Baker Hamilton, Frances S. Shofer, Kristy M. Walsh, Christopher S. Decker, Mary Calderone, Jeffrey A. Le, Judd E. Hollander
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.036
Published online: April 29 2011
xYoung patients are at low risk for an acute coronary syndrome (ACS); however, many of these patients still enter a “rule-out ACS” pathway and receive stress testing. We hypothesized that stress testing in patients younger than 40 years without known coronary disease will not identify patients at high risk for 30-day adverse cardiovascular events.
Wolfgang Weihs, Danica Krizanac, Fritz Sterz, Gerald Hlavin, Andreas Janata, Wolfgang Sipos, Michael Holzer, Udo M. Losert, Wilhelm Behringer
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.002
Published online: May 13 2011
xThe induction of deep cerebral hypothermia (15°C) via large-volume cold (4°C) saline aortic flush during cardiac arrest and resuscitation with cardiopulmonary bypass improves neurologic outcome in pigs. We hypothesized that induction of mild cerebral hypothermia (33°C) via smaller volume and resuscitation without bypass will improve survival and neurologic outcome after 15 minutes of cardiac arrest as compared with conventional resuscitation attempts.
Te-Fa Chiu, Chien-Cheng Huang, Jiann-Hwa Chen, Wei-Lung Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.037
Published online: May 13 2011
xThe objective of this study is to investigate the role of sympathovagal balance in predicting inhospital mortality by assessing power spectral analysis of heart rate variability (HRV) among patients with nontraumatic subarachnoid hemorrhage (SAH) in an emergency department (ED).
Shahed Iqbal, Huay-Zong Law, Jacquelyn H. Clower, Fuyuen Y. Yip, Anne Elixhauser
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.003
Published online: May 13 2011
xUnintentional, non–fire-related (UNFR) carbon monoxide (CO) poisoning is a leading cause of poisoning in the United States, but the overall hospital burden is unknown. This study presents patient characteristics and the most recent comprehensive national estimates of UNFR CO–related emergency department (ED) visits and hospitalizations.
Anthony S. Kim, Stephen Sidney, Jeffrey G. Klingman, S. Claiborne Johnston
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.038
Published online: May 13 2011
xThe appropriate role of neuroimaging to evaluate emergency department (ED) patients with dizziness is not established by guidelines or evidence.
Subhash Chandra, Erik P. Hess, Dipti Agarwal, David M. Nestler, Victor M. Montori, Louis M. Wong Kee Song, George A. Wells, Ian G. Stiell
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.010
Published online: June 6 2011
xThe Glasgow-Blatchford Bleeding Score (GBS) and Rockall Score (RS) are clinical decision rules that risk stratify emergency department (ED) patients with upper gastrointestinal bleeding (UGIB). We evaluated GBS and RS to determine the extent to which either score identifies patients with UGIB who could be safely discharged from the ED.
Hwa-Yeon Yi, Jang-Young Lee, Seung Yun Lee, Sung-Youp Hong, Young-Mo Yang, Gyeong-Nam Park
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.011
Published online: June 6 2011
xWe recently observed a case of propafenone self-poisoning in which the patient was initially unresponsive to conventional therapies such as sodium bicarbonate, dopamine, and norepinephrine but recovered with intravenous glucose-insulin infusion. We raised the hypothesis that insulin may have a cardioprotective effect in acute propafenone toxicity.
Jung Hee Wee, Kyu Nam Park, Sang Hoon Oh, Chun Song Youn, Han Joon Kim, Seung Pill Choi
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.013
Published online: June 6 2011
xThe aim of this study was to review patient characteristics and analyze the outcomes in patients who have had cardiac arrest from hanging injuries.
Jiri Karasek, Petr Widimsky, Petr Ostadal, Hana Hrabakova, Martin Penicka
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.027
Published online: June 6 2011
xAcute heart failure (AHF) is associated with a poor prognosis.
Owen McGrane, Gerald Hopkins, Adam Nielson, Christopher Kang
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.002
Published online: June 6 2011
xThe objective of this study is to evaluate the types and rates of adverse events associated with the use of propofol for procedural sedation by physicians from our emergency medicine residency program and compare those adverse event rates with those rates already published for all moderate and deep sedatives for procedural sedation, including propofol.
