Louise Martinell, Malena Larsson, Angela Bång, Thomas Karlsson, Jonny Lindqvist, Ann-Britt Thorén, Johan Herlitz
DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.042
Published online: February 8 2010
xKnowledge of the epidemiology of postresuscitation care is insufficient. We describe the epidemiology of postresuscitation care in a community from a 26-year perspective, focusing on incidence, patient characteristics, survival, and estimated cerebral function in relation to intensified postresuscitation care and initial arrhythmia.
Denise Livingston, Andreia Marques-Baptista, Richard Brown, Junfeng Liu, Mark A. Merlin
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.002
Published online: November 23 2009
xThis article models use of emergency medical services (EMS) within a defined geographical area. Our goal was to develop an original quantitative method to delineate the need for EMS units within a geographical population.
Adam Balls, Frank LoVecchio, Amy Kroeger, J. Stephan Stapczynski, Mary Mulrow, David Drachman, For the CLEAR investigators
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.003
Published online: February 8 2010
xUltrasound guidance of central venous catheter (CVC) insertion improves success rates and reduces complications and is recommended by several professional and regulatory organizations.
Ulrike Weber, Agnes Reitinger, Tomasz Erdeii, Christian Hellmich, Barbara Steinlechner, Helmut Hager, Michael Selzer, Michael Hiesmayr, Angela Rajek, Alexander Kober
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.041
Published online: November 30 2009
xWe hypothesized that pro-B-type natriuretic peptide (proBNP) levels in venous blood increase in patients with acute out-of-hospital heart failure because of stress during emergency ambulance transportation, and furthermore, we wanted to show if there is an effect of increasing proBNP levels on hemodynamic parameters.
Norio Otani, Sachiko Ohde, Toshiaki Mochizuki, Shinichi Ishimatsu
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.011
Published online: November 23 2009
xAnion gap (AG) is a useful index for assessing the clinical condition of critically ill patients especially in intoxication. Recently, AG can be obtained easily using a blood gas analyzer (BGA); however, its reliability requires validation.
Ronald Moscati, Jeffrey D. Ho, Donald M. Dawes, James R. Miner
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.010
Published online: February 8 2010
xThis study examines the physiologic effects of prolonged conducted electrical weapon (CEW) exposure on alcohol-intoxicated adult subjects.
Loren Yamamoto, Joan Kanemori
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.009
Published online: November 23 2009
xCompared to fixed-dose single-vial drug administration in adults, pediatric drug dosing and administration requires a series of calculations, all of which are potentially error prone. The purpose of this study is to compare error rates and task completion times for common pediatric medication scenarios using computer program assistance vs conventional methods.
Asia N. Quan, Dan Quan, Steven C. Curry
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.008
Published online: November 23 2009
xCrotalidae polyvalent immune Fab (CroFab) is used to treat rattlesnake envenomations in the United States. Time to infusion may be a critical factor in the treatment of these bites. Per manufacturer's instructions, 10 mL of sterile water for injection (SWI) and hand swirling are recommended for reconstitution. We wondered whether completely filling vials with 25 mL of SWI would result in shorter reconstitution times than using 10-mL volumes and how hand mixing compared to mechanical agitation of vials or leaving vials undisturbed.
Susan Y. Kim-Katz, Ilene B. Anderson, Thomas E. Kearney, Conan MacDougall, Karen S. Hudmon, Paul D. Blanc
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.007
Published online: February 8 2010
xThe study aimed to assess the effects of topical antacids for treatment of capsaicin-induced dermal pain after exposure to capsaicin containing hot peppers, personal protection sprays, or topical creams.
Sze Yee Chong, Lee Ai Chong, Hany Ariffin
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.006
Published online: February 8 2010
xThe aim of this study is to formulate an accurate estimate of the spinal needle depth for a successful lumbar puncture in pediatric patients.
Dawn Kleindorfer, Christopher J. Lindsell, Charles J. Moomaw, Kathleen Alwell, Daniel Woo, Matthew L. Flaherty, Opeolu Adeoye, Tarek Zakaria, Joseph P. Broderick, Brett M. Kissela
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.016
Published online: November 23 2009
xMany studies show that a major barrier to short-term treatment of stroke is patient or bystander delay in responding to stroke symptoms. Most studies have found that less than half of stroke/transient ischemic attack (TIA) events result in a 911 call. We sought to determine which symptoms prompt the public to call 911.
