Thomas M. Schmelzer, Andrew D. Perron, Michael H. Thomason, Ronald F. Sing
DOI: http://dx.doi.org/10.1016/j.ajem.2007.01.024
Published in issue: February 2008
xThe arterial base deficit has been demonstrated to be a marker of shock and predictive of survival in injured patients. The venous blood, however, may better reflect tissue perfusion. Its usefulness in trauma is unknown. We compared central venous with arterial blood gas analysis to determine which was a better predictor of survival in injured patients.
David Donaldson, Ryan Sundermann, Raymond Jackson, Aveh Bastani
DOI: http://dx.doi.org/10.1016/j.ajem.2007.03.029
Published in issue: February 2008
xSome physicians prescribe corticosteroids as adjunctive therapy for patients with migraine headaches to decrease the rate of rebound headache. The efficacy of this practice has not been tested. Our objective is to determine the efficacy of single-dose dexamethasone as adjunctive therapy for emergency medicine patients with migraine headache in preventing headache recurrence at 3 and 30 days posttreatment.
Michael D. Witting, Steven M. Scharf
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.002
Published in issue: February 2008
xWe sought to determine the distribution of oximetry (Spo2) values in awake, asymptomatic adults and the effect of personal characteristics on these values.
Bulent Erdur, Gurkan Ersoy, Osman Yilmaz, Aydan Ozkutuk, Banu Sis, Ozgur Karcioglu, Ismet Parlak, Cuneyt Ayrik, Ersin Aksay, Melek Guryay
DOI: http://dx.doi.org/10.1016/j.ajem.2007.03.030
Published in issue: February 2008
xThis work was conducted to study the prophylactic efficacy of 2 topical antibiotic ointments (mupirocin and nitrofurazone) against wound infection in experimental contaminated crush wounds.
Mark A. Graber, Bradley D. Randles, John W. Ely, Jay Monnahan
DOI: http://dx.doi.org/10.1016/j.ajem.2007.03.031
Published in issue: February 2008
xThe objective of the study was to determine how many patient-related questions emergency medicine physicians have and how they answer them at the point of care.
Vincent Bounes, Sandrine Charpentier, Charles-Henri Houze-Cerfon, Cédric Bellard, Jean Louis Ducassé
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.020
Published in issue: February 2008
xWe aimed to determine the best intravenous morphine titration protocol by comparing 2 protocols for prehospital treatment of patients with severe acute pain.
Martha Shumway, Alicia Boccellari, Kathy O'Brien, Robert L. Okin
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.021
Published in issue: February 2008
xThe objective of the study was to test the hypothesis that clinical case management is more cost-effective than usual care for frequent users of the emergency department (ED).
Phillipe Bruge, Patricia Jabre, Michel Dru, Chadi Jbeili, Eric Lecarpentier, Mohamed Khalid, Alain Margenet, Jean Marty, Xavier Combes
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.022
Published in issue: February 2008
xOut-of-hospital clinical experience with noninvasive bilevel positive airway pressure (BiPAP) ventilation is extremely limited compared to inhospital management. The aims of this study were to assess the feasibility of out-of-hospital BiPAP ventilation in patients with acute respiratory distress of various origins, and to look for specific factors associated with failure of this respiratory support.
Cheng-Ting Hsiao, Hsu-Huei Weng, Yao-Dong Yuan, Chih-Tsung Chen, I-Chuan Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.023
Published in issue: February 2008
xNecrotizing fasciitis is an uncommon and life-threatening soft tissue infection with high mortality. Though early aggressive surgical intervention is important for improving survival, the impact of mortality from different microorganisms remains uncertain. Our study aims to identify the association of mortality and different microorganisms, and the positive and negative predictors of mortality in patients with necrotizing fasciitis.
Steven P. Frei, William F. Bond, Robert K. Bazuro, David M. Richardson, Gina M. Sierzega, Thomas E. Wasser
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.024
Published in issue: February 2008
xWe sought to investigate the relationship between delay in treatment of appendicitis and early use of analgesia.
Stephen J. Wolf, Tracy R. McCubbin, Kristen E. Nordenholz, N. Ward Naviaux, Jason S. Haukoos
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.026
Published in issue: February 2008
xOveruse of resources when evaluating pulmonary embolism (PE) is a concern if the D-dimer assay is improperly used in the evaluation of emergency department patients with suspected PE. The pulmonary embolism rule-out criteria (PERC) rule was derived to prevent unnecessary diagnostic testing in this patient population. The objective of this study was to assess the PERC rule's performance in an external population.
