Kelly E. Quinley, Hsien-Yi Chen, He S. Yang, Kara L. Lynch, Kent R. Olson
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.086
Publication stage: In Press Corrected Proof
Published online: January 5 2016
x We present a case of myocardial injury in a 17-year-old adolescent girl who took clenbuterol with the goal of losing weight. We correlated serum clenbuterol concentrations with troponin levels and patient symptoms.
M. Piastra, A. Pizza, D.G. Biasucci, T.C. Morena, L. Marzano, D. De Luca, O. Genovese, M. Bolzon, C. Betto, G. Conti
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.091
Publication stage: In Press Corrected Proof
Published online: January 5 2016
x Hanging attempt is increasingly gaining attention and concern in the pediatric emergency setting. Indeed, intentional hanging attempts by adolescents and preadolescents and unintentional occurrences of hanging among younger children are becoming more and more common. In the case of postasphyxiation by hanging in adults, there are several evidences showing the benefit of target temperature management or therapeutic hypothermia (TH), but such data are lacking in the pediatric case. The new 2015 International Liaison Committee for Resuscitation guidelines suggest that, for infants and children with secondary brain injury after out-of-hospital cardiac arrest, it is reasonable to maintain either 5 days of continuous normothermia or 2 days of initial TH followed by 3 days of continuous normothermia.
Joaquín Valle Alonso, Beatrix Huei-Yi Teo, F. Javier Fonseca del Pozo, Miguel Angel Aguayo, Almudena Sanchez
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.081
Publication stage: In Press Corrected Proof
Published online: December 30 2015
x The objective of this study was to present a case report that brings attention to relationship between cannabis consumption and Brugada electrocardiogram pattern. Here, we present a case of a 19-year-old male patient with symptomatic Brugada electrocardiogram pattern induced after cannabis consumption. With the potential for more widespread legalization of cannabis, several studies are raising the issue of adverse vascular effects of cannabis, including myocardial infarction, sudden cardiac death, cardiomyopathy, stroke, transient ischemic attack, and cannabis arteritis.
Nazim Bozan, Mehmet Parlak, Mehmet Reşat Ceylan, Abdulzaziz Yalınkılıc, Hakan Cankaya, Mehmet Fatih Garca
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.071
Publication stage: In Press Corrected Proof
Published online: December 28 2015
x Brucellosis may cause various clinical conditions. However, to our knowledge, there is no case report on the sublingual abscess caused by Brucella in the medical literature. In this case report, we present a 45-year-old male patient who presented with acute shortness of breath. A sublingual abscess was identified, and brucellosis was diagnosed based on Brucella species. The patient achieved full recovery after the lesion was drained with a catheter, and he was treated with rifampicin and doxycycline for 6 weeks.
Wesley R. Zemrak, Erin Kelley, Nicole L. Kovacic, Deirdre M. Mooney, Jane G. Morris, Casey Z. MacVane, Jeffrey A. Rosenblatt
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.069
Publication stage: In Press Corrected Proof
Published online: December 27 2015
x The use of 4-factor prothrombin complex concentrate (PCC) for urgent warfarin reversal has been approved by the Food and Drug Administration since November 2013. Dosing recommendations were not determined by dose-finding studies. Current recommendations use a combination international normalized ratio (INR) and weight-based approach to dosing. The thromboembolic risk in clinical trials appeared to be similar to that of fresh frozen plasma; however, real-world use suggests that the current dosing strategy may lead to overcorrection of anticoagulation with life-threatening thrombotic complications.
Ali Pourmand, Kathryn Guida, Assya Abdallah, M. Reza Taheri, Hamid Shokoohi
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.063
Publication stage: In Press Corrected Proof
Published online: December 23 2015
x Gadolinium-based contrast agents (GBCAs) for magnetic resonance imaging have emerged as safe and well-tolerated agents with minimal adverse effects over the past 3 decades. Hypersensitivity reactions to GBCAs including skin and/or mucocutaneous involvement and occasionally respiratory reactions occur approximately in 0.1% of the cases. Severe adverse events including GBCA-induced anaphylaxis are extremely rare, occurring in 0.004%-0.01% of the cases. We report a severe case of GBCA-induced anaphylaxis who presented with a sudden onset of severe abdominal pain shortly after receiving a dose of GBCA.
