Łukasz Szarpak, Zenon Truszewski, Jacek Smereka, Togay Evrin, Łukasz Czyzewski
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.062
Publication stage: In Press Corrected Proof
Published online: March 1 2016
x Patients with trauma present unique airway management concerns. Conventional oral intubation with manual in-line stabilization (MILS) is still the most effective approach for early control of the airway in trauma [1]. However, there are situations in which access to the patient is difficult and direct viewing of the airways is impossible [2,3]. Such a situation might be encountered when a patient requires intubation when trapped in a vehicle [4]. In such cases, alternative methods of endotracheal intubation can be used, including videolaryngoscopy or video tubes, ie, the ETView VivaSight-SL (ETView Ltd., Misgav, Israel).
Łukasz Szarpak, Zenon Truszewski, Jacek Smereka
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.061
Publication stage: In Press Corrected Proof
Published online: February 29 2016
x We read with great interest the paper by Cho et al [1] describing needle guides for venous catheter insertion during chest compressions. They use needle guides during ultrasound-guided central venous catheterization (CVC) with and without chest compressions on manikin. Catheterization was performed by anesthesiologists stuff.
Tsung-Han Ho, Fu-Chi Yang, Hung-Wen Kao, Sy-Jou Chen, Jiunn-Tay Lee, Liang-Wei Wen, Heng-Cheng Chu, Jiann-Chyun Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.065
Publication stage: In Press Corrected Proof
Published online: February 29 2016
x Leptomeningeal carcinomatosis is an atypical behavior of cancer as a consequence of infiltration of malignant cells into the leptomeninges. Leptomeningeal carcinomatosis may share similar clinical manifestations with other etiologies involving the leptomeninges such as infectious meningitis or meningoencephalitis. We present a diagnostic pitfall of acute leptomeningeal carcinomatosis from a latent gastric cancer in a 28-year-old woman presenting with being rapidly comatose and an initial misdiagnosis of bacterial meningitis.
Łukasz Szarpak, Zenon Truszewski, Andrzej Kurowski, Silvia Samarin, Togay Evrin, Piotr Adamczyk, Łukasz Czyzewski
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.063
Publication stage: In Press Corrected Proof
Published online: February 29 2016
x We read with great interest an article published in The American Journal of Emergency Medicine by Komut et al titled “Bedside sonographic measurement of optic nerve sheath diameter as a predictor of intracranial pressure in Emergency Department” [1]. We congratulate the authors for great work on how important medical problem, which is the prediction of increased intracranial pressure (IIP). Research conducted by Komut et al confirms the results of research carried out by us. In our Emergency Department, ultrasonography is also used to evaluate optic nerve sheath (ONS).
Saher Iftikhar, Amal Mattu, William Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.060
Publication stage: In Press Corrected Proof
Published online: February 29 2016
x Patients with implantable cardiac defibrillators not infrequently present to the emergency department after experiencing an implantable cardiac defibrillator shock. This review considers the management of such patients in the emergency department, including appropriate, inappropriate, and phantom shocks as well as electrical storm.
Takeshi Ueno, Nobuyasu Komasawa, Takanobu Fujisawa, Tomoki Yamasaki, Toshiaki Minami
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.067
Publication stage: In Press Corrected Proof
Published online: February 29 2016
x The polyvinyl chloride (PVC) type face mask has been a standard model for administering oxygen postoperatively. Recently, a polypropylene-based face mask, EcoLite (“EcoLite”; Sentri Intersurgical Ecolite adult mask with CO2 monitoring and tube, Intersurgical, Berkshire, UK), which has a new shape, was developed. We conducted a prospective crossover study in healthy individuals to evaluate the efficacy of oxygenation with the EcoLite and conventional PVC medium concentration face mask with a luer lock connector enabling the connection of a monitoring line, the other end of which is connected to a capnometer.
Katelin M. Morrissette, Norman A. Paradis
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.070
Publication stage: In Press Corrected Proof
Published online: February 29 2016
x The article by Fei Han et al in this issue of the Journal may be an important bit of bench science. In a rodent model of global ischemia, they found that both the moderate-sized (cyclic non-ribosomal peptide) pharmaceutical drug cyclosporine and therapeutic hypothermia appear to blunt reperfusion related neuroinjury through similar mechanisms. Even more intriguingly, Fei Han et al provide a first indication that the pharmaceutical efficacy of cyclosporine and the physical efficacy of hypothermia may be somewhat additive.
