Rosanne S. Naunheim, Matthew Treaster, Joy English, Teya Casner
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.010
Published online: May 3 2010
xAdvances in analysis of electrical signals have now made it possible to create a handheld electroencephalogram (EEG).
Jungyoup Lee, Kyuseok Kim, Christopher C. Lee, Yeoun Woo Nam, Jin Hee Lee, Joong Eui Rhee, Adam J. Singer, Kyung Su Kim, Youngsun Ro
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.021
Published online: May 3 2010
xDiltiazem is one of the most commonly used medications to control the rapid ventricular response in atrial fibrillation (AF). The recommended starting dose is an intravenous bolus of 0.25 mg/kg over 2 minutes. To avoid hypotension, we have empirically used a lower dose of diltiazem. We compared the efficacy and safety of different doses of diltiazem in rapid AF.
Frank Peacock, Alpesh Amin, Christopher B. Granger, Charles V. Pollack Jr, Phillip Levy, Richard Nowak, Kurt Kleinschmidt, Joe Varon, Allison Wyman, Joel M. Gore, For the Stat Investigators
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.022
Published online: May 3 2010
xAcute heart failure (AHF) is a common, poorly characterized manifestation of hypertensive emergency. We sought to describe characteristics, treatment, and outcomes of patients with severe hypertension complicated by AHF.
Sam Phillips, Antonio Celenza
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.024
Published online: May 3 2010
xThe aim of this study was to evaluate the Pentax AWS videolaryngoscope (PAV) in intubation of simulated difficult airways by emergency medical staff.
Michael C. Kontos, Michael C. Kurz, Charlotte S. Roberts, Sarah E. Joyner, Laura Kreisa, Joseph P. Ornato, George W. Vetrovec
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.025
Published online: May 3 2010
xWe evaluated the impact of emergency physician (EP)–initiated primary percutaneous coronary intervention (PCI) via a single-group page on door to balloon (D2B) interval times in patients with ST-segment elevation myocardial infarction.
Travis Olives, Roma Patel, Sagar Patel, Julie Hottinger, James R. Miner
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.031
Published online: July 14 2010
xThe aim of the study was to assess the prevalence of limited health literacy in an urban emergency department (ED) and its association with sociodemographic variables.
Yan-Ren Lin, Tzu-Hsuan Liu, Tung-Kung Wu, Yu-Jun Chang, Chu-Chung Chou, Han-Ping Wu
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.004
Published online: July 14 2010
xThis study's aim was to determine the predictive factors of the duration of first-attack acute urticaria in children.
Chaitan K. Narsule, Eden J. Kahle, Daniel S. Kim, Angela C. Anderson, Francois I. Luks
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.005
Published online: July 14 2010
xAppendicitis is the most common emergency operation in children. The rate of perforation may be related to duration from symptom onset to treatment. A recent adult study suggests that the perforation risk is minimal in the first 36 hours and remains at 5% thereafter. We studied a pediatric population to assess symptom duration as a risk factor for perforation.
Robert Rodriguez, Harrison Alter, Kaija-Leena Romero, Bory Kea, William Chiang, Jonathan Fortman, Christina Marks, Paul Cheung, Simon Conti
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.006
Published online: August 5 2010
xSeeking to evaluate the feasibility of a prediction instrument for endocarditis in febrile injection drug users (IDUs), we determined (1) the frequency percentage of IDUs admitted with fever diagnosed with endocarditis and (2) whether individual or combinations of emergency department (ED) clinical criteria (patient history, physical examination findings, and laboratory tests) are associated with endocarditis in IDUs admitted to rule out endocarditis.
Timothy P. Young, Lee Maas, Andrea W. Thorp, Lance Brown
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.008
Published online: August 5 2010
xWe sought to describe the causative organisms and joints involved in cases of pediatric septic arthritis in the post–Haemophilus influenzae type B and post-pneumococcal vaccine age and in the age of increasing infection with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA).
Han Joon Kim, Sang Hoon Oh, Chun Song Youn, Jung Hee Wee, Ji Hoon Kim, Won Jung Jeong, Soo Hyun Kim, Seung Hee Jeong, Kyu Nam Park
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.032
Published online: December 15 2010
xThe aim of this study was to investigate the associative factors of rhabdomyolysis in patients with doxylamine overdose who had normal creatine phosphokinase levels at admission.
