Sergio Manzano, Benoit Bailey, Jean-Bernard Girodias, Annick Galetto-Lacour, Jocelyne Cousineau, Edgard Delvin
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.022
Published online: November 23 2009
xThe aim of the study was to evaluate the impact of procalcitonin (PCT) measurement on antibiotic use in children with fever without source.
Hyuk J. Choi, Christopher C. Lee, Tae H. Lim, Bo S. Kang, Adam J. Singer, Mark C. Henry
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.015
Published online: February 8 2010
xMouth-to-mouth ventilation is a skill taught in cardiopulmonary resuscitation (CPR) training for laypersons. However, its effectiveness is questioned. Our aim was to determine the effectiveness of mouth-to-mouth ventilation training using a self-instruction CPR training video for laypersons.
Alexander T. Limkakeng Jr., Abhinav Chandra
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.014
Published online: November 30 2009
xThe impact of renal disease on risk stratification of patients at low risk for potential acute coronary syndrome has not been well defined. The objective of this study was to document the prevalence of renal dysfunction and assess the association between renal impairment and abnormal cardiac evaluation in observation unit (OU) patients.
Yi Li, Tiekuan Du, Matthew R. Lewin, Houli Wang, Xu Ji, Yanping Zhang, Tengda Xu, Lingjie Xu
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.033
Published online: March 26 2010
xPrevious in-hospital studies suggest that there are significant circadian rhythms associated with the incidence of acute coronary syndromes (ACSs). No study to date has examined the presentation of ACS in the prehospital setting. Our goal was to examine circadian, day-of-week, and age patterns of occurrence in ACS in a large, urban emergency medical services (EMS) system.
Sarat Thikkurissy, Joseph T. Rawlins, Ashok Kumar, Erik Evans, Paul S. Casamassimo
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.028
Published online: April 5 2010
xThe study aimed to assess characteristics of facial cellulitis admissions and their relationship to cost of hospitalization (COH) and length of stay (LOS) in children ages 0 to 20 years at an urban hospital and to compare outcomes of rapid management to published and national statistics for LOS and COH.
Kazuaki Kuwabara, Shinya Matsuda, Kiyohide Fushimi, Koichi B. Ishikawa, Hiromasa Horiguchi, Kenji Fujimori
DOI: http://dx.doi.org/10.1016/j.ajem.2009.02.030
Published online: February 8 2010
xTrauma Injury Severity Score is a frequently used prediction model for mortality. However, few studies have assessed the probability of survival (Ps) and early resource use after trauma. We studied the impact of Ps on early critical care or costs to test its applicability to efficient trauma care.
Jon W. Schrock, Svetlana Reznikova, Suki Weller
DOI: http://dx.doi.org/10.1016/j.ajem.2009.03.003
Published online: July 16 2009
xWe sought to determine if the opening of an adult emergency department (ED) observation unit (OU) would impact the rate of hospital admission and ED discharges for pyelonephritis.
Colleen A. Crowe, Chintan D. Mistry, Kathleen Rzechula, Christine E. Kulstad
DOI: http://dx.doi.org/10.1016/j.ajem.2009.03.007
Published online: February 8 2010
xThe study aimed to determine mortality in septic patients 2 years after introduction of a modified early goal-directed therapy (EGDT) protocol and to measure compliance with the protocol.
Clare L. Atzema, Peter C. Austin, Jack V. Tu, Michael J. Schull
DOI: http://dx.doi.org/10.1016/j.ajem.2009.03.010
Published online: March 26 2010
xVirtually all emergency department (ED) patients receive an ED triage assessment that determines their priority to be seen by a physician. Previous research found that half of patients who are having an acute myocardial infarction (AMI) are given a low priority triage score, which is associated with delays in electrocardiogram (ECG) acquisition and reperfusion therapy. We sought to determine some of the reasons why ED triage is failing in these patients.
Youichi Yanagawa, Masaki Miyazaki, Toshihisa Sakamoto
DOI: http://dx.doi.org/10.1016/j.ajem.2009.03.012
Published online: March 26 2010
xThe association between abnormal pupil reactivity (abnormal) and the outcome among patients with psychotropic drug overdose (OD) was retrospectively investigated.
