a child with ornithine transcarbamylase deficiency due to a novel combined heterozygous mutations Jiandi Gao, Feng Gao, Fang Hong, Huimin Yu, Peifang Jiang
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.038
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: August 22 2014
x Ornithine transcarbamylase deficiency (OTCD) is an X-linked disorder of metabolism of the urea cycle. It usually causes hyperammonemic encephalopathy in males during the neonatal-to-infantile period, whereas female carriers present with variable manifestations depending on their pattern of random chromosome X inactivation in the liver. Early clinical manifestations of hyperammonemia are nonspecific often leading to a delay in the diagnosis of OTCD. Unfortunately, delays in initiating treatment often lead to poor neurologic outcomes and overall survival.
Serum concentration of eperisone hydrochloride correlates with QT interval Takeshi Yamagiwa, Seiji Morita, Mari Amino, Naoya Miura, Takeshi Saito, Sadaki Inokuchi
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.006
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: October 17 2013
x Eperisone hydrochloride is a centrally acting muscle relaxant prescribed for muscle stiffness that acts by depressing the activities of α and γ efferent neurons in the spinal cord and supraspinal structures. Although a case of eperisone-induced severe QT prolongation had been reported, the relationship between serum eperisone concentration and QT interval remains obscure.
Two cases of disseminated intravascular coagulation due to “bath salts” resulting in fatalities, with laboratory confirmation Amy C. Young, Evan S. Schwarz, Larissa I. Velez, Melody Gardner
DOI: http://dx.doi.org/10.1016/j.ajem.2012.05.032
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: August 6 2012
x Synthetic cathinones are phenylalkylamines developed for both medicinal use and as substances of abuse referred to as “bath salts.” The rapid emergence of these bath salts over the recent years has been concerning to the medical community and law enforcement. Widespread availability, legality, and desired amphetamine-like effects have dramatically increased sales of these compounds. Only recently has regulations on specific derivatives been enacted in the United States. The acute sympathomimetic toxidrome associated with bath salts by virtually any route can result in harmful effects.
Mollaret meningitis: case report with a familial association Christopher W. Jones, Graham E. Snyder
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.008
The American Journal of Emergency Medicine , Vol. 29 , Issue 7 ,
Published online: May 3 2010
x Mollaret meningitis is a syndrome characterized by recurrent bouts of meningitis that occur over a period of several years in an affected patient. Also known as recurrent lymphocytic meningitis, this entity involves repeated episodes of headache, stiff neck, fever, and cerebrospinal fluid pleocytosis. Herpes simplex virus type 2 is the most frequently implicated causative agent, and treatment involves the use of antiviral medications. We describe a case of Mollaret meningitis in a 47-year-old man who presented to the emergency department with his eighth episode of meningitis during a period of 20 years.
Validating a pragmatic definition of shock in adult patients presenting to the ED Yan-ling Li, Cangel Pui-yee Chan, King-keung Sin, Stewart S.W. Chan, Pei-yi Lin, Xiao-hui Chen, Brendan E. Smith, Gavin M. Joynt, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.029
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: August 22 2014
x The importance of the early recognition of shock in patients presenting to emergency departments is well recognized, but at present, there is no agreed practical definition for undifferentiated shock. The main aim of this study was to validate an a priori clinical definition of shock against 28-day mortality.