F. Ben Housel, Terry G. Murphy
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.025
Published in issue: February 2008
xNitrous oxide has been occasionally used as a prehospital analgesic over the last 3 decades. It has been shown to be an effective analgesic agent [1], but concerns have been raised about exposing prehospital personnel to high ambient levels of nitrous oxide within the confines of the ambulance. Historical concerns about possible detrimental effects of long-term exposure to health care workers prompted the National Institute of Occupational Safety and Health (NIOSH) to issue recommendations regarding acceptable levels of nitrous oxide exposure.
Michael Andrew Meyer
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.027
Published in issue: February 2008
xThe 15-item National Institutes of Health Stroke Scale is depicted here as a single diagram with major categories of deficits placed into 3 separate functional groups with 7 points assigned to each, in addition to 4 points for motor deficits in each of 4 extremities. This simple composite visual aid, known as the Stroke Quick Score, may help in training stroke team members in the use of the National Institutes of Health Stroke Scale.
Neil B. Hampson
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.028
Published in issue: February 2008
xElevated blood carboxyhemoglobin (COHb) levels are used to confirm a clinical diagnosis of exposure to carbon monoxide (CO) and, in some instances, assess severity of poisoning. However, many hospital laboratories cannot measure COHb because they do not have CO-oximeters. In such instances, blood samples are often sent to outside laboratories or with a transported patient for measurement at the receiving hospital. This study was conducted to assess the stability of COHb in stored and mailed blood samples anticoagulated with heparin.
Ahmed Chaudhry, Adam J. Singer, Jasmine Chohan, Valerie Russo, Christopher Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.029
Published in issue: February 2008
xHemodynamic profiling (HP) of patients with heart failure (HF) based on clinical assessment of central congestion and peripheral perfusion has been widely used by cardiologists to help guide therapy and determine prognosis but has never been tested or validated in the emergency department (ED). We hypothesized that the interrater reliability of HP in the ED would be good or greater than 0.6.
Abdulkadir Gunduz, Suleyman Turedi, Ahmet Mentese, Suleyman Caner Karahan, Gultekin Hos, Ozgur Tatlı, Ibrahim Turan, Utku Ucar, Robert Michael Russell, Murat Topbas
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.030
Published in issue: February 2008
xIschemia-modified albumin (IMA) is a sensitive marker of myocardial ischemia, skeletal muscle ischemia, pulmonary embolism, and stroke. However, there are no studies showing whether IMA increases in mesenteric ischemia. The aim of this study was to determine whether IMA was elevated in acute mesenteric ischemia. This case-controlled study was performed in an emergency department of a university hospital. The measurement of IMA levels in patient plasma yielded means of 0.264 ± 0.057 absorbance units (ABSU) in the thromboembolic occlusion of the superior mesenteric artery (SMA) group and 0.163 ± 0.025 ABSU in the control group.
Jared Strote, Pamela Kohler
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.032
Published in issue: February 2008
xAccepted guidelines define when to terminate unsuccessful resuscitations. We examined whether such resuscitations last longer for transported arrests in the field compared with those occurring in the emergency department (ED).
William E. Boden, James Hoekstra, Chadwick D. Miller
DOI: http://dx.doi.org/10.1016/j.ajem.2007.03.033
Published in issue: February 2008
xAntiplatelet therapy to reduce the risks of recurrent myocardial infarction and restenosis after primary percutaneous coronary intervention is critically important to optimize the early treatment of ST-segment elevation myocardial infarction (STEMI). Traditionally, acetylsalicylic acid (ASA; aspirin) has been recommended for patients with suspected STEMI, but this agent targets only one of several pathways of platelet aggregation. Antiplatelet agents with different inhibitory mechanisms may act synergistically with ASA.
Matthew O'Connor, Nancy McDaniel, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2007.08.003
Published in issue: February 2008
xEmergency physicians attending to pediatric patients in acute care settings use electrocardiograms (ECGs) for a variety of reasons, including syncope, chest pain, ingestion, suspected dysrhythmias, and as part of the initial evaluation of suspected congenital heart disease. Thus, it is important for emergency and acute care providers to be familiar with the normal pediatric ECG in addition to common ECG abnormalities seen in the pediatric population. The purpose of this 3-part review will be to review (1) age-related changes in the pediatric ECG, (2) common arrhythmias encountered in the pediatric population, and (3) ECG indicators of structural and congenital heart disease in the pediatric population.
