Jeong Ho Park, Ki Ok Ahn, Sang Do Shin, Won Chul Cha, Hyun Wook Ryoo, Young Sun Ro, Taeyun Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.058
Published online: December 22 2015
xInterhospital transfer delays for ST-elevation myocardial infarction (STEMI) patients requiring primary percutaneous coronary intervention (PCI) may be shortened by improved regional care systems. We evaluated the transfer process and first door-to-balloon (D1toB) time in STEMI patients who underwent interhospital transfer for primary PCI.
Huibao Long, Bincan Xu, Yanling Luo, Keqin Luo
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.075
Published online: December 29 2015
xNLRP3 inflammasome activation is recently reported to be linked to the pathogenesis of sepsis. Artemisinin is shown to play beneficial effects in sepsis. However, the impacts of artemisinin on burn sepsis have not been investigated. This study is designed to investigate the role of artemisinin in burn sepsis and the involvement of NLRP3 inflammasome activation.
Yan-Bing Gao, Jun-Hong Yan, Jian-Min Ma, Xiao-Na Liu, Jing-Yun Dong, Fang Sun, Li-Wei Tang, Jie Li
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.092
Published online: January 5 2016
xCurrently, whether long-axis in-plane (LA-IP) is superior to short-axis out-of-plane (SA-OOP) during ultrasound-guided vascular access remains inconclusive. We, therefore, conducted a meta-analysis of randomized controlled trials to compare the effects of LA-IP vs SA-OOP techniques in patients undergoing ultrasound-guided vascular access (USGVA).
Soumitra S. Bhuyan, Yang Wang, Jay Bhatt, S. Edward Dismuke, Erik L. Carlton, Dan Gentry, Chad LaGrange, Cyril F. Chang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.089
Published online: January 5 2016
xThe United States (US) is the only developed country that does not guarantee short-term or longer-term paid sick leave.
Margaret Story, Bradford Reynolds, Meghan Bowser, Hongyan Xu, Matthew Lyon
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.083
Published online: January 5 2016
xOutpatient stress testing (OST) after evaluation in the emergency department (ED) is an acceptable evaluation method for patients presenting to the ED with low-risk chest pain (CP). However, not all patients return for OST. Barriers to follow-up evaluation exist and are poorly understood. In this study, we examined the influence of demographic and social characteristics on OST compliance.
Seyyid Bilal Acikgoz, Ahmet Bilal Genc, Savas Sipahi, Mehmet Yildirim, Behice Cinemre, Ali Tamer, Yalcin Solak
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.003
Published online: January 6 2016
xSeveral studies investigated the agreement between central laboratory biochemistry analyzers and blood gas analyzers for potassium measurements. However, data are scarce when the potassium level is moderate to severely high. We aimed to evaluate the agreement between central laboratory biochemistry analyzers and blood gas analyzer in terms of serum potassium level measurement because differences in potassium at this level translate into very different clinical actions.
Sharon E. Mace
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.002
Published online: January 6 2016
xTopical anesthetics are used to decrease procedural pain such as venipuncture. Advantages of vapocoolants include rapid onset, ease of application, low cost, and lack of associated pain of injection and other needlestick-related risks. We hypothesized that the pain of venipuncture would be reduced by at least 1.8 points on a 10-point numerical rating scale after application of a vapocoolant compared with placebo.
Allison Tadros, Shelley M. Layman, Marissa Pantaleone Brewer, Stephen M. Davis
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.012
Published online: January 11 2016
xA 2005 study examined emergency department (ED) utilization by homeless patients in the United States. Within the following 5 years, unemployment increased by 5%.
Ersin Aksay, Turgay Yılmaz Kilic, Murat Yesılaras, Feriyde Calıskan Tur, Mustafa Sever, Onder Kalenderer
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.010
Published online: January 12 2016
xDiagnosis of bone fractures by ultrasonography is becoming increasingly popular in emergency medicine practice. We aimed to determine the diagnostic sensitivity and specificity of point-of-care ultrasonography (PoCUS) compared with plain radiographs in proximal and middle phalanx fractures.