Jared Baylis, Nick Balfour
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.047
Publication stage: In Press Corrected Proof
Published online: December 22 2015
x Pharyngeal foreign bodies are a common emergency department complaint and have been attributed to approximately 3000 deaths annually in the United States [1]. In adults, fish bones are the most common ingested foreign body, whereas metallic foreign bodies are relatively rare [2]. In recent years, ingestion of wire brush bristles has been reported with increasing frequency [3–14]. Many times embedded wire bristles require endoscopic removal and occasionally open surgical removal [3–10,12,14]. In this case report, we describe an ingestion of a wire brush bristle associated with a barbecued steak.
Giuseppe Famularo
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.057
Publication stage: In Press Corrected Proof
Published online: December 22 2015
x Patients with convulsive seizures are exposed to a wide spectrum of cardiovascular events, and the risk is particularly elevated in patients with refractory epilepsy. I present a patient with refractory status epilepticus who had a type 2 myocardial infarction (MI) during relapsing seizures and ultimately died of multiorgan failure. Type 2 MI happens because of an imbalance between blood supply and myocardial oxygen demand; however, very few cases have been described in patients with convulsive seizures or status epilepticus .
Mary Garland, Kristen A. Zeller, Avinash K. Shetty
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.060
Publication stage: In Press Corrected Proof
Published online: December 22 2015
x Staphylococcal toxic shock syndrome (TSS) is relatively rare after burns but can be fatal if missed. The diagnosis of staphylococcal TSS may be challenging in pediatric burn patients. We report a previously healthy 14-month-old African American boy with 12% total body surface area partial thickness scald burns who developed TSS due to methicillin-resistant Staphylococcus aureus . Debridement in conjunction with appropriate combination antibiotic therapy, intravenous immune globulin resulted in clinical recovery.
Lyndsay Christie, Dong Haur Phua, Chee Kheong Ooi
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.052
Publication stage: In Press Corrected Proof
Published online: December 21 2015
x Needle aspiration is a low-risk, minimally invasive treatment compared with tube thoracostomy for primary spontaneous pneumothoraces in a hemodynamically stable patient. Pulmonary contusion is a rare complication of needle aspiration. This case suggests that although this complication may occur, the clinical course is benign and responds well to conservative management.
A. Attila Aydin, Rahman Şenocak, Sedat Bilge, Şahin Kaymak, Zafer Kilbaş
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.044
Publication stage: In Press Corrected Proof
Published online: December 21 2015
x Splenic rupture is a life-threatening condition and the most frequently seen cause of trauma. A splenic rupture as the initial manifestation of acute myeloid leukemia is extremely rare, and only a few cases have been reported thus far. Here, we present a case of a spontaneous splenic rupture in a patient with no history of prior trauma but who presented with abdominal pain and in advanced tests had a definitive diagnosis of acute myeloid leukemia.
Fumiko Inoue, Ryota Sato, Tadaaki Takada
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.041
Publication stage: In Press Corrected Proof
Published online: December 21 2015
x Various complications may occur with the use of barium during upper gastrointestinal imaging. We describe a case of barium appendicitis and suggest that physicians beware of various complications, including appendicitis, when evaluating patients with a history of barium swallowing.
Stephanie Bauer, Michael A. Darracq
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.038
Publication stage: In Press Corrected Proof
Published online: December 21 2015
x Salicylates are a common ingredient in many over-the-counter and prescription medications. Classically, salicylate poisoning is associated with an elevated anion gap acidosis; however, the absence of an anion gap does not rule out salicylate toxicity.
Murat Yücel, Özgür Deniz Sadioğlu, Halil İbrahim Çıkrıklar, Fikret Halis, Yusuf Yürümez
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.039
Publication stage: In Press Corrected Proof
Published online: December 21 2015
x A 66-year-old diabetic man presented to the emergency department with 3 days of abdominal distension and constipation. There was no history of neurologic and urologic disorders. A giant bladder was detected with abdominal ultrasound and computed tomography (CT). A total of 10,500 mL of urine was drained with urinary catheter. The diagnosis was neurogenic bladder due to diabetes mellitus with autonomic neuropathy. This is the largest volume of bladder in the literature.
