Nonfatal tramadol overdose may cause false-positive phencyclidine on Emit-II assay Andrew M. King, Jennifer L. Pugh, Nathan B. Menke, Matthew D. Krasowski, Michael J. Lynch, Anthony F. Pizon
DOI: http://dx.doi.org/10.1016/j.ajem.2012.05.028
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: September 3 2012
x False-positive results are a common finding with qualitative urine drug screens. This report describes 2 patients with positive phencyclidine (PCP) screens using the Emit II Plus Drugs-of-Abuse Test (Siemens Healthcare Diagnostics, Inc, Tarrytown, NY) after tramadol ingestion. Our first case was a 43-year-old woman with a history of bipolar disorder who presented to the emergency department(ED) for medical clearance after ingesting an unknown amount of tramadol. Her urine drugs-of-abuse screen was positive for PCP.
A healthy young woman with headache and focal seizures David Barbic
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.040
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: February 5 2014
x A previously healthy 21-year-old woman presented to the emergency department with a history of headache and 3 recent focal seizures. She was otherwise healthy and denied recent head trauma or infective symptoms. She denied pet ownership or foreign travel in the last 5 years. She was HIV negative during a recent prenatal screen. Her head and neck, cardiovascular, respiratory, and neurologic physical examinations were normal. Subsequent computed tomographic scan of the brain with intravenous contrast revealed a lesion consistent with Toxoplasma gondii brain abscess.
Incidence and patterns of hemolytic anemia in acute dapsone overdose Yong Sung Cha, Hyun Kim, Juwon Kim, Oh. Hyun Kim, Hyung Il Kim, KyoungChul Cha, Kang Hyun Lee, Sung Oh Hwang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.021
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: September 19 2015
x Hemolytic anemia is one of the complications related to the chronic consumption of dapsone. However, in acute dapsone overdose, there have been few case reports regarding hemolytic anemia. Herein, we reported the prevalence and patterns of hemolytic anemia in acute dapsone overdose, and compared clinical features including mortality in the non-hemolytic anemia and the hemolytic anemia groups.
Table of Contents
DOI: http://dx.doi.org/10.1016/S0735-6757(16)00142-X
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published in issue: April 2016
A sinister cause of anterograde amnesia: painless aortic dissection Michael D. April, Kurt Fossum, Charles Hounshell, Katherine Stolper, Leigh Spear, Kevin Semelrath
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.052
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: December 29 2014
x Aortic dissection is a frequently devastating diagnosis classically associated with severe chest pain. We present a case of painless aortic dissection with anterograde amnesia. An 84-year-old man was brought to the emergency department by ambulance, when his wife noted that he developed acute onset complete loss of short-term memory. Medical history was notable for a 4.5-cm fusiform thoracic aortic root aneurysm. On arrival, he denied pain or syncope. On examination, he was mildly hypotensive (110/59 mm Hg); and there were no murmurs, pulse deficits, or focal neurologic deficits.
Analysis of the appropriate age and weight for pediatric patient sedation for magnetic resonance imaging Yu Jin Lee, Do Kyun Kim, Young Ho Kwak, Hahn Bom Kim, Jeong Ho Park, Jin Hee Jung
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.009
The American Journal of Emergency Medicine , Vol. 30 , Issue 7 ,
Published online: March 19 2012
x Sedatives with a long duration are required for pediatric magnetic resonance imaging (MRI) in the emergency department. The success rate of chloral hydrate for pediatric sedation is 80% to 100% according to some studies. However, the success rate varies by age, weight, and underlying disease. To identify factors affecting the success rate, we compared the chloral hydrate sedation success rate and adverse event rate by age, weight, and underlying disease. Compared with patients in the failure group, patients in the successful group were younger (23.8 vs 36.9 months, P < .01) and weighed less (11.4 vs 14.4 kg, P < .01).
Inborn errors of metabolism: an emergency medicine approach Drew Long, Brit Long, Alex Koyfman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.017
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: November 9 2015
x Recognizing and managing metabolic emergencies due to inborn errors of metabolism (IEM) can be challenging to emergency physicians. Inborn errors of metabolism present similarly to systemic pathologic conditions and are less common than many other conditions (up to 1 in 800 to 1 in 2500 live births) [1,2], such as sepsis and congenital heart disease. Infants with IEM may have a normal birth and an uneventful period for days to years before manifestation of symptoms. These symptoms are variable in nature and nonspecific, placing a great deal of importance on a thorough yet efficient utilization of laboratory tests.