Kaushal Shah, Barbara Kilian, Wei-Jen Hsieh, Emily Kyrillou, Vishal Hedge, David H. Newman
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.020
Published online: November 23 2009
xChart review studies have suggested that point-of-care urine dipstick testing may accurately predict an elevation in serum creatinine (Cr). We aimed to prospectively evaluate the test characteristics of proteinuria/hematuria in predicting elevated serum Cr.
Ghanshyam Palamaner Subash Shantha, Yadav Srinivasan, Anita A. Kumar, Shihas Salim, Suhas Prabakhar, Anish George Rajan, T.R. Muralidharan
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.007
Published online: March 10 2010
xThe prevalence of coronary artery disease (CAD) has been increasing in India, and so is the population of elderly patients with hypertension. In the predominantly resource-poor setting prevailing in India, this study is an effort to analyze the accuracy of retinal changes in predicting CAD among a cohort of elderly patients with hypertension presenting to the emergency department with angina.
Sarah Unterman, Chad Kessler, H. Zoltan Pitzele
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.025
Published online: March 26 2010
xVA (Veteran's Affairs) emergency departments (EDs) are generally staffed with physicians trained in internal medicine (IM), although recently, a movement has begun toward hiring emergency medicine (EM)-trained staff. At our institution, the ED is staffed by physicians of both specialties. This study examines the frequency of unscheduled return visits to the ED in an effort to compare the quality of emergency care given by physicians trained in IM and EM.
Toby O. Salz, Sharon R. Wilson, Otto Liebmann, Daniel D. Price
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.010
Published online: July 16 2009
xAn initial description of a sonographic finding predictive of intrathoracic chest tube placement.
Jeffrey M. Caterino, Tracy Jalbuena, Benjamin Bogucki
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.020
Published online: March 26 2010
xThe aim of the study was to identify predictors of acute decompensation within 48 hours of admission among infected emergency department (ED) patients admitted to a regular nursing floor.
Oscar M.P. Jolobe
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.030
Published in issue: June 2010
xThe differential diagnosis of reversible leukoencephalopathy should include reversible cerebral vasoconstrictor syndrome. The suggestion that bilateral infarction of the posterior cerebral arteries is the closest differential diagnosis of reversible posterior leukoencephalopathy syndrome (RPLS) probably applies to patients such as the one who featured in a recent report [1], who present without headache, but alternative diagnoses such as reversible cerebral vasoconstrictor syndrome (RCVS) have to be considered in those who present with headache [2].
Oscar M.P. Jolobe
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.009
Published in issue: June 2010
xGiven the increasing recognition of the risk of narrow QRS complex proarrhythmia after “as required” self-administration of flecainide in patients with paroxysmal atrial fibrillation (AF) [1], it seems prudent that over and above the documentation of age, sex, chief complaint, specific indication for the test, history of the present illness, medical history, and baseline electrocardiogram, the static algorithm [2] ought also to document cardiovascular drug history. In particular, the phenomenon of atrial flutter, with 1:1 conduction, but at a ventricular rate of 200 beats/min, or 2:1 atrioventricular block with a ventricular rate of 100 beats/min, seems to be almost unique to narrow QRS complex proarrhythmia attributable to class 1 drugs such as flecainide which, in the process of organizing AF into atrial flutter, slow down the atrial flutter rate from the typical rate of 300 beats/min to 200 beats/min [1].
Oscar M.P. Jolobe
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.010
Published in issue: June 2010
xGiven the fact that the use of plasminogen activator in elderly subjects with ischemic stroke is one characterized by a precarious balance between risk and benefit [1], more rigorous profiling of prospective candidates for this treatment modality ought to be undertaken to reduce the risk of treatment-related intracerebral hemorrhage (ICH). Cerebral amyloid angiopathy (CAA), already identified as a risk factor for warfarin-related ICH [2], is the most obvious candidate risk factor for plasminogen activator–related ICH.
Mucahit Emet, Ibrahim Caner, Murteza Cakir, Sahin Aslan, Zeynep Cakir
DOI: http://dx.doi.org/10.1016/j.ajem.2009.07.010
Published online: March 11 2010
xHyponatremia is the most frequent electrolyte disorder of hospitalized patients and is associated with a longer hospital stay and serious symptoms. The syndromes of inappropriate antidiuretic hormone secretion (SIADH) and cerebral salt wasting (CSW) are 2 potential causes of hyponatremia in patients with disorders of the central nervous system. In both syndromes, serum osmolality and plasma uric acid are decreased; blood antidiuretic hormone and urine sodium levels are increased; and plasma albumin concentration and plasma K+ levels are normal.
