Adam H. Miller, Gregory L. Larkin, Claudie H. Jimenez
DOI: http://dx.doi.org/10.1016/j.ajem.2005.01.009
Published in issue: July 2005
xDetermine predictors of medication refill–seeking behavior in ED patients with chronic illness.
Bernard L. Lopez, Jacob F. Cogen, Leemu Kerkula, Theodore Corbin, Pamela Flenders
DOI: http://dx.doi.org/10.1016/j.ajem.2004.09.035
Published in issue: July 2005
xWe performed a retrospective chart review of adult patients with sickle cell presenting with vasoocclusive crisis to determine the association between pulse oximetry and emergency department (ED) disposition. Subjects were divided into a NORMAL (pulse oximetry ≥95%) and a LOW (pulse oximetry <95%) group. Two hundred ten consecutive charts showed no significant difference between NORMAL (n = 163) and LOW (n = 47) groups regarding admission or discharge from the ED (P > .05). A higher percentage in the LOW group received chest radiographs (40.9% vs 29%, P < .05), suggesting that pulse oximetry may have influenced ordering of this test.
Michael Blaivas, Matthew Lyon, Sandeep Duggal
DOI: http://dx.doi.org/10.1016/j.ajem.2004.09.037
Published in issue: July 2005
xEmergency physicians using ultrasound frequently encounter unfamiliar findings during routine ultrasound examination. This is especially common for less experienced practitioners.
Daniel P. Davis, Karun Grossman, Danielle C. Kiggins, Gary M. Vilke, Theodore C. Chan
DOI: http://dx.doi.org/10.1016/j.ajem.2004.10.010
Published in issue: July 2005
xAortic dissection (AD) may present similarly to acute coronary syndrome or pulmonary embolus; however, anticoagulation may be detrimental to patients with AD.
James A. Feldman, Kathryn Brinsfield, Sheilah Bernard, Daniel White, Thomas Maciejko
DOI: http://dx.doi.org/10.1016/j.ajem.2004.10.011
Published in issue: July 2005
xThe aim of the study were to determine if paramedics can accurately identify ST-segment elevation myocardial infarction (STEMI) on prehospital 12-lead (PHTL) electrocardiogram and to compare paramedic with blinded physician identification of STEMI. Paramedics identified definite STEMI, or possible acute myocardial infarction but not definite, and nondiagnostic. Two blinded readers (cardiologist and emergency physician) independently categorized each PHTL. A third reviewer assigned final diagnoses and determined whether the PHTL met STEMI criteria.
Han-Ping Wu, Ching-Yuang Lin, Chin-Fu Chang, Yu-Jun Chang, Chin-Yi Huang
DOI: http://dx.doi.org/10.1016/j.ajem.2004.10.013
Published in issue: July 2005
xDetermining the different cutoff values of C-reactive protein (CRP) on the basis of how long the patient's symptoms were present can be used to early predict acute appendicitis. We analyzed retrospectively from 2001 to 2004 the hospital records of 568 patients who underwent appendectomies for suspected appendicitis. Receiver operating characteristic analysis has shown that CRP measurement can increase the diagnostic accuracy in acute appendicitis. The cutoff values of CRP concentration taken as the first, second, and third days after onset of symptoms that distinguish acute appendicitis from other acute abdominal diseases were 1.5, 4.0, and 10.5 mg/dL, respectively; the values that distinguish perforated appendicitis from other acute abdominal diseases were 3.3 mg/dL (first day), 8.5 mg/dL (second day), and 12.0 mg/dL (third day).
Eric H. Kajioka, Erick M. Itoman, M. Lily Li, Deborah A. Taira, Gaylyn G. Li, Loren G. Yamamoto
DOI: http://dx.doi.org/10.1016/j.ajem.2004.10.015
Published in issue: July 2005
xTo determine the compliance rate in filling outpatient medication prescriptions written upon discharge from the emergency department (ED).