Successful treatment of epidural anesthesia–induced severe pneumocephalus by hyperbaric oxygen therapy Chang-Chih Shih, Shih-Hung Tsai, Wen-I Liao, Jen-Chun Wang, Chin-Wang Hsu
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.044
The American Journal of Emergency Medicine , Vol. 33 , Issue 8 ,
Published online: February 2 2015
x Pneumocephalus is a rare complication after using loss-of-resistance to air technique of epidural anesthesia and is usually caused by inadvertent dural puncture. Most patients with pneumocephalus have headache, motor weakness, seizures, and focal neurologic deficits depending on the distribution and amount of intracranial air. Consciousness decline and death had been reported because of mass effect or cerebral gas embolism. Either conservative treatment with 100% oxygen and ventilator support or surgical intervention with external ventricular drain had been reported as a treatment.
Intralipid emulsion treatment as an antidote in lipophilic drug intoxications Sebnem Eren Cevik, Tanju Tasyurek, Ozlem Guneysel
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.019
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: May 20 2014
x Intravenous lipid emulsion (ILE) is a lifesaving treatment of lipophilic drug intoxications. Not only does ILE have demonstrable efficacy as an antidote to local anesthetic toxicity, it is also effective in lipophilic drug intoxications. Our case series involved 10 patients with ingestion of different types of lipophilic drugs. Intravenous lipid emulsion treatment improved Glasgow Coma Scale or blood pressure and pulse rate or both according to the drug type. Complications were observed in 2 patients (minimal change pancreatitis and probable ILE treatment–related fat infiltration in lungs).
Impact of case volume on outcome and performance of targeted temperature management in out-of-hospital cardiac arrest survivors Seung Joon Lee, Kyung Woon Jeung, Byung Kook Lee, Yong Il Min, Kyu Nam Park, Gil Joon Suh, Kyung Su Kim, Gu Hyun Kang, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.003
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: October 10 2014
x This study aimed to determine the effect of case volume on targeted temperature management (TTM) performance, incidence of adverse events, and neurologic outcome in comatose out-of-hospital cardiac arrest (OHCA) survivors treated with TTM.
Risk factors for QT prolongation associated with acute psychotropic drug overdose Naoya Miura, Takeshi Saito, Takayuki Taira, Rimako Umebachi, Sadaki Inokuchi
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.048
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: October 3 2014
x Antipsychotic/Antidepressant use is a risk factor for QT interval (QT) prolongation and sudden cardiac death. However, it is unclear which drugs are risk factors for QT prolongation and torsades de pointes in cases of psychotropic drug overdose.
Oral pure tramadol exposure like other opioids can cause apnea- why not be careful? Hossein Hassanian-Moghaddam
DOI: http://dx.doi.org/10.1016/j.ajem.2012.08.020
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: November 1 2012
x I appreciate the opportunity and respond to some criticism that has targeted our study regarding “tramadol-induced apnea” [1,2]. First of all, the retrospective nature of our study imposes some limitations, which are inevitable, and coingestants cannot be fully ruled out. Nonetheless, there is some evidence and strengths, which suggests that these cohort data are reliable.
Managing combined critical hypothermia, diabetic ketoacidosis and cocaine intoxication noninvasively Miriam Freundt, Adel Obaji, John K. Hix
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.042
The American Journal of Emergency Medicine , Vol. 32 , Issue 4 ,
Published online: November 4 2013
x Severe hypothermia with a core temperature below 28°C is critical especially in patients with diabetic ketoacidosis (DKA) and carries a high risk of mortality. Our case of a 52-year-old woman presenting with DKA, pH of 6.9, potassium of 7.6 mEq/L, and body temperature of 26°C demonstrates that conservative management can be safe and successful. We used an established cardiac arrest rewarming phase protocol modified to active warming with the Meditherm 3 Machine and the facility-used rigorous DKA protocol to successfully and safely achieve rewarming without hemodialysis or extracorporeal maneuvers.
