Synthetic drugs: time to ring the warning bell? Getaw Worku Hassen, Hossein Kalantari
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.016
The American Journal of Emergency Medicine , Vol. 31 , Issue 12 ,
Published online: October 24 2013
x The use of synthetic or designer drug has increased among youth in the past couple of years, and it is still on the rise. We recently have reported about the associated health complications of these drugs [1] and have tried to raise awareness to the public ( http://www.newsdaily.com/article/d308725ad6c7c6c60b11d2ab4c16c8ac/researchers-warn about- increasing-use-of-designer-drugs ).
Fire extinguisher: an imminent threat or an eminent danger? Subramanian Senthilkumaran, Ramachandran Meenakshisundaram, Namasivayam Balamurgan, Krishnanswamy SathyaPrabhu, V Karthikeyan, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.018
The American Journal of Emergency Medicine , Vol. 30 , Issue 3 ,
Published online: March 16 2011
x Acute phosphate toxicity following rectal administration of phosphate-containing preparations was documented earlier. However, acute phosphate toxicity due to inhalation of monoammonium phosphate (MAP) is rarely reported. The present report describes the systemic toxicity following intentional inhalation of MAP, a dry chemical powder present in fire extinguishers, in a 25-year-old healthy man with normal renal function resulting in hyperphosphatemia (11.0 mg/dL), hypocalcemia (ionized calcium, 1.18 mg/dL; total calcium, 3.6 mg/dL), hypomagnesemia (1.2 mg/dL), seizures, and 4 episodes of pulseless polymorphic ventricular tachycardia requiring defibrillation.
Thoracic spine fracture in the course of severe nocturnal hypoglycemia in young patients with type 1 diabetes mellitus—the role of low bone mineral density Liliana Majkowska, Ewa Waliłko, Piotr Molęda, Andrzej Bohatyrewicz
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.055
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: January 6 2014
x Thus far, only a few spine fracture cases related to severe nocturnal hypoglycemia in type 1 diabetes patients have been reported. Due to the relatively young age of these subjects, osteoporosis was not taken into consideration and bone mineral density was not assessed.
Approach to the diagnosis and treatment of acute subarachnoid hemorrhage in a patient with sickle cell disease Matthew Lyon, Justin Jeter, Richard Lottenberg
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.068
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: August 29 2014
x We report a case of subarachnoid hemorrhage in a 38-year-old patient with sickle cell anemia. This case highlights the limitations of noncontrast computed tomography in the diagnosis of subarachnoid hemorrhage in patients with sickle cell disease as well as the special needs of this patient population in addressing the treatment of stroke.
Posterior reversible encephalopathy syndrome: a unique presentation Christopher R. Lang, Nathalie Coeller
DOI: http://dx.doi.org/10.1016/j.ajem.2013.05.018
The American Journal of Emergency Medicine , Vol. 31 , Issue 9 ,
Published online: June 24 2013
x We present a case of a patient presenting with posterior reversible encephalopathy syndrome to the emergency department. We discuss the various symptoms that lead to the identification of posterior reversible encephalopathy syndrome and the important clinical clues. Posterior reversible encephalopathy syndrome is a very uncommon diagnosis/clinical presentation that requires the understanding of the condition and awareness in distinct/specific patient populations. Without this understanding, the diagnosis may be missed and appropriate management delayed.
A fatal case of thiacloprid poisoning Kolar Vishwanath Vinod, Sadashivan Srikant, Gnanavel Thiruvikramaprakash, Tarun Kumar Dutta
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.013
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: August 7 2014
x Neonicotinoid insecticides are considered to be less toxic to humans compared to older insecticides such as organophosphates, carbamates, pyrethroids, and organochlorine compounds. However, reports of severe human toxicity with neonicotinoids are emerging. Acute human thiacloprid poisoning and death as a result have not been reported in the literature so far. Here we report a case of thiacloprid poisoning resulting from deliberate ingestion in a 23-year-old man, manifesting with status epilepticus, respiratory paralysis, rhabdomyolysis, metabolic acidosis, and acute kidney injury (AKI), and ultimately giving rise to refractory shock and death.