Jin H. Han, Amanda Wilson, Amy J. Graves, Ayumi Shintani, John F. Schnelle, E. Wesley Ely
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.069
Publication stage: In Press Corrected Proof
Published online: February 29 2016
x Delirium in the emergency department (ED) is an emerging field of research. Most ED research infrastructures utilize lay personnel to collect data, but delirium assessments that can be reliably performed by nonphysicians are lacking. We evaluated the diagnostic performance of the modified Brief Confusion Assessment Method (modified bCAM) for this purpose.
M. Kennedy Hall, R. Andrew Taylor, Seth Luty, I. Elaine Allen, Chris L. Moore
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.059
Publication stage: In Press Corrected Proof
Published online: February 26 2016
x Nontraumatic shock in the emergency department (ED) has multiple causes and carries in-hospital mortality approaching 20%, underscoring the need for prompt diagnosis and treatment. Diagnostic ultrasonography at the point of care is one method that may improve the ability of ED physicians to quickly diagnose and treat. This study assesses the effect of the use and timing of point-of-care (POC) ultrasonography on time to disposition request.
Blair J. Smart, Sterling R. Haring, Anthony O. Asemota, John W. Scott, Joseph K. Canner, Besma J. Nejim, Benjamin P. George, Hatim Alsulaim, Thomas D. Kirsch, Eric B. Schneider
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.057
Publication stage: In Press Accepted Manuscript
Published online: February 25 2016
x American tackle football is the most popular high energy impact sport in the United States with approximately 9 million participants competing annually. Previous epidemiologic studies of football-related injuries have generally focused on specific geographic areas or pediatric age groups. Our study sought to examine patient characteristics and outcomes, including hospital charges, among athletes presenting for emergency department (ED) treatment of football-related injury across all age groups in a large nationally representative dataset.
Tae Sun Ha, Tae Gun Shin, Ik Joon Jo, Sung Yeon Hwang, Chi Ryang Chung, Gee Young Suh, Kyeongman Jeon
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.053
Publication stage: In Press Corrected Proof
Published online: February 25 2016
x Serum lactate clearance (LC) during initial resuscitation is a potentially useful prognostic marker in patients with severe sepsis or septic shock. However, it is unclear whether LC is also associated with the outcome in septic patients with hepatic dysfunction that may impair lactate elimination, which may contribute to elevated serum lactate levels or decreased LC.
Zeynep Karakaya, Erden Erol Ünlüer, Ayşen Ersan
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.055
Publication stage: In Press Corrected Proof
Published online: February 25 2016
x Inferior vena cava (VCI) spontaneous rupture is a rare clinical case. It is generally diagnosed via laparotomy in the absence of any personal history. We hereby present a case that applied to the emergency department (ED) with flank pain, who was discharged in the first application with renal colic diagnosis and who was afterward diagnosed with aorta dissection combined with VCI spontaneous rupture during the urgent operation. Our objective was to increase awareness by emphasizing the fact that VCI spontaneous rupture might be the cause of massive intra-abdominal hemorrhage without being related with trauma.
Namkee G. Choi, Diana M. DiNitto, C. Nathan Marti, Bryan Y. Choi
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.058
Publication stage: In Press Corrected Proof
Published online: February 25 2016
x Although the number of older adults who engage in nonsuicidal self-injury (NSSI) is not insignificant, research on older adults' NSSI is scant. The current study examined the prevalence and characteristics of NSSI compared to suicide attempt (SA) in adults older than 50 years who were seen at Emergency Departments (EDs) and their ED visit outcomes.
Violeta González-Salvado, Felipe Fernández-Méndez, Roberto Barcala-Furelos, Carlos Peña-Gil, José Ramón González-Juanatey, Antonio Rodríguez-Núñez
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.047
Publication stage: In Press Corrected Proof
Published online: February 21 2016
x Bystander cardiopulmonary resuscitation (CPR) improves survival from out-of-hospital cardiac arrest, but rates and performance quality remain low. Although training laypeople is a primary educational goal, the optimal strategy is not well defined. This study aimed to determine whether a short training with real-time feedback was able to improve hands-only CPR among untrained citizens.