Joon Min Park, Junho Cho, Sung Pil Chung, Min Joung Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2009.08.018
Published online: March 29 2010
xKounis syndrome is the concurrence of acute coronary syndrome with mast cell activation induced by inflammatory mediators released during an allergic reaction. Two types of Kounis syndrome have been described. In type II, coronary spasm occurs adjacent to a preexisting atheromatous lesion in which allergic stimulation results in plaque erosion or rupture leading to myocardial infarction (MI). Herein, we report a case of contrast-induced Kounis syndrome type II and provide coronary angiography (CAG) computed tomography (CT) images of the vasospasm as the hypersensitivity reaction evolved during the imaging procedure.
Jonathan S. Auerbach, Jeffrey Hom
DOI: http://dx.doi.org/10.1016/j.ajem.2009.08.026
Published online: March 26 2010
xAn 11-year-old male from Uzbekistan presented with a primary complaint of an unresolved rash to the ED. Three months prior, the patient was diagnosed with streptococcal pharyngitis and was treated with Ciprofloxin. After the fifth day of antibiotic therapy, the patient developed a nonpuritic papular rash, which was limited to the torso. Concerned about the rash, the mother treated the skin with an over-the-counter topical agent that darkened the papules. An alternate treatment with amoxicillin/clavulanic acid and acyclovir for herpes zoster was started, when the mother brought the child to a different ED.
Leo Marcoff, Andra Popescu, Gilbert A. Leidig Jr., Anthony W. Clay, John J. Kelly III, Ehsanur Rahman, Letitia Price
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.005
Published online: March 10 2010
xPregnancy-associated spontaneous coronary artery dissection is a rare but potentially lethal condition presenting as acute coronary syndrome. Forty percent of patients die suddenly or within a few hours of symptom onset. Survivors of the acute phase who subsequently receive proper diagnosis and treatment usually have good prognosis. Proposed etiologies include altered endocrine status, hemodynamic stress, eosinophilic inflammatory infiltrate, and disruption of vasa vasorum. Definitive diagnosis is made by coronary angiography.
S. Simi, T.M. Anoop, K.C. George
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.006
Published online: February 24 2010
xIntramural duodenal hematoma is a rare cause of proximal gastrointestinal tract obstruction. We report an unusual case of duodenal obstruction caused by spontaneous intramural duodenal hematoma secondary to coagulopathy after hepatic encephalopathy. Patient was treated symptomatically with nil orally, intravenous fluids, nasal gastric tube, vitamin K, frozen fresh plasma. Patient recovered completely 48 hours after medical treatment. Intramural hematoma of the gastrointestinal tract is an uncommon occurrence1 [1].
Christine Payen, Christian Combe, Catherine Le Meur, Yvan Gaillard, Corine Pulce, Jacques Descotes
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.007
Published online: March 26 2010
xWe report the first case ever published of death after acute poisoning with potassium ferrocyanide. A 56-year-old retired pharmacist who was practicing oenology called the emergency telephone service to tell that he had just ingested 2 glasses of potassium ferrocyanide. He had vomiting and then collapsed within less than 1 hour. Later on, aggressive cardiopulmonary resuscitation rapidly restored stable hemodynamics. Although laboratory findings evidenced the hallmark of cyanide poisoning, which is dramatically elevated lactate concentrations, blood cyanide level (0.70 mg/L) was below lethal values, which typically exceed 2.5 to 3.0 mg/L.
Americo Testa, Rosangela Giannuzzi, Kathleen de Gaetano Donati, Nicolò Gentiloni Silveri
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.008
Published online: March 29 2010
xGas gangrene is a rapidly progressive pathology caused by different species of Clostridium that can induce a severe myonecrosis with gas production and sepsis. In rare cases, clostridia disseminate via the bloodstream, even in absence of wounds as source of departure; this is more frequent in immunodeficient patients. About one third of the cases of “spontaneous” gas gangrene are caused by Clostridium septicum.
Rina K. Shah, Marcia M. Wofford, Thomas G. West, Avinash K. Shetty
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.011
Published online: March 26 2010
xLemierre syndrome is a rare condition, characterized by an acute oropharyngeal infection with secondary internal jugular vein thrombosis, and subsequent metastatic infection. Lemierre syndrome is usually caused by Fusobacterium necrophorum. We report a case of Lemierre syndrome caused by group A Streptococcus (GAS) in a 4-year-old girl. She was initially diagnosed with GAS pharyngitis but failed treatment with azithromycin and subsequently developed right-sided neck swelling concerning for a deep neck abscess.
