Xiang-yu Zhang, Zi-jian Yang, Qi-xing Wang, Hai-rong Fan
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.042
Published online: May 3 2010
xTraumatic brain injury or intracranial hemorrhage patients with acute lung injury/acute respiratory distress syndrome need mechanical ventilation. The use of positive end-expiratory pressure (PEEP) in this situation remains controversial. This study explored the impact of PEEP on intracranial pressure (ICP), cerebral perfusion pressure (CPP), central venous pressure (CVP), and mean arterial pressure (MAP) in cerebral injury patients.
Brian E. Perron, Amy S.B. Bohnert, Sarah E. Monsell, Michael G. Vaughn, Matthew Epperson, Matthew O. Howard
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.044
Published online: July 14 2010
xDrug treatment can be effective in community-based settings, but drug users tend to underuse these treatment options and instead seek services in emergency departments (EDs) and other acute care settings. The goals of this study were to describe prevalence and correlates of drug-related ED visits.
Ramin S. Hastings, Robert D. Powers
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.045
Published online: May 3 2010
xResearch published in 1972 and 1993 has detailed the demographics, diagnoses, and diagnostic test utilization of adult patients presenting with nontraumatic abdominal pain to the emergency department (ED) at the University of Virginia Hospital. This is an update of those studies, designed to examine the present state of diagnosis and management of abdominal pain, as well as to look at trends during the 35-year span of the investigations.
Hamid Reza Hatamabadi, Ali Abdalvand, Saeed Safari, Hamid Kariman, Ali Arhami Dolatabadi, Ali Shahrami, Hossein Alimohammadi, Mostafa Hosseini
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.046
Published online: May 3 2010
xTetanus vaccine and immunoglobulin administration are challenging decisions mostly because of the fact that the current protocol for immunization against tetanus is based on 2 variables: the vaccination status of the patient and the nature of wound and its exposure. To solve this problem, Tetanus Quick Stick (TQS; Nephrotek Laboratory, Rungis, France), an immunochromatographic dipstick test, was developed to determine the tetanus immunity of the patients. The aim of this present study was to investigate the sensitivity, specificity, and the positive and negative predictive values and cost-effectiveness of TQS in the emergency department (ED) setting.
Kuo-Chih Chen, Shih-Wen Hung, Vei-Ken Seow, Chee-Fah Chong, Tzong-Luen Wang, Yu-Chuan Li, Hang Chang
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.047
Published online: May 3 2010
xControversy remains over the imaging method of choice for evaluating acute pyelonephritis (APN) in the emergency department (ED).
Ran Arieli, Yohanan Daskalovic, Ofir Ertracht, Yehuda Arieli, Yohai Adir, Amir Abramovich, Pinchas Halpern
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.003
Published online: May 3 2010
xHumidification of inspired gas is critical in ventilated patients, usually achieved by heat and moisture exchange devices (HMEs). HME and the endotracheal tube (ETT) add airflow resistance. Ventilated patients are sometimes treated in hyperbaric chambers. Increased gas density may increase total airway resistance, peak pressures (PPs), and mechanical work of breathing (WOB). We tested the added WOB imposed by HMEs and various sizes of ETT under hyperbaric conditions. We mechanically ventilated 4 types of HMEs and 3 ETTs at 6 minute ventilation volumes (7-19.5 L/min) in a hyperbaric chamber at pressures of 1 to 6 atmospheres absolute (ATA).
Yi Han, Chun-sheng Li, Zhi-yu Su, Yi Lu, Sheng-qi Wang
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.005
Published online: May 3 2010
xThe aim of this study was to study the effects of norepinephrine (NE)-induced hypertension (HT) on renal biochemistry, enzymology, and morphology after restoration of spontaneous circulation (ROSC) by cardiopulmonary resuscitation (CPR) in swine.