Philip Salen, Larry Melniker, Carolyn Chooljian, John S. Rose, Janet Alteveer, James Reed, Michael Heller
DOI: http://dx.doi.org/10.1016/j.ajem.2004.11.007
Published in issue: July 2005
xThis study evaluated the ability of cardiac sonography performed by emergency physicians to predict resuscitation outcomes of cardiac arrest patients. A convenience sample of cardiac arrest patients prospectively underwent bedside cardiac sonography at 4 emergency medicine residency–affiliated EDs as part of the Sonography Outcomes Assessment Program. Cardiac arrest patients in pulseless electrical activity (PEA) and asystole underwent transthoracic cardiac ultrasound B-mode examinations during their resuscitations to assess for the presence or absence of cardiac kinetic activity.
Bonnie Chin-Yet O'Sullivan, John Lafleur, Kirsa Fridal, Stephen Hormozdi, Steve Schwartz, Mark Belt, Madelon Finkel
DOI: http://dx.doi.org/10.1016/j.ajem.2004.12.017
Published in issue: July 2005
xWe report on the incidence of emergency department (ED) asthma presentations and admissions to the Lincoln Hospital, located in the South Bronx of New York City, during the 1999 eradication program of the mosquito vector for West Nile virus. Spraying of Malathion and Resmethrin occurred in the hospital's geographic area over 4 days in September 1999. During that time, 1318 pediatric and adult patients were seen in the ED for asthma-related symptoms. Of these, 222 (16.8%) were hospitalized. Emergency department visits, during days when spraying occurred, were compared with visits during days when no spraying occurred.
Jin H. Han, Christopher J. Lindsell, Richard J. Ryan, W. Brian Gibler
DOI: http://dx.doi.org/10.1016/j.ajem.2005.01.006
Published in issue: July 2005
xThe purpose of this study was to determine whether long-term and short-term changes in cardiac troponin T (cTnT) were associated with adverse cardiac events (ACEs) in patients with chronic kidney disease. Long-term changes were defined as changes in cTnT between ED visits, and short-term changes were defined as changes between 2 consecutive serial cTnT measurements within an ED visit. A retrospective chart review of patients with chronic kidney disease with suspected acute coronary syndromes presenting to the ED between December 1999 and November 2003 was conducted.
Thomas Dieterle, Macé M. Schuurmans, Werner Strobel, Edouard J. Battegay, Benedict Martina
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.046
Published in issue: July 2005
xIt is controversial whether arterial hypertension (AHT) can be diagnosed in the emergency department (ED). We sought to prospectively investigate the natural time course of blood pressure (BP) to define an optimal period for AHT screening in ED patients with an elevated initial BP.
Nobuaki Inoue, Steven C. Crook, Loren G. Yamamoto
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.023
Published in issue: July 2005
xThere are several types of emergent zipper release methods described. The standard method can be difficult. The purpose of this study is to determine if an alternate method of zipper release can be easier to accomplish.
Jesse Pines, Lori Uscher Pines, Annara Hall, John Hunter, Rajagopalan Srinivasan, Chris Ghaemmaghami
DOI: http://dx.doi.org/10.1016/j.ajem.2004.09.034
Published in issue: July 2005
xThe physical examination of the abdomen is crucial to emergency department (ED) management of patients with abdominal pain. We sought to determine the interrater variation between attending and resident physicians in detecting abdominal exam findings.
Ilan Gur, Ephraim Bar-Yishay, Ron Ben-Abraham
DOI: http://dx.doi.org/10.1016/j.ajem.2004.10.004
Published in issue: July 2005
xThe MRTX portable lightweight respirator (MRTX) provides noninvasive respiratory support using biphasic extrathoracic ventilation via a cuirass fitted around the patient's chest.
Steven J. Weiss, Amy A. Ernst, Margaret Ong, Ray Jones, Debra Morrow, Rosemary Milch, Katie O'Neil, Jay Glass, Todd Nick
DOI: http://dx.doi.org/10.1016/j.ajem.2004.11.003
Published in issue: July 2005
xTo determine whether emergency medical services (EMS) 911 frequent users would benefit from social services intervention.