Fabrizio Elia, Giovanni Ferrari, Paola Molino, Marcella Converso, Giovanna De Filippi, Alberto Milan, Franco Aprà
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.019
Published online: June 24 2011
xUltrasound (US) is a useful tool for peripheral vein cannulation in patients with difficult venous access. However, few data about the survival of US-guided peripheral catheters in acute care setting exist. Some studies showed that the survival rate of standard-length catheters (SC) is poor especially in obese patients. The use of longer than normal catheters could provide a solution to low survival rate. The aim of the present study was to compare US-guided peripheral SCs vs US-guided peripheral long catheters inserted with Seldinger technique (LC) in acute hospitalized patients with difficult venous access.
Amy A. Ernst, Steven J. Weiss, Arthur Sullivan IV, Dusadee Sarangarm, Shannon Rankin, Martha Fees, Preeyaporn Sarangarm
DOI: http://dx.doi.org/10.1016/j.ajem.2011.05.002
Published online: June 13 2011
xThe objective of the study was to compare errors in the emergency department (ED) with pharmacists present (PPs) for resuscitations and traumas vs with pharmacists absent (PAs). Our hypothesis was that errors would be significantly fewer during PP than PA times. We also hypothesized that times with PP would affect patients greater when disposition was to more critical areas (intensive care unit, or ICUs).
Adi Einan Lifshitz, Lee Hilary Goldstein, Moshe Sharist, Refael Strugo, Einav Asulin, Shmuael Bar Haim, Zvi Feigenberg, Matitiahu Berkovitch, Eran Kozer
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.023
Published online: July 11 2011
xMedication errors are a common cause of iatrogenic adverse drug events. The incidence and nature of medication errors during prehospital treatment have not been fully described.
Chien-Cheng Huang, Chi-Hung Huang, Hung-Yi Kuo, Chia-Meng Chan, Jiann-Hwa Chen, Wei-Lung Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2011.05.003
Published online: June 6 2011
xThe aim of this study was to investigate if the electrocardiographic (ECG) abnormalities assessed early in the emergency department (ED) are associated with the in-hospital mortality of the patients with spontaneous subarachnoid hemorrhage (SAH).
Jerry Ray Baskerville, Robert K. Moore
DOI: http://dx.doi.org/10.1016/j.ajem.2011.05.019
Published online: August 22 2011
xOur study compares treatment times of morbidly obese patients (body mass index [BMI] >40 kg/m2) with patients having BMI less than 35 kg/m2.
Pierre Hausfater, Bruno Mégarbane, Laurent Fabricatore, Sandrine Dautheville, Anabela Patzak, Marc Andronikof, Aline Santin, Gérald Kierzek, Benoît Doumenc, Christophe Leroy, Jafar Manamani, Florence Peviriéri, Bruno Riou
DOI: http://dx.doi.org/10.1016/j.ajem.2011.05.020
Published online: December 14 2011
xAlthough heatstroke is often associated with dehydration, the clinical significance of serum sodium abnormalities in patients with heat-related illness during heat wave has been poorly documented.
Seong Youn Hwang, Jun Ho Lee, Young Hwan Lee, Chong Kun Hong, Ae Jin Sung, Young Cheol Choi
DOI: http://dx.doi.org/10.1016/j.ajem.2011.05.022
Published online: August 1 2011
xThe aim of this study was to assess the ability of the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system, and Trauma and Injury Severity Score (TRISS) method to predict group mortality for intensive care unit (ICU) trauma patients.
Michael D. Menchine, Warren Wiechmann, Anne L. Peters, Sanjay Arora
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.028
Published online: May 13 2011
xThe aims of the study were to describe temporal trends in the number, proportion, and per capita use of diabetes-related emergency department (ED) visits and to examine any racial/ethnic disparity in ED use for diabetes-related reasons.
Andrew A. Herring, Michael B. Stone, Arun D. Nagdev
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.008
Published online: May 13 2011
xThe anterolateral abdominal wall is innervated by the T7 to L1 anterior rami, whose nerves travel in the fascial plane between the internal oblique and transversus abdominus muscles, known as the transversus abdominus plane (TAP). Ultrasound-guided techniques of regional anesthesia that target the TAP are increasingly relied upon by anesthesiologists for pain management related to major abdominal and gynecologic surgeries. Our objective was to explore the potential utility of these techniques to provide anesthesia for abdominal wall procedures in the emergency department (ED).
François Templier, Laetitia Labastire, Philippe Pes, Frédéric Berthier, Philippe Le Conte, Frédéric Thys
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.012
Published online: June 6 2011
xThe objective of our study was to describe noninvasive ventilation (NIV) practices (pressure support ventilation and continuous positive airway pressure) in French out-of-hospital mobile intensive care units (SMUR) and their compliance with national consensus guidelines.
