Shahram Paydar, Hamed Ghoddusi Johari, Fariborz Ghaffarpasand, Danial Shahidian, Afsaneh Dehbozorgi, Bijan Ziaeian, Shahram Bolandparvaz, Hamid Reza Abbasi, Maryam Sharifian
DOI: http://dx.doi.org/10.1016/j.ajem.2010.08.010
Published online: November 9 2010
xRadiology plays an important role in evaluation of a trauma patient. Although chest radiography is recommended for initial evaluation of the trauma patient by the Advanced Trauma Life Support course, we hypothesized that precise physical examinations and history taking accurately identify those blunt trauma patients at low risk for chest injury, making routine radiographs unnecessary. Thus, this study was performed to investigate the role of chest radiography in initial evaluation of those trauma patients with normal physical examination.
Charles Lim, Jaime Bawden, Andrew Wing, Cristina Villa-Roel, David P. Meurer, Michael J. Bullard, Brian H. Rowe
DOI: http://dx.doi.org/10.1016/j.ajem.2010.08.011
Published online: October 28 2010
xEvidence-based clinical practice guidelines (CPGs) for managing febrile neutropenia (FN) are widely available; however, the integration of guidelines into routine practice is often incomplete. This study evaluated the uptake and clinical impact of implementing an electronic CPG on the management and outcomes of patients presenting with FN at 4 urban emergency departments (ED).
Michael M. Hirschl, Harald Mayr, Friedrich Erhart, Walter Brunner, Friedrich Steger, Martin Gattermeier, Franz Pfeffel
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.010
Published online: October 25 2010
xPatients with acute myocardial infarction are at high risk of dying within the first hours after onset of coronary ischemia. Therefore, pharmacological intervention should be started in the prehospital setting. This study investigates the effect of the prehospital administration of bivalirudin on short-term morbidity and mortality compared to heparin plus abciximab in patients with ST-segment-elevation myocardial infarction (STEMI).
Roma Patel, James R. Miner, Stephanie L. Miner
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.011
Published online: October 28 2010
xThe study aimed to estimate the prevalence of need for dental care among patients in the ED and assess associated characteristics.
Chih Yuan Fu, Yu Chun Wang, Shih Chi Wu, Yuan Fang Chen, Ray Jade Chen, Chi Hsun Hsieh, Hung Chang Huang, Jui Chien Huang, Chih Wei Lu, Yi Chieh Huang
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.023
Published online: October 15 2010
xAngioembolization is an effective adjunct to the management of retroperitoneal hemorrhage in pelvic fractures. Most patients with stable-type pelvic fracture are treated conservatively. However, in some stable pelvic fracture cases, patients should receive angioembolization for hemostasis upon incidental finding of contrast extravasation on computed tomography (CT). In this study, we attempted to define the characteristics of patients with stable pelvic fracture requiring angioembolization.
Bruce J. Kimura, Glynn W. Gilcrease III, Brian K. Showalter, James N. Phan, Tanya Wolfson
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.024
Published online: November 1 2010
xAlthough pocket-sized, simplified ultrasound devices have emerged to enable subjective point-of-care assessment, few data on their cardiac application exist. We sought to examine the image quality and the accuracy of subjective diagnosis of video loops obtained from a pocket-sized ultrasound device for 2 significant cardiac abnormalities, left ventricular systolic dysfunction and left atrial enlargement, obtained from a single, quick-look view.
Steve W. Goodacre, Mike Bradburn, Abdikudus Mohamed, Alasdair Gray
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.013
Published online: October 22 2010
xWe aimed to evaluate the Global Registry of Acute Cardiac Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) scores in patients with suspected but not proven acute coronary syndrome (ACS).
Chia-Hung Chen, Wei-Chih Liao, Yi-Heng Liu, Wei-Chun Chen, Te-Chun Hsia, Wu-Huei Hsu, Chuen-Ming Shih, Chih-Yen Tu
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.014
Published online: October 22 2010
xThe study aimed to assess the clinical efficacy of pigtail catheter drainage for patients with a first episode of secondary spontaneous pneumothorax (SSP) and different associated conditions.