Chen Rui-feng, Huang Li-song, Zheng Ji-bo, Jia Yi-qing, Liu Yu-jie, Shan Yi
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.043
Publication stage: In Press Corrected Proof
Published online: February 20 2016
x The objectives were to investigate the emergency treatment of serious dog bite lacerations on limbs and to identify whether negative pressure wound therapy (NPWT) was beneficial in these instances.
Michael E. Abboud, Sarah E. Frasure
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.048
Publication stage: In Press Corrected Proof
Published online: February 20 2016
x Sotalol, a nonselective β -adrenergic receptor blocker with Class III anti-arrhythmic properties, is commonly used in patients with a history of ventricular tachycardia or ventricular fibrillation. Although lower extremity edema is a well-known side-effect of this medication, there have been no reports of bilateral upper extremity edema due to sotalol. We present the first case report of sotalol-induced symmetric bilateral upper extremity edema.
Nicole L. Kaban, Nicholas C. Avitabile, Sebastian D. Siadecki, Turandot Saul
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.049
Publication stage: In Press Corrected Proof
Published online: February 20 2016
x The peripheral veins in the arms and forearms of patients with a history of intravenous (IV) drug use may be sclerosed, calcified, or collapsed due to damage from previous injections. These patients may consequently require alternative, more invasive types of vascular access including central venous or intraosseous catheters. We investigated the relationship between hand dominance and the presence of patent upper extremity (UE) veins specifically in patients with a history of IV drug-use. We predicted that injection into the non-dominant UE would occur with a higher frequency than the dominant UE, leading to fewer damaged veins in the dominant UE.
Michael S. Merrill, Catherine M. Wares, Alan C. Heffner, Kenneth L. Shauger, H. James Norton, Michael S. Runyon, David A. Pearson
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.002
Publication stage: In Press Corrected Proof
Published online: February 20 2016
x Recent advances in post–cardiac arrest (CA) care including therapeutic hypothermia (TH) have improved survival and favorable neurologic outcomes for survivors of CA. Survivors often present with deep coma and lack of brainstem reflexes, which are generally associated with adverse outcomes in many disease processes. Little is known regarding the role of initial emergency department (ED) neurological examination and its potential for prognostication.
Travis D. Olives, Roma G. Patel, Hannah M. Thompson, Scott Joing, James R. Miner
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.046
Publication stage: In Press Corrected Proof
Published online: February 18 2016
x Limited health literacy is a risk factor for poor outcomes in numerous health care settings. Little is known about the impact of instructional modality and health literacy on adherence to emergency department (ED) discharge instructions.
Mehmet Cihat Demir, Damlanur Kucur, Eda Çakır, Nalan Metin Aksu, Mehmet Ruhi Onur, Timuçin Sabuncu, Meltem Akkaş
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.045
Publication stage: In Press Corrected Proof
Published online: February 18 2016
x May-Thurner syndrome (MTS)—also termed iliac vein compression syndrome, Cockett syndrome, or iliocaval compression syndrome —is caused by the compression of the left common iliac vein lumen due to pressure of the right common iliac artery as it crosses anteriorly. May-Thurner syndrome is usually diagnosed in autopsy studies and incidence of it varies between 22% and 32%. May-Thurner syndrome–related deep venous thrombosis (DVT) is only 2% to 3% of all lower extremity DVTs. May-Thurner syndrome may be asymptomatic or may cause leg swelling, varicosities, DVT, chronic venous stasis ulcers, and more serious complications, such as pulmonary embolism or phlegmasia cerulea dolens.
Takashi Cho, Nobuyasu Komasawa, Masanori Haba, Shunsuke Fujiwara, Ryosuke Mihara, Toshiaki Minami
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.036
Publication stage: In Press Corrected Proof
Published online: February 16 2016
x Recent guidelines for cardiopulmonary resuscitation emphasize that all rescuers should minimize the interruption of chest compressions, even for intravenous access. We assessed the utility of needle guides during ultrasound-guided central venous catheterization (US-CVC) with chest compressions via simulation.