SOS-KANTO study group
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.031
Published online: June 6 2011
xThe hemoglobin (Hb) level is an essential determinant of oxygen delivery. The restoration of blood perfusion to vital organs and the capacity for oxygen delivery may be associated with ischemia and reperfusion injuries during cardiac arrest and after cardiac arrest. However, whether the Hb level is associated with neurologic outcome in post–cardiac arrest patients remains unclear.
Atahan Acar, Mehmet Keskek, Ferruh Kemal Işman, Mine Kucur, Mesut Tez
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.006
Published online: June 6 2011
xChitotriosidase is one of the most quantitative proteins secreted by activated macrophages, so its activity has been proposed as a biochemical marker of macrophage accumulation. The clinical importance of the chitotriosidase is still largely unknown. Our aim was to evaluate diagnostic accuracy of serum chitotriosidase activity in acute appendicitis (AA). A total of 34 patients with preoperative AA diagnosis (18 men and 16 women; mean age, 28.8 ± 10.9 years) were enrolled in this study. The appendix specimens were classified as normal appendix (10 patients) and AA (24 patients).
Joseph B. Miller, Ayan Sen, Seth R. Strote, Aaron J. Hegg, Sarah Farris, Abigail Brackney, David Amponsah, Usamah Mossallam
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.008
Published online: June 13 2011
xThe objective of this study was to determine the test characteristics of the caval index and caval-aortic ratio in predicting the diagnosis of acute heart failure in patients with undifferentiated dyspnea in the emergency department (ED).
Chen-lu Yang, Jin Wen, You-ping Li, Ying-kang Shi
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.035
Published online: April 29 2011
xThe objective of this study is to evaluate the efficacy of cardiocerebral resuscitation (CCR) vs cardiopulmonary resuscitation (CPR) for patients with out-of-hospital cardiac arrest (OHCA).
Peter D. Panagos
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.004
Published online: May 13 2011
xMany patients with transient ischemic attacks (TIA) are at high risk of stroke within the first few days of onset of symptoms. Emergency physicians and primary care physicians need to assess these patients quickly and initiate appropriate secondary stroke prevention strategies. Recent refinements in diagnostic imaging have produced valuable insight into risk stratification of patients with TIA. Clinical data regarding urgent initiation of antiplatelet therapy specifically in this patient population with non-cardioembolic TIA are limited but promising.
Joseph Varon, Paul E. Marik, Sharon Einav
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.007
Published online: May 13 2011
xTherapeutic hypothermia (TH) has gained popularity as a brain-protective strategy for victims of sudden cardiac death in whom return of spontaneous circulation has been achieved but coma persists. Trials have also demonstrated some advantageous effects of lowering core body temperature after stroke and hypoxic-ischemic encephalopathy of the newborn. In a variety of clinical conditions, TH is still being studied (eg, hepatic encephalopathy and traumatic brain injury). This study describes the historical development of TH, its current applications in emergency medicine, and its potential future uses.
Tanner Boyd, William Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.009
Published online: June 13 2011
xIn October of 2010, the American Heart Association (AHA) published the 2010 Guidelines on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. These guidelines place significant emphasis on 5 major areas of therapy in patient with cardiac arrest, including immediate recognition and activation of the emergency response team, effective chest compressions, rapid defibrillation, effective advanced life support (ALS), and integrated postresuscitation care. “Effective ALS” includes the placement of an advanced airway, establishment of parenteral access, and the administration of cardioactive medications.
Supawat Ratanapo, Narat Srivali, Promporn Suksaranjit, Wisit Cheungpasitporn
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.019
Published online: March 2 2012
xWe thank Hu et al [1] for their article entitled “The fifth chamber of the heart: huge left atrial aneurysm,” which was published in The American Journal of Emergency Medicine. The authors wrote very excellent case report and review on left atrial aneurysm and diagnostic workups. From the case presentation, multidetector-row computed tomography (MDCT) was a useful method to confirmed of diagnosis and planning for surgical intervention. Although there is no specific guideline for investigation and treatment of left atrial aneurysm, the previous reports and reviews showed that combination of plain chest x-ray and cardiac magnetic resonance imaging have been the major modality in terms of investigation [2].
Jason T. Nomura, Nicholas Genes, Hannah R. Bollinger, Melissa Bollinger, James F. Reed III
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.020
Published online: March 19 2012
xThe Internet has become ubiquitous in all of our lives and medical education. With the advent of Web 2.0 and social media, there has been a push for new media to have value and purpose. It has been postulated that social media has value as a tool for medical education [1]. However, most publications focus on guidelines or reports of unprofessionalism [2-4].