Aaron B. Dahl, Joseph M. Neal, Michael F. Mulroy
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.053
Publication stage: In Press Corrected Proof
Published online: December 21 2015
x Regional anesthesia and analgesia for shoulder surgery has gained favor over the last 20 years as more shoulder operations are being performed in the ambulatory setting. The continuous interscalene perineural catheter is a common technique that targets the C5-C7 cervical nerve roots that innervate the deltoid region. This analgesic approach provides superior pain control compared with opioids but produces ipsilateral hemidiaphragmatic paresis (HDP) because local anesthetic is deposited near the phrenic nerve.
Benjamin Chaucer, Marie Chevenon, Cloty Toro, Teresa Lemma, Melissa Grageda
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.045
Publication stage: In Press Corrected Proof
Published online: December 21 2015
Open Access x Swyer-James-Macleod syndrome is a rare pulmonary disorder. It is characterized as a constrictive bronchiolitis resulting from loss of pulmonary vascularity secondary to a previous upper respiratory infection.
Andrew P. Harris, Joey Johnson, Gregory R. Waryasz
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.054
Publication stage: In Press Corrected Proof
Published online: December 21 2015
x The transverse tarsal (Chopart) joints are defined as the talonavicular and calcaneocuboid articulations [1]. Dislocations of Chopart joints, although uncommon, have been reported from a variety of high-energy mechanisms, resulting in medial, lateral, plantar, or dorsal displacement [2]. In this article, we describe a case of isolated dorsal fracture dislocations of the talonavicular and calcaneocuboid articulations in a 25-year-old man after a low-energy missed-step mechanism. The mechanism of injury, diagnosis, and management in the emergency department, operative intervention, and follow-up are discussed.
Muhammed Keskin, Mert İlker Hayıroğlu, Ümran Keskin, Adnan Kaya, Berat Arıkan Aydın, Edibe Betül Börklü, Göksel Çinier, Mehmet Eren
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.043
Publication stage: In Press Corrected Proof
Published online: December 21 2015
x Use of cocaine spans thousands of years, with a duality of effects noted throughout history. It is the most commonly used illicit drug. Although cardiovascular system is mainly affected, nearly every organ can be affected by cocaine toxicity. We report a case with rhabdomyolysis, acute renal failure, and acute pulmonary edema related to cocaine abuse. The patient suffered from cocaine inhalation and went to cardiac arrest because of deep acidosis. There are very few cases of cardiac arrest associated with cocaine inhalation.
Jason K. Bowman, Xiao C. Zhang, Jason B. Hack
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.046
Publication stage: In Press Corrected Proof
Published online: December 19 2015
x More than one million cases of bacterial meningitis occur each year worldwide, with a mortality rate of more than 70% in some populations. Although most emergency physicians are familiar with treating the bacteria that frequently cause meningitis, it is important to also consider less common organisms that infect a different patient demographic, such as children or neonates, and immunocompromised adult.
James Tse, Kevin Ferguson, K. Scott Whitlow, Karly Erickson
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.055
Publication stage: In Press Corrected Proof
Published online: December 19 2015
x Methamphetamine is a synthetic sympathomimetic amine that is abused worldwide for recreational purposes. We present the case of a 55-year-old man who presented to the emergency department after a deliberate large ingestion of methamphetamine who rapidly progressed into autonomic instability refractory to traditional supportive therapy. Treatment with lipid emulsion therapy was initiated with immediate improvement in his clinical presentation and avoidance of endotracheal intubation or intensive care unit admission.
Pinar Hanife Kara, Rifat Urnal, Erden Erol Unluer
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.051
Publication stage: In Press Corrected Proof
Published online: December 19 2015
x Chronic eosinophilic pneumonia (Carrington disease) is a rare disorder with no clear diagnostic criteria. We reported an unusual pneumonia presentation in the emergency department. Eosinophilic pneumonia should be considered in patients with standard antibiotic-resistant symptoms. Peripheral eosinophilia may be helpful for initial suspicion, but computed tomography and bronchoalveolar lavage should be planned for definitive diagnosis.
Javier González García, Belén Moreno Pavón, Laura Míguez Martín, Begoña Fernández Martínez, Cristina Molinos Norniella, Francisco Álvarez Caro
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.027
Publication stage: In Press Corrected Proof
Published online: December 17 2015
x Lipschütz ulcer is a rare condition characterized by rapid onset of vulval edema and painful necrotic ulcerations. It typically occurs in sexually inactive young women. Presenting symptoms in the emergency department may be confused with sexual abuse, a terrible diagnosis especially in children, leading to unnecessary investigations, treatment, and anxiety to the family. We present the case of a 12-year-old girl presenting in the emergency department with suspicion of child abuse.