Brian T. Fengler
DOI: http://dx.doi.org/10.1016/j.ajem.2007.03.032
Published in issue: February 2008
xEtomidate is an agent often used by emergency medicine physicians for rapid-sequence intubation induction of critically ill patients because of its reliable pharmacokinetics and cardiovascular stability. Etomidate is known to inhibit endogenous cortisol production through inhibition of 11β-hydroxylase. Previous studies in undifferentiated emergency department patients and healthy, elective surgical patients have shown this effect to be only transient and not clinically significant. Recent retrospective studies in the pediatric and adult intensive care literature have shown an association between a single induction dose of etomidate in critically ill septic patients and sustained suppression of the adrenal axis with an increase in mortality.
John P. Benner, Josh Hilton, Gordon Carr, Kimberly Robbins, Robert C. Schutt, Matthew P. Borloz, Kostas Alibertis, Benjamin Sojka, Korin Hudson, Dayton Haugh, William Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.003
Published in issue: February 2008
xThe integration of emergency medical services (EMS) with other health care providers, particularly emergency department (ED)–based personnel, has been identified as an area deserving of attention and improvement [1]. The enhancement of communication, particularly at patient transfer, between EMS and the ED health care team is certainly a first step to such integration. We write to you with the results of an ED-based study that we performed involving both qualitative and quantitative analysis of patient-specific data relayed to the ED staff by EMS at the time of patient transfer of care in the ED.
Samuel Delerme, Patrick Ray
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.009
Published in issue: February 2008
xWe read with great interest the article by Aksay et al [1]. To our knowledge, this is the first study performed in an emergency department (ED) that suggested that cardiac troponin I (cTnI) could predict in-hospital complicated pulmonary embolism (PE). It is interesting because echocardiography is rarely available in most EDs. However, we have several concerns and comments about the method they used and their conclusions. First, it was a retrospective study (with all the methodological biases [2]) of patients admitted with a diagnosis of PE in the ED; we suggest that some PEs could have been missed in the ED and diagnosed later in the ward but not included in their study.
Ersin Aksay
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.023
Published in issue: February 2008
xReviewer 1: I disagree with the author's concern about clinical features of patients presenting with pulmonary embolism (PE) to the emergency department (ED). I think emergency physicians commonly meet complicated patients with PE because those patients have more serious complaints and they tend to present to EDs rather than hospital polyclinics or the offices of private physicians. Therefore, it is not surprising that these patients revealed serious deviations in vital parameters and elevated cardiac troponin I (cTnI) levels more frequently.
Olivier Steichen, Laurent Martinez-Almoyna
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.010
Published in issue: February 2008
xWe read with interest the recent article by Ray et al [1] regarding the accuracy of cerebrospinal fluid (CSF) results to differentiate bacterial from aseptic meningitis in case of negative Gram stain. As the authors state, their results are of great value because they address the real issue faced by practicing physicians when they have to distinguish bacterial from aseptic meningitis. Indeed, if bacteria are seen on the Gram stain, the diagnosis of bacterial meningitis can be made with confidence [2].
Shivani Gupta, Chris Gennings, Richard P. Wenzel
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.001
Published in issue: February 2008
xThe respiratory rate is a valuable component of patients' vital signs. Abnormal rates may indicate direct cardiopulmonary diseases, adverse responses to drugs, and compensating responses to acid-base abnormalities. Furthermore, a rate of more than 20 is 1 of the 4 defined criteria for systemic inflammatory response syndrome (SIRS). The other 3 SIRS criteria include a temperature higher than 38°C or lower than 36°C; pulse of more than 90/min; and a white blood cell count of more than 12 × 109/L, less than 4 × 109/L, or with more than 10% bands [1].
Jacqueline Dovgalyuk, William J. Brady, Marge Sidebottom, Todd Hansen
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.002
Published in issue: February 2008
xDisaster planning has become a popular media topic in light of some of the national and world events of late including the severe acute respiratory syndrome epidemic, the events of September 11, Hurricane Katrina, and the threat of the H5N1 avian flu. Although much of the literature has focused on strategies for governmental and regional preparedness, very little information is available regarding the local preparedness of the primary care physician and his or her role in the medical management of such a disaster.