Christopher L. Hunter, Salvatore Silvestri, George Ralls, Amanda Stone, Ayanna Walker, Linda Papa
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.017
Published online: January 20 2016
xTo determine the utility of a prehospital sepsis screening protocol utilizing systemic inflammatory response syndrome (SIRS) criteria and end-tidal carbon dioxide (ETCO2).
Cara Bergamo, Elizabeth Juarez-Colunga, Roberta Capp
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.023
Published online: January 20 2016
xAdult Medicaid enrollees are more likely to have mental health disorders (MHDs) than privately insured patients and also have high rates of emergency department (ED) visits for ambulatory care–sensitive conditions (ACSCs). We aimed to evaluate the association of MHD and insurance type with ED admissions for ACSC in the United States.
Tomohiro Sonoo, Satoshi Iwai, Ryota Inokuchi, Masataka Gunshin, Susumu Nakajima, Naoki Yahagi
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.021
Published online: January 22 2016
xPlasma lactate concentration is known to increase after alcohol intake. However, this increase has rarely been analyzed quantitatively in emergency department (ED) settings. Evaluating plasma lactate elevation in ED patients after alcohol intake is important because it can affect patients' evaluation based on the plasma lactate level.
Jessica Moe, Justin Brett Belsky
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.015
Published online: January 25 2016
xMany patients leave the Emergency Department (ED) before beginning or completing medical evaluation. Some of these patients may be at higher medical risk depending on their timing of leaving the ED.
Paisit Nakprasert, Khrongwong Musikatavorn, Dhanadol Rojanasarntikul, Khuansiri Narajeenron, Patima Puttaphaisan, Suthaporn Lumlertgul
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.013
Published online: January 20 2016
xAlthough emergency department (ED) patients with asymptomatic severe hypertension (ASH) generally have no serious short-term hypertension-related adverse events, it is unclear whether persistently high discharge blood pressure (BP) affects the outcome due to the dynamic nature of BP.
Hakki Kaya, Abuzer Coşkun, Osman Beton, Ali Zorlu, Recep Kurt, Hasan Yucel, Hakan Gunes, M. Birhan Yılmaz
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.036
Published online: February 12 2016
xThere are several studies evaluating the cardiac effects of carbon monoxide (CO) poisoning during the acute period; however, the number of studies evaluating the long-term cardiac effects is limited.
Kurt Fossum, Sue L. Love, Michael D. April
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.039
Published online: February 12 2016
xTo compare pain associated with venous catheterization after administration of topical ethyl chloride vs placebo among emergency department health care providers.
Eun-Hee Kim, Ji-Hyun Lee, In-Kyung Song, Hyun-Chang Kim, Hee-Soo Kim, Jin-Tae Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.038
Published online: February 11 2016
xThe first step for successful ultrasound (US)–guided subclavian vein (SCV) catheterization using a supraclavicular approach is to obtain a good longitudinal image of SCV for in-plane needle placement. We evaluated the efficacy of caudal traction of ipsilateral arm on the exposure of the SCV.
Julien G. Cohen, Yvonnick Boué, Bastien Boussat, Emilie Reymond, Sylvie Grand, Marc Blancher, Gilbert R. Ferretti, Pierre Bouzat
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.037
Published online: February 11 2016
xBrain anoxia after complete avalanche burial and cardiac arrest (CA) may occur despite adequate on-site triage.
Junaid A. Bhatti, Avery B. Nathens, Deva Thiruchelvam, Donald A. Redelmeier
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.007
Published online: February 12 2016
xThis study assessed long-term emergency care utilization after weight loss surgery.
Can Akyol, Faruk Gungor, Angelika Janitzky Akyol, Mustafa Kesapli, Ramazan Guven, Umut Cengiz, Halil İbrahim Toksul, Cenker Eken
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.006
Published online: February 15 2016
xPoint-of-care ultrasonography (POCUS) is an easily available and noninvasive tool without radiation exposure that is also gaining a broad range of use in emergency departments. The aim of this study is to evaluate the value of POCUS in the diagnosis of shoulder dislocation by comparing with plain radiography.