Luca Tagliabue, David Rotzinger, Olivier Hugli
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.032
Publication stage: In Press Corrected Proof
Published online: December 17 2015
x Traumatic splenic tissue injury in patients having previously undergone splenectomy has been very rarely reported. However, bleeding from splenic tissue (splenosis or accessory spleen) is should be added to the differential diagnosis of traumatic hemoperitoneum in patients having undergone previous splenectomy.
Mustafa Uzkeser, Abdullah Osman Kocak, İlker Akbas, Gokhan Polat, Mecit Kantarci, Mucahit Emet, Sahin Aslan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.031
Publication stage: In Press Corrected Proof
Published online: December 17 2015
x A 20-year-old male patient was found unconscious and delivered to our emergency department by ambulance for suspected carbon monoxide poisoning. When he arrived to the emergency department, there was no neurologic finding. Initial brain computed tomography failed to show any damage. His laboratory results were within reference range, except carboxyhemoglobin being 40%. Dual-energy computed tomography (DECT; as far as we know, first in the literature) revealed perfusion defect as it showed hypodense areas on the right temporal lobe.
Hampton M. Vernon, Andrew K. Nielsen, Edward C. O'Bryan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.021
Publication stage: In Press Corrected Proof
Published online: December 17 2015
x Little has been documented regarding hypersensitivity reactions with rivaroxaban or other factor Xa inhibitors. We report the development of a hypersensitivity reaction to rivaroxaban in a 64-year-old African American male patient who presented to the emergency department and was subsequently evaluated in dermatology consultation and follow-up. This case highlights the vigilance required by health care workers in recognizing potential adverse effects of newer anticoagulation therapy and in making medication changes where necessary.
Ajay Madhavan, Shawn Pritchard, Benjamin Wedro
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.026
Publication stage: In Press Corrected Proof
Published online: December 16 2015
x A 28-year-old obese woman with no significant medical history presented to the emergency department with a 1-day history of progressive left lower extremity pain and swelling. Risk factors for deep vein thrombosis included oral contraceptive use and a 10-hour car ride several days prior. On examination, vital signs were stable, and the only positive physical findings were significant edema, tenderness, and purplish discoloration of the entire left lower extremity from the inguinal canal distally.
Yoon-Je Lee, Sang-Hyun Lee, Hyuk Joong Choi, Chang Sun Kim, Tae Ho Lim
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.018
Publication stage: In Press Accepted Manuscript
Published online: December 14 2015
x This article has been retracted at the request of the authors on December 24, 2015. Please see the Elsevier Policy on Article Withdrawal ( http://www.elsevier.com/locate/withdrawalpolicy ).
Kuo-Song Chang, Yu-Jang Su
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.003
Publication stage: In Press Corrected Proof
Published online: December 12 2015
x A 40-year-old man presented at our emergency department with his left forearm swollen with palmar blisters. He did not remember what had happened to him, and he was unconscious for 1 day before arrival at the hospital. He was afebrile (37°C), with a heart rate of 92 beats per minute, and blood pressure at 136/94 mm Hg. Laboratory tests showed high creatine phosphokinase: 38
Ayça Açıkalın, Nezihat Rana Dişel, Ebru Çil Direk, Murat Türkeün Ilgınel, Ahmet Sebe, Şebnem Bıçakçı
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.013
Publication stage: In Press Corrected Proof
Published online: December 12 2015
x Enzyme deficiencies in the urea cycle are rarely seen metabolic diseases in adulthood. Deficiencies of these enzymes or a lack of enzyme activity is asymptomatic in adults. Prolonged catabolic situations, surgery, and delivery may cause encephalopathy related to hyperammonemia in such patients. Early diagnosis and treatment may be lifesaving for these patients. A case who was admitted with seizures initiated on the fifth postpartum day due to isolated hyperammonemia is presented here.