Jonathan R. Studnek, Melanie R. Artho, Craymon L. Garner Jr, Alan E. Jones
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.015
Published online: October 28 2010
xThe identification and treatment of critical illness is often initiated by emergency medical services (EMS) providers. We hypothesized that emergency department (ED) patients with severe sepsis who received EMS care had more rapid recognition and treatment compared to non-EMS patients.
Taku Taira, Breena R. Taira, Jasmine Chohan, Daniel Dickinson, Regina M. Troxell, Henry C. Thode Jr., Adam J. Singer
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.027
Published online: October 25 2010
xThe objective of the study was to explore the association between physical fitness and the likelihood of acute coronary syndrome (ACS) in patients presenting to the emergency department (ED) with chest pain (CP). We hypothesized that the likelihood of ACS would be lower in physically fit patients and higher in patients with exercise-induced CP.
Andrea Fabbri, Filippo Ottani, Giulio Marchesini, Marcello Galvani, Alberto Vandelli
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.022
Published online: November 1 2010
xIn subjects with chest pain of undifferentiated origin, the risk of unfavorable outcome cannot be accurately predicted by the selected clinical items.
Thana Khawcharoenporn, Shawn Vasoo, Edward Ward, Kamaljit Singh
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.030
Published online: November 15 2010
xThe objectives of this study are to examine antibiotic resistance rates and to determine appropriate empiric oral antibiotic for patients with urinary tract infections (UTIs) evaluated and discharged from the ED.
Shervin Farahmand, Omid Ahmadi, Ahmadreza Dehpour, Patricia Khashayar
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.031
Published online: November 15 2010
xThe present study aims to assess the influence of ultra-low doses of opioid antagonists on the analgesic properties of opioids and their side effects.
Reuven Gurfinkel, Merav Palivatkel-Naim, Ronen Gleisinger, Lior Rosenberg, Adam J. Singer
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.003
Published online: December 15 2010
xBurns are widespread in the developed world, and expensive burn dressings are not universally available. Most burn patients suffer from a partial thickness burn that can be treated conservatively. Nevertheless, the ideal dressing for the burn wound has not been identified. We performed an animal experiment to compare the healing of partial thickness burns treated with silver sulfadiazine (SSD) and olive oil.
Bulent Erdur, Pinar Tura, Berrin Aydin, Mert Ozen, Ahmet Ergin, Ismet Parlak, Burhan Kabay
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.007
Published online: December 15 2010
xThe study aimed to evaluate the effects of midazolam and diphenhydramine for the prevention of metoclopramide-induced akathisia.
Chiara Lazzeri, Serafina Valente, Marco Chiostri, Claudio Picariello, Gian Franco Gensini
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.008
Published online: November 26 2010
xThe prognostic role (if any) of lactate for early mortality in patients with ST-elevation myocardial infarction (STEMI) submitted to primary percutaneous coronary intervention (PCI) is so far not elucidated. We therefore assessed whether lactic acid (LA) was a prognostic predictor for early mortality in 807 patients with STEMI submitted to primary PCI consecutively admitted to our intensive cardiac care unit (ICCU) from January 1, 2006, to December 31, 2009.
Ayman El-Menyar, Mohammad Zubaid, Wael AlMahmeed, Kadhim Sulaiman, AbdulRahman AlNabti, Rajvir Singh, Jassim Al Suwaidi
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.011
Published online: December 15 2010
xThe purpose of this study was to assess the prognostic value of the Killip classification at the presentation in patients with acute coronary syndrome (ACS). In 2007 and over 5 months, 6704 consecutive patients with ACS were enrolled in the Gulf Registry of Acute Coronary Events. Patients were categorized according to Killip classification at presentation (Classes I, II, III, and IV). Patients' characteristics and in-hospital outcomes were analyzed. High Killip classes were defined in 22% of patients.