Najafi Iraj, Safari Saeed, Hosseini Mostafa, Sanadgol Houshang, Sharifi Ali, Rashid Farokhi Farin, Seirafian Shiva, Mooraki Ahmad, Hamidreza Samimagham, Vahid Pourfarziani, Atabak Shahnaz, Osareh Shahrzad, Boroumand Behrooz
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.018
Published online: May 3 2010
xAcute kidney injury (AKI) is a severe and preventable problem of crushed earthquake victims. Early hydration therapy started before fully removing earthquake rubbles has been claimed to play a decisive role in AKI prevention, which saves the necessity of later dialysis. However, the extent, quality, and appropriateness of its know-how are controversial.
Guillaume Foldes-Busque, André Marchand, Jean-Marc Chauny, Julien Poitras, Jean Diodati, Isabelle Denis, Marie-Josée Lessard, Marie-Ève Pelland, Richard Fleet
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.021
Published online: May 3 2010
xThis study aimed at (1) establishing the prevalence of paniclike anxiety in emergency department (ED) patients with unexplained chest pain (UCP); (2) describing and comparing the sociodemographic, medical, and psychiatric characteristics of UCP patients with and without paniclike anxiety; and (3) measuring the rate of identification of panic in this population.
Angela M. Mills, Frances S. Shofer, Ann K. Boulis, Daniel N. Holena, Stephanie B. Abbuhl
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.023
Published online: May 3 2010
xResearch on how race affects access to analgesia in the emergency department (ED) has yielded conflicting results. We assessed whether patient race affects analgesia administration for patients presenting with back or abdominal pain.
Ludovic Trinquart, Patrick Ray, Bruno Riou, Antonio Teixeira
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.026
Published online: May 3 2010
xThe aim of the study was to assess the usefulness of systematic natriuretic peptide testing in the management of patients presenting with acute dyspnea to emergency departments (EDs).
Yi Li, Tiekuan Du, Matthew R. Lewin, Houli Wang, Xu Ji, Yanping Zhang, Tengda Xu, Lingjie Xu, Jack S. Wu
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.027
Published online: May 3 2010
xMost research on the seasonality of acute coronary syndrome (ACS) has been were reported from hospital-based data. We aimed to investigate the seasonal distribution of ACS in Beijing and to elucidate the relations between ACS occurrence and climatic parameters in a prehospital setting.
Philippe Frontin, Vincent Bounes, Charles Henri Houzé-Cerfon, Sandrine Charpentier, Vanessa Houzé-Cerfon, Jean Louis Ducassé
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.007
Published online: May 3 2010
xThe purpose of this randomized controlled trial was to determine the immediate and delayed effects of noninvasive ventilation for patients in acute cardiogenic pulmonary edema (ACPE) in addition to aggressive usual care in a medical prehospital setting.
Richard M. Nowak, Ayan Sen, Audwin J. Garcia, Heidi Wilkie, James J. Yang, Michael R. Nowak, Michele L. Moyer
DOI: http://dx.doi.org/10.1016/j.ajem.2011.05.014
Published online: August 1 2011
xContinuous invasive blood pressure (BP) and heart rate (HR) monitoring in the emergency department (ED) is valuable in managing critically ill patients. Novel noninvasive finger cuff technology allows this same uninterrupted monitoring for almost any individual. This exploratory study compares ED noninvasive continuous to intermittent measurements of these variables.
Srikar Adhikari, Michael Blaivas, Lina Lander
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.005
Published online: May 3 2010
xThe purpose of the study was to compare bedside ultrasound (US) and panorex radiography in the diagnosis of a dental abscess in emergency department (ED).
Juliane Bohan, Lynne Fullerton, Barbara Oakland, Jill Oldewage
DOI: http://dx.doi.org/10.1016/j.ajem.2010.05.003
Published online: August 5 2010
xThis project measured the effect of a multifaceted intervention on health care provider identification and treatment of undiagnosed hypertensive patients. The intervention comprised provider education, audit, and feedback. The primary outcomes were pre-/postintervention differences in the proportion of patients presenting with elevated blood pressure who were (1) identified, (2) given blood pressure measurements, (3) counseled regarding behavior change, (4) prescribed medications, and (5) advised of the need for follow-up.