Michael D. Witting, Sam Hsu, Carlos Andres Granja
DOI: http://dx.doi.org/10.1016/j.ajem.2004.12.006
Published in issue: July 2005
xTo estimate the sensitivity of room-air pulse oximetry in the detection of moderate hypercapnia.
Chad Aleman, Shu B. Chan, Mary Frances Kordick
DOI: http://dx.doi.org/10.1016/j.ajem.2004.12.009
Published in issue: July 2005
xB-Type natriuretic peptide (BNP) values greater than 400 pg/mL have high positive likelihood ratio (>10) for the diagnosis of clinical congestive heart failure (CHF). However, in patients with CHF, it is not known what correlation, if any, exists for the BNP levels above 400 pg/mL and the findings on the initial chest x-ray (CXR).
Carl A. Germann, Andrew D. Perron
DOI: http://dx.doi.org/10.1016/j.ajem.2004.09.036
Published in issue: July 2005
xA conditioned athlete is usually regarded as a member of the healthiest segment of society, and exercise itself is looked upon as a means to improve health. Although extremely uncommon, sudden cardiac death (SCD) in young athletes is a devastating medical event to all involved (patient, family, community, team, and caregivers). Most etiologies of SCD in athletes result in the same final common denominator (cardiac arrest) on presentation to an emergency physician. There are, however, certain historic, physical examination, and electrocardiographic features of many of these disease processes that emergency physicians should have a working knowledge of to try to identify them before they result in SCD.
Claire U. Plautz, Andrew D. Perron, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2004.03.014
Published in issue: July 2005
xThe diagnosis of myocardial contusion in the setting of blunt trauma engenders much discussion and controversy—partly because of the lack of a gold standard for its identification other than histologic findings at autopsy. Furthermore, blunt cardiac trauma represents a spectrum of disorders ranging from transient electrocardiographic change to sudden death from myocardial rupture; hence, no single terminology exists to define such a wide range of scenarios. Here, we present 2 cases of electrocardiographic ST-segment elevation after high-speed motor vehicle crashes resulting in numerous injuries, including blunt chest trauma.
S. Timothy McIlrath, Michael Blaivas, Matthew Lyon
DOI: http://dx.doi.org/10.1016/j.ajem.2004.10.001
Published in issue: July 2005
xOcular trauma can occur from isolated facial trauma or in major blunt trauma such as motor vehicle accidents or falls. Despite the etiology of the injury, a thorough evaluation is important but may often be difficult if severe swelling is present. Recently, emergency ultrasound has seen the use of ocular ultrasound to evaluate visual changes and trauma. Literature suggests that unsuspected and difficult to diagnose pathology may be easily detected on ultrasound of the orbit. We present 3 cases of isolated facial trauma in which routine evaluation with ocular ultrasound led to the discovery of periorbital air with one patient having air insufflating the upper lid of the affected side.
Federico Vallejo-Manzur, Eduardo Mireles-Cabodevila, Joseph Varon
DOI: http://dx.doi.org/10.1016/j.ajem.2004.10.006
Published in issue: July 2005
xThe purple urine bag syndrome (PUBS) is a rare condition associated with chronic urinary catheterization. It is characterized by the purple discoloration of the urine, collecting bag, and tubing. A number of factors are involved, but not always present, in its development including female sex, urinary tract infection, constipation, indicanuria, and alkaline urine. Despite multiple theories that involve the complex tryptophan metabolism to the tubing dye, the cause remains elusive. The syndrome resolves usually after treatment of urinary tract infection or changing of the collecting bag.
