Shih-Chi Wu, Chih-Yuan Fu, Ray-Jade Chen, Yung-Fang Chen, Yu-Chun Wang, Ping-Kuei Chung, Shu-Fen Yu, Cheng-Cheng Tung, Kun-Hua Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2009.07.026
Published online: March 10 2010
xNonoperative management (NOM) of blunt splenic injuries has been widely accepted, and the application of splenic artery embolization (SAE) has become an effective adjunct to NOM. However, complications do occur after SAE. In this study, we assess the factors leading to the major complications associated with SAE.
Ariane Neyou, Brian O'Neil, Aaron D. Berman, Judith A. Boura, Peter A. McCullough
DOI: http://dx.doi.org/10.1016/j.ajem.2009.08.003
Published online: March 26 2010
xA modestly increased plasma B-type natriuretic peptide (BNP) level of greater than 80 pg/mL has been associated with increased mortality in patients with ST-segment elevation myocardial infarction (STEMI). However, the prognostic significance of larger increases in BNP during STEMI has not been reported.
Jin Joo Kim, Hyuk Jun Yang, Yong Su Lim, Jae Kwang Kim, Sung Youl Hyun, Sung Youn Hwang, Jong Hwan Shin, Jung Bea Park, Gun Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2009.08.021
Published online: March 29 2010
xAccording to the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation, unconscious adult patients with a return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest should be cooled to 32°C to 34°C for 12 to 24 hours. However, it is unclear which target temperature is more adequate. In this study, we prospectively evaluated the outcome and adverse effects following 3 target temperatures (32°C, 33°C, and 34°C) during therapeutic hypothermia with ROSC after out-of-hospital cardiac arrest.
Sébastien Larréché, Georges Mion, Aurélie Mayet, Catherine Verret, Marc Puidupin, Alain Benois, Fabrice Petitjeans, Nicolas Libert, Max Goyffon
DOI: http://dx.doi.org/10.1016/j.ajem.2009.08.022
Published online: March 29 2010
xViperidae bites represent a public health issue in Africa and are responsible for a hemorrhagic syndrome with fatal outcome in the short term. A research on Medline database does not reveal any data definitively demonstrating the efficiency of antivenom in case of delayed administration. The aim of this study, based on a 12-year survey of viperine syndromes in Republic of Djibouti, was to compare the normalization of the hemostasis disorders with an early administration of antivenin versus a delayed administration.
Nolan McMullin, Christopher J. Lindsell, Lei Lei, John Mafi, Preeti Jois-Bilowich, Venkataraman Anantharaman, Charles V. Pollack Jr., Judd E. Hollander, W. Brian Gibler, James W. Hoekestra, Deborah Diercks, W. Frank Peacock, for the EMCREG i*trACS Investigators
DOI: http://dx.doi.org/10.1016/j.ajem.2009.08.016
Published online: March 10 2010
xTroponin concentrations rising above an institutional cutpoint are used to define acute myocardial necrosis, yet it is uncertain what outcomes are associated with fluctuations in troponin that do not exceed this level. We evaluate the association between troponin fluctuations below an institutional upper limit of normal and acute coronary syndrome (ACS).
Parthak Prodhan, Sarit Sharoor-Karni, James Lin, Natan Noviski
DOI: http://dx.doi.org/10.1016/j.ajem.2009.08.020
Published online: March 29 2010
xRespiratory syncytial virus (RSV)–related disease is the leading cause of hospitalization among infants, with approximately 7% to 21% of these patients developing acute respiratory failure.
Brenda J. Shields, Elizabeth Burkett, Gary A. Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2009.08.023
Published online: March 26 2010
xFalls from heights are common in urban areas in the United States. This study describes the epidemiology of balcony fall–related injuries requiring emergency department (ED) treatment among children and adults in the United States from 1990 through 2006.
Richard F. Edlich, Shelley S. Mason, Rober J. Vissers, K. Dean Gubler, John G. Thacker, Paul Pharr, Mark Anderson, William B. Long III
DOI: http://dx.doi.org/10.1016/j.ajem.2009.08.027
Published online: March 26 2010
xPatients with suspected spinal cord injuries are immobilized to a backboard during ambulance and helicopter air transport. It has been well documented that patients who are immobilized to a backboard experience discomfort and eventually become susceptible to pressure ulcer formation. Because the patient lying on a backboard is subjected to high skin interface pressures, it is imperative to improve patient comfort and prevent pressure ulcer formation.
