Shawn M. Varney, Melissa Dooley, Vikhyat S. Bebarta
DOI: http://dx.doi.org/10.1016/j.ajem.2008.02.003
Published in issue: March 2009
xTo compare average time to successful intubation and success rates using direct laryngoscopy (DL) with those using a battery-operated videoscope (VS) in uncomplicated manikin intubations.
Meir Antopolsky, Nurit Hiller, Shaden Salameh, Beth Goldshtein, Ruth Stalnikowicz
DOI: http://dx.doi.org/10.1016/j.ajem.2008.02.014
Published in issue: March 2009
xThe aim of this study was to study the clinical presentation of splenic infarction.
Darren Braude, David Ronan, Steven Weiss, Michel Boivin, Neal Gerstein
DOI: http://dx.doi.org/10.1016/j.ajem.2008.02.021
Published in issue: March 2009
xThe purpose of this study was to compare 4 different gum-elastic bougies (GEBs) for differences in success rate, speed of intubation, and device preference.
Louise R.A. Olde Nordkamp, Nynke van Dijk, Karin S. Ganzeboom, Johannes B. Reitsma, Jan S.K. Luitse, Lukas R.C. Dekker, Win-Kuang Shen, Wouter Wieling
DOI: http://dx.doi.org/10.1016/j.ajem.2008.02.022
Published in issue: March 2009
xWe assessed the prevalence and distribution of the different causes of transient loss of consciousness (TLOC) in the emergency department (ED) and chest pain unit (CPU) and estimated the proportion of persons with syncope in the general population who seek medical attention from either their general practitioner or the ED/CPU.
Alissa A. Arnold, B. Evan Ross, Paul A. Silka
DOI: http://dx.doi.org/10.1016/j.ajem.2008.02.018
Published in issue: March 2009
xWe conducted a pilot study to assess the efficacy of acupuncture as an analgesic intervention for patients presenting to the emergency department (ED) after minor acute trauma to the extremities. In addition, we sought to assess the feasibility of performing acupuncture in this setting.
Adam J. Singer, Steve A. McClain, Breena R. Taira, Alexander Romanov, Jean Rooney, Tom Zimmerman
DOI: http://dx.doi.org/10.1016/j.ajem.2008.02.019
Published in issue: March 2009
xA brass comb burn model that creates 3 full-thickness burns separated by 3 interspaces of unburned skin representing the zone of ischemia has been described in rats. We evaluated this model in pigs.
Breena R. Taira, Adam J. Singer, Henry C. Thode Jr, Christopher C. Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2008.02.027
Published in issue: March 2009
xLittle has been reported regarding the national epidemiology of cutaneous abscesses. We examined the National Hospital Ambulatory Medical Care Survey (NHAMCS) national estimates of all emergency department (ED) visits from 1996 to 2005 to determine the trend and the epidemiology of ED abscess visits.
Sean P. Collins, Daniel P. Schauer, Amit Gupta, Hermine Brunner, Alan B. Storrow, Mark H. Eckman
DOI: http://dx.doi.org/10.1016/j.ajem.2008.02.025
Published in issue: March 2009
xThe ED disposition of patients with non–high-risk acute decompensated heart failure (ADHF) is challenging. To help address this problem, we investigated the cost-effectiveness of different ED disposition strategies.
Frédéric Bloch, David Jegou, Jean-François Dhainaut, Anne-Sophie Rigaud, Joël Coste, Jean-Eric Lundy, Yann-Erick Claessens
DOI: http://dx.doi.org/10.1016/j.ajem.2008.02.026
Published in issue: March 2009
xFall-related morbidity is a serious public health issue in older adults referred to emergency departments (EDs). Emergency physicians mostly focus on immediate injuries, whereas the specific assessment of functional consequences and opportunities for prevention remain scarce. The aim of this study was to determine the factors influencing 6-month independence.
Youichi Yanagawa, Toshihisa Sakamoto, Hiroki Sato
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.001
Published in issue: March 2009
xThe aim of this study was to investigate whether laboratory findings on arrival may be useful in predicting the outcome of out-of-hospital cardiopulmonary arrest (CPA).
Rebecca Jeanmonod, Christopher Brook, Mark Winther, Soma Pathak, Molly Boyd
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.002
Published in issue: March 2009
xWe sought to determine if resident productivity changed based on emergency department (ED) volume, shift time of day, or over time during a shift.