Sadik Acikel, Ekrem Yeter, Harun Kilic, Ramazan Akdemir
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.012
Published online: March 26 2010
xPrimary percutaneous coronary intervention (PCI) is an effective strategy in the opening of infarct-related artery in ST-segment elevation myocardial infarction (STEMI). However, macro- and microembolization during PCI in STEMI is frequent and may induce microvascular obstruction (Thromb Haemost. 2006;96:700-710; Catheter Cardiovasc Interv. 2008;71:863-869; Circulation. 2009;119:1311-1319). Distal macroembolization of atheromatous and thrombotic debris can be detected by angiography in up to 15% of patients undergoing primary PCI (Eur Heart J.
Kaira King, David C. Pigott, Andrew R. Edwards
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.013
Published online: March 10 2010
xAcute angle-closure glaucoma is a clinical phenomenon with potentially devastating consequences, including permanent blindness, if not promptly diagnosed and treated. We describe an unusual case of acute angle-closure glaucoma, leading to the detection of a uveal melanoma, a potentially life-threatening cause of glaucoma. Bedside ultrasonography of the eye was used to assist in the diagnosis, providing rapidly available diagnostic information about the size and extent of the tumor. Because acute angle-closure glaucoma may occur due to multiple etiologies, this case highlights the importance of uncovering occult causes of increased intraocular pressure.
Yu-Tso Liao, Tzu-Hsin Lin, Wen-Je Ko
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.015
Published online: March 10 2010
xBlunt abdominal trauma is a common but potentially lethal injury at the emergency department. Traumatic colonic perforation occurs rarely among blunt abdominal injury. The appropriate surgical intervention depends on early detection and diagnosis. The diagnosis of traumatic colonic perforation might be difficult especially while confronting a stable patient with equivocal peritoneal sign. Recently, the wide use of the computed tomography (CT) increased the diagnostic accuracy of traumatic colonic perforation.
James Walker, Rebecca Jeanmonod
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.016
Published online: March 26 2010
xAscaris lumbricoides infection affects one quarter of the world's population. Although considered rare in the United States, the organism is found in that country, particularly in the southeast. Epidemiologic studies suggest up to 4 million Americans may be infected, many with no symptoms. Ascaris is the most common helminthic infection in humans, and as travel, immigration, and international adoption become more common, it is likely to become more commonly seen in the United States. Ascaris infection can present early, with pulmonary symptoms related to worm migration, or late, with mechanical symptoms depending on worm number and location.
Youichi Yanagawa, Tomonori Imamura, Shinichiro Iwamoto
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.017
Published online: March 26 2010
xA 61-year-old man became unconsciousness after falling down a flight of stairs due to the consumption of alcohol. The patient showed a deep comatose state, and therefore, he was transferred to this department. On examination, he showed a disoriented state and left hemiplegia. Computed tomographic scan of his head demonstrated 3 small intracerebral hemorrhages in the bilateral temporal and left frontal lobe as well as a subarachnoid hemorrhage near the left cerebellar tentorium, thus suggesting diffuse axonal injury.
Jia-Fu Liu, Qin-Min Ge, Miao Chen, Lu-Jia Tang, Li-Jun Dong, Shu-Ming Pan
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.021
Published online: March 26 2010
xAortic dissection (AD) is often a life-threatening condition that may not always present with classic symptoms, such as abrupt chest pain that sometimes radiates to the back, abdominal pain, or back pain alone. An atypical presentation makes it difficult to diagnose promptly. Painless AD occurs in approximately 5% to 15% of patients, and the diagnosis may often be delayed. We report a case of painless AD where the patient presented with acute congestive heart failure. On physical examination, he had a very high blood pressure in both his left and right arms, which was difficult to control.
DOI: http://dx.doi.org/10.1016/S0735-6757(10)00219-6
Published in issue: June 2010
DOI: http://dx.doi.org/10.1016/S0735-6757(10)00220-2
Published in issue: June 2010
DOI: http://dx.doi.org/10.1016/S0735-6757(10)00221-4
Published in issue: June 2010
DOI: http://dx.doi.org/10.1016/S0735-6757(10)00222-6
Published in issue: June 2010
