Lack of adverse effects from flumazenil administration: an ED observational study Tammy T. Nguyen, Michelle Troendle, Kirk Cumpston, S. Rutherfoord Rose, Brandon K. Wills
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.031
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: July 21 2015
x Flumazenil is an effective benzodiazepine (BZD) antagonist. Empiric use of flumazenil in the emergency department (ED) is not widely recommended due to concerns of seizures, which are commonly associated with coingestants and BZD withdrawal.
Combined intraaortic balloon counterpulsation and extracorporeal membrane oxygenation in 2 patients with fulminant myocarditis Weihang Hu, Changwen Liu, Lan Chen, Wei Hu, Jun Lu, Yin Zhu, Jianrong Wang, Bingwei Liu
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.043
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: October 29 2014
x Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an effective treatment for fulminant myocarditis (FM). However, VA-ECMO has a limited ability to facilitate left ventricular unloading. Therefore, increased afterload is still a significant concern, especially for those with diffuse myocardial damage and serious left ventricular dysfunction. To our knowledge, there is no report concerning the use of these therapies to treat FM in China. This study investigates the efficacy of using intraaortic balloon counterpulsation to facilitate left ventricular unloading in patients treated with VA-ECMO.
Cysticercotic encephalitis: a life threatening form of neurocysicercosis Rajendra Singh Jain, Rahul Handa, Arvind Vyas, Swayam Prakash, Kadam Nagpal, Indu Bhana, Mahendra S. Sisodiya, Pankaj Kumar Gupta
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.048
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: April 28 2014
x Neurocysticercosis is the most frequent neuroparasitosis and is caused by Taenia solium larvae (cysticerci). Its most common presenting feature is seizure, although it may present as headache, focal deficits, hydrocephalous, or as features of raised intracranial pressure. We herein report a case of 40-year-old male who presented with features of acute encephalitis and raised intracranial pressure with magnetic resonance imaging suggestive of multiple neurocysticerci with diffuse cerebral edema. A diagnosis of cysticercotic encephalitis was made, which is a syndrome of encephalitis with clinical and radiologic evidences of diffuse cerebral edema caused by parenchymal cysticercosis.
Outcome and adverse events with 72-hour cooling at 32°C as compared to 24-hour cooling at 33°C in comatose asphyxial arrest survivors Byung Kook Lee, Seung Joon Lee, Kyung Woon Jeung, Hyoung Youn Lee, Tag Heo, Yong Il Min
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.046
The American Journal of Emergency Medicine , Vol. 32 , Issue 4 ,
Published online: December 9 2013
x Studies suggest that the current therapeutic hypothermia (TH) protocol does not improve outcomes in adult asphyxial arrest survivors. We sought to compare the effect of 24-hour cooling at 33°C vs that of 72-hour cooling at 32°C on outcomes and the incidence of adverse events in unconscious asphyxial arrest survivors.
Subarachnoid hemorrhage and pneumocephalus due to epidural anesthesia Murat Güzel, Ömer Salt, Ali K. Erenler, Ahmet Baydın, Mehmet T. Demir, Anil Yalcin, Zahide Doganay
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.029
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: January 30 2014
x Epidural analgesia is an extremely effective and popular treatment for pain during labor. Subarachnoid hemorrhage and pneumocephaly is a serious but rare complication of puncture of the dura mater in epidural anesthesia. To best of our knowledge, intracranial subarachnoid hemorrhage together with pneumocephaly hasn’t been reported as a complication after the lumbar puncture so far. Our purpose is to increase awareness for serious complications such as subarachnoid hemorrhage and pneumocephaly following regional procedures (See Fig.
The toxicology literature of 2011: issues impacting the emergency physician Nathan P. Charlton, Peter S. Morse, Heather A. Borek, David T. Lawrence, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2012.10.011
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: February 4 2013
x Annane D, Chadda K, Gajdos P, et al. Hyperbaric oxygen therapy for acute domestic carbon monoxide poisoning: two randomized controlled trials. Intensive Care Med . 2011;37(3):486–492.