Yu-Hui Chiu, Jen-Dar Chen, Chui-Mei Tiu, Yi-Hong Chou, David Hung-Tsang Yen, Chun-I Huang, Cheng-Yen Chang
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.004
Published in issue: March 2009
xThis study aimed to evaluate the sensitivities of the reported free air signs on supine chest and abdominal radiographs of hollow organ perforation. We also verified the value of supine radiographic images as compared with erect chest and decubitus abdominal radiographs in detection of pneumoperitoneum.
Peter B. Smulowitz, Long Ngo, Stephen K. Epstein
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.012
Published in issue: March 2009
xTo determine if a new outpatient preauthorization process for radiologic studies was associated with a change in emergency department (ED) CT and MRI utilization rates. Methods: This was a retrospective study set in an urban tertiary teaching hospital. Subjects included all nonadmitted ED patients who had either a CT or MRI during a control or preauthorization period. The study group consisted of those patients whose insurance required preauthorization. The control group consisted of those patients for whom preauthorization was not required.
Ben Harris, Ula Hwang, Won S. Lee, Lynne D. Richardson
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.041
Published in issue: March 2009
xHeadache is a common presenting complaint in the emergency department (ED). Physicians may choose to screen for causes of headache using computed tomography (CT). It is not known whether patient characteristics influence this decision. This study sought to identify patient demographic factors associated with CT evaluation for adult patients with headache.
Nicholas Hartman, Allen Williamson, Benjamin Sojka, Kostas Alibertis, Marjorie Sidebottom, Thomas Berry, Jay Hamm, Robert E. O'Connor, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.042
Published in issue: March 2009
xMass gathering events require varying types and amounts of medical resources to deal with patient presentations. The needs of various events have so far been difficult to predict with precision, yet likely are impacted by several factors which may be used in a predictive fashion.
Gus W. Krucke, Deanna E. Grimes, Richard M. Grimes, Thai D. Dang
DOI: http://dx.doi.org/10.1016/j.ajem.2008.03.046
Published in issue: March 2009
xThe aim of this study was to document the resistance patterns found in exudates from cutaneous abscesses of HIV-infected persons.
David Slattery, Charles V. Pollack Jr
DOI: http://dx.doi.org/10.1016/j.ajem.2008.01.017
Published in issue: March 2009
xCurrent treatment guidelines recommend an early, aggressive strategy in patients with non–ST-elevation acute coronary syndromes. Administration of antiplatelet therapy—a glycoprotein IIb-IIIa inhibitor with or without clopidogrel—before catheterization in patients with high-risk features confers substantially reduced risk of ischemic events while potentially increasing bleeding risk. Strategies for risk stratification are therefore important in the emergency department, with appropriate pharmacotherapy.
Òscar Miró
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.007
Published in issue: March 2009
xI have read the interesting proposal of Ong et al [1] of emergency department (ED) physicians' roster adjustment according to daytime, weekday, and seasonal fluctuations of ED necessities, basically estimated by the total number of ED attendances. The aim of the study is to face ED overcrowding, a major ED worldwide blight [2-4], by matching ED staffing and resources to actual conditions. I have no doubt regarding the robustness of the methodology used for achieving their final model. However, I believe that this is a path that ED physicians should not undertake.
Marcus Eng Hock Ong
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.008
Published in issue: March 2009
xIn “Regarding the Adjustment of Roster According to ED census,” the author has rightly pointed out that a solution to ED overcrowding cannot be solely be the responsibility of the ED but must involve addressing issues like lack of physical space in the ED, excessive boarding of patients in the ED, limitation of in-hospital beds leading to hospital bed-block, and other hospital administrative issues. We agree wholeheartedly with this sentiment.
Elke Platz, Rita Cydulka, Sandra Werner, Jessica Resnick, Robert Jones
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.012
Published in issue: March 2009
xUltrasound is highly sensitive for ruling out a pneumothorax in supine patients by identifying lung sliding, a to-and-fro movement along an echogenic line observed when the visceral pleura slides on the parietal pleura during respiration (Fig. 1) [1-4]. However, concern exists that the presence of pulmonary contusions may affect lung sliding and limit the usefulness of ultrasound to exclude a pneumothorax under these circumstances [3]. We sought to investigate in a pilot study the potential influence of pulmonary contusions on lung sliding.
Cenker Eken
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.022
Published in issue: March 2009
xI am pleased to read the interesting article by Dr Manini et al [1] entitled “Limitation of risk score models in patients with acute chest pain.” However, there is an interesting misunderstanding in the interpretation of the medical phrases in the management of chest pain patients that may cause fatal errors on the hypothesis of this study.