Young Sun Ro, Sang Do Shin, Kyoung Jun Song, Sung Ok Hong, Young Taek Kim, Sung-Il Cho
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.001
Publication stage: In Press Corrected Proof
Published online: December 7 2015
x We hypothesized that recent hands-on practice for cardiopulmonary resuscitation (CPR) would be strongly associated with a higher likelihood of self-efficacy in bystander CPR among laypersons according to age and gender group.
Stefan Flores, Ashley C. Rider, Harrison J. Alter
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.048
Publication stage: In Press Corrected Proof
Published online: November 25 2015
x The emergency department (ED) is responsible for managing a variety of chronic kidney diseases. Recently, a pattern of chronic kidney disease (CKD) has been described among Central American men who work in agriculture. The disease process, coined Mesoamerican nephropathy (MeN), includes patients with CKD of unknown origin with specific characteristics, including geographic region, lack of predisposing factors, young age of onset, and work environment. The underlying cause of nephrotoxicity has not been elucidated; however, investigators are working to identify a etiologic agent.
Lukasz Szarpak, Zenon Truszewski, Lukasz Czyzewski, Tomasz Gaszynski, Antonio Rodríguez-Núñez
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.060
Publication stage: In Press Corrected Proof
Published online: November 23 2015
x Prehospital tracheal intubation by paramedics during cardiopulmonary resuscitation (CPR) in children is challenging. The potential role of new intubation devices during CPR is unclear. Our objective was to assess the impact of CPR (with and without chest compressions [CCs]) on the success and time to intubation (TTI) with the Macintosh laryngoscope vs the McGrath video laryngoscope on a pediatric manikin.
Selim Topcu, Oktay Gulcu, Uğur Aksu, Serdar Sevimli
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.054
Publication stage: In Press Corrected Proof
Published online: November 21 2015
x Apical hypertrophic cardiomyopathy (HCM) is a phenotypic variant of nonobstructive HCM in which hypertrophy of the myocardium predominantly involves the left ventricular apex. Hypertrophic cardiomyopathy in patients is associated with the risk for sudden death, heart failure, and peripheral thromboembolism [1–3].
Jun Wan Lee, Seung Woo Yoo, Won Joon Jeong, Seung Ryu, Youn Ho Yoo, In Sool Yoo, Sang Il Park, Joon Hyung Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.061
Publication stage: In Press Corrected Proof
Published online: November 20 2015
x Out-of-hospital cardiac arrest is uncommon in children. Survival until hospital discharge and probability of having no neurologic complications remain poor. Inherited arrhythmia syndromes are characterized by genetic heterogeneity and variable penetrance. Congenital long QT syndrome is one of the causes of sudden death in the young, caused by mutations in genes encoding ion channels in the control of ventricular repolarization. We report a case of extracorporeal cardiopulmonary resuscitation and therapeutic hypothermia in a 13-year-old adolescent presenting out-of-hospital cardiac arrest from congenital long QT syndrome.
Nicole M. Vetter, Henry M. Feder Jr., Richard M. Ratzan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.051
Publication stage: In Press Corrected Proof
Published online: November 20 2015
x Nonspecific presentations, such as fever and rash, commonly present to the emergency department (ED). In such situations, a thorough history should be obtained, which includes any pet or animal exposure. When history elicits a recent rat exposure in combination with a patient presenting with fever and a rash, rat bite fever (RBF) should be considered. A bacterial illness caused by Streptobacillus moniliformis , RBF has a high mortality, and treatment should begin promptly once suspected. As its name suggests, RBF is most commonly caused by a rat bite, although any exposure to a rat or other rodent should raise suspicion for the illness.
Benjamin Chaucer, Lalanthica Yogendran, Lyudmila Rubinshteyn
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.064
Publication stage: In Press Corrected Proof
Published online: November 20 2015
x Bilateral facial nerve paralysis is an extremely rare disease with an annual incidence of 1 in 5 million cases. Although unilateral facial nerve paralysis is often a benign illness, bilateral facial nerve palsy is a harbinger of more serious pathology. We present the case of a 25-year-old man who presented with alternating left then right facial weakness. We diagnosed him with bilateral facial nerve palsy and scheduled further diagnostic tests, but he was lost to follow-up. Given the severity of the differential diagnosis of bilateral facial nerve paralysis, diagnostic tests must be done at time of initial presentation.