Propafenone-induced cardiac arrest: full recovery with insulin, is it possible? Basak Bayram, Erhan Dedeoglu, Nil Hocaoglu, Emine Gazi
DOI: http://dx.doi.org/10.1016/j.ajem.2012.08.003
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: October 19 2012
x Propafenone may cause mental depression, mania, convulsion, metabolic acidosis, hypotension, prolonged QRS, atrioventricular block, and cardiac arrest if it is taken at a dose greater than recommended. There is no standard specific treatment or antidote for a propafenone overdose, and life-supporting treatments are applied in these cases. In this case report, we report a case of a 15-year-old female patient who experienced cardiac arrest after an oral propafenone overdose. She was successfully treated using cardiopulmonary resuscitation, which took approximately 1.5 hours.
Do outcomes of near syncope parallel syncope? Shamai A. Grossman, Mathew Babineau, Laura Burke, Adarsh Kancharla, Lawrence Mottley, Andrea Nencioni, Nathan I. Shapiro
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.001
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: December 27 2010
x Limited information on the evaluation of emergency department (ED) patients complaining of “near syncope” exists. Multiple studies of syncope exclude near syncope claiming near syncope is poorly defined and its definition is nonuniform.
Does an energy drink cause a transient ischemic attack? Suber Dikici, Ayhan Saritas, Seyma Kilinc, Semih Guneysu, Harun Gunes
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.037
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: July 1 2014
x Energy drinks have become a popular beverage especially among young individuals. The growing literature sheds light on acute health problems associated with these products, although they have not yet been in existence long enough to build a solid, evidence-based appreciation of potential long-term effects. Perhaps the greatest concern about energy drinks is the amount of caffeine they contain, which generally far exceeds that in other beverages. A transient ischemic attack (TIA) has been traditionally defined as an episode of neurologic dysfunction caused by focal cerebral ischemia with complete recovery within 24 hours.
Accuracy of weight estimates in pediatric patients by prehospital Emergency Medical Services personnel C. Anthoney E. Lim, Bradley J. Kaufman, John O’Connor Jr., Sandra J. Cunningham
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.018
The American Journal of Emergency Medicine , Vol. 31 , Issue 7 ,
Published online: May 23 2013
x Most medications administered to children are weight-based, and inaccurate weight estimation may contribute to medical errors. Previous studies have been limited to hypothetical patients and those in cardiopulmonary arrest. We aim to determine the accuracy of weight estimates by Emergency Medical Services (EMS) personnel of children receiving medications and to identify factors associated with accuracy.
Cerebral venous sinus thrombosis as an initial manifestation of primary antiphospholipid syndrome Chia-Lin Tsai, Dueng-Yuan Hueng, Wen-Long Tsao, Jiann-Chyun Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.020
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: April 19 2013
x Cerebral venous sinus thrombosis is a rare neurologic manifestation of antiphospholipid syndrome. We report a case of a 49-year-old woman who presented to the emergency department with recurrent episodes of transient clumsiness of the left upper extremity. The results of unenhanced brain computed tomography and electroencephalography were unremarkable. Serial neuroimages revealed superior sagittal sinus thrombosis. Thrombophilia screen disclosed positive lupus anticoagulant. In this case report, we aim to emphasize the significance of recognizing an unusual presentation of antiphospholipid syndrome.
Heart-type fatty acid-binding protein as a potential biomarker of acute carbon monoxide poisoning Ali Kemal Erenler, Turker Yardan, Ahmet Baydin, Murat Gunay, Ramazan Amanvermez
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.005
The American Journal of Emergency Medicine , Vol. 31 , Issue 8 ,
Published online: June 27 2013
x The aim of this study was to investigate the role of serum heart-type fatty acid-binding protein (H-FABP) in the evaluation of patients with carbon monoxide (CO) poisoning.
Listeria meningitis–associated bradyarrhythmia treated with isoproterenol Samantha W. Gee, Todd J. Karsies
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.022
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: June 26 2014
x In the setting of increased intracranial pressure (ICP), various rhythm disturbances have been associated, ranging from tachyarrhythmias to bradyarrhythmias with atrioventricular dissociation. Although most of these observations have been in patients with traumatic brain injuries, it is known that children with acute bacterial meningitis may also have severe intracranial hypertension. We present the case of a previously healthy 2-year-old boy diagnosed with listeria meningitis. Along with clinical signs suggestive of increased ICP and brainstem involvement, our patient had persistent bradyarrhythmia with hemodynamic compromise that was refractory to epinephrine and successfully managed with isoproterenol.