Alex Manini, Nina Dannemann, Javed Butler, Fabian Bamberg, John Nichols, Udo Hoffmann, David Brown, John Tobias Nagurney
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.021
Published in issue: March 2009
xWe thank Dr Eken for the thoughtful letter [1], which clearly highlights 2 important points. First, there are inherent difficulties with sorting out the concepts of likelihood classification vs risk stratification for a given disease process. Second, risk stratification is particularly problematic for patients with acute chest pain, especially that subset with normal initial cardiac biomarkers and a nondiagnostic electrocardiogram.
Clare Dieppe, Sapna Verma, Bridget Wilson
DOI: http://dx.doi.org/10.1016/j.ajem.2008.05.022
Published in issue: March 2009
xWe present the case of a 13-month-old boy who initially presented with a 2-day history of cough and coryzal symptoms with significant wheeze and a respiratory acidosis. His viral-induced wheeze was initially treated with nebulized salbutamol and oral prednisolone, but then, he went on to develop hyperglycemia, ketonuria, and glycosuria with a partially compensated metabolic acidosis. We discuss the differential diagnoses of salbutamol-induced lactic acidosis, steroid-induced hyperglycemia, new presentation of diabetic ketoacidosis, or transient hyperglycemia.
Wei-Khie Kuar, Wen-Liang Yu, Shian-Chin Ko, Che-Kim Tan
DOI: http://dx.doi.org/10.1016/j.ajem.2008.07.002
Published in issue: March 2009
xGlottic web may be congenital or a result from injury of endotracheal intubation, thermal, corrosive, and endoscopic surgery. We report a case of difficult intubation and a glottic web was revealed from bronchoscopic examination after extubation. Treatment options include laser web lysis, kneel placement, or open surgery. Glottic web, though rare, may be a reason for difficult endotracheal intubation.
Jiun-Hao Yu, Yi-Ming Weng
DOI: http://dx.doi.org/10.1016/j.ajem.2008.05.031
Published in issue: March 2009
xWe described the case of a 17-year-old adolescent girl with Graves disease and unique combination of acute chorea and decreased cerebral perfusion on single photon emission computed tomographic images. She returned to euthyroid state in 2 weeks with partial improvement of choreic movement, which resolved by 6 weeks after additional treatment with haloperidol. The relationship between chorea, Graves disease, and abnormal cerebral perfusion is discussed.
Keith S. Boniface, Hamid Shokoohi, Shaneen Doctor, Ali Pourmand,, Mary Pat McKay
DOI: http://dx.doi.org/10.1016/j.ajem.2008.07.011
Published in issue: March 2009
xBedside ocular ultrasound by emergency physicians has been used effectively in the rapid evaluation of acute vision loss and ocular trauma. Individual emergency departments have varying degrees of accessibility to surgical subspecialists, including ophthalmologists; rapid, accurate diagnosis of ocular pathology can facilitate ophthalmology consultation or expedite transfer to a referral center for emergent care. Beside, ultrasound is a rapid diagnostic technique that can simplify the interaction and allow treatment planning to begin immediately.
Shey-Ying Chen, Pei-Chieh Kao, Zhong-Zhe Lin, Wen-Chu Chiang, Cheng-Chung Fang
DOI: http://dx.doi.org/10.1016/j.ajem.2008.07.012
Published in issue: March 2009
xMyxedema coma, the most extreme form of untreated hypothyroidism, is associated with a high mortality rate. A high index of clinical suspicion and recognition of potential precipitating factors for myxedema coma are crucial for emergency department physicians so that they can make a timely diagnosis and initiate appropriate treatment. We report the first documented case of sunitinib-induced myxedema coma in a patient who was presented to the emergency department with severe hypothermia. Physicians should be aware of this potential complication among patients treated with sunitinib for cancer.
Kuan-Ting Liu, Chen-San Su
DOI: http://dx.doi.org/10.1016/j.ajem.2008.07.014
Published in issue: March 2009
xMany patients with spinal epidural abscess did not have classic symptoms, and delayed diagnosis may occur. We present a patient who visited the emergency department for a headache. The pain was twitching and over the left fronto-pariero-occipital area. Left eye lacrimation was found. Erythematous change of the skin over left parietooccipital area was also noted. The patient was hospitalized for further evaluation. Cervical epidural abscess was diagnosed when upper limb weakness developed during hospitalization.
Julie Gorchynski, Hilary Nwosu, James Frame
DOI: http://dx.doi.org/10.1016/j.ajem.2008.07.018
Published in issue: March 2009
xThyrotoxic hypokalemic periodic paralysis is an endocrine emergency characterized by acute attacks of profound weakness or paralysis of the proximal muscles as a result of hypokalemia in the presence of thyrotoxicosis that resolves with the treatment of hyperthyroidism. We report a first case of acute ascending paralysis in a patient without prior history of periodic paralysis and new onset of thyrotoxicosis. An autosomal recessive genetic disorder, it has been suggested that the paralysis unmasks only in the presence of thyrotoxicosis [Am J Emerg Med.