J. Benito, Y. Acedo, L. Medrano, E. Barcena, R. Perez Garay, E. Arana Arri
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.011
Published online: February 11 2016
xThe objective of the study is to evaluate the usefulness of the leukocyte (white blood count [WBC]) and neutrophil (absolute neutrophil count [ANC]) counts; the values of C-reactive protein (CRP), procalcitonin, and calprotectin (CP); and the APPY1 Test panel of biomarkers, to identify children with abdominal pain at low risk for appendicitis.
Y.K. Wong, C.T. Lui, K.K. Li, C.Y. Wong, M.M. Lee, W.L. Tong, K.L. Ong, S.Y.H. Tang
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.009
Published online: February 12 2016
xThe objective was to determine the accuracy of the outcome predictive scores (Modified Early Warning Score [MEWS]; Hypotension, Low Oxygen Saturation, Low Temperature, Abnormal ECG, Loss of Independence [HOTEL] score; and Simple Clinical Score [SCS]) in predicting en-route complications during interfacility transport (IFT) in emergency department.
Shaker Hossein, Akhavan Pegah, Farsi Davood, Abbasi Said, Mahshidfar Babak, Mofidi Mani, Rezai Mahdi, Hafezimoghadam Peyman
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.024
Published online: January 20 2016
xThirty percent of people with asthma do not respond to standard treatment, and complementary therapies are needed. The objective of this study was to investigate the impact of inhaled magnesium sulfate on the treatment response in emergency department (ED) patients with moderate to severe attacks of asthma.
Mohammad Fazel Bakhsheshi, Lynn Keenliside, Ting-Yim Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.001
Published online: February 10 2016
xVortex tubes are simple mechanical devices to produce cold air from a stream of compressed air without any moving parts. The primary focus of the current study is to investigate the feasibility and efficiency of nasopharyngeal brain cooling method using a vortex tube. Experiments were conducted on 5 juvenile pigs. Nasopharygeal brain cooling was achieved by directing cooled air via a catheter in each nostril into the nasal cavities. A vortex tube was used to generate cold air using various sources of compressed air: (I) hospital medical air outlet (n = 1); (II) medical air cylinders (n = 3); and (III) scuba (diving) cylinders (n = 1).
Matthew A. Weeks, Erin P. Clark, Mark B. Mycyk
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.005
Published online: February 11 2016
xLimited data suggest that heroin worsens asthma severity, but little is known about heroin-dependent patients who seek emergency department (ED) care for asthma.
Kouichiro Minami, Yota Kokubo, Ichinosuke Maeda, Shingo Hibino
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.052
Published online: February 25 2016
xFeedback devices are used to improve the quality of chest compression (CC). However, reports have noted that accelerometers substantially overestimate depth when cardiopulmonary resuscitation (CPR) is performed on a soft surface. Here, we determined whether a flexible pressure sensor could correctly evaluate the depth CC performed on a mannequin placed on a mattress.
John E. Madias
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.002
Published online: December 11 2013
xPrompt differentiation of Takotsubo syndrome (TTS) from acute coronary syndromes (ACS) is crucial in the management of patients presenting with chest pain/dyspnea/palpitations/weakness/dizziness/presyncope/syncope in the emergency department (ED), since it is imperative that the latter receive expedited therapy with thrombolysis or percutaneous coronary interventions, while the former are cared for along the lines of symptomatic nonspecific management, until we know more about the pathogenesis of TTS [1].
Daria Falkowitz, Stephen Alerhand, Mark Su
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.011
Published online: January 13 2016
xWe read the article with great interest by Sircar et al, which characterized unintentional, non–fire-related (UNFR) carbon monoxide (CO) poisoning deaths in the United States
[1]
. We commend the authors' efforts in their attempt to identify at-risk populations and risk stratify patients based on demographic factors. This information would be vital to prevention.
John Papanikolaou, Konstantinos Spathoulas, Demosthenes Makris, Triantafillia Koukoubani, Epaminondas Zakynthinos
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.041
Published online: February 12 2016
xWe have read with great interest the recent review by Varvarousi et al
[1]
on the role of levosimendan in the clinical setting of aneurysmal subarachnoid hemorrhage (SAH). Previous work by us
[2]
and others
[3,4]
proposed depressed cardiac output (CO), mainly attributed to catecholamine-mediated myocardial dysfunction, as a critical determinant of delayed cerebral ischemia (DCI) and poor neurologic outcome. In this respect, rapid hemodynamic augmentation, with either levosimendan
[5]
or other agents
[6]
, has the potential to reverse cerebral ischemia and prevent further brain damage.