Stewart Siu-Wa Chan, Paulina Siu-Kuen Mak, Kwok Kuen Shing, Po Nin Chan, Wing Hung Ng, Timothy Hudson Rainer
DOI: http://dx.doi.org/10.1016/j.ajem.2004.10.014
Published in issue: July 2005
xThe purpose of the study was to evaluate the use of chest radiography for the screening of severe acute respiratory syndrome (SARS). We retrospectively analyzed all patients who attended an Emergency Department SARS screening clinic during the outbreak in Hong Kong, from March 10 to June 5, 2003. Patients with clinical and epidemiologic suspicion of SARS were evaluated by serial chest radiography. All radiographs were reported by consensus from 2 radiologists, blinded to the clinical records. The prevalence of SARS was 13.3% among 1328 patients included.
Siang-Hiong Goh, Wee-Ping Tan, Shu-Woan Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2004.10.005
Published in issue: July 2005
xSome authors have found that thrombocytopenia (<118000/mm3), splenomegaly, and ascites are useful predictors of large esophageal varices in cirrhotic patients. We decide to see whether these factors could also be used to predict bleeding esophageal varices in patients known to have chronic liver disease in the ED.
Jacek M. Mazurek, Kim Winpisinger, Barbara J. Mattson, Rosemary Duffy, Ronald L. Moolenaar
DOI: http://dx.doi.org/10.1016/j.ajem.2004.11.005
Published in issue: July 2005
xWe studied early clinical features of the West Nile virus (WNV) infection. Case patients were Ohio residents who reported to the Ohio Department of Health from August 14 to December 31, 2002, with a positive serum or cerebrospinal fluid for anti–WNV IgM. Of 441 WNV cases, medical records of 224 (85.5%) hospitalized patients were available for review. Most frequent symptoms were fever at a temperature of 38.0°C or higher (n = 155; 69.2%), headache (n = 114; 50.9%), and mental status changes (n = 113; 50.4%).
Daniel Morrison, Michael Blaivas, Matthew Lyon
DOI: http://dx.doi.org/10.1016/j.ajem.2004.12.010
Published in issue: July 2005
xFournier gangrene is a life-threatening infection of the scrotal skin. Although originally thought to be an idiopathic process, Fournier gangrene has been shown to have a predilection for patients with diabetes as well as chronic alcohol abuse; however, it can also affect patients with nonobvious immune compromise. Because of potential complications, it is important to diagnose the disease process as early as possible. Ultrasound has been previously described to aid in the diagnosis of Fournier's gangrene.
W. Douglas Browder, Marcus P. Cromer, Francis L. Counselman
DOI: http://dx.doi.org/10.1016/j.ajem.2004.10.012
Published in issue: July 2005
xTo determine if endotracheal tubes (ETTs) that are opened, prepared, and stored in an ED airway cart are prone to bacterial contamination.
Patricia Jabre, Xavier Combes, Bertrand Leroux, Emanuelle Aaron, Harold Auger, Alain Margenet, Gilles Dhonneur
DOI: http://dx.doi.org/10.1016/j.ajem.2004.12.005
Published in issue: July 2005
xThe objective of this study was to assess effectiveness of gum elastic bougie (GEB) in case of difficult intubation occurring in the prehospital settings. After manikin training to GEB handling, physicians were recommended to use GEB as first alternative technique in case of difficult intubation. Intubating conditions and details of patients requiring GEB-assisted laryngoscopy were recorded over 30 months. Among the 1442 extrahospital intubations performed, 41 patients (3%) required GEB. Gum elastic bougie allowed successful intubation in 33 cases (78%) and 8 patients sustained a second alternative technique.
John G. Schumacher
DOI: http://dx.doi.org/10.1016/j.ajem.2004.12.011
Published in issue: July 2005
xThe treatment of older adults in the emergency department (ED) has been a part of emergency medicine (EM) since its inception. Nationwide, older adults represent an important and growing patient population representing about 18% of ED admissions annually [1]. Although geriatric EM has attracted limited clinical and research attention, there continues to be significant challenges, needs, as well as opportunities in pursuit of providing high-quality care to older adults.