Sang Hoon Oh, Kyu Nam Park, Seung Hee Jeong, Han Joon Kim, Christopher C. Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.015
Published online: June 6 2011
xTo investigate potential risk factors associated with the repetition of deliberate self-poisoning (DSP).
Zhiyu Su, Chunsheng Li, Yi Han, Xi Yin, Min Guo
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.001
Published online: July 14 2010
xPrevious studies have shown that therapeutic hypothermia could improve neurologic recovery when induced after cardiac arrest, but dynamic changes in cerebral metabolism have not been studied at low temperature. In this study, we aim to evaluate hypothermia-induced changes in pigs' cerebral metabolism by 1H-magnetic resonance spectroscopy (1H-MRS).
Joseph Varon, Pilar Acosta
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.028
Published online: May 3 2010
xNorepinepinephrine (NE) is a naturally occurring potent vasopressor and inotrope that is commonly used in acute care medicine [1]. It is an α1,2-β1,2 adrenergic agonist, with a marked α1-sympathomimetic and β1-sympathomimetic activity. This agent has been used in cardiopulmonary arrest events and in the immediate postarrest period [2]. The basic rationale of using vasopressors, such as NE, in the context of a cardiac arrest is an attempt to restore the threshold levels of coronary perfusion pressure and myocardial blood flow [3].
Alan S. Maisel, W. Frank Peacock, Kevin S. Shah, Paul Clopton, Deborah Diercks, Brian Hiestand, Michael C. Kontos, Christian Mueller, Richard Nowak, Wen Jone Chen, Sean P. Collins
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.032
Published online: July 14 2010
xDyspneic emergency department (ED) patients present a diagnostic dilemma. The S3, although highly specific for acute heart failure (AHF) and predicting death and readmission, is often difficult to auscultate. The HEart failure and Audicor technology for Rapid Diagnosis and Initial Treatment (HEARD-IT) multinational trial evaluated the S3 via acoustic cardiography (Audicor). Our goal in this secondary analysis was to determine if the strength of the S3 can provide diagnostic/prognostic information in problematic heart failure subgroups.
Jean P. Tourtier, Emmamuelle Fontaine, Sébastien Coste, Solange Ramsang, Patrick Schiano, Marie Viaggi, Nicolas Libert, Xavier Durand, Cyrus Chargari, Marc Borne
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.002
Published online: August 5 2010
xThe ability to auscultate during air medical transport is compromised by high ambient noise levels. The aim of this study was to assess the capabilities of a traditional and an amplified stethoscope (which is expected to reduce background and ambient noise) to assess heart and breath sounds during medical transport in a Falcon 50 plane.
William J. Meurer, Eve D. Losman, Barbara L. Smith, Preeti N. Malani, John G. Younger
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.003
Published online: July 14 2010
xWe investigated the degree of functional decline and loss of independence among older adults presenting to the emergency department (ED) with serious infection and to estimate 90-day case fatality.
Michael C. Bond, Daniel L. Lemkin, William Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.028
Published online: October 11 2010
xGreen DW, Mogekwu N, Scher DM, et al. A modification of Klein's Line to improve sensitivity of the anterior-posterior radiograph in slipped capital femoral epiphysis. J Pediatr Orthop 2009;29:449-453.
Angela Pugliese, A. Joseph Garcia, William Dobson, Linoj Samuel, Gerard Martin
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.024
Published online: August 5 2011
xThe emergency department (ED) at Henry Ford Hospital (HFH) is a “paperless” system, and all ED personnel must complete their documentation electronically. Previous studies have shown computer hardware as reservoirs for infectious agents, noting a prevalence rate around 50% (range, 26%-95%) of bacterial contamination. Some studies have linked nosocomial infections to computer contamination. These studies have not been performed previously in a “paperless” ED that relies on computer entry for all data.
Oscar M.P. Jolobe
DOI: http://dx.doi.org/10.1016/j.ajem.2011.05.004
Published online: June 13 2011
xThe prevalence of hypokalemia quoted in the recent study [1] may not necessarily be a reflection of the state of affairs when diabetic ketoacidosis (DKA) coexists with hypervolemia attributable to heart failure. Documentation of potassium status in all body compartments is relevant to the management of these patients because unlike their hypovolemic counterparts who can tolerate the large volumes of intravenous fluids required to deliver appropriate doses of potassium replacement therapy [2], patients with DKA with coexisting heart failure and, hence, hypervolaemia incur the risk of worsening of heart failure with such treatment.