Steven B. Bird, Christopher Rosenbaum
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.003
Published in issue: February 2008
xWe observed that the brief report “Onset of symptoms after methadone overdose” by LoVecchio et al [1] has some dramatic shortcomings that severely limit the applicability of their findings.
Yen-Yue Lin, Chin-Wang Hsu, Shi-Jye Chu, Shih-Hung Tsai
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.004
Published in issue: February 2008
xWe have read with great interest the article recently published by Williamson et al entitled “ Electrocardiographic applications of lead aVR” [1], which addressed the findings of lead aVR regarding 4 important conditions, including acute coronary syndrome with left main coronary artery occlusion, acute pericarditis, significant tricyclic antidepressant poisoning, and Wolff-Parkinson-White syndrome. From medical literature review and our experience, we would like to mention 3 additional conditions that might present with electrocardiographic changes in lead aVR: dextrocardia, tension pneumothorax, and pulmonary embolism.
Joseph Varon, Pilar Acosta
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.025
Published in issue: February 2008
xTherapeutic hypothermia (TH) has been demonstrated to have beneficial effects in brain injury, cardiac arrest, perinatal asphyxia, and some cardiac and intracranial surgical procedures [1]. In 2005, the Advanced Cardiovascular Life Support and the International Liaison Committee on Resuscitation (ILCOR) guidelines recommended induced hypothermia for comatose victims of cardiac arrest [2]. The recommendations included inducing TH at 32°C to 34°C for 12 to 24 hours when the initial presenting rhythm was ventricular fibrillation (class IIA recommendation) or nonventricular fibrillation (class IIb recommendation) [3].
Hung-Hsin Mo, Chien-Chang Lee, Shyr-Chyr Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2007.03.026
Published in issue: February 2008
xAortic dissection is a potentially life-threatening condition that must be diagnosed early and accurately. Here we report a case of type A aortic dissection presenting with seizure and unconsciousness. We thought this rare manifestation should be reported because misdiagnosis of such cases could lead to disastrous results.
Hsin-Chi Lin, Chien-Chih Chen, Tzong-Luen Wang, Chee-Fah Chong, Ruei-Fang Wang
DOI: http://dx.doi.org/10.1016/j.ajem.2007.03.034
Published in issue: February 2008
xPeritoneal dialysis (PD) has been applied to patients with end-stage renal disease for more than 2 decades. It should raise physicians' concern about the serious complications of prolonged PD therapy, particularly encapsulating peritoneal sclerosis (EPS), the most potentially life-threatening one. The prevalence and mortality rate of EPS increase as PD duration increases [1]. We report a case of EPS presented with blood-tinged effluents and abdominal pain.
Michael A. Miller, Doug Borys, Michele Riggins, David C. Masneri, Marc E. Levsky
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.004
Published in issue: February 2008
xThe use of liquid skin cleanser or body wash has become common in the United States. We report 2 cases of contact dermatitis secondary to the application of Dove Body Wash (Unilever US, Inc., Englewood Cliffs, NJ) with the consumer misconception that the product was a skin moisturizing cream.
Allen Yu-Hung Lai, Yuh-Chen Kuo
DOI: http://dx.doi.org/10.1016/j.ajem.2007.03.035
Published in issue: February 2008
xWe present a 69-year-old man with repeated urinary tract infection and lower abdominal pain. Kidney-ureter-bladder (KUB) scout film showed a huge, 320-g triangular pelvic calculus that was surgically removed with excellent results. Bladder stone is a common disease, but it is rare for such a calculus to be so large as to cause bilateral hydronephrosis. Surgical intervention by cystolithotomy or endoscopic cystolithotripsy can achieve satisfactory results. Bladder outlet obstruction should be treated simultaneously.
Kuan-Che Lu, Chun-Chieh Chao, Tzong-Luen Wang, Chee-Fah Chong, Chien-Chih Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.005
Published in issue: February 2008
xThe causes of postural headache are usually associated with low intracranial pressure. However, there are still rare causes of posture-related headaches that are not associated with low intracraninal pressure and caused by pathologic processes. Herein, we report a patient with giant posterior fossaarachnoid cyst herniating below the level of foramen magnum presenting with postural headache, which has not been described previously in the literature. Emergency physicians should be aware that posterior fossa arachnoid cysts should be considered one of the differential diagnoses in patients with postural headache.