Kentaro Nakai, Kazuhito Takeda, Hiroshi Kimura, Shuhei Miura, Atsuhiro Maeda
DOI: http://dx.doi.org/10.1016/j.ajem.2008.07.020
Published in issue: March 2009
xWe report the case of a 69-year-old woman with seizures and acute renal failure with hyperkalemia. She presented with bladder turgescence and hydronephrosis on admission and was diagnosed as obstructive acute renal failure. Urethral catheterization was performed after a single-session hemodialysis. It resulted in immediate improvement of renal function and consciousness, and subsequent disappearance of seizures. Improvement of serum creatinine level to 0.7 from 10.6 mg/dL was associated with a fall in blood level of amantadine hydrochloride from 4.40 to 0.47 μg/mL.
Sri Vengadesh Gopal, Ian Smith, Valerie Malka
DOI: http://dx.doi.org/10.1016/j.ajem.2008.07.021
Published in issue: March 2009
xPortal venous thrombosis after blunt abdominal trauma is rarely encountered and carries high morbidity and mortality. We present a trauma patient with liver laceration associated with acute portal vein and mesenteric vein thrombosis. A 26-year-old man presented to emergency department after motor vehicle accident with blunt abdominal trauma. His primary survey was unremarkable and secondary survey showed tenderness in the right hypochondrium. Computed tomography (CT) of the abdomen showed a grade III liver laceration involving segments VI and VII extending near the porta hepatis.
Michael D. Nauss, Erin L. Schmidt, Arthur M. Pancioli
DOI: http://dx.doi.org/10.1016/j.ajem.2008.07.022
Published in issue: March 2009
xViral infections are associated with a wide clinical spectrum of muscular syndromes, ranging from myalgias to rhabdomyolysis with renal failure. Viral myositis progressing to rhabdomyolysis is uncommon but is associated with life-threatening complications such as hyperkalemia and acute renal failure. Several viruses have been implicated in rhabdomyolysis: influenza A/B, parainfluenza, coxsackie, Epstein-Barr, herpes simplex, adenovirus, and cytomegalovirus. We report a case of severe rhadomyolysis after a viral upper respiratory infection.
Justin S.W. Taylor, Richard Purnell, Zaheer R. Yousef
DOI: http://dx.doi.org/10.1016/j.ajem.2008.07.023
Published in issue: March 2009
xβ-Blockers are normally contraindicated in the treatment of cardiogenic shock. A 70-year-old lady presents with an acute coronary syndrome complicated by critical cardiogenic shock. Coronary angiography shows an ulcerated nonobstructing plaque in the left anterior descending artery. She fails to improve with standard treatment with inotrope and intraaortic balloon pump. Echocardiography revealed acquired left ventricular outflow tract (LVOT) obstruction and secondary mitral regurgitation. Treatment with intravenous β-blockers produced both clinical and hemodynamic improvement as well as resolution of LVOT obstruction.
Ernesto Muñoz-Mahamud, Luis Casanova, LLuis Font, Jenaro A. Fernández-Valencia, Guillem Bori
DOI: http://dx.doi.org/10.1016/j.ajem.2008.07.024
Published in issue: March 2009
xOsteoarticular infections due to nontyphi Salmonella (NTS) are rarely encountered. We describe the case of an adult patient with septic arthritis of the hip caused by NTS. Debridement of the hip and a total hip arthroplasty were required for total recovery to occur. A 57-year-old man was admitted in our hospital for pain, fever, and motion range limitation in the right hip. The patient had been being treated with high doses of prednisone for the previous 2 months. The patient also had had a urine infection for 2 weeks.
Farhan Ali, Tamam Mohamad, Mahir Elder, Sony Jacob, Delair O. Gardi
DOI: http://dx.doi.org/10.1016/j.ajem.2008.07.028
Published in issue: March 2009
xTemporary cardiac pacing is usually performed via transcutaneous patches or transvenous temporary wires. This is routinely practiced in emergency and nonemergency situations. However, it is increasingly more common to encounter patients with venous thrombosis; particularly in patients on hemodialyis who have end-stage renal disease or patients with other intravenous implantations. In this article, we describe a patient with very difficult venous access, who during a cardiac catheterization needed emergent cardiac pacing, and an alternate approach via the femoral artery was performed successfully.
