Spotted lipid sign floating on the blood to differentiate obscured open fractures from simple wound lacerations Mucahit Emet, Kenan Atac, Ali Aydın, Nasuhi Altay, Murat Saritemur
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.009
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: August 7 2014
x Open fractures are not so obvious sometimes, and in the case of multiorgan injuries, they may be misdiagnosed in emergency department. Here, we report a 48-year old man with motor vehicle crash injury. There were ominous facial, vertebral, thoracic, and abdominal injuries as well as distal femoral shaft fracture and multiple skin lacerations in different parts of the body in the initial examination. On the tertiary examination, we incidentally caught an important finding showing an open fracture: oily (greasy) bleeding from the wound (Video 1, Fig. 1 and 2).
In vitro efficacy testing of a novel high-pressure wound irrigator Emma K. Crill, Ian Marriott
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.044
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: June 6 2015
x The incidence of traumatic skin injuries in the United States is estimated to range from 4 to 14 million emergency department (ED) visits per year [1]. Such cases often present late after transport delays or long ED wait times, and delays beyond 6 hours foster continual propagation of the residing bacterial population [2]. Effective treatment of these wounds therefore requires the successful removal of colonizing bacteria, and saline irrigation can substantially improve the clinical outcome of even the most contaminated wounds [3].
Novel technique to diagnose parotid duct injuries at the bedside using fluorescein David T. Montag, Ashok R. Jethwa, Rick M. Odland
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.017
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 15 2015
x Deep penetrating facial soft tissue trauma can potentially involve the parotid duct. This injury requires a high degree of suspicion as it is not readily evident on physical examination, although buccal branch injury may accompany it. Unrecognized parotid duct injury could lead to sialocele, salivary fistula, parotitis, wound dehiscence, or abscess [1]. There are multiple methods of detecting parotid duct injury at the bedside. The most frequently utilized method is cannulation of the papilla with identification of the cannulating object in the wound [2].
Effective prevention of posttraumatic tattoo using hydrosurgical debridement in the ED Jung Soo Park, Jin Hong Min
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.033
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: August 18 2015
x Traumatic tattoos can result from the accidental deposition of foreign particles in the dermis. These pigmented particles can become permanently lodged in the dermis after wound re-epithelialization and lead to irregular black or blue skin discoloration. Different methods exist for tattoo removal. The best strategy is to prevent traumatic tattoo formation by immediately removing the foreign particles before the healing process begins. Here, we present a fine-tuned, hydrosurgical debridement system to selectively debride wounds and preserve as much viable tissue as possible.
Subject Index
DOI: http://dx.doi.org/10.1016/S0735-6757(15)00997-3
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published in issue: December 2015
Stove-related injuries treated in EDs in the United States, 1990-2010 Anita Sivam, Lynne M. Rochette, Gary A. Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.034
The American Journal of Emergency Medicine , Vol. 31 , Issue 11 ,
Published online: September 16 2013
x Household stoves are a common source of injury in the United States.
Cervical spine immobilization may be of value following firearm injury to the head and neck Sebastian D. Schubl, R. Jonathan Robitsek, Christian Sommerhalder, Kimberly J. Wilkins, Taylor R. Klein, Scott Trepeta, Vanessa P. Ho
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.014
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: January 20 2016
x Penetrating injuries to the head and neck may not be able to cause unstable fractures without concomitant spinal cord injury, rendering prehospital spinal immobilization (PHSI) ineffectual, and possibly harmful. However, this premise is based on reports including predominantly chest and abdominal injuries, which are unlikely to cause cervical spine (CS) injuries.
Epidemiology of injuries to wildland firefighters Carla Britton, Charles F. Lynch, Marizen Ramirez, James Torner, Christopher Buresh, Corinne Peek-Asa
DOI: http://dx.doi.org/10.1016/j.ajem.2012.08.032
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: November 19 2012
x Wildland fires have significant ecologic and economic impact in the United States. Despite the number of firefighters involved in controlling them, little is known about the injuries that they sustain. We hypothesized that the mechanism of injury would predict injury characteristics and severity of fire-related injuries.
Prehospital trauma arrival notification associated with more image studies in patients with minor head trauma discharged from ED Shujun Xia, Thomas Perera, Ethan Cowan, Michael P. Jones, Adrienne Birnbaum
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.024
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: February 19 2015
x The objective of this study was to determine whether prehospital trauma arrival notification was associated with more head computed tomography (CT) scans and image studies performed in patients with minor head trauma and discharged from emergency department (ED).
Respiratory depression in the intoxicated trauma patient: are opioids to blame? Eleni Shenk, Cassie A. Barton, Nathan D. Mah, Ran Ran, Robert G. Hendrickson, Jennifer Watters
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.053
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: November 3 2015
x Providing effective pain management to acutely intoxicated trauma patients represents a challenge of balancing appropriate pain management with the risk of potential respiratory depression from opioid administration. The objective of this study was to quantify the incidence of respiratory depression in trauma patients acutely intoxicated with ethanol who received opioids as compared with those who did not and identify potential risk factors for respiratory depression in this population. Retrospective medical record review was conducted for subjects identified via the trauma registry who were admitted as a trauma activation and had a detectable serum ethanol level upon admission.
Rapid Emergency Medicine Score as a main predictor of mortality in Vibrio vulnificus –related patients Sheng-Hung Kuo, Chin-Feng Tsai, Chi-Rong Li, Shih-Jei Tsai, Wai-Nang Chao, Khee-Siang Chan, Yuan-Ti Lee, Ruey-Hong Wong, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.030
The American Journal of Emergency Medicine , Vol. 31 , Issue 7 ,
Published online: May 22 2013
x Vibrio vulnificus causes potentially life-threatening and rapidly progressing infections. Therefore, the severity-of-illness assessment appears to be important for V vulnificus –infected patients at the time of admission. The aim of our study was to evaluate the performance of the severity-of-illness scoring model on admission in V vulnificus –infected patients.