Andrew Moffat, Frank Lovecchio
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.025
Published online: January 27 2016
xCoccidioidomycosis is a fungal infection found in Arizona, California, New Mexico, Texas, northern Mexico and other areas of similar climate in South America
[1]
. The state of Arizona diagnoses 60% of cases nationwide per year
[3]
. Over the last five years coccidioidomycosis patients have presented to the Maricopa Medical Center Emergency Department in Phoenix, Arizona with a variety of chief complaints. Review of each patient's history revealed several similarities between presentations of the disease.
Shailendra Kapoor
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.040
Published online: February 12 2016
xA rare variant of Stevens-Johnson syndrome [1] that is rarely mentioned is “Fuchs syndrome” (FHS).
Sumit Gupta, Pushpendra Singh, Kapil D. Soni, Richa Aggarwal, Devender Yadav
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.019
Published online: February 12 2016
xWe hereby describe the case of a patient of post–cervical spine fixation. The patient was quadriplegic after road traffic accident and underwent anterior and posterior cervical spine fixation. The patient had hypoxic cardiac arrest in perioperative period due to refractory bronchospasm and required mechanical ventilation. However, she did not improve neurologically and needed tracheostomy for expected prolonged mechanical ventilation.
Ali Attila Aydin, Sedat Bilge, Murtaza Kaya, Guclu Aydin, Orhan Cinar
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.032
Published online: February 12 2016
xDistal radius fractures (DRFs) of the wrist are the most common upper extremity fracture presented to an emergency department (ED). Distal radius fracture, requiring manipulation and reduction, is frequently encountered in the ED. Several methods have been used for pain management during the procedure. These include peripheral nerve block (PNB), hematoma block (HB), intravenous regional anesthesia (IVRA), procedural sedation analgesia (PSA), nitrous oxide and general anesthesia
[1]
. Ultrasound (US)–guided PNBs, performed by emergency physicians, have gradually gained a place in emergency practice.
Lukasz Szarpak, Zenon Truszewski, Robert Gałązkowski, Lukasz Czyzewski
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.029
Published online: February 12 2016
xChest compression (CC) quality is decisive for survival and good neurologic outcome of patients in sudden cardiac arrest
[1,2]
. Both the 2015 European Resuscitation Council and American Heart Association guidelines advise the CC should be performed at recommended depth and rate
[1,3]
. According to Kurowski et al chest compressions are often too shallow, and hands-of time is to long
[4]
. This issue becomes even more complicated by the need of the rescuer to wear chemical, biological, radiations, nuclear, personal protective equipment (CBRN-PPE) which adversely affects fine motor skills
[5]
.
Amy Funkenstein, Stephanie Hartselle, J. Wesley Boyd
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.027
Published online: February 12 2016
xFour million children and adolescents in the US suffer from a serious mental disorder that causes significant functional impairments at home, at school and with peers [1]. In any given year, only 20% of children with mental disorders are identified and receive mental health services [2]. In youth, many of these disorders can have life-long deleterious effects.
Ben McCartney, Paula McQuail, Peter Garrett
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.018
Published online: February 12 2016
xIt appears that there is benefit with thrombolysis in ST-elevation myocardial infarction (STEMI) and hemodynamically unstable pulmonary embolism (PE) [1,2]. In cardiac arrest the evidence is inconclusive although there is a robust biological rationale [1,2]. TROICA (Thrombolysis for Out of Hospital Cardiac Arrest), a large double-blinded randomized placebo controlled trial showed no difference in 30-day mortality between thrombolysis and placebo group [3]. However, anti-thrombotics and salicylates weren't given with the fibrinolytic agent in the TROICA trial, and multiple case reports and animal studies in the literature did show benefit in return of spontaneous circulation and neurological outcome in subjects given thrombolysis [4,5].
