Profound alkalemia secondary to gastric outlet obstruction and acute renal insufficiency David P. Betten, Daniel J. Bridger, Brent M. Felton
DOI: http://dx.doi.org/10.1016/j.ajem.2012.05.025
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published in issue: February 2013
x Alkalemia in patients presenting to the emergency department can be from a multitude of causes. Although most individuals will present with relatively mild to moderate alkalemia (pH <
Low-impact trauma causing acute compartment syndrome of the lower extremities Kristen Aliano, Salil Gulati, Steve Stavrides, Thomas Davenport, George Hines
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.004
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: March 7 2013
x Compartment syndrome usually occurs in the muscles of an extremity as a consequence of trauma or reperfusion. However, it can also occur from minor injuries with resulting hematoma. We reviewed the charts of 5 individuals who presented to the emergency department after minimal or no known trauma and were ultimately diagnosed with acute compartment syndrome. None sustained fractures, and 2 had documented muscle tears. All patients were found to have hematomas in the affected compartment at the time of surgery.
Severe poisoning after self-reported use of 2-(4-iodo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine, a novel substituted amphetamine: a case series M.A. Hieger, S.R. Rose, K.L. Cumpston, P.E. Stromberg, S. Miller, B.K. Wills
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.065
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: May 1 2015
x Significant toxicity from amphetamine and cathinone derivatives is being increasingly reported. We describe a series of self-reported exposures to 2-(4-iodo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine (25-I-NBOME or 25-I), a novel amphetamine derivative. Ten patients with an average age of 17 years presented to local emergency departments (EDs) in our community after ingestion and/or insufflation of a drug referred to as “25-I.” Of 10 patients, 6 reported taking 25-I alone; other substances included ethanol; 2,5-dimethoxy-4-ethylphenethylamine; marijuana; and ketamine.
Free phenytoin toxicity Syed Haider Imam, Kristen Landry, Viren Kaul, Harvir Gambhir, Dinesh John, Brian Kloss
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.036
The American Journal of Emergency Medicine , Vol. 32 , Issue 10 ,
Published online: April 2 2014
x Phenytoin has a narrow therapeutic window, and when managing cases of toxicity, clinicians are very wary of this fact. Typically, if patient presents with symptoms suggestive of phenytoin toxicity, total serum phenytoin is promptly ordered. That could be falsely low especially in elderly or critically ill patients, which may lead to a low albumin level resulting in this discrepancy. The free phenytoin can be best estimated using the Sheiner-Tozer equation. Herein, we describe a case of an elderly male patient who presented with drowsiness, gait changes, and elevated liver enzymes and a normal total serum phenytoin level of 18 ng/dL (normal, 10-20 ng/dL).
Hemodialysis as an alternative treatment of mexiletine intoxication Emine Akıncı, Yücel Yüzbaşıoglu, Figen Coşkun
DOI: http://dx.doi.org/10.1016/j.ajem.2010.08.027
The American Journal of Emergency Medicine , Vol. 29 , Issue 9 ,
Published online: October 25 2010
x Mexiletine is a class IB antiarrhythmic agent. Although it is primarily used in treating ventricular arrhythmias, recent indications for use of mexiletine include chronic and neuropathic pains. At high doses, mexiletine causes drowsiness, confusion, nausea, hypotension, sinus bradycardia, paresthesia, seizures, bundle branch block, atrioventricular heart block, ventricular arrhythmias, asystole, cardiovascular collapse, and coma. A 23-year-old male patient presented to the emergency department with intentional ingestion of high-dose mexiletine.
S100B protein in children with carbon monoxide poisoning Ahmet Zulfikar Akelma, Aydin Celik,, Osman Ozdemir, Fatma Kavak Akelma
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.014
The American Journal of Emergency Medicine , Vol. 31 , Issue 10 ,
Published online: August 12 2013
x S100B has been shown to increase in patients with cardiac arrest, stroke, subarachnoid hemorrhage, and traumatic and hypoxic brain damage [1-4]. In contrast to adult studies, we found that serum S100B protein levels did not increase in pediatric patients with carbon monoxide (CO) poisoning [5]. Patients with a positive history of CO exposure and elevated blood carboxyhemoglobin (>
Naltrexone prevents delayed encephalopathy in rats poisoned with the sarin analogue diisopropylflurophosphate Kori L. Brewer, Michelle M. Troendle, Laura Pekman, William J. Meggs
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.003
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 4 2013
x Acute poisoning with organophosphate compounds can cause chronic neuropsychological disabilities not prevented by standard antidotes of atropine and pralidoxime. We determine the efficacy of naltrexone in preventing delayed encephalopathy after poisoning with the sarin analogue diisofluorophosphate (DFP) in rats.
Table of Contents
DOI: http://dx.doi.org/10.1016/S0735-6757(15)00648-8
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published in issue: September 2015
Bilateral hippocampal abnormalities in magnetic resonance imaging in transient global amnesia Jian Li, Wen li Hu
DOI: http://dx.doi.org/10.1016/j.ajem.2012.11.007
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 4 2013
x Transient global amnesia (TGA) is an isolated amnesic syndrome with normal neurologic examination. Patients remain alert and communicative with no loss of personal identity; however, they experience striking loss of memory for recent events and an impaired ability to retain new information. We report a case of TGA in a patient with acute ischemia in bilateral hippocampal abnormalities. This provides evidence in support of an ischemic hypothesis as the possible etiology of TGA.