Kenneth Heinrich, Heather M. Prendergast, Timothy Erickson
DOI: http://dx.doi.org/10.1016/j.ajem.2004.10.009
Published in issue: July 2005
xWe present a case of patient with chronic digoxin toxicity with minimal evidence of heart failure, but a significantly elevated B-type natriuretic peptide (BNP) levels.
Sahin Aslan, Ozgur Karcioglu, Yavuz Katirci, Hayati Kandiş, Naci Ezirmik, Ozlem Bilir
DOI: http://dx.doi.org/10.1016/j.ajem.2004.12.015
Published in issue: July 2005
xCompression fracture of the vertebral body is common, especially in older adults. Injuries to the spinal column are one of the most frequent injuries by accidents and falls from heights. Vertebral fracture associated with minor trauma, however, is a rare occasion.
Alexandre Herbland, Nam Bui, Anne Rullier, Frederic Vargas, Didier Gruson, Gilles Hilbert
DOI: http://dx.doi.org/10.1016/j.ajem.2004.12.001
Published in issue: July 2005
xA 50-year-old woman presented to the emergency department complaining of recent cephalalgias with sudden onset of palpitations, abdominal, and thoracic pain followed by nausea and vomiting. She had no medical history, but she reported a case of rhinitis treated for 2 days with a nonsteroidal anti-inflammatory agent. On examination, she was afebrile, with cold peripheries and discreet cyanosis, and abdominal palpation was normal and painless. There were no signs of heart failure, blood pressure was 164/114 mm Hg, and heart rate was 150 beats per minute, but she was oliguric.
Cheng-Chun Hsieh, Chung-Liang Shih, Cheng-Chung Fang, Wen-Jone Chen, Chien-Chang Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.045
Published in issue: July 2005
xDuring an election campaign held in a mansion hall, a previous healthy 33-year-old man was discovered unconscious in a wooden coverless box. The young man was a worker of a public relations company and was assigned to hide in a 7-ft-long, 2-ft-wide and 2.5-ft-deep topless wooden box. According to the designed scenario, he was made to help rise a big Taiwan-map slogan out of the box, symbolic of “Taiwan on the rise.” He lay at the bottom of the box and a 3-in pipe was pouring dry ice near his right arm.
Alfred Sacchetti, Russell H. Harris, Dighton Packard
DOI: http://dx.doi.org/10.1016/j.ajem.2004.12.004
Published in issue: July 2005
xThe ideal procedural sedation agent for any patient may be less a function of pharmacology and more a function of physician access. This study was undertaken to profile ED procedural sedation formularies and define which agents are available for use by emergency physicians (EPs) within their departments. Relationships between medication availability and ED characteristics were also examined.
Timothy Mader, Eric Beauvois
DOI: http://dx.doi.org/10.1016/j.ajem.2004.12.002
Published in issue: July 2005
xAlthough upper gastrointestinal (GI) bleeding has an overall annual incidence of 100 per 100000 in the general population, bleeding secondary to Dieulafoy's lesion is rare and likely underdiagnosed. This vascular malformation can present with massive and catastrophic hemorrhage that can be fatal if not managed aggressively. We present the case of an unusual presentation of upper GI bleeding secondary to Dieulafoy's lesion.
Huan-Wen Chen, Deng-Huang Su, Tzuu-Shuh Jou, Jia-Horng Kao
DOI: http://dx.doi.org/10.1016/j.ajem.2004.12.003
Published in issue: July 2005
xWhether diabetes could prevent attacks of acute intermittent porphyria (AIP) remains incompletely understood. Lithner described 16 AIP patients who had complete remission of AIP attacks after onset of diabetes [1]; however, a correlation between blood glucose level and frequency/severity of AIP attacks was not mentioned. Can AIP be excluded in a diabetic patient who visits ED for severe abdominal pain? AIP is a very rare hereditary metabolic disorder in Taiwan; herein, we reported a patient who had diabetes antedated AIP.