Hemichorea after multiple bee stings Jin Young An, Ji Seon Kim, Jin Hong Min, Kyu Hong Han, Jun Ho Kang, Jung Soo Park, Hoon Kim, Suk Woo Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.024
The American Journal of Emergency Medicine , Vol. 32 , Issue 2 ,
Published online: October 28 2013
x Bee sting is one of the most commonly encountered insect bites in the world. Despite the common occurrence of local and systemic allergic reactions, there are few reports of ischemic stroke after bee stings. To the best our knowledge, there have been no reports on involuntary hyperkinetic movement disorders after multiple bee stings. We report the case of a 50-year-old man who developed involuntary movements of the left leg 24 hours after multiple bee stings, and the cause was confirmed to be a right temporal infarction on a diffusion magnetic resonance imaging scan.
Cerebral regional oxygen saturation monitoring in pediatric malfunctioning shunt patients Thomas J. Abramo, Chuan Zhou, Cristina Estrada, Patrick C. Drayna, Matthew R. Locklair, Renee Miller, Matthew Pearson, Noel Tulipan, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2012.09.006
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: November 14 2012
x Shunt malfunction produces increased intracranial pressure causing decreased cerebral regional perfusion and tissue O2 sat. Cerebral regional oxygen saturation (rSO2 ) by near-infrared spectroscopy represents tissue perfusion and oxygen saturation. Cerebral rSO2 is used to detect cerebral ischemia in pediatric clinical settings.
The first 500: initial experience with widespread use of low-dose ketamine for acute pain management in the ED Terence L. Ahern, Andrew A. Herring, Erik S. Anderson, Virat A. Madia, Jahan Fahimi, Bradley W. Frazee
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.010
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: November 14 2014
x The objective of this study is to describe the clinical use and safety profile of low-dose ketamine (LDK) (0.1-0.3 mg/kg) for pain management in the emergency department (ED).
What is the real incidence of oral tramadol-induced apnea? Is there any association between this type of apnea and mortality? Hossein Sanaei-Zadeh
DOI: http://dx.doi.org/10.1016/j.ajem.2012.08.021
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: November 19 2012
x I would like to address the article recently published online in your journal titled “Tramadol-induced apnea” [1]. This is an interesting study aiming to determine the incidence and predisposing factors of tramadol-related apnea. The authors reviewed the medical charts of the patients with their principle diagnostic code to be pure tramadol intoxication within a 14-month period. They determined an incidence rate of 3.6% of oral tramadol-induced apnea. They, then, divided the patients into 2 groups of those who had and had not developed apnea and compared some variables between these 2 groups finding no predisposing factors for oral tramadol-induced apnea.
Low plasma C-reactive protein level as an early diagnostic tool for heatstroke vs central nervous system–associated infection in the ED Esther Dahan, Sara Dichtwald, Eyal Amar, Patrick Sorkine, Avi A. Weinbroum
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.030
The American Journal of Emergency Medicine , Vol. 31 , Issue 8 ,
Published online: June 3 2013
x Heatstroke (HS) is a life-threatening condition, manifested by systemic inflammation and multiorgan failure. Rapid recognition and treatment are life saving. We report a laboratory-oriented characterization of HS by low plasma C-reactive protein (CRP) level and propose its usefulness in distinguishing this type of hyperpyrexia from central nervous system–associated high core temperature.
Fatal myocardial ischemia in a 12-year old secondary to fibromuscular dysplasia Paul M. Swaney, B. Daniel Nayman, Jose G. Cabañas, J. Brent Myers
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.027
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: December 19 2013
x Cardiac causes of chest pain in children are rare; however, they continue to account for 1% to 6% of all cases dependent on the practice setting and patient history. Here we describe the case of a 12-year old with fibromuscular dysplasia that died from an acute myocardial infarction. Although this specific etiology is uncommon, the case illustrates the need for broad differentials when treating children with chest pain in the emergency medicine environment. In particular, even if the specific diagnosis cannot be readily made in the prehospital or emergency department (ED) setting, the possibility of cardiac disease should be considered.
Prehospital recognition of severe sepsis: development and validation of a novel EMS screening tool Carmen C. Polito, Alex Isakov, Arthur H. Yancey II, Duncan K. Wilson, Blake A. Anderson, Ingrid Bloom, Greg S. Martin, Jonathan E. Sevransky
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.024
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: April 22 2015
x To derive and validate a predictive model and novel emergency medical services (EMS) screening tool for severe sepsis (SS).