Zenon Truszewski, Lukasz Szarpak, Andrzej Kurowski, Togay Evrin, Marcin Madziała, Lukasz Czyzewski
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.025
Published online: February 12 2016
xAfter sudden cardiac arrest, high-quality chest compressions (CCs) are required to improve the chance of restoring spontaneous circulation [1,2]. Unfortunately, even health care professionals have difficulty in performing effective CC. According to Wik et al [3], CCs are often too shallow, and hands-off time is to long. This is also confirmed from a research conducted by Kurowski et al [4]. Because mechanical CC devices may improve the efficiency of CC, in this study we use a new mechanical CC device—LifeLine ARM (ARM; DefibTech, Guilford, CT)—which was designed to deliver compressions of consistent rate and depth according to European Resuscitation Council guidelines [1,2].
Yoon Je Lee, Hyuk Joong Choi, Tae Ho Lim, Sang Hyun Lee, Se Jin Hwang
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.016
Published online: February 12 2016
xIn general, a chest tube is inserted for drainage to treat conditions such as pneumothorax, hemothorax, and pyothorax. Because of the clinical usefulness of closed thoracostomies, the ability to perform this procedure is an essential skill for not only physicians who treat trauma patients but also general surgeons and emergency physicians [1–2]. In this method, there is a lengthy period between incision and chest tube insertion (CTI); as a result, air within the thoracic cavity can leak out to reexpand the lung, which may increase the possibility of lung injury caused by the chest tube.
Łukasz Szarpak, Zenon Truszewski, Robert Gałązkowski, Togay Evrin, Łukasz Czyzewski
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.003
Published online: February 12 2016
xThe ability to intubate the patient is one of the key skills they should possess as paramedics
[1,2]
. Standard endotracheal intubation (ETI), when patient is lying on his back and intubation is located behind the patient's head, is one of the most commonly used techniques for ETI
[3,4]
. However, the technique of intubation is not always possible; therefore, paramedics should be able to intubate using other techniques. Face-to-face (FTF) intubation technique is usually performed in EMS when patient is found in a position that makes the performance of standard intubation difficult, such as when a patient is trapped in a seated position in a car
[5]
.
Hidetaka Tamune, Takaie Kuki
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.030
Published online: February 11 2016
xWe read with great interest the recent case report entitled “Streptococcus pneumoniae meningitis without pleocytosis of the cerebrospinal fluid” by Sato et al [1]. The patient had a small spleen (6 × 2 × 1 cm) requiring prompt treatment, as duly administered by the authors. We would like here to propose that the patient with small spleen should be considered as a potentially immunocompromised patient.
Turgay Celık, Cengiz Ozturk, Sevket Balta, Sait Demırkol, Atila Iyısoy
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.035
Published online: February 11 2016
xWe have read with great interest the recently published article by Burgert and coworkers entitled “The effects of proximal and distal routes of intraosseous epinephrine administration on short-term resuscitative outcome measures in an adult swine model of ventricular fibrillation: a randomized controlled study”
[1]
. In that well-designed animal study, the authors tried to explore the relationships between the anatomical distance of intraosseous (IO) epinephrine injection and measures of resuscitative outcome in an adult swine model of ventricular fibrillation.
Zenon Truszewski, Silvia Samarin, Łukasz Czyzewski, Togay Evrin, Łukasz Szarpak
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.034
Published online: February 12 2016
xEndotracheal intubation is one of the key skills that should be possessed by every physician in Emergency Medicine as well as every paramedic [1]. For confirming endotracheal tube (ET) placement, there are multiple options, including direct visualization of the vocal cords, observation of chest auscultation, or chest expansion [2]. However, each of those methods has unique limitations, particularly during CPR, because observation of chest movements requires interruption in chest compression. According to the American Heart Associate 2015 guidelines for CPR, capnography is recommended as the criterion standard for confirming correct ET placement; however, this method has also limitations, especially in patients in cardiac arrest.