Robert E. Suter
DOI: http://dx.doi.org/10.1016/j.ajem.2011.05.017
Published online: August 12 2011
xThe authors of “Are scoop stretchers suitable for use on spine-injured patients?” are to be applauded for their innovative study and basic study design [1]. That said, the description of the methodology omitted an important detail regarding whether a specific variation of the log-roll maneuver was used in the control group, and if the log roll was standardized, which technique was used.
Gianluca Del Rossi
DOI: http://dx.doi.org/10.1016/j.ajem.2011.05.018
Published online: August 12 2011
xWe would like to thank the reader for the interest expressed in our journal article [1] and have provided a response to the concerns conveyed in their letter. As practitioners working in both prehospital- and hospital-based settings, we have personally observed health care personnel perform the log-roll maneuver on numerous occasions and would definitely agree with the reader's assertion that there is almost certainly a lack of emphasis placed on arm placement during the performance of this task.
Barry J. Knapp, Sara N. Tsuchitani
DOI: http://dx.doi.org/10.1016/j.ajem.2011.05.024
Published in issue: October 2011
xUnderstanding the epidemiological spread of methicillin-resistant Staphylococcus aureus (MRSA) is an important aspect in limiting the pathogen's prevalence in a community. Because emergency medical service (EMS) personnel are potential portals of infection both into and out of the hospital, knowledge of their MRSA colonization status may have implications on limiting the further spread of this organism. The prevalence of nasal MRSA colonization in EMS providers has not been documented in the current literature.
Je Sung You, Young Eun Chung, Kang Su Cho, Sun Wook Kim, Incheol Park
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.019
Published online: October 18 2010
xA-37-year-old male presented to the Emergency Department with scrotal swelling, pain that lasted 3 days. A supine radiograph showed abnormal lucency in the right scrotum and right inguinal area. A contrast-enhanced CT revealed extensive gas formation at the right scrotum which extended to right inguinal area, and lower anterior abdominal wall. These findings were compatible with Fournier’s gangrene. Fournier gangrene is rapidly progressing necrotizing fasciitis involving the perineal, perianal or genital region.
Karin Amrein, Harald Sourij, Julia Mader, Steven Amrein, Tanja Robl
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.025
Published online: October 28 2010
xWe report the case of an adult woman who presented to the medical emergency department because of a swollen neck, eye lid, and chest pain. Vital signs were normal except for tachycardia; a trauma was denied. Clinical examination was remarkable for crepitation on the neck and thoracic wall indicating subcutaneous emphysema. The chest radiograph confirmed extensive emphysema; and a computed tomography scan diagnosed pneumothorax on both sides invisible on conventional radiography with gas in the soft tissue of the neck, chest, and abdominal wall.
Douglas D. Brunette, Chad Roline
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.028
Published online: October 25 2010
xA previously healthy 32-year-old woman presented to the emergency department complaining of sudden onset of abdominal pain, nausea with vomiting, and syncope. The patient underwent in vitro fertilization 6 weeks prior. The initial differential diagnosis was intrauterine pregnancy with ovarian hyperstimulation syndrome vs heterotopic pregnancy. A deteriorating clinical condition and ultrasound findings prompted emergent exploratory laparotomy. A ruptured ectopic pregnancy was resected, and the patient was discharged with a viable intrauterine pregnancy.
David Wendlandt, Ben King, Chris Ziebell, Truman Milling
DOI: http://dx.doi.org/10.1016/j.ajem.2010.08.019
Published online: November 15 2010
xHere we report an atypical case of meningococcemia presenting as peritonitis and later developing a centrifugal rash. The patient was a previously healthy 21-year-old Hispanic man who presented to the emergency department (ED) with a low-grade fever, right lower quadrant pain, and right lower extremity myalgia. Physical examination was suggestive for appendicitis, and the patient was showing signs of septic shock: hypotension, tachypnea, tachycardia, and a mottled appearance shortly after admission.