Tara Cassidy-Smith, Rakesh D. Mistry, Christopher J. Russo, Kathryn McCans, Naomi Brown, Lisa M. Capano-Wehrle, Lisa A. Drago, Patty A. Vitale, Brigitte M. Baumann
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.020
Published online: December 3 2010
xThe objective of the study was to determine whether use of topical anesthetic cream increases spontaneous drainage of skin abscesses and reduces the need for procedural sedation.
Pedro Roque, Brian Oliver, Leigh Anderson, Mary Mulrow, Dave Drachman, Stephan Stapczynski, Frank LoVecchio
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.022
Published online: December 3 2010
xBloodstream infections are now ranked as the 10th leading cause of death in the United States. Given the severity of bacteremia, physicians routinely order multiple sets of blood cultures in the emergency department. This is a retrospective chart review on 1124 patients admitted to the hospital for suspected bacteremia during calendar year 2004. The aims of the present investigation were to investigate the overall utility of blood cultures by the admitting services and to identify patient factors that might influence culture yield.
Emily L. Willner, Hollie A. Jackson, Alan L. Nager
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.033
Published online: February 7 2011
xWe sought to describe the use of radiographic studies in pediatric major trauma patients and determine the extent to which a selective, clinically guided use of imaging contributes to delayed diagnosis of injury (DDI).
Chun Song Youn, Seung Pill Choi, Soo Hyun Kim, Sang Hoon Oh, Won Jung Jeong, Han Joon Kim, Kyu Nam Park
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.006
Published online: December 15 2010
xThere is growing evidence that inflammation plays an important role in atherogenesis. Previous studies have shown that the concentration of peripheral inflammatory markers, particularly C-reactive protein (CRP), strongly correlates with stroke severity and independently predicts mortality and recurrent vascular events in patients with acute ischemic stroke. The aim of this study was to clarify the relationship between inflammatory markers and stroke severity by means of volumetric measurement of infarct size.
Farees T. Farooq, Michael H. Lee, Ananya Das, Rahul Dixit, Richard C.K. Wong
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.007
Published online: December 27 2010
xAcute upper gastrointestinal hemorrhage (UGIH) is a common reason for hospitalization with substantial associated morbidity, mortality, and cost. Differentiation of high- and low-risk patients using established risk scoring systems has been advocated. The aim of this study was to determine whether these scoring systems are more accurate than an emergency physician's clinical decision making in predicting the need for endoscopic intervention in acute UGIH.
Carolyn Horney, Kenneth Schmader, Linda L. Sanders, Mitchell Heflin, Luna Ragsdale, Eleanor McConnell, Michael Hocker, S. Nicole Hastings
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.036
Published online: January 10 2011
xOlder adults in the United States receive a significant amount of care in the emergency department (ED), yet the associations between ED and other types of health care utilization have not been adequately studied in this population.
Wei-Lung Chen, Ying-Sheng Shen, Chien-Cheng Huang, Jiann-Hwa Chen, Cheng-Deng Kuo
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.013
Published online: January 5 2011
xThis study explored whether post-resuscitation status resembles severe sepsis in terms of autonomic nervous modulation by using heart rate variability (HRV) analysis.
Tyler W. Barrett, Alan B. Storrow, Cathy A. Jenkins, Frank E. Harrell Jr., John Amdahl, Stephan Russ, Corey M. Slovis, Dawood Darbar
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.018
Published online: January 5 2011
xAtrial fibrillation (AF) is often first diagnosed in the emergency department (ED) and accounts for nearly 1% of all emergency department (ED) visits. Our objective was to assess the Framingham Heart Study risk score for AF development in ED patients with newly diagnosed AF.
Haralabos Zacharatos, Ameer E. Hassan, Gabriela Vazquez, Haitham M. Hussein, Gustavo J. Rodriguez, M. Fareed K. Suri, Kamakshi Lakshminarayan, Mustapha A. Ezzeddine, Adnan I. Qureshi
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.019
Published online: January 19 2011
xThe aim of this study was to compare the clinical outcomes of acute ischemic stroke patients 80 years or older treated with intravenous recombinant tissue plasminogen activator (IV rt-PA), or endovascular intervention with or without IV rt-PA, or nonthrombolytic medical treatment.