Nishant Sahay, Abhishek Chatterjee, Anubha Sahay
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.041
Publication stage: In Press Corrected Proof
Published online: February 15 2016
x We read with great interest a meta-analysis published in your journal by Akihisa et al titled “Effects of sniffing position for tracheal intubation: a meta-analysis of randomized controlled trials” [1]. We congratulate the authors for working on the important and basic issue pertaining to laryngoscopy and intubation. Positioning during laryngoscopy is of immense importance for prehospital and resuscitation providers in emergency settings also where, most of the time, professionals are not anesthesiologists.
Tsung-Han Ho, Hung-Wen Kao, Sy-Jou Chen, Jiunn-Tay Lee, Yaw-Don Hsu
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.040
Publication stage: In Press Corrected Proof
Published online: February 15 2016
x Hypertensive brainstem encephalopathy, an unusual form of hypertensive encephalopathy resulting from failure of autoregulation of the cerebral blood flow causing vasogenic edema of brainstem, is a medical emergency. Hypertensive brainstem encephalopathy may share similar clinical manifestations to other etiologies involving the brainstem such as central pontine myelinolysis or acute pontine infarcts. However, misdiagnosis by the emergency physicians results in an inappropriate treatment and may lead to permanent neurologic deficits or even death.
Brian Morgan, Michael Cabezon, Tom Kennedy, Charles Pereyra, Barbara Gatton, Athena Mihailos
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.038
Publication stage: In Press Corrected Proof
Published online: February 15 2016
x Spontaneous spinal epidural abscess formation is a rare finding, and unless there is a “classic triad” of fever, spine pain, and neurologic deficits, varied presentations often lead to missed and delayed diagnosis. We present a case in which spinal epidural abscess was missed upon initial presentation and subsequently diagnosed the following day on a second visit. We also discuss the impact of neurologic outcome of diagnostic delays.
Atsushi Sugiura, Takashi Nakayama, Masayuki Takahara, Kazumasa Sugimoto, Noriyuki Hattori, Ryuzo Abe, Yoshihide Fujimoto, Shigeto Oda, Yoshio Kobayashi
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.039
Publication stage: In Press Corrected Proof
Published online: February 15 2016
x Anaphylactic shock is the most critical iodine contrast media-mediated adverse reaction. Although nonionic iodine contrast media is widely used and is less likely to induce adverse reactions compared with ionic contrast media, patients with a history of contrast-induced allergic reactions provide a dilemma to interventional cardiologists because of the greater risk of nonionic or ionic contrast media-induced allergic reactions [1]. Most episodes of anaphylaxis develop early and resolve completely with appropriate treatment; however, approximately 10%–20% of these cases present with delayed onset of symptoms, follow a biphasic or protracted course, and create a very critical situation that requires immediate intervention [2,3].
Jung-Wan Yoo, Ho Cheol Choi, Seung Jun Lee, Yu Ji Cho, Jong Deog Lee, Ho Cheol Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.037
Publication stage: In Press Corrected Proof
Published online: February 15 2016
x Although systemic thrombolysis (ST) or catheter-directed therapy (CDT) is performed in patients with acute massive or submassive pulmonary embolism (PE), clinical data comparing between both therapies remain limited. We compared clinical outcomes between ST and CDT in patients with acute massive and submassive PE.
Mary Yuling Lim, Dong Haur Phua, Chee Kheong Ooi
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.014
Publication stage: In Press Corrected Proof
Published online: February 12 2016
x “Mad honey” poisoning has been well reported in the Eastern Black Sea region of Turkey. The toxin implicated is grayanotoxin, which is found in honey derived from nectar of plants belonging to Rhodendron species. We report 2 cases of middle-aged healthy Nepalese men who presented simultaneously to the emergency department with hypotension, bradycardia, and conduction disturbance after consumption of contaminated honey. Their symptoms and conduction abnormalities resolved after administration of intravenous atropine.
Göksel Çinier, Hakan Barutca, Ahmet Oz, Sami Ilhan, Hatice Betul Erer, Mert İlker Hayıroğlu, Ahmet Ilker Tekkesin, Sinan Sahin
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.031
Publication stage: In Press Corrected Proof
Published online: February 12 2016
x Unilateral absence of pulmonary artery is a rare congenital anomaly. Isolated cases are usually silent until adulthood. Clinical symptoms include exercise intolerance, dyspnea, hemoptysis, and recurrent pulmonary infections. Diagnosis is difficult because of nonspecific symptoms and usually suspected from abnormal findings in chest radiograph. Imaging modalities including transthoracic echocardiography, contrasted thorax computed tomography, and thorax magnetic resonance imaging can be performed for the correct diagnosis and to assess any concomitant cardiovascular malformations.