Esther H. Chen, Alexander Nemeth
DOI: http://dx.doi.org/10.1016/j.ajem.2010.05.010
Published online: August 5 2010
xMinimally invasive percutaneous procedures are increasingly being performed by both interventional radiologists and noninterventionalists. Patients with postprocedural issues will likely present to the emergency department for evaluation and treatment. This review focuses on the evaluation and management of the complications of common percutaneous procedures.
Nishal Amin, Helen Woodward, Harriet Gunn, Fey Probst, Alison Sanders
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.020
Published in issue: September 2011
xDiarrhea and vomiting are common modes of presentation to an emergency department (ED). National Health Service guidelines recommend a stool culture be sent for patients who are systemically unwell or immunocompromised, have a recent history of travel or suspected giardiasis, have blood or pus in the stool, or had recent antibiotic usage or hospital admission. It is recommended that a stool sample be considered where there is a suspected public health hazard, such as diarrhea in food handlers, health care workers, elderly residents in care homes, or suspected outbreaks [1].
Zhanna Livshits, Robert S. Hoffman
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.032
Published in issue: September 2011
xThe recent article by Fasano et al [1] contributed to the knowledge of the mechanism of sulfonylurea-induced hypoglycemia with potential to impact clinical practice. Unfortunately, the results of the study were quite variable with regard to both insulin and C peptide concentrations in those patients who developed hypoglycemia after reported therapeutic use of sulfonylureas.
Robert H. Birkhahn, Elizabeth Haines, Wendy Wen, Lakshmi Reddy, William M. Briggs, Paris A. Datillo
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.003
Published in issue: September 2011
xWe would like to thank Professor Lippi for the comments regarding our recent article and would like to respond to 5 areas of concern raised in his letter.
Qiang Wang, Fu-Shan Xue, Xu Liao, Yu-Jing Yuan, Jun Xiong
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.033
Published online: April 25 2011
xIn their recent article that retrospectively assessed the performance of disposable stainless steel vs plastic laryngoscope blades for emergence intubation in the prehospital setting by paramedics, Dos Santos et al [1] reported that stainless steel disposable blade was superior to plastic disposable blade in first attempt and overall number of attempts to intubation. From this, they conclude that, before further research is done, stainless steel disposable blades should be recommended for tracheal intubations.
Frank D. Dos Santos, Mark A. Merlin
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.034
Published in issue: September 2011
xThank you for the comments regarding our article. Our study was conceived because of an apparent belief by our paramedics that stainless steel blades are superior to plastic blades. We found this belief to be overwhelming among paramedics who have used both blades. We were surprised to find a difference on our 2 end points of intubation success rate and number of intubation attempts. Although multiple variables exist in intubation as is pointed out, we decided that our results were interesting enough to publish, although we could not control for some of the variables.
Gibrham Rodriguez, Dan Quan
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.009
Published online: June 15 2011
xEmergency department (ED) patients are often treated for soft-tissue infections and now demonstrate a high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) [1]. It has been well documented that this pathogen can be transmitted by direct contact from an infected source such as a human or an inanimate object. Spread of MRSA and many other bacterial pathogens in the ED has become an infection control issue for many hospitals because of ED overcrowding, lack of adequate hand washing, and lack of universal precautions by health care providers [3].
Fabrizio Elia, Giovanni Ferrari, Franco Aprà
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.021
Published online: June 6 2011
xWe read with great interest the letter by Dr Hasanin and Kinsara [1] in the February 2011 issue of the American Journal of Emergency Medicine, in which they described a case of fatal multiple infarcts 1 hour after initiation of thrombolytic therapy for acute ST-elevation myocardial infarction [1]. In their case report, echocardiography study disclosed a dilated left ventricle with severe global hypokinesis suggestive of preexisting cardiomyopathy and a disintegrated left ventricular apical thrombus pointing out to the source of the embolic complications.