Frédéric Lapostolle, Tomislav Petrovic, Jean Catineau, Gille Lenoir, Frédéric Adnet
DOI: http://dx.doi.org/10.1016/j.ajem.2005.01.008
Published in issue: July 2005
xWe read with interest the paper from Jang et al [1] on training for ultrasonography in emergency cases. Training is a crucial matter when ultrasonographic examination is performed by a nonradiologist operator [2]. Our experience could contribute to this issue as we recently evaluated initial training for emergency physicians performing out-of-hospital ultrasonography.
Ryoko Ogawa, Yusuke Yamamoto, Norihiro Haraguchi, Hiroaki Satoh, Kiyohisa Sekizawa
DOI: http://dx.doi.org/10.1016/j.ajem.2004.12.007
Published in issue: July 2005
xSpontaneous pneumothorax is a common disease encountered in hospital practice. It usually occurs in young men and presents with sudden onset of respiratory distress and chest pain. We report on a patient with spontaneous pneumothorax, who presented with epigastric pain, mimicking peptic ulcer disease or acute pancreatitis. The pain subsided after chest tube thoracostomy.
Robert J. Freishtat, James M. Chamberlain, Christina M.S. Johns, Stephen J. Teach, Cynthia Ronzio, Melissa M. Murphy-Smith, Neelam Gor
DOI: http://dx.doi.org/10.1016/j.ajem.2004.12.008
Published in issue: July 2005
xThe prevalence of clinically significant methemoglobinemia (MHb) is unknown among previously healthy infants presenting to the emergency department (ED) with diarrhea and dehydration. However, it is well described in these infants and, when present, can be associated with significant morbidity [1-4]. Nevertheless, it may not be clinically apparent until levels reach almost 7 times normal levels [5]. Based on this, we hypothesized that dehydrated infants younger than 3 months with diarrhea would commonly have MHb levels above normal but below that causing cyanosis and obvious distress.
Hahn-Shick Lee, Seung-Whan Kim, In-Sool Yoo, Sung-Pil Chung
DOI: http://dx.doi.org/10.1016/j.ajem.2004.12.014
Published in issue: July 2005
xHemiballism is a rare hyperkinetic movement disorder, characterized by irregular, wide amplitude and vigorous involuntary movements of the unilateral limbs. The term ballismus is derived from the Greek word meaning “to throw” because the abnormal movements resemble the motions of throwing. The movements are usually continuous but may be intermittent and can be voluntarily restrained by the patient, although only for a few minutes. They are most prominent during periods of rest but are absent during sleep.
Zuber D. Mulla
DOI: http://dx.doi.org/10.1016/j.ajem.2004.12.016
Published in issue: July 2005
xInvasive group A streptococcal (GAS) disease is a disease of public health importance in the United States. The annual incidence of invasive GAS disease is 4 times that of meningococcal disease [1]. The case-fatality rates of GAS necrotizing fasciitis (NF) and streptococcal toxic shock syndrome, 2 severe manifestations of invasive GAS disease, are high (20% and 45%, respectively).
Klementyna Breyer, S. Eliza Halcomb, Nicole C. Bouchard, Robert S. Hoffman, Paul Dohrenwend, Mary Ann Howland
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.047
Published in issue: July 2005
xWe compliment Adams et al [1] for their elegant use of scintography to verify the commonly held belief that significant delays in gastric emptying occur after intentional overdose. Given that histories obtained from suicidal patients are inherently unreliable and that toxicology screening was not obtained in a standardized manner, we caution readers not to overinterpret the association between the individual drugs categorized in this study and their effects on gastric motility. We agree with the authors' conclusion that poisoning from drug overdose (in general) results in hypomotility and delayed gastric emptying.