Benefits of CT tractography in evaluation of anterior abdominal stab wounds Tamer Ertan, Yusuf Sevim, Talha Sarigoz, Omer Topuz, Baki Tastan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.018
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: May 29 2015
x The study aimed to identify the presence of peritoneal penetration in management of anterior abdominal stab wound by using computed tomography (CT) tractography.
Gauze vs XSTAT in wound packing for hemorrhage control John F. Kragh Jr., James K. Aden, John Steinbaugh, Mary Bullard, Michael A. Dubick
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.048
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: March 25 2015
x Hemorrhage is the primary cause of mortality on the battlefield [1,2], and packing of subfascial, cavitary wounds by US combat medics is a common way to control out-of-hospital hemorrhage. The objectives of the present study are 2-fold: (1) to improve awareness of the mechanics of wound packing for hemorrhage control, and (2) to compare wound packing with standard gauze vs a new product of expanding sponges.
Significance of the vacuum phenomenon in patients with trauma evaluated by whole-body computed tomography Kazuhiko Omori, Kouhei Ishikawa, Mariko Obinata, Kentaro Mishima, Shin Fukusato, Hiromichi Ohsaka, Yasumasa Oode, Youichi Yanagawa
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.055
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: December 3 2014
x Severely traumatized patients undergo whole-body computed tomography (WCT) to detect lethal anatomical injuries. When checking the images, we have sometimes recognized minute gas (the vacuum phenomenon [VP]) near the traumatized lesions. Accordingly, we investigated the significance of the VP in patients with trauma.
The characteristics and correlation between the ischemia-reperfusion and changes of redox status in the early stage of severe burns Lizhu Zhi, Xinlei Hu, Jun Xu, Chaoheng Yu, Huawei Shao, Xuanliang Pan, Hang Hu, Chunmao Han
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.026
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: November 28 2014
x Both the ischemia-reperfusion injury and the abnormal changes of redox status are the important pathologic changes in the burn shock stage for severe burns. The study of clinical dynamic, quantitative relevance about them was performed.
An urban Northeastern United States alligator bite Suzanne Moore Shepherd, William H. Shoff
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.004
The American Journal of Emergency Medicine , Vol. 32 , Issue 5 ,
Published online: November 11 2013
x Individuals who live and work in the Southeastern coastal range of the 3 US crocodilian carnivores, American alligators, American crocodiles, and caiman, understand the risks of reptile-human encounters. Individuals who live in other parts of the country may be exposed through contact with exotic pets at private homes, small menageries, or petting zoos or from escaped or abandoned animals. During these encounters, individuals may be severely injured. Emergency medical services, law enforcement, and animal welfare workers in nonhabitat areas are usually not trained in the handling and safe removal of injured individuals from the scene when the reptile is present.
A fish-stunning wound infection with acute cardiac injury Khee-Siang Chan, Kuo-Chen Cheng, Mei-Feng Lee, Wen-Liang Yu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.040
The American Journal of Emergency Medicine , Vol. 32 , Issue 3 ,
Published online: October 31 2013
x Vibrio vulnificus typically causes septicemia and necrotic wound infection. Among V vulnificus– related complications, acute nonthrombotic myocardial damage has not been reported. The most effective antibiotic treatment of V vulnificus infection includes combination of a third-generation cephalosporin and a tetracycline or its analogue. However, recommendations of a fourth-generation cephalosporin-based regimen for treating the disease are not established. A 67-year-old diabetic man acquired V vulnificus infection via a fish-stunning wound on the right foot.
Application of the shock index to the prediction of need for hemostasis intervention Jonas P. DeMuro, Susan Simmons, Judy Jax, Scott M. Gianelli
DOI: http://dx.doi.org/10.1016/j.ajem.2013.05.027
The American Journal of Emergency Medicine , Vol. 31 , Issue 8 ,
Published online: June 26 2013
x The traditional method to identify hemorrhage after trauma has been vital signs–based. More recent attempts have used mathematical prediction models, but these are limited by the need for additional data including a Focused Assessment with Sonography for Trauma exam, or an arterial blood gas. Shock Index (SI) is the mathematical relationship of the heart rate divided by the systolic blood pressure; the cutoff of >
Leg and Abdominal Impalement With Rebar John P. Sarwark, Danielle M. McCarthy, Charles Pearce, Akhil Seth, Nabil Issa
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.006
The American Journal of Emergency Medicine , Vol. 33 , Issue 8 ,
Published online: January 16 2015
x Although abdominal impalement injuries are less common than other types of penetrating trauma (eg, gunshot wounds), these injuries present providers with a unique set of challenges.
Closed traumatic finger tip injuries in patients with artificial nails: removal of UV gel and acrylic nails Joseph A. Gil, Steven DeFroda, Daniel Reid, P. Kaveh Mansuripur
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.014
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: November 9 2015
x Traumatic fingertip injuries are exceedingly common and often times very easy to diagnose based on mechanism and visual inspection [1]. The presence of artificial nails, however, can mask the presentation of an underlying nail bed injury. In addition, they can theoretically increase the risk of infection in the setting of nail bed laceration over a fracture as artificial nails have been shown to harbor pathogens in a number of studies [2-4]. Although obvious crush injuries result in marked deformity of the digit, more subtle mechanisms may result in a nail bed laceration that presents solely as a subungual hematoma.
