September 2009 Volume 27, Issue 7, p761-904

Original Contributions

Body surface mapping vs 12-lead electrocardiography to detect ST-elevation myocardial infarction

Joseph P. Ornato, Ian B.A. Menown, Mary Ann Peberdy, Michael C. Kontos, John W. Riddell, George L. Higgins III, Suzanne J. Maynard, Jennifer Adgey

DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.010

p779–784

Published in issue: September 2009

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xA prospective, multicenter trial was conducted in patients with nontraumatic chest pain in 4 hospitals to determine whether an 80-lead body surface map electrocardiogram system (80-lead BSM ECG) improves detection of ST-segment elevation in acute myocardial infarction (STEMI) compared with a standard 12-lead electrocardiogram (ECG) in an emergency department (ED) setting. A trained ED or cardiology staff member (technician or nurse) recorded a 12-lead ECG and 80-lead BSM ECG from each subject at initial presentation.

The worsening of ED on-call coverage in California: 6-year trend

Scott E. Rudkin, Mark I. Langdorf, Jennifer A. Oman, Christopher A. Kahn, Hayley White, Craig L. Anderson

DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.012

p785–791

Published in issue: September 2009

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xTo reassess problems with on-call physician coverage in California, we repeated our anonymous 2000 survey of the California chapter of the American College of Emergency Physicians. Physicians responded from 77.4% of California emergency departments (EDs), 51.0% of ED directors, and 34% of those surveyed. Of 21 specialties, on-call availability worsened since 2000 for 9, was unchanged for 11, and improved for 1. Of ED directors, 54% report medical staff rules require on-call duty, down from 72% in 2000.

Emergency endoscopy for upper gastrointestinal bleeding in patients with coronary artery disease

Ping-Huei Tseng, Jyh-Ming Liou, Yi-Chia Lee, Lian-Yu Lin, Alyssa Yan-Zhen Liu, Dun-Cheng Chang, Han-Mo Chiu, Ming-Shiang Wu, Jaw-Town Lin, Hsiu-Po Wang

DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.018

p802–809

Published in issue: September 2009

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xEndoscopy is useful for diagnosis and treatment of upper gastrointestinal bleeding (UGIB). However, both endoscopy and UGIB may compromise the cardiovascular function. The present study is to investigate the cardiovascular responses of emergency endoscopy for patients with UGIB and stable coronary artery disease (CAD).

Improving length-based weight estimates by adding a body habitus (obesity) icon

Loren G. Yamamoto, Alson S. Inaba, Lynette L. Young, Kathy M. Anderson

DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.023

p810–815

Published in issue: September 2009

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xLength-based dosing systems reduce errors associated with resuscitation drug dosing. Obese and thin children of the same length are dosed the same despite their different weights.

A comparison of 2 types of chest compressions in a porcine model of cardiac arrest

Jun-Yuan Wu, Chun-Sheng Li, Zhao-Xia Liu, Cai-Jun Wu, Gui-Chen Zhang

DOI: http://dx.doi.org/10.1016/j.ajem.2008.07.001

p823–829

Published in issue: September 2009

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xChest compressions performed by some medical workers are of poor quality, which are too few and shallow with incomplete release. This study was designed to compare the effects of these clinical quality chest compressions with standard manual chest compressions in a porcine model of cardiac arrest.

Brief Reports

Elevated serum S100B protein and neuron-specific enolase levels in carbon monoxide poisoning

Turker Yardan, Yunsur Cevik, Omer Donderici, Cemil Kavalci, Fatma Meric Yilmaz, Gulsen Yilmaz, Kubilay Vural, Yucel Yuzbasioglu, Yahya Kemal Gunaydin, Ahmet Ali Sezer

DOI: http://dx.doi.org/10.1016/j.ajem.2008.04.016

p838–842

Published in issue: September 2009

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xCarbon monoxide (CO) poisoning causes cerebral and generalized hypoxia. This study aimed to assess the possible use of serum glial marker S100B protein and neuron-specific enolase (NSE) as biochemical markers of hypoxic brain damage in acute CO poisoning.

Expedited admission of patients decreases duration of mechanical ventilation and shortens ICU stay

Scott D. Cline, Robyn A.K. Schertz, Eric C. Feucht

DOI: http://dx.doi.org/10.1016/j.ajem.2008.04.018

p843–846

Published in issue: September 2009

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xTo determine if expedited admission (<2 hours) of critically ill patients requiring intubation and mechanical ventilation from the emergency department (ED) to the intensive care unit (ICU) decreases ICU and hospital length of stay.