Posterior reversible encephalopathy syndrome presenting as papilledema Nicholas D. Caputo, Robert M. Fraser, Jumana Abdulkarim
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.016
The American Journal of Emergency Medicine , Vol. 30 , Issue 5 ,
Published online: June 6 2011
x Posterior reversible encephalopathy syndrome (PRES) is a central nervous system pathology characterized by headaches, altered mental status, seizures, and visual loss. The syndrome is a clincoradiologic diagnosis, which mandates neuroimaging.
Long-acting neuromuscular paralysis without concurrent sedation in emergency care Ian D. Chong, Benjamin J. Sandefur, Dorothy E. Rimmelin, Christian Arbelaez, Calvin A. Brown III, Ron M. Walls, Daniel J. Pallin
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.002
The American Journal of Emergency Medicine , Vol. 32 , Issue 5 ,
Published online: January 16 2014
x Neuromuscular paralysis without sedation is an avoidable medical error with negative psychologic and potentially physiologic consequences. We determine the frequency of long-acting paralysis without concurrent sedation among patients intubated in our emergency department (ED) or before arrival.
Carotid artery dissection presenting with isolated headache and Horner syndrome after minor head injury Samuel Thomas Creavin, Claire M. Rice, Adrian Pollentine, Philip Cowburn
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.010
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: May 25 2012
x A woman aged 31 years presented to the emergency department after a minor head injury. She reported mild headache and a metallic taste in her mouth. Full neurologic examination was remarkable only for left-sided Horner syndrome. Left internal carotid artery dissection was confirmed on magnetic resonance imaging. She was treated with aspirin. Symptoms and signs persisted 3 months later, but there was no additional neurologic deficit.
Alcoholic ketoacidosis coincides with acute Marchiafava-Bignami disease Ming-Hua Chen, Chun-An Cheng
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.021
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: February 10 2012
x Alcoholism is the major cause of electrolyte and acid-base imbalance and nutrition deficiency. Ketoacidosis is one of major advised effect on alcoholism. Marchiafava-Bignami disease, a rare alcohol-related disorder, characterized by altered mental status, seizure, and multifocal central nervous system signs, which results from progressive demyelination and necrosis of corpus callosum. Here, we presented a 53-year-old man presented as decreased conscious level and 4 extremity rigidity on admission.
Availability of intravenous lipid emulsion therapy on endosulfan-induced cardiovascular collapse Hyung Jun Moon, Jung Won Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2012.10.006
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: March 20 2013
x Acute Endosulfan poisoning is associated with a high mortality rate in humans, and can exceed 30% [Moon JM, Chun BJ. Acute endosulfan poisoning: a retrospective study. Hum Exp Toxicol 2009;28:309-16]. Prophylactic anticonvulsant therapy for symptomatic patients and aggressive treatment for seizures may limit morbidity, but, no effective antidote is available [Moses V, Peter JV. Acute intentional toxicity: endosulfan and other organochlorines. Clin Toxicol (Phila) 2010;48:539-44]. However, endosulfan poisoning is often completely reversible with the appropriate management [Karatas AD, Aygun D, Baydin A.
Wax on, wax off: a rare case of catatonia Karen Greenberg, Michael D’Ambrosio, Kenneth M. Liebman, Erol Veznedaroglu
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.047
The American Journal of Emergency Medicine , Vol. 32 , Issue 10 ,
Published online: April 7 2014
x Catatonia was first described by a German psychiatrist, Karl Kahlbaum, in 1874. It is a behavioral syndrome marked by an inability to move normally, which can occur in the context of many underlying general medical and psychiatric disorders. A wide variety of neurologic, metabolic, drug-induced, and psychiatric causes of catatonia have been reported. We present a unique case of late onset catatonia in a 56-year-old man with no prior medical or psychiatric history initially presenting with stroke-like symptoms.
Overuse of energy drinks: why death? Hossein Sanaei-Zadeh
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.009
The American Journal of Emergency Medicine , Vol. 31 , Issue 12 ,
Published online: October 21 2013
x I read with interest the case presented by Avcı et al [1] published in your journal. The authors present a 28-year-old man who collapsed 5 hours after the consumption of three 250-mL energy drinks (almost 240 mg of caffeine) during a basketball match. Fifteen minutes later, he was brought to the emergency department with ventricular tachycardia (VT) restoring to normal sinus rhythm with cardioversion. His arterial blood gas showed metabolic acidosis, and in the echocardiography, he had anteroseptal and left ventricular hypertrophy.