Jason J. Tanguay, Paul J. Allegretti
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.006
Published in issue: February 2008
xA 35-year-old woman, gravida 5 para 3, presented to the emergency department 9 days after a cesarean delivery with a new-onset headache, hypertension, and hyperreflexia. Formal urinalysis did not demonstrate proteinuria. Computed tomography of the brain demonstrated bilateral parietal subarachnoid hemorrhages. The patient was subsequently transferred to a tertiary care hospital where she underwent magnetic resonance imaging and computed tomographic angiography that were not suggestive of intracerebral aneurysm, arteriovenous malformation, sinus thrombosis, or angiopathy.
Ruei-Fang Wang, Tzu-Yao Hung, Chee-Fah Chong, Tzong-Luen Wang, Chien-Chih Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.007
Published in issue: February 2008
xSystemic lupus erythematosus (SLE) is a multisystemic autoimmune disorder. The initial manifestation complicating any organ system either singly or in combination is protean. Herein we report a 26-year-old female patient with fresh SLE whose initial manifestation was central cyanosis caused by severe pulmonary hypertension and acute pericarditis. The symptoms were relieved dramatically after treatment with steroid and bosentan. Accurate and timely diagnosis in SLE-associated pulmonary hypertension may be life saving.
Alfonso Lagi, Elisa Meucci, Simone Cencetti
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.008
Published in issue: February 2008
xThe objective of this study was to evaluate whether increased c-Tnl in patients suffering from mild trauma without cardiac disease may be prognostic for future cardiac events. Consecutive patients suffering from mild trauma were recruited and evaluated for levels of creatinine, creatine–kinase (CK) and c–Tnl. Patients with elevated c–Tnl were selected and followed up for six months for cardiac events (cardiac death, Myocardial Infarction, Acute Coronary Syndromes, cardiac syncope, pacemaker or Intracardiac Device Implantation, Percutaneous Cardiac Intervention, and aortic–coronary bypass).
Chien-Liang Liu, Yung-Cheng Su, Chien-Chih Chen, Chee-Fah Chong, Tzong-Luen Wang
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.011
Published in issue: February 2008
xNontraumatic subarachnoid hemorrhage is a neurologic emergency, and prompt treatment is necessary to avoid catastrophic result. We present a patient with subarachnoid hemorrhage caused by ruptured cervical intradural extramedullary arteriovenous fistulas, which rapidly progressed to quadriplegia. Because of the timely management, the patient had a good recovery. This is a rare but important case that emergency physicians should be aware of.
Li Wei Hao, Chiu-Mei Lin, Shin-Han Tsai
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.012
Published in issue: February 2008
xAbstract Managing acute abdomen is a challenge for physicians in the emergency department. An immediate surgery is sometimes required for the hemorrhagic uropathy of renal angiomyolipoma. We present a case with left flank pain and findings of hematuria and pyuria. Abdominal and pelvic computed tomographic scans showed a 3 × 5-cm, fat-containing tumor at the left lower pole of the kidney and a bleeding and perirenal hematoma in the left perirenal space. An urgent left nephrectomy was lifesaving for the postoperative finding of renal angiomyolipoma.
Christophe Lelubre, Philippe E.R. Lheureux
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.013
Published in issue: February 2008
xAccidental intra-arterial injection is a potentially devastating complication of the intragluteal injection of benzathine penicillin. A 35-year-old woman developed after intramuscular injection of benzathine penicillin G acute paraplegia and noncardiogenic pulmonary edema. Noninvasive positive pressure ventilation was initiated with furosemide and corticosteroids. A magnetic resonance imaging scan showed findings consistent with syringomyelia and spinal cord ischemia at T9 through T10. Vascular injury may be the result of microemboli of the injected crystals of the penicillin salts.
Lawrence W. Raymond, Melissa M. Jones, Eric Warren, David A. Weinrib
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.014
Published in issue: February 2008
xAmong many causes of penile injury, sexual activity is infrequently reported. The present case involved delay in recognition, which led to development of a phlegmon near major vascular structures. Positive serologic evidence of syphilis was an incidental finding.
Liang-Chi Kuo, Hsing-Lin Lin, Chao-Wen Chen, Wei-Che Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.015
Published in issue: February 2008
xFractures of hyoid bone are rare and most of the injuries cause by strangulation. Hyoid bone fractures are usually the result of direct trauma to the neck through manual strangulation or hanging, blunt trauma or from projectiles. But hyoid bone fracture caused by helmet strap has not been reported before. We present a young man wearing a helmet had an isolated hyoid bone fractures after a motorcycle-to-motorcycle accident. So, we should be more aware that helmet wearing riders are prone to have this kind of injury.