Correlation of sonographic measurements of the internal jugular vein with central venous pressure

Sean P. Donahue, Joseph P. Wood, Bhavesh M. Patel, James V. Quinn

DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.005

p851–855

Published in issue: September 2009

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xDetermination of volume status is crucial in treating acutely ill patients. This study examined bedside ultrasonography of the internal jugular vein (IJV) to predict central venous pressure (CVP). Ultrasonography was performed on 34 nonventilated patients with monitored CVPs. The IJV was measured during the respiratory cycle and with the patient in different positions. Mean IJV diameter in patients with CVP less than 10 cm H₂O was 7.0 mm (95% confidence interval [CI], 5.7-8.3) vs 12.5 mm (95% CI, 11.2-13.8) in patients with CVP of 10 cm H₂O and greater.

Is female sex associated with ED delays to diagnosis of appendicitis in the computed tomography era?

Sarah McGann Donlan, Mark B. Mycyk

DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.004

p856–858

Published in issue: September 2009

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xHistorically, females had delays to definitive diagnosis of appendicitis when compared to males. In this current millennium, appendicitis is now most commonly diagnosed by computed tomography (CT) in the emergency department (ED) rather than at surgery.

The usefulness of the semiquantitative procalcitonin test kit as a guideline for starting antibiotic administration

Joo Suk Oh, Seong Uk Kim, Young Min Oh, Se Min Choe, Gyeong Ho Choe, Seung Pil Choe, Young Min Kim, Tae Yong Hong, Kyu Nam Park

DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.021

p859–863

Published in issue: September 2009

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xThe Surviving Sepsis Campaign has recommended that antibiotic therapy should be started within the first hour of recognizing severe sepsis. Procalcitonin has recently been proposed as a biomarker of bacterial infection, although the quantitative procalcitonin assay is often time consuming, and it is not always available in many emergency departments (EDs). Our aim is to evaluate usefulness of the semiquantitative procalcitonin fast kit as a guideline for starting antibiotic administration for patients with severe sepsis or septic shock that requires prompt antibiotic therapy in the ED.

The Rusch ViewMax vs Macintosh laryngoscopy in human cadavers: impoved vocal cord visualization?

Aaron Brillhart, Aizad Dasti, Whitney Matz, Walter A. Schrading

DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.011

p864–867

Published in issue: September 2009

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xAdequate vocal cord visualization via laryngoscopy is a key component of successful endotracheal intubation. Several tools exist to facilitate laryngoscopy in difficult airways. We compared one such device, the Rusch “ViewMax” (Rusch, Duluth, Ga), to a standard Macintosh laryngoscope blade (Heine USA Ltd, Dover, NH) using human cadaver models. The purpose of this study was to determine if the ViewMax improved vocal cord visualization.

HIV testing in US EDs, 1993-2004

Roland C. Merchant, Bethany M. Catanzaro

DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.019

p868–874

Published in issue: September 2009

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xThe aims of the study were to (1) estimate the incidence rates (IRs) of human immunodeficiency virus (HIV) testing among 13-year-old to 64-year-old patients in US emergency departments (EDs); (2) determine ED compliance with Centers for Disease Control and Prevention (CDC) recommendations for HIV testing for patients with nonsexual blood or body fluid exposures, sexually transmitted diseases (STDs), and sexual assaults; and (3) ascertain if HIV testing in EDs varies by patient demographic characteristics.

Diagnostics

Preexcitation syndromes: diagnostic consideration in the ED

Dustin G. Mark, William J. Brady, Jesse M. Pines

DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.013

p878–888

Published in issue: September 2009

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xPreexcitation syndromes are a common cause of paroxysmal tachycardias presenting to the ED. Emergency physicians should be familiar with the common electrocardiographic manifestations of preexcitation, particularly the Wolff-Parkinson-White abnormality, as these conditions require specific therapeutic management. This article reviews the pathophysiology of preexcitation, along with the electrocardiographic findings of Wolff-Parkinson-White and its associated tachyarrhythmias.

Correspondence

Purple urine bag syndrome, not always a benign process

Ying-Ming Tasi, Ming-Shyan Huang, Chih-Jen Yang, Shih-Meng Yeh, Chia-Chu Liu

DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.030

p895–897

Published in issue: September 2009

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xThe subject of the case report presented by Su et al [1] is quite interesting as authors described a patient that was sent to the emergency department in critical condition upon arrival, and purple urine bag syndrome (PUBS) was also found at that time. Finally, the patient died of aspiration pneumonia and septic shock in the intensive care unit. The case report described the first case of PUBS that occurred involving a patient in critical condition. The authors claimed that PUBS was not the leading cause of mortality in this case.