Cheng-Hsuan Ho, Ya-Chieh Wu, Yen-Yue Lin, Chin-Wang Hsu, Shih-Hung Tsai
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.017
Published online: July 16 2009
xMyocarditis can be totally asymptomatic or can manifest with chest pain syndromes, ranging from mild persistent chest pain of acute myopericarditis to severe symptoms that mimic acute myocardial infarction. About 60% of patients may have antecedent arthralgias, malaise, fevers, sweats, or chills consistent with viral infections 1 to 2 weeks before onset. Here, we report a postpartum young woman who developed postural hypotension as the first manifestation of fulminant myocarditis with initially acute “cold and dry” right-sided heart failure and cardiogenic shock.
Samuel Delerme, Yonathan Freund, Robin Renault, Catherine Devilliers, Samuel Castro, Sebastien Chopin, Gaelle Juillien, Bruno Riou, Patrick Ray
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.028
Published online: March 26 2010
xEnd-tidal carbon dioxide pressure (etCO2) is widely used in anaesthesia and critical care in intubated patients. The aim of our preliminary study was to evaluate the feasibility of a simple device to predict capnia in spontaneously breathing patients in an emergency department (ED).
Roberto Manfredini, Rodolfo Citro, Mario Previtali, Olga Vriz, Quirino Ciampi, Marco Pascotto, Ercole Tagliamonte, Gennaro Provenza, Fabio Manfredini, Eduardo Bossone, for the Takotsubo Italian Network investigators
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.023
Published online: February 26 2010
xAcute cardiovascular events show definite temporal patterns of occurrence. Takotsubo cardiomyopathy (TTC) has been recently shown to exhibit a seasonal (summer) and circadian (morning) temporal distribution. The aim of this study, based on the database of a multicenter Italian network, was to investigate the possible existence of a weekly pattern of onset of TTC.
Hamdi Boubaker, Riadh Boukef, Yann-Erick Claessens, Wahid Bouida, Mohamed Habib Grissa, Kaouther Beltaief, Mohamed Naceur Trimech, Wiem Kerkeni, Latifa Boudhib, Semir Nouira
DOI: http://dx.doi.org/10.1016/j.ajem.2009.04.030
Published online: May 3 2010
xWe tested whether the addition of phloroglucinol to piroxicam could improve pain relief in patients with acute renal colic visiting the emergency department.
Siu Fai Li, Michael Cole, Rhonda Forest, Mikaela Chilstrom, Eugene Reinersman, Michael P. Jones, Shreni Zinzuwadia, Sheila King, Kabir Yadav
DOI: http://dx.doi.org/10.1016/j.ajem.2009.05.003
Published online: March 26 2010
xUsing Poiseuille's law and standardized gauge sizes, an 18-gauge (g) intravenous catheter (IV) should be 2.5 times faster than a 20-g IV, but this is not borne out by observation, in vitro testing, and manufacturer's data. Our objective was to determine if the infusion rate of a single 18-g IV was equivalent to the infusion rate of two 20-g IVs.
Tzung-Hai Yen, Ja-Liang Lin, Dan-Tzu Lin-Tan, Ching-Wei Hsu, Cheng-Hao Weng, Yu-Hui Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2009.06.001
Published online: February 26 2010
xThis is an observational study that examines the clinical features, the degrees of esophageal injury, physiological markers, and clinical outcomes after paraquat ingestion and seeks to determine what association, if any, may exist between these findings.
Yoshimi Fukuoka, Masako Takeshima, Noriko Ishii, Miura Chikako, Miyuki Makaya, Linda Groah, Erick Kyriakidis, Kathleen Dracup
DOI: http://dx.doi.org/10.1016/j.ajem.2009.06.020
Published online: March 29 2010
xThe purpose of the study was to examine the association between working hours, job strain, and duration of prehospital delay in seeking care by employed patients with acute coronary syndrome (ACS) in the United States and Japan.