Kevin M. Takakuwa, Ethan J. Halpern, Frances S. Shofer
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.002
Published online: March 26 2010
xThe study aimed to examine time and imaging costs of 2 different imaging strategies for low-risk emergency department (ED) observation patients with acute chest pain or symptoms suggestive of acute coronary syndrome. We compared a “triple rule-out” (TRO) 64-section multidetector computed tomography protocol with nuclear stress testing.
Chiaki Takahashi, Hiroshi Okudera, Hideki Origasa, Eiichi Takeuchi, Kazuhito Nakamura, Osamu Fukuda, Isao Date, Takashi Tokutomi, Tohru Aruga, Tetsuya Sakamoto, Hitoshi Kobata, Tomio Ohta
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.018
Published online: March 26 2010
xThe Emergency Coma Scale (ECS) was developed in Japan in 2003. We planned a multicenter study to evaluate the utility of the ECS by comparison of the ECS and the Glasgow Coma Scale (GCS).
Mohamed Habib Grissa, Yann-Erick Claessens, Wahid Bouida, Hamdi Boubaker, Latifa Boudhib, Wieme Kerkeni, Riadh Boukef, Semir Nouira
DOI: http://dx.doi.org/10.1016/j.ajem.2009.09.019
Published online: October 11 2010
xWe tested whether paracetamol could improve pain relief in patients visiting the emergency department with acute renal colic as compared to piroxicam, a nonsteroidal anti-inflammatory drug (NSAID).
Shaun C. Spalding, Paula H. Mayer, Adit A. Ginde, Steven R. Lowenstein, Michael Yaron
DOI: http://dx.doi.org/10.1016/j.ajem.2009.10.007
Published online: March 29 2010
xWe evaluated whether implementation of computerized physician order entry (CPOE) reduces length of stay (LOS) for discharged emergency department (ED) patients.
Max H. Minnerop, Gregory Garra, Jasmine K. Chohan, Regina M. Troxell, Adam J. Singer
DOI: http://dx.doi.org/10.1016/j.ajem.2009.10.017
Published online: March 26 2010
xReliance upon patient assessment in excluding pregnancy is questionable. Physicians are encouraged to obtain pregnancy tests in all women of childbearing age. We affirmed the accuracy of women and their physicians in predicting pregnancy.
Giovanni Volpicelli
DOI: http://dx.doi.org/10.1016/j.ajem.2009.03.018
Published online: February 8 2010
xTreatment of nontraumatic cardiac arrest in the hospital setting depends on the recognition of heart rhythm and differential diagnosis of the underlying condition while maintaining a constant oxygenated blood flow by ventilation and chest compression. Diagnostic process relies only on patient's history, physical findings, and active electrocardiography. Ultrasound is not currently scheduled in the resuscitation guidelines. Nevertheless, the use of real-time ultrasonography during resuscitation has the potential to improve diagnostic accuracy and allows the physician a greater confidence in deciding aggressive life-saving therapeutic procedures.
Thomas E. Goffman
DOI: http://dx.doi.org/10.1016/j.ajem.2009.03.022
Published online: July 16 2009
xA 10-kiloton tactical nuclear device will be considered, like the remarkably simple guntype nuclear “gadget” inside the bomb called Little Boy dropped over Hiroshima. It is a size of bomb that would destroy the better part of a large American city and is the sort those concerned with terrorist nuclear threat often consider, and the entire nuclear gadget is about the size of an office refrigerator. In addition to the initial mighty blast that raised the psi to the point of tearing apart brick buildings and the mighty wind that followed, tossing heavy objects in the air, sending wood and glass into unsuspecting humans—in addition to this traditional blast were other effects.
Dimos Karangelis, Georgios Tagarakis, Christos Karkos, Ioanna Pantelaki, Nicholas Desimonas, Dimitrios Papadopoulos, Nikolaos Tsilimingas
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.005
Published online: November 9 2010
xRib fractures have been reported to be the most common significant thoracic injury and may be associated with significant pulmonary morbidities. Common legacy among older colleagues has it that during the healing process of a fractured rib, many patients manifest a rather unexpected and unjustified peak of pain about 2 weeks after the occurrence of the fracture. This pain is often the incentive that leads the patient to seek medical assistance for a problem that has its root about 2 weeks earlier.
Lisa H. Merck, Margaret G. Hauck, Debra E. Houry, Douglas W. Lowery-North, Robin R. Hemphill, Kimberly E. Applegate
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.006
Published online: November 9 2010
xComputed tomography (CT) accounts for a large quantity of patient exposure to ionizing radiation. Ionizing radiation is listed by the World Health Organization as a carcinogen [1,2]. Over the last thirty years in the United States, the rate of CT use in medical imaging has increased from 2.3 million to more than 60 million scans/y [3-5]. Between 2000 and 2006, Broder [6] reported a 4-fold increase in utilization within US emergency departments (EDs). For example, abdominal CT delivers a dose of 3.5 to 25 mSv, or 1 to 8 years of background radiation [1,2,6-25].