American Journal of Emergency Medicine Electronic-Extra Pages (Full text articles available online at www.ajemjournal.com)

Case Reports

T-wave inversion: cardiac memory or myocardial ischemia?

Carol Chen-Scarabelli, Tiziano M. Scarabelli

DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.037

p898.e1–898.e4

Published in issue: September 2009

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xThis article presents a case report of a 74-year-old man with T-wave inversion (TwI) in atrial fibrillation noted during routine pacemaker interrogation.

Rupture of splenic artery aneurysm during early pregnancy: a rare and catastrophic event

Julien Chookun, Vincent Bounes, Jean Louis Ducassé, Olivier Fourcade

DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.039

p898.e5–898.e6

Published in issue: September 2009

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xSpontaneous rupture of splenic artery aneurysm during pregnancy is a rare, life-threatening event with a catastrophic prognosis. Splenic artery aneurysm, known to be more frequent in women, especially among multiparous ones, is generally asymptomatic until rupture. Because of increased blood flow and hormonal modifications, this rupture occurs frequently during pregnancy, most often at the end of the third trimester. We present the case of a second parous woman in early pregnancy with a rupture of splenic artery aneurysm initially diagnosed as a complicated ectopic pregnancy, which profoundly modifies surgical treatment.

A case of rectus sheath hematoma caused by yoga exercise

Yoonhee Choi, Donghoon Lee

DOI: http://dx.doi.org/10.1016/j.ajem.2008.11.003

p899.e1–899.e2

Published in issue: September 2009

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xRectus sheath hematoma is a relatively rare condition but a significant cause of acute abdominal pain. The acute abdominal pain associated with rectus sheath hematoma can mimic several conditions, such as appendicitis, intestinal problems (obstruction, perforation, hernia, malignancy), and gynecologic disease (ovarian cyst, torsion, tubo-ovarian abscess, ectopic pregnancy). Correct diagnosis and subsequent treatment depends on careful history taking and appropriate use of diagnostic tools to avoid unnecessary laparotomy.

Acute myocardial infarction with cardiogenic shock in a patient with acute aortic dissection

Cyril Camaro, Noëmi T.A.E. Wouters, Melvyn Tjon Joe Gin, Hans A. Bosker

DOI: http://dx.doi.org/10.1016/j.ajem.2008.11.007

p899.e3–899.e6

Published in issue: September 2009

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xDiagnosing acute Stanford type A aortic dissection with the uncommon involvement of the left main coronary artery (LMCA) remains challenging for the emergency physician because it can resemble acute myocardial infarction with cardiogenic shock. The following case report illustrate this infrequent but critical situation. A 52-year-old woman with a history of hypertension awakened with acute retrosternal chest pain accompanied by nausea and vomiting. She was referred to our hospital for primary coronary intervention because of acute myocardial infarction with cardiogenic shock.

Thirteen-week cornual ectopic pregnancy

Karen Gaber-Patel, Michael D. Smith

DOI: http://dx.doi.org/10.1016/j.ajem.2008.11.005

p900.e1–900.e2

Published in issue: September 2009

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xWe present the unusual case of a 13-week cornual ectopic pregnancy with fetal movement. The patient presented with a protuberant abdomen, intoxicated with cocaine and alcohol, and in hemodynamic compromise. Bedside emergency ultrasonography led to rapid diagnosis and treatment.

Acute inflammatory demyelinating polyneuropathy as the initial presentation of lupus

Tai-Yi Hsu, Shih-Hao Wang, Chang-Fu Kuo, Te-Fa Chiu, Yu-Che Chang

DOI: http://dx.doi.org/10.1016/j.ajem.2008.11.006

p900.e3–900.e5

Published in issue: September 2009

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xA 28-year-old woman presented at the emergency department (ED) with acute bilateral leg weakness and lost the ability to walk 1 day after noticing bilateral leg numbness and intermittent pleuritic pain for 3 weeks. Physical examination revealed bilateral decreased muscle strength with score 4 symmetrically in the legs and decreased deep tendon reflex. Laboratory tests indicated lymphopenia but no other grossly remarkable findings. Cerebrospinal fluid analysis demonstrated albuminocytologic dissociation.