Graham Roche-Nagle, George Oreopolous
DOI: http://dx.doi.org/10.1016/j.ajem.2008.07.029
Published in issue: March 2009
xWe report a patient with life-threatening gastrointestinal bleeding caused by a secondary aortoenteric fistula (AEF). Because the patient had severe medical comorbidities, an endovascular approach was chosen for hemorrhage control. Endovascular treatment of aortoenteric fistula provides another treatment option that may be particularly valuable in patients whose comorbidities would preclude open repair.
Sanooj Soni, Sandeep Gandhi
DOI: http://dx.doi.org/10.1016/j.ajem.2008.07.038
Published in issue: March 2009
xThe genetic nature of Brugada syndrome has been well reported, with the causative factor being a mutation in the gene encoding cardiac sodium ion channels. Yet, although Brugada syndrome requires specific conditions to be satisfied, a Brugada pattern on electrocardiogram (ECG) has been reported in numerous situations. We describe a typical Brugada-type picture in a previously healthy man, with no cardiac history or risk factors, who presented after a substantial overdose of flecainide. This suggests that a severe overdose of flecainide can sufficiently suppress cardiac sodium ion channels, triggering a Brugada-type pattern in patients without the hereditary form.
Sarah Barker, Chris Ghaemmaghami
DOI: http://dx.doi.org/10.1016/j.ajem.2008.08.006
Published in issue: March 2009
xBlunt myocardial contusion encompasses a diverse history of definitions and associated diagnostic modalities. A case report of a 24-year-old man who sustained blunt myocardial contusion during a motor vehicle collision shows the appropriate evaluation and treatment of this condition. In a patient presentation with concern for myocardial contusion, an electrocardiogram combined with a 6-hour post injury troponin can stratify which patients require admission for further monitoring and echocardiogram imaging vs who may be discharged home without concern for subsequent dysrhythmias or cardiac output failure.
Michael B. Stone
DOI: http://dx.doi.org/10.1016/j.ajem.2008.08.007
Published in issue: March 2009
xBedside ultrasound has been used to identify intracranial hypertension through the measurement of optic nerve sheath diameter. This case report describes the sonographic detection of papilledema and a wide optic nerve sheath in a patient with pseudotumor cerebri who presented to the Emergency Department with headache and photophobia, and in whom fundoscopy was poorly tolerated. Bedside ultrasound may represent an alternate means of assessing for papilledema when a traditional fundoscopic exam is non-diagnostic.
Gustavo R. Iralde, Hernan Cohen Arazi, Silvina Waldman, Mauricio Abello, David Doiny, Ricardo Spampinatto, Mario Russo, Cláudio Pensa, Hugo Grancelli
DOI: http://dx.doi.org/10.1016/j.ajem.2008.08.010
Published in issue: March 2009
xSyncopal episodes of any cause that generate long lasting brain hypoperfusion can cause seizures and could be interpreted mistakenly as primary epilepsy. In some cases, syncopes are due to ventricular arrhythmias in the setting of genetic diseases of cardiac ion channels (channelopathies) such as long QT syndrome (LQTS), short QT syndrome, and Brugada syndrome. These affect ventricular repolarization, with high risk of sudden death, and are usually recognized in the standard electrocardiogram (ECG).
Omid Zad, Hassie Cooper, Patrick Crocker, Truman Milling
DOI: http://dx.doi.org/10.1016/j.ajem.2008.08.013
Published in issue: March 2009
xWe report the first documented case of rapid onset shock, respiratory failure, and coagulopathy after an intravenous copperhead envenomation. The 47-year-old victim, bitten over his left greater saphenous vein, responded to Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV, Savage Laboratories, Melville, NY) fragment therapy and recovered completely, leaving the hospital 3 days later.
Argyrios Ntalianis, Kostantinos Mandrekas, Christos Papamichael, Maria I. Anastasiou-Nana
DOI: http://dx.doi.org/10.1016/j.ajem.2008.08.014
Published in issue: March 2009
xA case of a patient with severe lactic acidosis as a result of profound iron-deficiency anemia (Hb: 1.3 g/dl) due to chronic uterine bleeding is presented. The pathophysiology of profound anemia and the reported cases of iron-deficiency anemia with very low hemoglobin values (≤ 2 g/dl) are reviewed and discussed.
DOI: http://dx.doi.org/10.1016/S0735-6757(09)00108-9
Published in issue: March 2009
DOI: http://dx.doi.org/10.1016/S0735-6757(09)00109-0
Published in issue: March 2009
DOI: http://dx.doi.org/10.1016/S0735-6757(09)00110-7
Published in issue: March 2009
DOI: http://dx.doi.org/10.1016/S0735-6757(09)00111-9
Published in issue: March 2009