Jiang-you Wang, Han Chen, Xi Su
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.022
Publication stage: In Press Corrected Proof
Published online: February 12 2016
x Straight back syndrome is a benign skeletal deformity of the thorax, which may mimic as heart disease. Patients are usually asymptomatic, and if symptomatic, chest pain and palpitations is most commonly reported. Straight back syndrome itself without structural heart disease, hemodynamic changes and abnormal diversion, which can mimic congenital abnormalities, especially atrial septal defect. We present a case of straight back syndrome induced myocardial damage manifesting as acute myocardial infarction in a 32-year-old man.
Marios Georgiou, Elizabeth Papathanassoglou, Nicos Middleton, Apostolos Papalois, Theodoros Xanthos
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.008
Publication stage: In Press Corrected Proof
Published online: February 12 2016
x The aim of this study was to investigate the effects of the combination of chest compressions and interposed abdominal compressions (IAC-CPR) in a swine model of ventricular fibrillation (VF).
Margarita Mendoza, Johnathan Michael Sheele
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.010
Publication stage: In Press Corrected Proof
Published online: February 12 2016
x Disseminated Mycobacterium tuberculosis is uncommon in the United States. We report a rare case of Pott disease and M tuberculosis iliopsoas abscess in an HIV-negative 25-year-old African American woman who presented to the emergency department with complaints of recurrent urinary tract infection after failed outpatient antibiotic treatment.
A.H. Miller, J.A. Monteiro de Oliveira Novaes, P.A. Brock, M. Sandoval
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.033
Publication stage: In Press Corrected Proof
Published online: February 12 2016
x Posterior reversible encephalopathy syndrome is a rare but increasingly identifiable clinicoradiologic syndrome typically characterized by the composite of symptoms including headache, altered mental status, visual disturbances, and seizures. On neuroimaging, there is a characteristic pattern of white-gray matter vasogenic edema involving, in most cases, the posterior regions of the central nervous system. As suggested by the name, the clinical and radiologic features are reversible. This syndrome was first described in 1996 by Hinchey et al [1] and was called reversible posterior leukoencephalopathy syndrome .
Selim Topcu, Oktay Gülcü, Uğur Aksu, Enbiya Aksakal
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.023
Publication stage: In Press Corrected Proof
Published online: February 12 2016
x Metastatic tumors are the most seen cardiac tumors. According to studies, lung and breast cancers are the most common cancer that metastasizes to myocardium. Hepatocellular carcinoma is the most common primary liver tumor, and myocardial involvement is very rare [1–5]. Here we present a case of myocardial metastasis in a patient who had history of hepatocellular carcinoma.
Ji Ning Sun, Bao Long Zhang, Hai Yan Yu, Qiang Zhang
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.015
Publication stage: In Press Corrected Proof
Published online: February 12 2016
x Spontaneous uterine rupture caused by placenta percreta during pregnancy is a rare, life-threatening, surgical emergency requiring timely and accurate diagnosis. Two cases of spontaneous uterine rupture due to placenta percreta are reported at a gestational age of 17 weeks and 34 weeks respectively. Imaging findings of ultrasonography and computed tomography (CT) are provided and are worthy of discussion so as to familiarize the radiologists and clinicians with this rare but important complication.
Erdal Komut, Nalan Kozacı, Bedriye Müge Sönmez, Fevzi Yılmaz, Seval Komut, Zeliha Nilgün Yıldırım, İnan Beydilli, Cihat Yel
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.012
Publication stage: In Press Corrected Proof
Published online: February 12 2016
x Ocular ultrasonography of optic nerve sheath diameter (ONSD) to determine intracranial pressure (ICP) has become favorable in recent years.
Morgan M. Ellis, Robert D. Welch
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.021
Publication stage: In Press Accepted Manuscript
Published online: February 12 2016
x A 65-year-old man developed profound hypothermia after environmental exposure. On arrival, he was unresponsive, with a core body temperature of 19.6°C (67.3°F), no discernable pulse or blood pressure, and no cardiac activity present on bedside cardiac echocardiography. Given the patient’s extreme cold temperature, mechanical chest compression was not initiated nor was it used at any point during the resuscitation process or hospital stay. Attempts to warm him with traditional surface warming methods and intravascular heating were initiated but were felt unlikely to be successful due to lack of any cardiac output and perfusion.