Jesse M. Pines, Andrew D. Perron
DOI: http://dx.doi.org/10.1016/j.ajem.2004.11.006
Published in issue: July 2005
xEffective management of pain is a fundamental aspect to the humane provision of emergency care. Multiple studies have identified oligoanalgesia as a significant problem in emergency medicine [1,2]. Pain is a subjective entity that manifests differently based upon specific injury, disease process, and the patients' physiological and psychological make-up [3]. Therefore, a similar anatomic injury or disease process may produce a very different sensation of pain depending on the host.
Steve Allison, Sean O. Henderson
DOI: http://dx.doi.org/10.1016/j.ajem.2004.11.008
Published in issue: July 2005
xA 77-year-old man presented to the emergency room with a heart rate (HR) of 130 beats per minute and a 2-week history of cough that was worse at night. His current medications included metoprolol for hypertension and, although not a current smoker, he did have a 30-year smoking history. He described no exacerbation with exercise, and his physical examination was negative for jugulovenous distension, calf edema, fevers, wheeze, or neck mass. His chest x-ray was negative. The patient's pulse oximetry was steady at 95%, and his electrocardiogram demonstrated possible left ventricular hypertrophy, a regular rhythm, a PR interval of 148 milliseconds, a QRS interval of 92 milliseconds, and a HR of 130 beats per minute.
Joseph R. Shiber
DOI: http://dx.doi.org/10.1016/j.ajem.2004.10.002
Published in issue: July 2005
xType B lactic acidosis, lactate accumulation without any clinical evidence of tissue hypoxia, occurs because of impairment in lactate use. Type B is further divided into subcategories based on underlying etiology. Type B1 is associated with systemic disease such as renal and hepatic failure, diabetes, and malignancy. Type B3 is associated with inherited metabolic disorders. Type B2 is known to be caused by several classes of drugs including biguanides, alcohols, iron, isoniazid, and salicylates.
Wei Hsi Chen, Yi Fen Kao, Ming Chin Hsu
DOI: http://dx.doi.org/10.1016/j.ajem.2004.10.007
Published in issue: July 2005
xEncephalitis is an emergent condition urgent for rapid and correct diagnosis. However, some patients may present with uncommon manifestations, such as behavioral change, sensorimotor deficit, psychosis, or hallucinosis [1], which make it difficult to establish an accurate diagnosis abruptly. We add an unusual flaccid bladder caused by detrusor hyporeflexia as an early symptom for encephalitis.
Frank LoVecchio, David Watts, Joe Winchell
DOI: http://dx.doi.org/10.1016/j.ajem.2004.10.008
Published in issue: July 2005
xAripiprazole is a second generation, atypical antipsychotic medication used in the treatment of schizophrenia, schizo-affective disorder, and acute bipolar mania. The mechanism of action of this drug is not entirely known; however, it has been shown to have high affinity agonistic activity at D2 dopamine and serotonin 5-HT1A receptors, and antagonistic activity at serotonin 5-HT2A receptors. Other affinities noted in premarketing studies [1] demonstrated moderate affinities for dopamine D4, serotonin 5-HT2C, histamine H1, and α1-adrenergic receptors.
Frank LoVecchio, David Watts, P. Eckholdt
DOI: http://dx.doi.org/10.1016/j.ajem.2004.09.033
Published in issue: July 2005
xZiprasidone (ZIP) is an atypical antipsychotic medication approved for treatment of schizophrenia, acute psychomotor agitation, and the treatment of bipolar disorder. Although the side effects of ZIP during standard clinical use are well described, there is a relative dearth of information regarding toxicity in either accidental ingestion or intentional overdose.
DOI: http://dx.doi.org/10.1016/S0735-6757(05)00220-2
Published in issue: July 2005
xRegarding the article “The value of protocol-driven CT scanning in stab wounds to the head,” which appeared in Am J Emerg Med 2002 Jul;20(4):295–7. by Exadaktylos AK, Stettbacher A, Bautz PC:
DOI: http://dx.doi.org/10.1016/S0735-6757(05)00203-2
Published in issue: July 2005
DOI: http://dx.doi.org/10.1016/S0735-6757(05)00204-4
Published in issue: July 2005