Differences in interpretation of cranial computed tomography in ED traumatic brain injury patients by expert neuroradiologists J. Stephen Huff, Sandeep Jahar
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.010
The American Journal of Emergency Medicine , Vol. 32 , Issue 6 ,
Published online: April 14 2014
x Cranial computed tomography (CT) is generally regarded as the standard for evaluation of structural brain injury in patients with traumatic brain injury (TBI) presenting to the emergency department (ED). However, the subjective nature of the visual interpretations of CT scans and the qualitative nature of reporting may lead to poor interrater reliability. This is significant because CT positive scans include a continuum of structural injury with differences in treatment. The purpose of the present study was to evaluate the consistency of readings of head CT scans obtained within 24 hours after mild TBI in the ED, as assessed by an independent adjudication panel of 3 experienced neuroradiologists.
Ischemic stroke presenting as fluctuating focal weakness in an otherwise healthy young man Melanie J. Lippmann, Adam H. Miller
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.019
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: March 13 2013
x A 32-year-old man presented to our emergency department (ED) with no complaints after paramedics responded to a fall. Medics noted left-sided weakness on scene. Symptoms were initially absent in the ED, although later recurred, and included dramatically waxing and waning focal weakness. An acute middle cerebral artery ischemic stroke was diagnosed, and tissue plasminogen activator was administered. Despite a fluctuating course of symptoms, our patient ultimately achieved a complete recovery.
Outcome analysis of cardiac arrest due to hanging injury Jung Hee Wee, Kyu Nam Park, Sang Hoon Oh, Chun Song Youn, Han Joon Kim, Seung Pill Choi
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.013
The American Journal of Emergency Medicine , Vol. 30 , Issue 5 ,
Published online: June 6 2011
x The aim of this study was to review patient characteristics and analyze the outcomes in patients who have had cardiac arrest from hanging injuries.
Acute vertebrobasilar ischemic stroke due to electric injury Rajendra Singh Jain, Sunil Kumar, Desai Tushar Suresh, Rakesh Agarwal
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.068
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: January 6 2015
x Electrical injuries are most commonly due to household accidents. Various factors determine the severity of electric injury, including type of current, amperage, voltage, tissue resistance, pathway of current, and duration of contact with the body. Various types of neurologic damage due to electrical injury have been described in literature. It may manifest as peripheral nerve injury, spinal cord damage, seizures, cerebellar ataxia, hypoxic encephalopathy, and intracerebral hemorrhage. Acute ischemic stroke is an infrequent complication of electrical injury.
Oxcarbazepine-induced resistant ventricular fibrillation in an apparently healthy young man Ayman El-Menyar, Mazhar Khan, Jassim Al Suwaidi, Esam Eljerjawy, Nidal Asaad
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.008
The American Journal of Emergency Medicine , Vol. 29 , Issue 6 ,
Published online: August 16 2010
x We report a 30-year-old man with recurrent loss of consciousness. His resting electrocardiogram revealed Brugada pattern. The patient developed resistant ventricular fibrillation after receiving oral oxcarbazepine. The clinical, echocardiographic, and electrocardiographic features are discussed in brief.
Neuron-specific enolase and S100B protein in children with carbon monoxide poisoning: children are not just small adults Ahmet Zulfikar Akelma, Aydin Celik, Osman Ozdemir, Fatma Kavak Akelma, Ayhan Abaci, Cem Hasan Razi, Fatih Mehmet Kislal, Okhan Akin
DOI: http://dx.doi.org/10.1016/j.ajem.2012.10.009
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: February 4 2013
x The aim of this study was to evaluate the role of S100B protein and neuron-specific enolase (NSE) in children with carbon monoxide (CO) poisoning.