Lidocaine-induced delirium: a case report Mustafa Ahmet Afacan, Sahin Colak, Mehmet Ozgür Erdogan, Mehmet Kosargelir, Abdullah Ibrahim, Kemal Tekesin, Hayati Kandis
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.044
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: October 2 2014
x Lidocaine is an amino amide and among local anesthetics that are commonly used at emergency departments. Although lidocaine has a wide safety range, it may present with various clinical signs such as dizziness, disorientation, blurred vision, numbness around mouth and tongue, irritability, agitation, loss of consciousness, convulsion, coma, respiratory arrest, and cardiovascular collapse. A 29-year-old patient was admitted to the emergency department due to the development of delirium after platelet-rich plasma and ozone therapy, under local anesthesia, to the scalp at a private aesthetic surgery center.
Parafalcine empyema, a tricky infectious cause of headache: a case report Thirza van der Stel, Frank E.E. Treuniet, Carel Hoffmann, Hille Koppen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.070
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: January 6 2015
x Headache caused by subdural empyema is usually associated with fever and symptoms and/or clinical signs of meningeal irritation and increased intracranial pressure. We describe a patient with headache with absence of these signs or symptoms of meningeal irritation or intracranial pressure, who turned out to have a parafalcine subdural empyema. A 28-year-old man had headache for 2 weeks, which had started with visual symptoms with duration of 5 minutes. Two days later, he developed fever. During these 2 weeks, he had recurrence of visual symptoms for 4 times, with duration of several minutes.
Medical conditions and restraint in patients experiencing excited delirium Jared Strote, Marilyn Walsh, Daniel Auerbach, Thomas Burns, Patrick Maher
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.023
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: May 21 2014
x Law enforcement restraint–related death is frequently associated with excited delirium syndrome (ExDS). Because such deaths are rare, the pathophysiology underlying ExDS deaths remains unknown, making identification of high-risk situations challenging. This study describes the medical conditions and situations surrounding restraint of individuals identified by law enforcement to be experiencing ExDS.
The role of hypertonic saline in exercise-induced hyponatremia Narat Srivali, Vareena Laohaphan, Nattamol Hosiriluck
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.023
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: August 15 2014
x We thank Severac et al [1] for their article entitled “A near-fatal case of exercise-associated hyponatremia,” which was published in The American Journal of Emergency Medicine.
Contents
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00423-8
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published in issue: October 2012
Association between ED crowding and delay in resuscitation effort Ki Jeong Hong, Sang Do Shin, Kyoung Jun Song, Won Chul Cha, Jin Seong Cho
DOI: http://dx.doi.org/10.1016/j.ajem.2012.09.029
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: November 19 2012
x Few investigations have been performed that address why emergency department (ED) crowding is associated with an increase in hospital mortality for emergency patients. The purpose of this study was to evaluate whether ED crowding is associated with delayed resuscitation efforts (DREs) that resulted in hospital mortality.
Table of Contents
DOI: http://dx.doi.org/10.1016/S0735-6757(15)00886-4
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published in issue: December 2015
Incidence of tricyclic antidepressant-like complications after cyclobenzaprine overdose Vikhyat S. Bebarta, Joseph Maddry, Douglas J. Borys, David L. Morgan
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.014
The American Journal of Emergency Medicine , Vol. 29 , Issue 6 ,
Published online: May 3 2010
x The cyclobenzaprine structure is similar to amitriptyline; however, tricyclic antidepressant (TCA)-like wide complex dysrhythmia has not been reported. Our objective was to determine the incidence of TCA-like effects in cyclobenzaprine overdoses as reported to 6 poison centers for 2 years. We compared the incidence of these effects to amitriptyline overdoses collected during the same period.
An unusual presentation of bee sting: subarachnoid hemorrhagia Suber Dikici, Leyla Yilmaz Aydin, Ayhan Saritas, Ozlem Kudas, Hayati Kandis
DOI: http://dx.doi.org/10.1016/j.ajem.2011.09.012
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: November 21 2011
x A person consists of a variety of immune reactions as a result of bee stings, depending on his/her immunologic structure. A 49-year-old male patient was brought to the emergency department because of generalized tonic clonic seizure and loss of consciousness after an hour of wild bee bite from the anterior abdomen in a rural area. After cardiopulmonary resuscitation, he was admitted to intensive care unit. Although cranial computed tomography taken in the emergency department was normal, control cranial computed tomography at the 36th hour after admission was consisted with subarachnoid hemorrhagia (SAH).
The critical care literature 2009 Michael E. Winters, Tsuyoshi Mitarai, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.009
The American Journal of Emergency Medicine , Vol. 29 , Issue 5 ,
Published online: May 3 2010
x Marchick MR, Kline JA, Jones AE. The significance of non-sustained hypotension in emergency department patients with sepsis. Intensive Care Med 2009;35:1261-1264.
Wide complex tachycardia after bupropion overdose Vanessa Franco
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.063
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 29 2015
x Here we describe a wide complex tachycardia after bupropion overdose that was responsive to sodium bicarbonate. This rhythm was likely secondary to bupropion-induced sodium channel blockade and corrected QT interval (QTc) prolongation. It is critical for the emergency medicine physician to recognize that a wide complex rhythm in a patient with bupropion overdose may be secondary to sodium channel toxicity and prolonged QTc as this rhythm may be responsive to sodium bicarbonate. Identifying this rhythm as purely ventricular tachycardia can lead to the administration of medications such as amiodarone that may further prolong QTc and contribute to sodium channel blockade, exacerbating bupropion-induced cardiotoxicity.