Christophe Lelubre, Philippe E.R. Lheureux
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.016
Published in issue: February 2008
xA 39-year-old woman presented with a 10-day history of epigastric pain accompanied by persistent fatigue and loss of appetite for 3 months. She had presented several weeks earlier with adhesive capsulitis, treated by local infiltration of corticosteroids. She was not taking any other medications. Results of heart, lung, and abdominal examinations were unremarkable, except for mild epigastric tenderness. Purple stretch marks were observed on examination of the skin. The only blood chemistry abnormalities were hyponatremia (125 mEq/L) and hyperkalemia (6.8 mEq/L).
Daniel P. O'Donnel, Rawle A. Seupaul
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.017
Published in issue: February 2008
xA healthy 19-year-old man presented with signs and symptoms of central cord syndrome after a moderate fall. He had congenital fusion of multiple cervical vertebrae consistent with Klippel-Feil syndrome. This disorder, although rare, is important for emergency medicine physicians to recognize as a risk factor for cervical cord syndromes.
Young-Shun Wu, Yen-Yue Lin, Chin-Wang Hsu, Shi-Jye Chu, Shih-Hung Tsai
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.018
Published in issue: February 2008
xTransdiaphragmatic intercostal hernia (TDIH) is a rare consequence from blunt chest-abdominal injury. The diagnosis of TDIH is often delayed. We report a patient who had a history of left-sided upper abdominal blunt injury 2 months before admission presented with a newly developed, massive pleural effusion and clinical manifestations of intestinal obstruction. A multidetector-row computed tomography confirmed the diagnosis of traumatic diaphragm rupture and TDIH. He underwent thoracotomy with reduction of herniated viscera and repair of the diaphragm and chest wall.
Tung-Yao Tsai, Ta-Chung Shen, Chin-Hsiang Chuang, Yi-Kung Lee, Chee-Fah Chong, Tzong-Luen Wang, Vei-Ken Seow
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.019
Published in issue: February 2008
xPainless aortic dissection with only focal neurological symptoms and signs can be a great challenge to the emergency physician. Inadvertently and erroneous treatment of stroke may threaten patient's life. We present a patient with painless aortic dissection (DeBakey I), which was initially misdiagnosed as brainstem stroke with catastrophic anticoagulant use. Finally, the patient died of multiorgan failure after surgical intervention.
Youichi Yanagawa, Shinichirou Iwamoto, Akiyoshi Hagiwara, Souichirou Seno
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.031
Published in issue: February 2008
xA 69-year-old man with epigastralgia and vomiting continuing for 7 hours was transported to this department. At the time of examination, he was drowsy and in a state of shock. He showed a markedly distended abdomen and epigastric tenderness. Arterial blood gas showed hypoxia and severe metabolic acidosis. Computed tomography revealed intramural gas in the wall of the stomach and small intestine, and multiple gas in the portal vein, mesenteric vein, pulmonary artery, coronary artery, and ascending aorta.
Matthew Hess, Branyan Booth, Richard T. Laughlin
DOI: http://dx.doi.org/10.1016/j.ajem.2007.04.033
Published in issue: February 2008
xCalcaneal fractures represent approximately 2% of all fractures, of which 25% to 40% are classified as extra-articular in nature. Most calcaneal fractures are closed injuries that are treated nonoperatively, or if treated operatively, surgery is delayed to allow subsidence of swelling. The purpose of this article is to highlight a subset of calcaneal fractures that should be addressed urgently. Calcaneal tuberosity avulsion fractures often compromise the thin posterior skin that covers the insertion of the Achilles tendon.
Hsing-Lin Lin, Wei-Che Lee, Liang-Chi Kuo, Chao-Wen Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2007.05.006
Published in issue: February 2008
xIn the emergency department, we frequently manage patients with multiple contusions and bruise over the trunk without severe injuries. Emergency department discharge is a common option for these patients, and we may neglect the existence of closed internal degloving injury, which is a soft tissue injury with pelvic trauma, combining the subcutaneous tissue torn away from the underlying fascia followed by a cavity being filled with hematoma and liquefied fat created in the next few days (Harefuah 2006;145:111-3:66, J Trauma 1997;42:1046).
DOI: http://dx.doi.org/10.1016/S0735-6757(07)00816-9
Published in issue: February 2008