Christopher Rodgman, Erik Kinzie, Elizabeth Leimbach
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.020
Published online: November 1 2010
xPsychotic symptoms developing in the setting of recent drug use are commonly seen in emergency departments. In New Orleans, a new entity, purchasable over the counter at marijuana paraphernalia shops and gas stations, has emerged, and this trend is both disturbing and increasing. We are seeing increasing use of the “legal” marijuana substitute, “Mojo.” As more and more people are using the hallucinogenic substance, more and more are seeking medical assistance for the onset of acute psychosis.
Hsing-Lin Lin, Tsung-Ying Lin, Wei-Che Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.021
Published online: October 22 2010
xWe read the interesting article wrote by Sébastien et al [1] entitled “Antivenin remains effective against African Viperidae bites despite a delayed treatment.” They studied the delayed administration of antivenin after Viperidae bites. Because snakebite is a neglected tropical disease [2], we would like to share our experience in the treatment of another species of Viperidae. Although antivenom was used to treat the victims, the use of antivenom still warrants regulation and further research, because placebo-controlled studies are generally regarded as unethical [3].
Itzhak Brook
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.022
Published online: November 15 2010
xAs a laryngectomee, I am at a high risk of getting inadequate therapy when forced to seek medical care in an emergency. I recently experienced this risk when I needed urgent medical care because of sudden onset of shortness of breath. Oxygen was administered to me through the nose instead of my stoma. My inability to speak made it difficult for me to communicate my needs. This experience brought home the need to improve the knowledge of emergency department personnel so that they can avoid such mistakes and delays in appropriate care.
Ching-Hsing Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.002
Published online: November 29 2010
xIn the September issue of the American Journal of Emergency Medicine, Dr Lee et al [1] reported that a carbon monoxide (CO) poisoning patient had hyperthermia after hyperbaric oxygen (HBO) therapy. They concluded that hyperthermia was associated with HBO therapy after CO poisoning, and the idea gas law was used to explain the temperature increase. This conclusion and explanation need further discussion. First, the temperature within the chamber may slightly increase during the compression stage of HBO therapy; but air conditioner is standard equipment for HBO chamber to maintain a stable therapeutic atmosphere.
Seung Han Lee, Seung Ryu, Jin Woong Lee, Seung Whan Kim, In Sool Yoo, YeonHo You
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.001
Published online: November 15 2010
xI want to thank the reader for his/her response to my article.
Chung-Pang Wang, Yao-Tien Chang, Yu-Tse Tsan, Jin-An Huang
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.037
Published online: November 15 2010
xWe read with great interest the paper by Lien et al who reported 3 cases of spontaneous urinary extravasation (SUE), secondary to ureteral rupture caused by impacted stones at ureterovesical junction (UVJ) [1]. All three of the authors' cases well demonstrated contrast leakage from ureteropelvic junction (UPJ) on enhanced computed tomographic (CT) scans. In this article, we present a case of SUE due to an impacted UVJ stone. Abdominal CT scans revealed perirenal fluid accumulation, hydronephrosis, and an impacted UVJ stone, but did not identify contrast medium extravasation.
Oscar M.P. Jolobe
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.004
Published online: November 26 2010
xDespite the fact that survivors of ST-segment elevation myocardial infarct with diastolic dysfunction had significantly (P = .01) higher median levels of brain natriuretic peptide (BNP), compared with counterparts without diastolic dysfunction, subjects with BNP greater than 500 pg/mL, nevertheless had significantly (P = .003) lower left ventricular ejection fraction (LVEF; mean value 37%) than counterparts with BNP less than 500 pg/mL (in whom the mean value was 48%) [1]. This was probably a reflection of the fact that in some post–myocardial infarction (post-MI) subjects, exemplified, in one study, by a subgroup of 18 subjects with mean LVEF as low as 36.9%, severe left ventricular diastolic dysfunction may coexist with systolic dysfunction and, hence, subnormal LVEF [2].
Ariane Neyou, Peter A. McCullough
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.006
Published online: December 3 2010
xIn our study of 91 patients admitted for acute ST-segment elevation myocardial infarction (STEMI), we found that elevated brain natriuretic peptide (BNP) (median >500 pg/mL) was predictive of increased mortality, diastolic dysfunction, left anterior descending artery culprit, and multivessel disease.