Jean Michel Yeguiayan, Isabelle Benatru, Boris Guiu, Jamal Abou Taam, Serge Albertini, Marc Freysz, Maurice Giroud
DOI: http://dx.doi.org/10.1016/j.ajem.2010.08.020
Published online: October 28 2010
xWe report a case of massive pulmonary embolism (PE) associated with ischemic stroke due to paradoxical embolism. The patient presented with coma, severe hypoxemia, and hemodynamic instability due to the severity of the PE. Initial neurologic evaluation, in particular, scoring the National Institutes of Health Stroke Scale, was impossible because of coma. Imaging showed a PE and an occlusion of the left middle cerebral artery. Transesophageal echocardiography showed a patent foramen ovale and a right-to-left shunt suggesting stroke with paradoxical embolism.
Amr El-Husseini
DOI: http://dx.doi.org/10.1016/j.ajem.2010.08.021
Published online: October 28 2010
xTherapeutic hypothermia (TH) is becoming a standard of care to mitigate neurologic injury for cardiac arrest (CA) survivors. However, coagulopathy and thrombocytopenia are considered contraindications to TH, and many institutions withhold the application of TH based on the presence of coagulopathy/thrombocytopenia. This is, in part, because the safety of applying TH in post-CA patients is not known in such settings. Herein we describe the first reported case of a successful TH application in a post-CA patient with profound thrombocytopenia.
Candace McNaughton, Stephen Morrow, Stephen John Cico
DOI: http://dx.doi.org/10.1016/j.ajem.2010.08.022
Published online: October 22 2010
xGenerally, acute acalculous cholecystitis (AC) is associated with significant morbidity and mortality. Chronic AC is a more benign but poorly understood clinical entity. The treatment of choice for acute and chronic AC is cholecystectomy. We review the case of a healthy 4-year-old boy who presented to the emergency department (ED) after several hours of intermittent, right-sided abdominal pain. Imaging by computed tomography and ultrasonography revealed AC. The patient underwent laparoscopic cholecystectomy with complete resolution of his symptoms.
Alluru S. Reddi, Arvind R. Kunadi
DOI: http://dx.doi.org/10.1016/j.ajem.2010.08.023
Published online: October 25 2010
xWe report an unusual case of high anion gap (AG) metabolic acidosis in a 50-year-old woman after long-term ingestion of acetaminophen in combination with hydrocodone (vicodin). After excluding the common causes of high AG metabolic acidosis, the diagnosis of pyroglutamic acidosis was made. Liver function tests were normal. In the literature, less than 40 cases of pyroglutamic acidosis were reported. This report, like many other reports, reiterates that pyroglutamic acidosis should be suspected in any patient ingesting acetaminophen alone or in combination with any narcotic.
Andrew A. Herring, Micheal B. Stone, Arun Nagdev
DOI: http://dx.doi.org/10.1016/j.ajem.2010.08.024
Published online: November 26 2010
xThe suprascapular nerve (SSN) emerges from the upper trunk of the brachial plexus (C5-C6) and provides the majority of the sensory innervation to the glenohumeral and acromioclavicular joints. In addition, it provides motor innervation to the supraspinatus and infraspinatus muscles [1]. Blockade of the SSN was first described in 1941 by Wertheim and Rovenstine [2] and, since then, has been used extensively by anesthesiologists for a variety of conditions including adhesive capsulitis and postoperative pain control for shoulder arthroscopy [3].
Ajeet Gordhan, Rich Castillo, William Reino, Jaydev Jani
DOI: http://dx.doi.org/10.1016/j.ajem.2010.08.025
Published online: October 22 2010
xPrimary stent revascularization of acute symptomatic flow-limiting critical atheromatous middle cerebral artery stenosis in the context of rapidly progressive acute neurologic decline with subsequent clinical recovery has, to our knowledge, not been previously reported. Primary middle cerebral artery stent revascularization for critical flow-limiting disease in 2 patients presenting to the emergency department with rapid neurologic decline was performed. After failure of medical management, a low-radial-force self-expanding stent was implanted with complete revascularization in one patient.
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00385-8
Published in issue: October 2011
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00386-X
Published in issue: October 2011
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00387-1
Published in issue: October 2011
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00388-3
Published in issue: October 2011