Nicholas Graff, Kristen Whitworth, Christopher Trigger
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.055
Publication stage: In Press Corrected Proof
Published online: November 19 2015
x A 36-year-old woman presented to the emergency department with 5 days of worsening painful bruising that started on her legs and spread to her torso and face. She reported recent use of heroin and cocaine. On examination, she was tachycardic with a nonblanching, painful, purpuric skin eruption on bilateral thighs, chest, upper arms, right cheek, and ears. Focal areas of necrosis without crepitance were noted. Emergency department workup ensued for possible drug-induced or bacterial coagulopathy with concern for purpura fulminans, disseminated intravascular coagulation, and/or necrotizing fasciitis.
Ömer Cenap Gülyüz, Sertaç Arslan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.049
Publication stage: In Press Corrected Proof
Published online: November 19 2015
x Behcet disease is a multisystem vasculitis of unknown etiology, and pulmonary involvement is unusual. Concurrent bilateral pneumothorax is also seen rarely. To the authors' knowledge, this is the first reported case of Behcet disease with concurrent bilateral pneumothorax in the literature.
Michael J. Miescier, Robert J. Bryant, Douglas S. Nelson
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.053
Publication stage: In Press Corrected Proof
Published online: November 19 2015
x Hypoxia is a common complication during the emergent intubation of children. Several approaches may help avoid hypoxia, including semiupright patient positioning, adequate preoxygenation, and nasal cannula apneic oxygenation. Delayed sequence intubation (DSI) is a strategy to facilitate preoxygenation when standard efforts using supplemental oxygen with nonrebreather (NRB) mask are not successful. In DSI, the sedative agent ketamine is administered to facilitate effective preoxygenation via NRB mask or continuous positive airway pressure (CPAP), followed by the delayed administration of a neuromuscular blocking agent once adequate preoxygenation has been achieved.
Alexander B. Norinsky, James Espinosa, Majid Kianmajd, Francesca DiLeonardo
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.050
Publication stage: In Press Corrected Proof
Published online: November 19 2015
x Upper extremity deep vein thrombosis is an uncommon and oftentimes overlooked phenomenon. The presentation may be subtle, especially in the young, otherwise healthy demographic. Review of the literature focuses on secondary causes, most commonly involving sicker patients with multiple underlying comorbidities and in the context of invasive venous catheters. Here, we report a case of a young woman who presented with an extensive upper extremity deep vein thrombosis secondary to thoracic outlet obstruction after just a few days of strenuous exercise.
Ali Pourmand, David Marcozzi, Hamid Shokoohi, Abdulla Alhmoudi, Samantha Olafson
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.052
Publication stage: In Press Corrected Proof
Published online: November 19 2015
x Atraumatic bilateral shoulder posterior fracture dislocation is a very rare and unusual presentation to emergency department (ED). Bilateral posterior shoulder dislocations are usually caused by seizures or electrical shock. The authors highlight the case of a healthy non traumatic patient who presented to the ED without any medical history who found himself in severe shoulder pain after having a nap on his bed.
Allison Rusgo, Michelle N. Carraro, Matthew T. Niehaus, Shawn C. Reynolds, Jeanne L. Jacoby
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.040
Publication stage: In Press Corrected Proof
Published online: November 18 2015
x We report a case of a 33-year-old, 28-week pregnant woman who presented to our suburban emergency department twice with symptoms of upper abdominal pain. She had a benign examination result, which elicited only mild tenderness and fullness in the right upper quadrant. Complete laboratory and radiographic studies, including computed tomographic scan of the chest, revealed only herniation of the left lobe of the liver through a divarication of the abdominal wall. At laparoscopic surgery, she was noted to have omental infarction, apparently secondary to entrapment and vascular compromise from postoperative adhesions.
Shing Ching, Soo Moi Ting
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.033
Publication stage: In Press Corrected Proof
Published online: November 18 2015
x “Time is brain” captures the essence of treating acute stroke. The diagnosis must be confidently established, whereas contraindications for thrombolysis must be excluded in a timely manner. However, stroke mimics always pose a challenge. We describe a case of aortic dissection presenting as right middle cerebral artery syndrome who received intravenous thrombolysis complicated by aortic rupture with a fatal outcome. A Medline search shows that this is the first report of aortic rupture since the inception of thrombolysis for acute stroke.