John G. Galbraith, Joseph S. Butler, Gerard T. McGreal
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.015
Published online: May 3 2010
xSpontaneous rupture of the urinary bladder is defined as rupture of the bladder into the peritoneal cavity, or pelvic cellular tissue, in the absence of trauma. It is a rare but important cause of generalized peritonitis. It produces a set of nonspecific symptoms and signs that mimic more common causes of peritonitis such as acute appendicitis. This often translates into a delay in establishing a diagnosis. Substance abuse, predominantly alcohol, is a recognized etiology of spontaneous bladder rupture.
Gaspare Parrinello, Daniele Torres, Salvatore Paterna, Caterina Trapanese, Marina Pomilla, Umberto Lupo, Giuseppe Licata
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.016
Published online: July 14 2010
xDecompensated heart failure (DHF) is one of the most common causes of hospital admission linked to alterations in the body fluid content due to hemodynamic, cardiorenal, and neurohormonal changes. An accurate diagnosis of DHF is a challenge because signs/symptoms are sometimes nonspecific given the frequency of comorbidities; thus, B-type natriuretic peptide (BNP) is associated with high probability of cardiogenic cause. However, the current methods to diagnose dyspnea due to DHF had to date many limitations; on the other hand, an early differentiation of cardiac cause from others may permit the institution of the appropriate treatment with improvement in clinical outcome.
Adel M. Hasanin, Abdulhalim J. Kinsara
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.017
Published online: May 3 2010
xWe report a case of a 41-year-old man who had fatal multiple cerebral and bilateral renal infarcts 1 hour after initiation of thrombolytic therapy for acute ST elevation myocardial infarction. Echocardiography study disclosed dilated left ventricle with severe global hypokinesia suggestive of preexisting cardiomyopathy and a disintegrated left ventricular apical thrombus pointing out to the source of the embolic complication. This raises the question whether echocardiography before initiating thrombolytic therapy would affect the decision of commencing thrombolytic therapy and help avoiding such lethal embolic complications.
Ching-Yi Chen, Fan-Yen Lee, Yeh-Lin Kuo, Chu-Feng Liu, Chia-Te Kung
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.024
Published online: May 3 2010
xAccurate identification of aortic dissection remains a great challenge to emergency physicians. In patients presenting with predominant neurologic symptoms instead of pain, diagnosis of aortic dissection can be especially difficult. Transient or permanent neurologic symptoms at the onset of aortic dissection are uncommon and often dramatic and may therefore mask the underlying condition, leading to the inadvertent and erroneous treatment of stroke that may threaten patient's life. A healthy 47-year-old man without a history of hypertension was referred for sudden onset of blurred vision in his right eye.
Raphael P.H. Meier, Christian Toso, Francesco Volonte, Gilles Mentha
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.025
Published online: May 3 2010
xColonoscopy is currently the gold standard diagnostic and therapeutic procedure for rectum and colon pathologies. The rate of complications is low; the most frequent are perforation and intraluminal bleeding. The occurrence of splenic rupture is uncommon after colonoscopy. Although potentially fatal, it remains rarely considered in the differential diagnosis of post-colonoscopic abdominal pain. We report a case of splenic rupture diagnosed 48 hours after colonoscopy, treated with urgent splenectomy.
Hong-Mo Shih, Chih-Chuan Lin, Ya-Wen Shiao
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.004
Published online: May 3 2010
xPulmonary tumor thrombotic microangiopathy (PTTM) is characterized by multiple microthrombi and intimal myofibroblast proliferation. Patients with PTTM often present with rapidly progressing dyspnea and acute pulmonary hypertension. Here, we described a case of PTTM in a 43-year-old woman with a history of metastatic gastric cancer and receiving chemotherapy. She came to our emergency department with dyspnea, which had been rapidly progressing for 10 days. Despite intubation, the hypoxia worsened, and cardiopulmonary failure developed 54 hours after admission to our emergency department.
Youichi Yanagawa, Chiaki Suzuki, Tomonori Imamura
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.028
Published online: May 3 2010
xA 60-year-old male who had alcoholism developed quadriparesis within a 5-day period and finally was unable to stand up. He had been drinking ethanol at a rate of about 150 g/d for 20 years. On arrival, he did not show any sensory disturbance, but he demonstrated quadriparesis. The results of a biochemical analysis of his blood revealed hypokalemia, hypomagnesemia, liver dysfunction, and rhabdomyolysis. The infusion of thiamine, glucose, potassium, and magnesium resulted in the recovery from both hypomagnesemia and muscle weakness, but no improvement in hypokalemia on the second hospital day were observed.