Funda Sungur Biteker, Selmin Dirgen Çaylak, Hamdi Sözen
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.028
Published online: February 12 2016
xWe have greatly enjoyed reading the recently published article by Yao et al
[1]
entitled “Higher serum level of myoglobin could predict more severity and poor outcome for patients with sepsis.” We thank them for sharing their experience; however, we have some concerns about the article. Patients with severe sepsis or septic shock have a high mortality
[2]
. The pathophysiology of sepsis may link to multiple mechanisms and is commonly associated with myocardial dysfunction
[3]
. Therefore, a prognostic evaluation is of importance for the outcome of patients with severe sepsis or septic shock.
Fernanda Duarte, Sharon Einav, Joseph Varon
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.042
Published online: February 15 2016
xMost studies show that less than one fifth of people who undergo cardiopulmonary resuscitation (CPR) are discharged from hospital and many survivors suffer some degree of functional and/or cognitive impairment
[1,2]
. Patients undergoing CPR in television (TV) series differ significantly from real-life cases, in terms of pre-event variables which may affect the likelihood of success. For example, many of them are younger and have unlikely causes of arrest
[3,4]
. Regardless of pre-event and event variables, both television and the press depict unrealistically good outcomes from CPR
[5,6]
.
Takuro Sanuki, Nobuyasu Komasawa, Shinji Kurata, Takao Ayuse
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.044
Published online: February 20 2016
xThe medical simulation application, SimMon (Castle Andersen ApS, DK), is a screen-based simulator application that mimics a vital signs monitor that can reproduce a variety of pathologies by altering blood pressure, heart rate, and ECG data. In the present study, we investigated the educational benefits of including simulations using the SimMon application in slide-based lectures on systemic events occurring during dental treatment.
Eric M. Rottenberg
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.056
Published online: February 25 2016
xI read with great interest the letter by Nishant and colleagues
[1]
in response to the meta-analysis by Akihisa and colleagues
[2]
regarding the effects of sniffing position for tracheal intubation. Nishant and colleagues suggested that changes in glottic exposure due to positioning are likely to be subtle and that the vast majority of the Cormack Lehane grades are the same in either position. Therefore, using this scale, one position may not prove to be better than the other despite it giving consistently better exposures when compared with the other.
Zenon Truszewski, Łukasz Szarpak, Jacek Smereka, Andrzej Kurowski, Togay Evrin, Łukasz Czyzewski
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.054
Published online: February 26 2016
xAirway management is one of the key skills required by paramedics
[1,2]
. The standard for definitive airway management is direct laryngoscopy and endotracheal intubation (ETI). The most common method of intubation is the aforementioned direct laryngoscopy using a laryngoscope with Miller or Macintosh blades. However, getting a good glottis visibility using direct laryngoscopy in patients trapped in the vehicle can be problematic
[2]
. Therefore, it seems reasonable to search for alternative methods of intubation of patients.
Mustafa Aparci, Omer Uz, Zafer Isilak
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.051
Published online: February 23 2016
xWe have read the case report of Patricia et al [1], titled ”Achieving ventricular rate control using metoprolol in beta-blocker naive patients versus patients on chronic beta-blocker therapy” with great interest. The authors reported that intravenous metoprolol for the treatment of atrial fibrillation with rapid ventricular rate was associated with a higher probability treatment response in patients considered β-blocker–naïve compared with patients receiving chronic β-blocker therapy.
Ran Ran, Patricia Kuang, Nathan D. Mah
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.050
Published online: February 23 2016
xThe commenters raise excellent points. We also share their perspective that several different disease processes can independently result in atrial fibrillation with rapid ventricular response. It is clinically important to distinguish the underlying etiologies in order to select the appropriate treatment. This author considers 3 physiologic states when faced with atrial fibrillation (Afib) with rapid ventricular response (RVR).
Mustafa Aparci, Omer Uz, Ejder Kardesoglu, Mehmet Uzun
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.071
Published online: February 29 2016
xWe have read the case report of Carpagnano et al entitled “Big atria, little P-waves: unexpected mismatch between chamber volume and electrocardiogram signal in ‘false’ atrial fibrillation” with great interest
[1]
. The authors reported an elderly patient whose severely enlarged atria (larger than ventricles) and severe mitral regurgitation mismatched with very small P-waves on the electrocardiogram, so small to go unseen at first hasty examination. We have some suggestions related to this issue.