Junho Cho, Hyun Soo Chung, Sung Pil Chung, Young-Min Kim, Young Soon Cho
DOI: http://dx.doi.org/10.1016/j.ajem.2009.06.021
Published online: March 11 2010
xThis study compared the Airway scope (AWS) to the Macintosh laryngoscope (ML) during chest compressions on a fresh cadaver.
Mani Mofidi, Nahid Kianmehr, Davood Farsi, Reza Yazdanpanah, Saeed Majidinezhad, Peiman Asadi
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.024
Published online: April 5 2010
xUnilateral anterior shoulder dislocation is the most common major joint dislocation seen by emergency physicians. Bilateral glenohumeral dislocations are rarely seen and almost always posterior after seizure or electrical shock. We present an unusual case of bilateral anterior dislocation of shoulder that had anterior dislocation of temporomandibular joint simultaneously. These problems occurred after a course of generalized tonic-clonic seizure. The coincidence of these dislocations is the first case published in the literature.
Ming-Tse Tsai, Jen-Tang Sun, Kuang-Chau Tsai, Wan-Ching Lien
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.025
Published online: March 26 2010
xTraumatic pancreatic rupture is associated with high morbidity and mortality. The diagnosis is difficult and usually accompanied with other injuries. We reported a 17-year-old adolescent boy who experienced this disease alone. The diagnosis was first suspected in ultrasonography and then confirmed by computed tomography. Endoscopic retrograde pancreatography showed his pancreatic duct was patent. He made an uneventful recovery after 10 days of hospitalization. Ultrasonography is well known for detecting the presence of hemoperitoneum in blunt abdominal trauma.
Samuel B. Adams Jr., Stephanie W. Mayer, Mark G. Hamming, Robert D. Zura
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.026
Published online: March 26 2010
xConcomitant fractures of the pelvic ring and proximal femur in the setting of low-energy trauma are rare but not mutually exclusive. An 82-year-old woman, without prior hip pain, presented to our institution after a fall from standing height. Ipsilateral pubic rami and sacral ala fractures were diagnosed with plain radiographs and computed tomography scanning, respectively, and corroborated by physical examination. No further imaging was performed in the emergency department. However, with adequate in-house pain control, the patient's complaints and physical examination were also indicative of a hip fracture.
Gerhard Prause, Sylvia Archan, Geza Gemes, Friedrich Kaltenböck, Ilja Smolnikov, Herwig Schuchlenz, Gernot Wildner
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.035
Published online: March 26 2010
xThe continuity of chest compression is the main challenge in prehospital cardiopulmonary resuscitation in the field as well as during transport. Invasive blood pressure monitoring with visible pulse waves by means of an arterial line set prehospitally allows for tight control of the effectiveness of chest compressions as well as of the impact of the administered epinephrine and also captures beginning fatigue of the rescuers. In this case, maintaining uninterrupted circulation through manual as well as mechanical chest compressions continued until the successful percutaneous coronary intervention saved the patients life without neurologic damage.
William C. Wu, Christopher A. Mitchell, Derek Linklater
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.036
Published online: March 26 2010
xAn 83-year-old woman presented to the emergency department (ED) via emergency medical services with the chief complaint of “strokelike symptoms.” Physical examination revealed altered mental status, tachycardia, hypotension, and a large nonpulsatile periumbilical mass. Bedside ultrasound revealed a 9-cm abdominal aortic aneurysm with absent central flow. Computed tomography scan demonstrated diffuse thoracic and abdominal aortic dilation with rupture into the mediastinum along with left hemothorax.
Richard Byrne, Lisa Filippone
DOI: http://dx.doi.org/10.1016/j.ajem.2009.10.003
Published online: March 26 2010
xThe electrocardiographic presence of deep T-wave inversions in a patient presenting with chest pain is highly concerning for cardiac ischemia. There are certain situations, however, when this finding may represent a benign phenomenon. In this report, we illustrate a case of non–ischemia-related T-wave inversion after resolution of a rate-related left bundle-branch block pattern—a case of cardiac memory. This poorly understood process occurs when the heart resumes a sinus rhythm after a period of abnormal depolarization, typically a bundle-branch block or ventricular pacing.