John P. Benner, Jeffrey D. Ferguson, Anthony E. Judkins, Robert E. O'Connor, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.022
Published online: June 6 2011
xWe write to you with the results of our investigation of ondansetron as an acceptable and efficacious antiemetic for the treatment of nausea and vomiting in the rural, out-of-hospital setting. Nausea is a commonly encountered patient complaint in both the out-of-hospital and emergency department (ED) settings [1]. Although a nonspecific symptom, nausea can result from a myriad of both benign and emergent etiologies, ranging from migraine headaches and gastroenteritis to intracranial hemorrhage and acute myocardial infarction.
Arjun Dutt Law, Ashish Bhalla, Vikas Suri
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.024
Published online: June 6 2011
xWe read, with great interest, the article published by Takahashi et al [1] that suggested the Emergency Coma Scale (ECS) as an alternate triage tool for the assessment of patients with neurologic impairment.
Michael Barakat, Haywood Hall, Ian Martin
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.026
Published online: June 6 2011
xThe mastery of resuscitation is the heart of emergency medicine (EM). It is preached from day 1 of residency. It is reinforced every time we march through the mantra of A to B then C. Whether it be traumatic or medical, adult or pediatric, our role in resuscitation remains paramount. In reality, this responsibility is the very essence of our profession and alone justifies our existence. Come what may, we will be ready. This was my thought process as I traveled to San Miguel de Allende, Mexico, in June 2010 for a medical Spanish immersion program called El Programa de Actualización Continua en Emergencias (PACE) led by Dr Haywood Hall.
Chih-Yuan Fu, Yu-Chun Wang, Chi-Hsun Hsieh, Ray-Jade Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.001
Published online: June 6 2011
xGunshot wounds may result in abdominal or extremity injuries, which have a high rate of mortality [1-8]. Multiple films may be needed to survey the injured sites and localize any residual bullet wounds. Therefore, emergency department (ED) physicians frequently face the challenge of deciding which films to take and how many films are needed because of the presence of multiple wounds and the unpredictable paths of projectiles.
Hichem Chenaitia, Khaled Abrous, Fabrice Louis, Christine Aimé, Tomislav Petrovic, WINFOCUS (World Interactive Network Focused On Critical UltraSound) Group France
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.005
Published online: June 6 2011
xRetroperitoneal hematoma (RH) is an uncommon emergency but with a high mortality rate [1]. Clinical diagnosis is difficult because of variable presentations, from mild flank and upper abdominal discomfort to shock, depending on degree and duration of bleeding [1]. The causes of RH are traumatic, iatrogenic, or “spontaneous.” Treatment depends on the cause and ranges from drainage of hematoma under ultrasound guidance to surgery or endovascular procedures [1]. Ultrasonography (US) is increasingly important for initial assessment of critically ill patients [2,3].
Thana Khawcharoenporn, Shawn Vasoo, Edward Ward, Kamaljit Singh
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.007
Published online: June 6 2011
xDifferentiation between asymptomatic bacteriuria (AB) and symptomatic urinary tract infection (SUTI) is important for treatment guidance because antibiotic therapy for AB offers benefit to only pregnant women and patients undergoing urologic procedures [1,2]. Unnecessary antibiotic prescription for AB may put patients at risk for development of antibiotic resistance and adverse reactions [1-3]. As previously described by our study in regard to the increased antibiotic resistance rates among SUTI patients presenting to our emergency department (ED) [4], unnecessary antibiotic treatment for AB was of concern.
Wisit Cheungpasitporn, Teeranun Jirajariyavej, Sirisak Chanprasert
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.010
Published online: June 13 2011
xWe have read with great interest the article by Mert et al [1]. The authors presented a case with atrial fibrillation that developed pulmonary edema in the setting of hypercalcemia secondary to hyperparathyroidism. However, an interesting topic that the authors did not mention about was patient's rate control medication for atrial fibrillation. Every rate control medication has different effects by hypercalcemia and eventually can cause pulmonary edema. Verapamil acts primarily at the cell membrane and inhibits transmural fluxes of calcium.