Kyle M. DeWitt, Steven J. Weiss, Shannon Rankin, Amy Ernst, Preeyaporn Sarangarm
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.004
Publication stage: In Press Corrected Proof
Published online: February 12 2016
x Overall medication-related errors in the emergency department (ED) are 13.5 times more likely to occur in the absence of an emergency medicine pharmacist (EMP). Although the effectiveness of pharmacist-driven renal dosing adjustment has been studied in the intensive care unit, data are lacking in the ED setting. The aim of our study was to evaluate the appropriateness of antibiotic dosing when an EMP is physically present in the ED compared to when absent.
Eitaro Okumura, Junya Tsurukiri, Taishi Oomura, Yosuke Tanaka, Ryoko Oomura
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.026
Publication stage: In Press Corrected Proof
Published online: February 12 2016
x Intractable hemorrhage is a main cause of death in the emergency department (ED). Acute care physicians also encounter various causes of life-threatening hemorrhagic shock, including trauma, ruptured abdominal aortic aneurysms, and postpartum bleeding secondary to placenta previa or placenta abruption. In a recent systematic review, resuscitative endovascular balloon occlusion of the aorta (REBOA) in various clinical settings was found to successfully elevate central blood pressure and control hemodynamic status as an adjunct for surgical hemostasis in life-threatening hemorrhagic shock.
Tyler Christensen, Gavin Budhram
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.024
Publication stage: In Press Accepted Manuscript
Published online: February 12 2016
x Impending paradoxical embolus (IPE) is a rare disease process where a thrombus is visualized crossing from the right heart to the left heart, typically through a patent foramen ovale (PFO). It can present to the ED with symptoms of cerebral vascular accident (CVA) or pulmonary embolus (PE). Mortality has been estimated at 18-20% mainly due to embolic CVA. Transthoracic echocardiography (TTE) or transesophageal echocardiography (TTE) have been the mainstay of diagnosis for the last three decades.
Victoria Lepere, Jonathan Messika, Béatrice La Combe, Jean-Damien Ricard
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.020
Publication stage: In Press Corrected Proof
Published online: February 12 2016
x We report the case of a chronic obstructive pulmonary disease (COPD) patient admitted for an acute-on-chronic respiratory failure with hypercapnia, successfully treated with high-flow nasal oxygen cannula.
Andrea Rowland-Fisher, Stephen Smith, Andrew Laudenbach, Robert Reardon
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.017
Publication stage: In Press Corrected Proof
Published online: February 12 2016
x Approximately 25% of patients with acute coronary occlusion present without diagnostic evidence of ST elevation on electrocardiogram. Traditionally, individuals that fall into this category have been detected by subsequent elevation of cardiac markers and are diagnosed with non–ST-elevation myocardial infarction. Early detection and intervention of these individuals lead to lower 6-month mortality; however, there has not been a good way to detect these individuals reliably. We report a case of a man presenting to the emergency department (ED) with a non–ST-elevation myocardial infarction who was found to have acute coronary occlusion detected by speckle tracking echocardiography performed by an emergency physician.
Timothy C. Jenkins, Bryan C. Knepper, Bruce D. McCollister, S. Jason Moore, Sean W. Pawlowski, Daniel M. Perlman, Carla C. Saveli, Sean T. O'Leary, William J. Burman
DOI: http://dx.doi.org/10.1016/j.ajem.2016.02.013
Publication stage: In Press Corrected Proof
Published online: February 11 2016
x Infectious Diseases Society of America guidelines recommend that patients hospitalized for acute bacterial skin infections after failure of outpatient antibiotic therapy be managed as “severe” infections; however, the clinical relevance of apparent failure of outpatient therapy is not clear.