Jean Lee Nelson, Frank LoVecchio
DOI: http://dx.doi.org/10.1016/j.ajem.2009.10.012
Published online: March 26 2010
xWe present the case of a 71-year-old man with hydatid disease who travels frequently to and from the United States and Mexico. He presented to the emergency department (ED) with a chief complaint of acute abdominal pain accompanied by neurological and urinary symptoms. A large cystic mass was found in the abdomen, as well as multiple metastases secondary to prostate cancer. Limited availability of history and lack of compliance in the past led to the unusual presentation of this patient. Challenges to diagnosis are discussed.
Amr El-Husseini, Nick Azarov
DOI: http://dx.doi.org/10.1016/j.ajem.2009.10.014
Published online: March 29 2010
xAcquired methemoglobinemia (MetHb) is a rare complication of exposure to toxic chemicals or drugs, most commonly topical anesthetic agents. This condition occurs when the rate of methemoglobin production exceeds the rate of methemoglobin reduction. Topical anesthetics have been reported to cause MetHb, but this adverse event is extremely rare and is not usually listed as one of the possible complications of transesophageal echocardiography (TEE). However, the number of published case reports of TEE-associated MetHb has recently increased [1-9].
Shao-Hsuan Hsia, Jainn-Jim Lin, Chang-Teng Wu, I-Anne Huang, Kuang-Lin Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2009.10.015
Published online: March 26 2010
xStridor is a commonly encountered presenting symptom of upper airway obstruction in the pediatric population. Although infection etiologies such as croup, retropharyngeal abscess, and epiglottitis predominate in the pediatric population, other less common etiologies must also be considered in the differential diagnosis. We report a case of 3-year-2-month-old girl who exhibited the following symptoms: progressive hoarseness, backing cough, and dyspnea. Initial clinical symptoms were mimicking croup.
Oscar M.P. Jolobe
DOI: http://dx.doi.org/10.1016/j.ajem.2009.11.001
Published online: March 26 2010
xWhen left bundle branch block (LBBB) is associated with accute myocardial infarction (AMI) as many as 39.2% to 46.9% of patients may have old LBBB, as opposed to new-onset LBBB. In a typical presentations of AMI, however, the prevalence of old LBBB relative to new-onset LBBB is known, and may well be higher, given the association of old LBBB and 3-vessel coronary heart disease even in the absence of AMI.
Jason Remick, Alfred Sacchetti, Gust Bages, Kristen Delagol
DOI: http://dx.doi.org/10.1016/j.ajem.2009.11.010
Published online: March 26 2010
xMaintenance of spontaneous effective ventilations can present unique challenges to emergency physicians directing procedural sedation in patients with underlying anatomic or physiologic upper airway pathology. In a morbidly obese patient requiring electrical cradioversion, use of bilevel positive airway pressure facilitated deep sedation while averting any adverse respiratory complications. Noninvasive pressure support ventilation may present another emergency department adjunct for difficult procedural sedation cases.
Chih-Hsien Wang, Chun-Chih Chou, Wen-Je Ko, Yung-Chie Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2009.11.011
Published online: April 5 2010
xDrowning is one of the most common causes of accidental events. Here we report a drowning patient who experienced acute respiratory distress syndrome after hospitalization. Although the compliance of lung was as poor less as 5 mL/cm H2O, this patient was eventually rescued and recovered by extraprolonged extracorporeal membrane oxygenation support for 117 days.
DOI: http://dx.doi.org/10.1016/S0735-6757(10)00268-8
Published in issue: July 2010
DOI: http://dx.doi.org/10.1016/S0735-6757(10)00269-X
Published in issue: July 2010
DOI: http://dx.doi.org/10.1016/S0735-6757(10)00270-6
Published in issue: July 2010
DOI: http://dx.doi.org/10.1016/S0735-6757(10)00271-8
Published in issue: July 2010