Cheol-In Kang, Doo Ryeon Chung, Kwan Soo Ko, Kyong Ran Peck, Jae-Hoon Song, Korean Network for Study of Infectious Diseases (KONSID)
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.003
Published online: October 18 2010
xThis study was performed to evaluate clinical features of community-onset Enterobacter bacteremia and determine the risk factors for Enterobacter bacteremia among patients admitted to the emergency department.
Philippe Le Conte, David Riochet, Laetitia Labastire, Jean Christophe Auneau, Estelle Legeard, Myriam Van Tricht, Eric Batard, Emmanuel Montassier, Arnaud Martinage, Gilles Potel
DOI: http://dx.doi.org/10.1016/j.ajem.2010.08.012
Published online: November 1 2010
xIn France and in Belgium, as in many countries, there is a shortage of organs for transplantation, which has led to strategies to recruit older potential donors who may die of stroke.
Rakesh S. Engineer, Justin L. Benoit, Caitlin W. Hicks, Sunny J. Kolattukudy, Daniel Burkhoff, W. Frank Peacock
DOI: http://dx.doi.org/10.1016/j.ajem.2010.08.016
Published online: October 28 2010
xTo examine whether posturally induced changes in cardiac output differentiate patients presenting with dyspnea to the emergency department (ED) with acute heart failure (AHF) from other causes.
Michael J. Ward, Baruch S. Fertel, Jordan B. Bonomo, Carol L. Smith, Kimberly W. Hart, Christopher J. Lindsell, Stewart W. Wright
DOI: http://dx.doi.org/10.1016/j.ajem.2010.08.018
Published online: October 22 2010
xA delay in diagnosis of sepsis and appropriate treatment increases subsequent mortality. An association with the degree of bandemia, or the presence of immature neutrophils in the white blood cell count, has not been explored in septic patients presenting to the emergency department (ED). We hypothesized that the presenting band levels would be higher in septic patients who die in hospital compared with survivors.
Emmanuel Montassier, Eric Batard, Julien Segard, Jean-Benoît Hardouin, Arnaud Martinage, Philippe Le Conte, Gille Potel
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.033
Published online: December 15 2010
xPrior studies showed that lactate is a useful marker in sepsis. However, lactate is often not routinely drawn or rapidly available in the emergency department (ED).
Kathryn A. Volz, Daniel C. McGillicuddy, Gary L. Horowitz, Leon D. Sanchez
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.016
Published online: December 3 2010
xThe aim of this study was to determine whether current troponin assay alone can be used for initial screening for acute myocardial infarction (AMI) and whether creatine kinase-MB (CK-MB) can safely be eliminated from this evaluation in the emergency department (ED).
Dietrich Jehle, Seth Gemme, Christopher Jehle
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.017
Published online: December 3 2010
xThe purpose of the study was to investigate the relationship between obesity and mortality of drivers in severe motor vehicle crashes involving at least one fatality.
Christopher J. Hogan, Kevin R. Ward, Michael C. Kontos, Leroy R. Thacker, Roland Pittman
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.019
Published online: January 5 2011
xThe objective of the study was to quantitatively characterize peripheral tissue microvascular oxygenation during emergency department (ED) treatment of acute heart failure (HF).
Shamai A. Grossman, Mathew Babineau, Laura Burke, Adarsh Kancharla, Lawrence Mottley, Andrea Nencioni, Nathan I. Shapiro
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.001
Published online: December 27 2010
xLimited information on the evaluation of emergency department (ED) patients complaining of “near syncope” exists. Multiple studies of syncope exclude near syncope claiming near syncope is poorly defined and its definition is nonuniform.