Sezai Cubuk, Salih Hamcan
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.026
Publication stage: In Press Corrected Proof
Published online: January 26 2016
x Some variations of the sternum may lead to misdiagnosis in trauma patients. We want to present a 21-year-old man who was admitted to our emergency department after a fight. He was suffering from pain on the midsternal region with palpation. Lateral chest graphy revealed a cortical bone interruption for a suspicion of a sternal fracture. We performed a 3D computed tomography of the sternum in order to reveal any potential abnormalities. The imaging led to a sternal fusion defect diagnosis. Knowledge of anatomical variations of the sternum prevents misdiagnosis and confusions.
Sinan Karacabey, Erkman Sanrı, Emin Gokhan Gencer, Ozlem Guneysel
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.027
Publication stage: In Press Corrected Proof
Published online: January 26 2016
x In this study we aimed to evaluate the success of ultrasonography (USG) for confirming the tube placement and timeliness by tracheal USG and ultrasonographic lung sliding in resuscitation and rapid sequence intubation.
Anwer Habib, Abhinav Jain, Bhawani Singh, Nayer Jamshed
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.019
Publication stage: In Press Corrected Proof
Published online: January 22 2016
x Acute pancreatitis (AP) is caused by inflammation of the pancreas. Diagnosis requires 2 of the following 3 criteria: abdominal pain consistent with the disease, serum amylase or lipase greater than 3 times the upper limit of normal, and imaging consistent with the diagnosis by using computed tomography (CT) or magnetic resonance imaging [1]. Etiology of AP includes gallstone, alcohol, drugs, hypertriglyceridemia, trauma, post–endoscopic retrograde cholangiopancreatography, hypercalcemia, hereditary pancreatitis, and vascular.
Isaac Boyack, Diana McPhee, Yocheved Rose, Menachem Gold
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.018
Publication stage: In Press Corrected Proof
Published online: January 20 2016
x We report a case of optic sheath pneumatization due to severe facial trauma. The mechanism of optic sheath pneumatization in the setting of trauma is likely indirect, via extension of pneumocephalus into the subarachnoid space that bathes the optic nerve. To our knowledge, this is the first reported such case in the emergency medicine literature.
Arthur Jey, Peter Hull, Victoria Kravchuk, Briana Carillo, Jaemes Benjamin Martel
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.005
Publication stage: In Press Corrected Proof
Published online: January 8 2016
x We describe the case of a patient who presented with an injury to the orbit. The patient was agitated and uncooperative in the emergency department. He was subsequently diagnosed as having a rupture of the sclera resulting from a TASER injury, an acronym for Thomas A. Swift Electric Rifle. The unusual nature of this type of injury necessitated emergent ophthalmological evaluation in the emergency department and expeditious management of the patient with a multispecialty team. This allowed for a favorable outcome in what could have otherwise been a devastating, blinding injury.
Liqiong Yao, Zhiwu Liu, Jinhong Zhu, Bin Li, Chen Chai, Yunlin Tian
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.009
Publication stage: In Press Corrected Proof
Published online: January 8 2016
x There have been sporadic case reports published focusing on myoglobin and sepsis. However, there are no systematic studies evaluating the correlation between myoglobin level and sepsis. This study investigated the correlation between the serum myoglobin level and the severity of septic patients. Next, we assessed the predictive value of the serum myoglobin level for the prognosis of septic patients.
Giuseppe Carpagnano, Riccardo Ieva, Michele Correale, Matteo Di Biase, Natale Daniele Brunetti
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.001
Publication stage: In Press Corrected Proof
Published online: January 7 2016
x We report the case of an 81-year-old woman referred for dizziness and suspected atrial fibrillation and hospitalized for bronchopneumonia and fever. The woman was diabetic in treatment with insulin; she also had history of chronic obstructive pulmonary disease, gastrointestinal bleeding after treatment with warfarin, and hypothyroidism.
Donnesha B. Clayton, Robert A. Ratzlaff
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.087
Publication stage: In Press Corrected Proof
Published online: January 5 2016
x The shoulder joint is the most commonly dislocated joint in the body. Complications of shoulder dislocations are usually rotator cuff injuries and an increased risk of recurrent shoulder dislocation in the future. It is very rare for a shoulder dislocation to result in vascular injury. It has been reported that axillary artery injury occurs in 1%-2% of all shoulder dislocations. Our patient presented to the emergency department (ED) with hypotension that did not respond to intravenous fluids. It was discovered that the cause of her hypotension was that she injured the axillary artery when she dislocated her shoulder.