Alfredo De Giorgi, Fabio Fabbian, Marco Pala, Ruana Tiseo, Francesco Portaluppi, Roberto Manfredini
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.012
Published online: June 13 2011
xIn 2010, in the United States, about 795 000 people had a stroke, and about 80% of them are new cases; in Italy, the cases of stroke are about 195 000, with an incidence of 2.15 to 2.54 new cases-1000 inhabitants per year [1]. Stroke is the third cause of death, after myocardial infarction and cancer, with an associated high incidence of disability and average cost of €40 000 to €50 000 per patient per year [2]. The social impact of this disease in general population suggests the need to adequately inform the patient about the risk of developing the disease, because this could favor appropriate changes in lifestyle habits, reduction of blood pressure (BP), smoking, and the incidence of diabetes mellitus and other cardiovascular diseases.
Giovanni Volpicelli
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.014
Published online: June 13 2011
xWe appreciate the interest of the authors regarding our recent article on the “double lung point.” We will try to answer several questions raised by the letter, giving more technical details.
Andrew Verniquet, Rafid Kakel
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.015
Published online: June 6 2011
xThe interesting case report “the double lung point: an unusual sonographic sign of juvenile spontaneous pneumothorax” by Volpicelli and Audino [1] raises several questions.
Mandeep Grewal, Mary Pat McKay, Alison Shaffer Teitlebaum
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.017
Published online: June 13 2011
xGang membership has been associated with a variety of high-risk behaviors: drug use and sales, violence both as perpetrator and as victim, and dropping out of high school [1,2]. Many of these risky behaviors increase the likelihood that gang members will land in an emergency department (ED) [3]. We do not yet know the types of health concerns that bring gang members to the ED, the ways in which their visits differ from those of nongang members, and we lack prevalence information that might lead to the development of interventions addressing gang issues or risky behaviors.
Salim Surani, Marlene Morales, Mauricio Rodriguez, Joseph Varon
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.020
Published online: June 13 2011
xThe human race has evolved over millions of years. This evolution has allowed our bodies to adapt to critical situations, which are otherwise lethal in other species. One example of such adaptation is the human blood pH. This characteristic measurement, by virtue of its compensatory mechanisms, keeps the pH in a range of 7.35 to 7.45 even under adverse circumstances. As clinicians, we have encountered patients with severe hypoxemia and hypercarbia in our emergency departments (EDs), medical and surgical wards, and the intensive care units.
George Perdrizet, Barnet Eskin, John Allegra, Melissa Kraynak, Scott Shapiro, Catherine Pocoroba, Francis Simons
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.022
Published online: June 24 2011
xCritically ill or injured patients often cannot give informed consent to be enrolled in clinical trials. In 1996, the US government passed a rule (21 CRF 50.24) [1] to allow research without informed consent in emergency situations. One of the requirements of the rule is “community consultation” (CC), that is, advance disclosure of the research plan with the community where the study will be conducted and solicitation of opinions regarding the acceptability of the research. However, there are no clear definitions or guidance that helps investigators and institutional review boards decide how to perform CC properly.
DOI: http://dx.doi.org/10.1016/j.ajem.2011.07.019
Published in issue: September 2011
xIn the article, “Diagnostic imaging rates for head injury in the ED and 4 states' medical malpractice tort reforms” (Am J Emerg Med. 2011 July;29(6):656-664), there was an error in the byline. The correct byline is below.
Christopher W. Jones, Graham E. Snyder
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.008
Published online: May 3 2010
xMollaret meningitis is a syndrome characterized by recurrent bouts of meningitis that occur over a period of several years in an affected patient. Also known as recurrent lymphocytic meningitis, this entity involves repeated episodes of headache, stiff neck, fever, and cerebrospinal fluid pleocytosis. Herpes simplex virus type 2 is the most frequently implicated causative agent, and treatment involves the use of antiviral medications. We describe a case of Mollaret meningitis in a 47-year-old man who presented to the emergency department with his eighth episode of meningitis during a period of 20 years.