Chih-Yuan Fu, Yu-Chun Wang, Shih-Chi Wu, Ray-Jade Chen, Chi-Hsun Hsieh, Hung-Chang Huang, Jui-Chien Huang, Chih-Wei Lu, Yi-Chieh Huang
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.005
Published online: December 15 2010
xPelvic fractures result in hemodynamic instability in 5% to 20% of patients, and the reported mortality rate is 18% to 40%. Previous studies have reported the application of angioembolization in pelvic fracture patients with a systolic blood pressure (SBP) less than 90 mm Hg, a fluid resuscitation requirement of more than 2000 mL, or a blood transfusion of more than 4 to 6 units within 24 hours. In the current study, we attempted to delineate the efficacy and outcome of angioembolization in unstable pelvic fracture patients with concomitant unstable hypotension status.
Alexander T. Limkakeng Jr., Weiying Drake, Giselle Mani, Debbie Freeman, Randall Best, L. Kristin Newby, Abhinav Chandra
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.021
Published online: December 27 2010
xEarly recognition of left ventricular hypertrophy is important because antihypertensive treatment decreases morbidity and mortality. The ideal screening method for left ventricular hypertrophy in hypertensive emergency department (ED) patients has not been identified. Our objective was to determine the diagnostic accuracies of electrocardiogram (ECG) and N-terminal Pro–B-type natriuretic peptide (pro-BNP) for left ventricular hypertrophy individually and in combination in hypertensive ED patients.
James H. Moak, Michael S. Lyons, Christopher J. Lindsell
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.024
Published online: December 27 2010
xTo determine whether ultrasound changes emergency physicians' estimated likelihood of acute ureterolithiasis in patients with flank pain.
Toshimitsu Ide, Yoshito Kamijo, Ayako Ide, Kuniko Yoshimura, Takashi Nishikawa, Kazui Soma, Hideki Mochizuki
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.025
Published online: December 27 2010
xS100B is a calcium-binding protein produced by astroglia in the brain and has been used as a marker of neuronal damage after brain trauma. We investigated the utility of S100B in cerebrospinal fluid (CSF) measured during the early phase of carbon monoxide (CO) poisoning in predicting the subsequent clinical course.
Tae Nyoung Chung, Sun Wook Kim, Je Sung You, Young Soon Cho, Sung Phil Chung, Incheol Park
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.026
Published online: January 5 2011
xMetronome guidance is a simple and economical feedback system for guiding cardiopulmonary resuscitation (CPR). However, a recent study showed that metronome guidance reduced the depth of chest compression. The results of previous studies suggest that a higher chest compression rate is associated with a better CPR outcome as compared with a lower chest compression rate, irrespective of metronome use. Based on this finding, we hypothesized that a lower chest compression rate promotes a reduction in chest compression depth in the recent study rather than metronome use itself.
Christopher Saeui, Nathan Charlton, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.032
Published online: November 15 2010
xUnderstanding biochemical concepts can assist in the diagnosis and treatment of certain presentations in the emergency department. Knowledge of the biochemistry responsible for certain presentations in the emergency department as well as behind various therapies also provides physicians better insight into the use of specific treatments. This review will focus on the biochemistry of numerous clinical syndromes, including methemoglobinemia, various poisoning presentations, including cyanide, methanol, and ethylene glycol—with an emphasis on the diagnostic and management considerations in these presentations.
Chris Mehta, William Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2010.08.017
Published online: October 22 2010
xPulseless electrical activity (PEA), a cardiac arrest rhythm scenario with an associated poor prognosis, is defined as cardiac electrical activity without a palpable pulse. Considering both outpatient and inpatient cardiac arrest presentations, PEA as a rhythm group has been increasing over the past 10 to 20 years with a corresponding decrease in the “shockable” rhythms, such as pulseless ventricular tachycardia and ventricular fibrillation. This review focuses on electrocardiographic findings encountered in PEA cardiac arrest presentations with an emphasis on recognition of patients with a potential opportunity for successful resuscitation.
Peter Whitney-Cashio, Melissa Sartin, William J. Brady, Kelly Williamson, Kostas Alibertis, Gilbert Somers, Robert E. O′Connor
DOI: http://dx.doi.org/10.1016/j.ajem.2011.07.015
Published in issue: January 2012
xWe undertook the addition of a public access defibrillation (PAD) program at a large mid-Atlantic university. In our design of the system, we found little useful information to guide us in the development and construction our system. This letter addresses the issues and methodology of our approach to this important program.