Adenosine-induced cardiopulmonary arrest in a patient with paroxysmal supraventricular tachycardia

R. Carlin Walsh, Kristen L. Felice, Timothy J. Meehan, Benjamin W. Stull, Heather M. Schumann, John L. Zautcke

DOI: http://dx.doi.org/10.1016/j.ajem.2008.11.008

p901.e1–901.e2

Published in issue: September 2009

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xAdenosine is commonly used for the chemical termination of supraventricular tachycardia. In addition, even when it is ineffective as an agent of chemical cardioversion, it may slow the cardiac rate to allow an analysis of the underlying rhythm. Common adverse effects include facial flushing, shortness of breath, and chest pain. Major contraindications include heart blocks and known adenosine hypersensitivity. This case report illustrates an episode of cardiopulmonary arrest after adenosine administration and, to the authors' knowledge, is the first occurrence reported in the literature.

Bilateral peroneal compartment syndrome after horse riding

Krishant S. Naidu, Terence Chin, Christain Harris, Simon Talbot

DOI: http://dx.doi.org/10.1016/j.ajem.2008.11.009

p901.e3–901.e5

Published in issue: September 2009

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xA healthy 20-year-old woman developed acute ischemia of the lateral compartment of both calves shortly after a 30-minute horse ride. On one side, she developed compartment syndrome with resultant complete myonecrosis of the compartment, whereas on the other side, there was spontaneous resolution. To our knowledge, this is the first report of bilateral lateral compartment ischemia after horse riding. Atraumatic compartment syndrome is a rare entity and is often missed at initial presentation. We discuss aspects of her management together with a review of the literature.

Spinal epidural hematoma after stretch exercise: a case report

Toshikazu Abe, Yasuhiro Nagamine, Shinichi Ishimatsu, Yasuharu Tokuda

DOI: http://dx.doi.org/10.1016/j.ajem.2008.11.011

p902.e1–902.e2

Published in issue: September 2009

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xSpinal epidural hematoma (SEH) is a rare but serious condition. Common causes of SEH include spinal fracture, spinal trauma, and invasive spinal procedures such as lumbar puncture, epidural anesthesia, or myelography. A few previous reports have suggested that SEH could be caused by minor triggers such as spinal manipulation therapy or spontaneously in rare cases. A 60-year-old man, immediately after stretch exercise, developed severe back cervicodynia and rapidly progressive weakness of left arm from SEH.

Entire pneumorrhachis due to isolated head trauma

Selcuk Coskun, Mahir Sahin, Murat Cobanoglu, Isa Kilicaslan

DOI: http://dx.doi.org/10.1016/j.ajem.2008.11.004

p902.e3–902.e6

Published in issue: September 2009

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xAir contained within the spinal canal is termed pneumorrhachis, and very rarely, traumatic pneumocephalus can cause pneumorrhachis. Pneumorrhachis can be classified as epidural or subarachnoid space pneumorrhachis.

Trastuzumab (Herceptin)–associated cardiomyopathy presented as new onset of complete left bundle-branch block mimicking acute coronary syndrome: a case report and literature review

Chung-Ming Tu, Kai-Ming Chu, Shin-Ping Yang, Shu-Mung Cheng, Wen-been Wang

DOI: http://dx.doi.org/10.1016/j.ajem.2008.11.012

p903.e1–903.e3

Published in issue: September 2009

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xTrastuzumab (Herceptin) is well documented in reducing suffering and mortality from breast cancer. The clinically most important side effect of Herceptin is cardiotoxicity, which is reported in 2.6% to 4.5% of patients receiving trastuzumab alone and in as many as 27% of patients when trastuzumabis combined with an anthracycline in metastatic disease. We reported the case of a 50-year-old woman who presented to our emergency department (ED) because of chest pain and shortness of breath. On physical examination, holosystolic murmur over apex could be heard.

Multiply organ dysfunction syndrome due to tramadol intoxication alone

Sheng-Qi Wang, Chun-Sheng Li, Yu-Guo Song

DOI: http://dx.doi.org/10.1016/j.ajem.2008.11.013

p903.e5–903.e7

Published in issue: September 2009

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xTramadol is a synthetic, centrally acting analgesic for the treatment of moderate to severe pain. It is widely used because of its efficacy and safety. A normal-dose tramadol has less adverse effects than other opioids. Multiply organ dysfunction syndrome due to tramadol intoxication is rare. We present a case of 19-year-old male patient who had multiply organ dysfunction syndrome due to oral tramadol alone. With a history of tramadol abuse for 6 months, the patient was found unconsciousness in bed 8 hours before hospitalization.

Frontmatter