Joseph P. Habboushe, Graham Walker
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.020
Published online: August 16 2010
xWe present the case of a 35-year-old woman with hypotension and abdominal tenderness after acute vomiting and syncope. The patient had been breast-feeding since the birth of a child 8 months earlier, was not yet menstruating, and felt that she was having a reaction to sushi. She was unable to provide a urine sample during initial evaluation, and a drop of whole blood was therefore applied to a qualitative urine human chorionic gonadotropin point-of-care test. This test result was positive for pregnancy, ultrasound revealed free fluid in the abdominal cavity, and emergency laparotomy by our gynecologists confirmed ruptured ectopic pregnancy.
Akinori Sekizawa, Youichi Yanagawa, Kouichirou Nishi, Akira Takasu, Toshihisa Sakamoto
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.021
Published online: October 11 2010
xA 75-year-old male patient suffered a chest degloving injury when he fell on his back and was run over by a small farm tractor he was pulling. At the time of patient admission, the paradoxical motion of the right chest wall was remarkable; and he had an open fracture of the right humerus, a dislocation of the right ankle, and a laceration of the right forearm. Chest computed tomography revealed fractures of the fifth to seventh ribs and detachment of both the right pectoralis major muscle and serratus anterior muscle from the chest wall, with a disconnected right thoracic cavity.
Gerard DeMers, Jacob L. Camp, Donald Bennett
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.022
Published online: August 16 2010
xPneumomediastinum from isolated blunt or penetrating oral-facial trauma is a rare occurrence, which can be associated with facial fractures or may be iatrogenic. We present two cases caused by high-pressure-induced facial injuries that had very different management and outcomes. The first patient had asymptomatic pneumomediastinum and an uncomplicated recovery, whereas the second had a complicated clinical course requiring extensive surgical debridement. Neither patient developed mediastinitis as a complication of pneumomediastinum.
Yiju Teresa Liu, Amit Bahl
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.025
Published online: September 27 2010
xChest radiographs are routinely obtained after the insertion of above-the-diaphragm central venous catheters to confirm placement and detect mechanical complications. At times, performing the radiograph can be time-consuming and findings may be inaccurate. We present a case of a patient with difficult access who required emergent resuscitation. A central venous catheter was inserted under ultrasound guidance into the patient's right internal jugular vein. After the procedure, a 2-dimensional bedside ultrasound of the heart was performed with simultaneous flush of saline through the catheter.
François Gilles Brivet, Abdelhamid Slama, Dominique Prat, Frédéric Marc Jacobs
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.005
Published online: October 11 2010
xIn adults, type B lactic acidosis is rare and generally associated with a toxin, particularly metformin or antiretroviral nucleosides analogues. We report a case of lactic acidosis caused by carboplatin in a 50-year-old woman suffering from primary peritoneal carcinoma. She was admitted for severe lactic acidosis (pH 6.77, lactate 19 mmol/L) associated with multiple organ failure (PaO2/FiO2 96, creatinine 231 μmol/L, aspartate aminotransferase >25 000 UI, factor V 13%) occurring during the sixth carboplatin cycle.
Jennifer Carnell, Jason Fischer, Arun Nagdev
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.006
Published online: October 11 2010
xIdentifying acute pyelonephritis (APN) with early obstructive uropathy is clinically important in the emergency department (ED) because obstructive urolithiasis is an independent risk factor for inpatient death, prolonged hospitalization, and failure of outpatient APN therapy. Furthermore, diagnosis of an early obstructive uropathy can be difficult when based solely on clinical findings. Clinicians may assume the cause of the patient's symptoms to be APN alone, without considering the concurrent presence of an obstructing stone.
Andrea Verhovez, Fabrizio Elia, Alessandra Riva, Giovanni Ferrari, Franco Aprà
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.035
Published online: September 27 2010
xAcute hepatotoxicity is a rare but potentially fatal complication of amiodarone use. Although oral long-term use of the drug is frequently complicated by an asymptomatic rise in serum aminotransferase concentrations, acute hepatotoxicity during intravenous loading is much less frequent and potentially fatal. We report a case of liver injury after intravenous administration in a patient with atrial fibrillation.
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00351-2
Published in issue: September 2011
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00352-4
Published in issue: September 2011
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00353-6
Published in issue: September 2011
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00354-8
Published in issue: September 2011
