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 Joaquín 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.