Drinking to near death—acute water intoxication leading to neurogenic stunned myocardium Lia I. Losonczy, Emily Lovallo, C. Daniel Schnorr, Daniel Mantuani
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.055
The American Journal of Emergency Medicine , Vol. 34 , Issue 1 ,
Published online: June 13 2015
x Neurogenic stunned myocardium is a rare disease entity that has been typically described as a consequence of subarachnoid hemorrhage and, less commonly, seizures. Here we describe a case of a healthy young woman who drank excessive free water causing acute hyponatremia complicated by cerebral edema and seizure, leading to cardiogenic shock from neurogenic stunned myocardium. Two days later, she had complete return of her normal cardiac function.
Caffeine-induced rhabdomyolysis Yalcin Golcuk, Murat Ozsarac, Burcu Golcuk, Erkan Gunay
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.016
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: November 11 2013
x To the Editor,
Hypertensive brain stem encephalopathy Pen-Yuan Liao, Chien-Chang Lee, Cheng-Yu Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.032
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: July 1 2014
x A 48-year-old man presented with headache and extreme hypertension. Computed tomography showed diffuse brain stem hypodensity. Magnetic resonance imaging revealed diffuse brain stem vasogenic edema. Hypertensive brain stem encephalopathy is an uncommon manifestation of hypertensive encephalopathy, which classically occurs at parietooccipital white matter. Because of its atypical location, the diagnosis can be challenging. Moreover, the coexistence of hypertension and brain stem edema could also direct clinicians toward a diagnosis of ischemic infarction, leading to a completely contradictory treatment goal.
Electrocardiographic implications of the prolonged QT interval Joshua B. Moskovitz, Bryan D. Hayes, Joseph P. Martinez, Amal Mattu, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.013
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: April 22 2013
x The QT interval measures the time from the start of the QRS complex to the end of the T wave. Prolongation of the QT interval may lead to malignant ventricular tachydysrhythmias, including torsades de pointes. Causes of QT prolongation include congenital abnormalities of the sodium or potassium channel, electrolyte abnormalities, and medications; idiopathic causes have also been identified. Patients can be asymptomatic or present with syncope, palpitations, seizure-like activity, or sudden cardiac death.
Intravenous migraine therapy in children with posttraumatic headache in the ED Steven Chan, Brad Kurowski, Terri Byczkowski, Nathan Timm
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.053
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: February 4 2015
x More than 3.8 million children sustain traumatic brain injuries annually. Treatment of posttraumatic headache (PTH) in the emergency department (ED) is variable, and benefits are unclear.
An uncommon cause of alteration of consciousness in a patient with systemic lupus erythematosus Patompong Ungprasert
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.040
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: March 6 2014
x Posterior reversible encephalopathy syndrome, which is commonly encountered in association with various medical conditions including systemic lupus erythematosus, is an uncommon cause of alteration of consciousness. However, failure to diagnose this condition can lead to permanent neurologic deficits. We report a case of 51-year-old woman who presented with altered mental status and was subsequently diagnosed with this syndrome.
Propofol for benzodiazepine-refractory alcohol withdrawal in a non–mechanically ventilated patient Darrel W. Hughes, Elizabeth VanWert, Lauren LePori, Bruce D. Adams
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.044
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: September 27 2013
x Long-term alcohol use confers neurochemical changes in response to alcohol's exogenous inhibitory effects. Downregulation and decreased sensitivity of γ -aminobutyric acid receptors render benzodiazepines less effective at controlling psychomotor agitation. Propofol has been reported to have successfully relieved alcohol withdrawal syndrome (AWS) symptoms in part because of activation of γ -aminobutyric acid channels in combination with antagonism of excitatory amino acids such as N -methyl-d -aspartate.
Association of blood glucose at admission with outcomes in patients treated with therapeutic hypothermia after cardiac arrest Soo Hyun Kim, Seung Pill Choi, Kyu Nam Park, Seung Joon Lee, Kyung Won Lee, Tae O. Jeong, Chun Song Youn, for the Korean Hypothermia Network Investigators
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.004
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: May 12 2014
x It is well known that hyperglycemia is associated with poor outcomes in critically ill patients. We investigated the association between blood glucose level at admission and the outcomes of patients treated with therapeutic hypothermia (TH) after cardiac arrest.