Koichi Maruyama, Tsutomu Mieda, Hideyuki Nakagawa, Akira Kitamura, Masakazu Hayashida
DOI: http://dx.doi.org/10.1016/j.ajem.2011.07.017
Published in issue: January 2012
xRecently, laryngoscope handles retrofitted with light-emitting diodes (LEDs) (Vital View II fibre optic laryngoscope handle; Vital Signs, Inc, Totowa, NJ) became commercially available for a dedicated plastic single-use blade (Vital View laryngoscope blade; Vital Signs, Ltd, West Sussex, UK). One of major features of LEDs illumination is the bluish-white color, which could have beneficial impact on the performance of intubation [1]. This manikin study compared intubation performance using a combination of Vital View II fibre optic laryngoscope handle and a blade (VV-LED laryngoscope) with a combination of metal reusable laryngoscope blade with halogen bulb light handle (conventional laryngoscope) during cardiopulmonary resuscitation in a randomized, controlled, cross-over fashion.
Juan Antonio Llompart-Pou, Josep Maria Abadal, Luis Rayo, Jon Pérez-Bárcena
DOI: http://dx.doi.org/10.1016/j.ajem.2011.07.021
Published in issue: January 2012
xWe read with interest the recently published article by Prunet et al regarding the role of transcranial Doppler (TCD) and a portable transcranial color coded sonography (TCCS) in the evaluation of pulsatility index (PI) and its correlation with intracranial pressure [1].
Bertrand Prunet, Yves Asencio, Guillaume Lacroix
DOI: http://dx.doi.org/10.1016/j.ajem.2011.07.023
Published in issue: January 2012
xWe thank Dr Llompart-Pou and colleagues [1] for showing interest in our work. We are pleased to have the opportunity to reply to this constructive comments. About the comparison of durations of PI measurement, the transcranial color coded sonography examination was indeed much longer than the transcranial Doppler. The reasons are many. First, performing transcranial color coded sonography need to image the cerebral arteries before to place the sample volume at the site of the best Doppler signal.
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.002
Published in issue: January 2012
xIn the article “Hyperventilation and finger exercise increase venous-arterial PCO2 and pH differences” by Umeda et al (Am J Emerg Med. 2008;26(9):975-80), there was an error in Fig. 2.
Melissa K. Leming, Michael J. Breyer
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.026
Published online: October 15 2010
xPatients with renal failure who are taking trimethoprim have an increased risk of developing hyperkalemia, which can cause muscle weakness. In patients with postpolio syndrome, a normal creatinine level could be abnormally high, renal failure is possible because of lack of creatinine production, and the muscle weakness from resultant hyperkalemia could be more severe because of their underlying condition. This abnormally high creatinine level has been termed from this point relative renal failure.
Nikki Higgins, John P. Burke, Charles J. McCreery
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.019
Published online: October 22 2010
xValvular cardiomyopathy can present a diagnostic challenge in the absence of overt cardiac symptoms. This report describes the case of a 46-year-old woman who presented with acute peritonitis associated with vomiting and abdominal distension. Subsequent abdominal computed tomography and ultrasound revealed bibasal pleural effusions, ascites, and normal ovaries. An echocardiogram revealed that all cardiac chambers were dilated with a global decrease in contractility and severe mitral, tricuspid, and aortic regurgitation.
Shao Hwa Lin, Chin I. Chen, Ching Chih Liu, Ming Hai Du, Carlos Lam
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.020
Published online: October 25 2010
xHarlequin syndrome is rare and typically characterized by asymmetric flushing and sweating. Although it is usually considered idiopathic, literature review shows that it may be caused by lesion over lung apex or after central venous catheterization in the internal jugular vein. We present a 74-year-old woman who had been experiencing recurrent chest pain and right shoulder pain since 2 weeks ago. The tentative diagnosis was made by the emergency physician (EP) as acute coronary syndrome. The patient was given nitroglycerin treatment.