Michael D. Repplinger, Peter M. Falk
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.006
Published online: May 5 2010
xDrug-induced aseptic meningitis is a known but rare adverse reaction to some medications including nonsteroidal antiinflammatory, antiepileptic, antimicrobial, and immune modulating medications. Of the antimicrobial medications causing aseptic meningitis, trimethoprim-sulfamethoxazole (TMP/SMX) is the most frequently cited cause in the literature. It has been reported to primarily affect women and patients with immune dysfunction. We report a case of a healthy 52-year-old man, the youngest adult male with TMP/SMX-induced aseptic meningitis reported in the United States.
Ko-Chen Chang, Yi-Ming Weng, Shou-Yen Chen, Yu-Che Chang
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.009
Published online: May 3 2010
xMesenteric venous thrombosis is rare in the emergency department (ED). Patients with mesenteric venous thrombosis should be evaluated for predisposing factors including a hypercoagulable state. Nephrotic syndrome is a well-known condition complicated by hypercoagulable states due to dysfunction in the hemostatic system. A mesenteric venous thrombosis with acute mesenteric ischemia as the initial manifestation of nephritic syndrome has not been reported previously. We report a case of nephrotic syndrome complicated with mesenteric venous thrombosis and acute mesenteric ischemia.
Jolene E.L. Oon, Adrian C.L. Kee, Hong Chuen Toh
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.011
Published online: May 3 2010
xAcute aortic dissection is a rapidly fatal condition that may present atypically with focal neurologic manifestations. We report a case of Stanford type A aortic dissection presenting with status epilepticus. This unusual presentation posed an initial diagnostic challenge to the managing physicians. We further emphasize the need to be aware of the diagnostic difficulties in this condition and that early recognition with prompt surgical intervention is imperative in reducing significant morbidity and mortality.
Sergio Emilio Prieto-Miranda, Maciel Joe Esparza-Ceseña
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.012
Published online: May 5 2010
xOrganophosphates include a large number of substances used for diverse purposes. Acute exposure by ingestion, inhalation, or contact with the skin or the eyes triggers off the toxicity of these substances. Organophosphates are potent inhibitors of cholinesterase, and the characteristic signs and symptoms of this intoxication are based on this inhibition. Their absorption is rapid; and they combine in an irreversible manner with erythrocyte acetylcholinesterase and butyrylcholinesterase, which are responsible for the hydrolysis of acetylcholine to choline and acetic acid.
Yu-Tzu Tsao, Chia-Chao Wu, Pauling Chu
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.013
Published online: May 3 2010
xHypercalcemic crisis, a life-threatening decompensation of mineral homeostasis, carries a high risk of mortality. A wide variety of causes have been implicated in different types of hypercalcemia; however, hypercalcemic crisis stemming from tuberculosis-associated immune reconstitution syndrome has been less recognized. This report profiled a case with mediastinal tuberculous lymphadenitis-associated immune reconstitution syndrome heralded by near-fatal hypercalcemic crisis. Calcium-free hemodialysis effectively corrected the life-threatening catastrophe.
Geoffrey E. Hayden, Carrie Klotz
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.014
Published online: July 14 2010
xA 47-year-old man presented to the emergency department with upper abdominal pain radiating to his back. Other than mild, reproducible abdominal pain, he had a normal physical examination. A bedside ultrasound examination of his aorta was performed and demonstrated a third vascular structure on axial (short-axis) imaging of the abdomen. Computed tomography of his abdomen and pelvis confirmed a duplicated inferior vena cava. This anomaly is discussed in terms of its relevance to the emergency sonographer, with a brief review of the literature on the subject.
Venkata M. Alla, Yeruva M. Reddy, Nancy Koster
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.015
Published online: May 3 2010
xCocaine has numerous acute and chronic deleterious effects on the cardiovascular system. It is one of the leading causes of death among illicit drug users and the mechanisms of sudden cardiac death related to cocaine use have not been firmly established. Repolarization abnormalities like QT interval prolongation and increased QT dispersion are important but frequently ignored ECG abnormalities following acute cocaine use. In this report we present the case of a patient with cocaine induced QT interval prolongation and increased QT dispersion.
DOI: http://dx.doi.org/10.1016/S0735-6757(10)00617-0
Published in issue: February 2011
DOI: http://dx.doi.org/10.1016/S0735-6757(10)00618-2
Published in issue: February 2011
DOI: http://dx.doi.org/10.1016/S0735-6757(10)00619-4
Published in issue: February 2011
DOI: http://dx.doi.org/10.1016/S0735-6757(10)00620-0
Published in issue: February 2011