Benjamin J. Lawner, Jon Mark Hirshon, Angela C. Comer, Jose V. Nable, Jeffrey Kelly, Richard L. Alcorta, Laura Pimentel, Christina L. Tupe, Mary Alice Vanhoy, Brian J. Browne
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.042
Publication stage: In Press Corrected Proof
Published online: November 18 2015
x The objective of the study is to examine the effect of the opening of a freestanding emergency department (FED) on the surrounding emergency medical services (EMS) system through an examination of EMS system metrics such as ambulance call volume, ambulance response times, and turnaround times.
Tetsu Sasaki, Jumpei Temmoku, Tomoya Inukai, Takuya Sugiyama, Ryota Inokuchi, Kazuaki Shinohara
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.032
Publication stage: In Press Corrected Proof
Published online: November 18 2015
x A 68-year-old man was brought to the emergency department because of blunt trauma following a motor vehicle accident. Electrocardiogram indicated acute myocardial infarction (AMI) in the posterior and inferior walls. Emergency coronary angiography showed occlusion of the right coronary artery, and we performed coronary stenting with drug-eluting stents and orally administered aspirin and clopidogrel with heparinization. During the intervention, active bleeding from the right chest tube was noted, and blood pressure was reduced significantly.
Ömer Salt, Mustafa Burak Sayhan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.036
Publication stage: In Press Corrected Proof
Published online: November 18 2015
x Kienbock disease is a very rare condition of the lunate bone that is characterized by sclerosis, cystic changes, fragmentation, and progressive osteonecrosis [1,2]. Patients usually have the history of recurrent trauma. Osteonecrosis of the lunate bone is most common between the second and fifth decade of life, and it affects men more than women [3,4]. Pain increases with activity and decreases with rest [3,5]. In this case report, we would like to highlight a case of Kienbock disease in a 56-year-old female patient without any medical or traumatic history.
Muhammed Keskin, Mert İlker Hayıroğlu, Ümran Keskin, Mehmet Eren
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.039
Publication stage: In Press Corrected Proof
Published online: November 18 2015
x Celiac sprue, also known as celiac disease (CD) or gluten-sensitive enteropathy, is a chronic disorder of the digestive tract that results in an inability to tolerate gliadin, the alcohol-soluble fraction of gluten. We present a case of a patient with CD who was admitted to the emergency department with diarrhea and epigastric and chest pain. The patient had been noncompliant and had eaten some wheat bread. The patient's electrocardiogram showed ST-segment elevations in leads D1 and aVL. Coronary angiography revealed normal coronary arteries.
Jiang-you Wang, Han Chen, Xi Su, Zhi-ping Zhang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.038
Publication stage: In Press Corrected Proof
Published online: November 18 2015
x We introduce a case of a 65-year-old man with a clinical history of hypertension and benign prostatic hyperplasia, who presented to the emergency department with hoarseness of voice and mild dysphagia of 4-week duration. No other neurologic or cardiorespiratory symptoms were found. Physical examination found no positive results. Laryngoscopy examination revealed a left vocal cord paralysis in the paramedian position, without signs of malignancy. Thoracoabdominal computed tomography angiography was performed to rule out an aortic dissection.
Erden Erol Ünlüer, Arif Karagöz, Yusuf Şahin, Serkan Bilgin, Orhan Oyar
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.037
Publication stage: In Press Corrected Proof
Published online: November 18 2015
x Appendicitis remains one of the most commonly presentations as acute abdominal pain to the emergency departments (EDs). Stump appendicitis is the reinflammation of any residual appendiceal tissue after appendectomy and one of the long-term complications. In case of stump appendicitis, the diagnosis is often not considered, and proper management is delayed because most emergency physicians do not realize that appendicitis can occur in the appendiceal stump that remains after an appendectomy has been performed.
Masakazu Nabeta, Osamu Takasu, Keita Tashiro, Toshio Morita, Atsuo Nakamura, Asako Kuhara, Masamichi Koganemaru, Toshi Abe, Teruo Sakamoto
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.034
Publication stage: In Press Corrected Proof
Published online: November 18 2015
x Traumatic hemothorax associated with the lumbar artery is extremely rare. In addition to tube thoracostomy, active hemostatic intervention is necessary in life-threatening massive hemothorax cases. Here we report a case of hemothorax resulting from a lumbar arterial injury accompanied by vertebral fracture, which was successfully treated with transcatheter lumbar arterial embolization.