Subramanian Senthilkumaran, Ramachandran Meenakshisundaram, Ponuswamy Suresh, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.023
Published online: March 19 2012
xWe have read the article by Davenport et al [1] with great interest. This article is a salient reminder for the emergency physicians (EP) to consider cardiac etiology in the high-risk patients whenever the symptoms are apparently only gastrointestinal and to give additional weightage for hiccup. Recent literature [2] suggests that diabetes is closely linked to heart disease, and it is a risk factor for acute myocardial infarction (MI) an equivalent to known coronary artery disease. Chowta and colleagues [3] had observed atypical symptoms such as epigastric pain or abdominal distress in 50% of patients with inferior-wall MI presented to them.
Pinar Hanife Kara, Erden Erol Unluer, Onder Limon, Nergiz Vanden Berk, Ozcan Yavasi, Kamil Kayayurt, Berrin Uzun
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.024
Published online: March 19 2012
xHypovolemia evaluation with bedside ultrasonography has been studied previously [1]. Difficulties as large body size, excessive bowel gasses, or large amount of intrathoracic air have been leaded emergency physicians (EPs) to investigate different types of ultrasonographic location to asses the hypovolemia by bedside ultrasonography (BUS). Previously, we have shown that right ventricular outflow tract fractional shortening (RVOTFS) can be alternative method for noninvasive measurement of low central venous pressure [2].
Khalil Zarrabi, Hamed Ghoddusi Johari, Azimeh Azimifar
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.043
Published online: March 19 2012
xWe read with great interest the article by Close and Cherkas [1] “Successful treatment of presumed massive pulmonary embolism during cardiac arrest,” which describes about the first documented case of successful use of reteplase for presumed massive pulmonary embolism during cardiac arrest in the United States. It is very interesting that the patient had such a dramatic response to reteplase. However, the fact that made us write this article is that we have performed and published a large study from 2004 until 2010 on 30 patients with massive and submassive pulmonary embolism in which retrograde pulmonary embolectomy was used as a main treatment modality [2].
Fabio Fabbian, Roberto Melandri, Gabriella Borsetti, Emanuele Micaglio, Marco Pala, Alfredo De Giorgi, Alessandra Mellozzi Menegatti, Arrigo Boccafogli, Roberto Manfredini
DOI: http://dx.doi.org/10.1016/j.ajem.2012.02.002
Published in issue: June 2012
xEmergency department (ED) crowding is an international public health problem. The mismatch in ED and hospital resources may cause long waiting times and delays in treatments [1] and exposes to preventable medical errors [2]. Moreover, ED crowding is associated with prolonged stay and increased risk of adverse drug events (ADEs), estimated in 3% increased odds for every hour in the ED [3]. Adverse drug reactions (ADRs) account for 3% to 6% of all hospital admissions and occur in 10% to 15% of hospitalized patients [4].
Ruggero M. Corso, Gabriele Giovannini, Mikela Berger, Andrea Fabbri, Giorgio Gambale
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.032
Published online: March 30 2012
xEndotracheal intubation (ETI) is currently the “gold standard” for airway management in a prehospital setting, but this is a complex technique requiring practice and experience. Alternative procedures are essential for emergency physicians, to reduce unfavorable effects of multiple failed intubation attempts [1]. The i-gel disposable airway (Intersurgical Ltd, Workingham, UK) is proposed as a new supraglottic airway device made of a medical grade thermoplastic elastomer (Fig. 1). Its unique design does not need an inflatable cuff because the thermoplastic elastomer provides the seal [2].
Martin N. Stienen, Oliver P. Gautschi
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.021
Published online: April 29 2011
xA 23-year-old motorcycle driver was admitted to our emergency department after being hit and run over by a tractor (initial Glasgow Coma Scale of 14). After pain-related analgosedation and normal computed tomographic scan of the head, multiple long-bone fractures of the upper and lower right extremity were repositioned and treated by osteosynthesis shortly after admission. Postoperatively, the cardiopulmonary stable patient did not wake from anesthesia. A follow-up magnetic resonance imaging with diffusion-weighted image (panel A) (Fig.
Michael Ybarra, Tina Rosenbaum
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.022
Published online: April 25 2011
xWe describe the case of a 47-year-old woman who came to the emergency department (ED) complaining of worse than typical migraine headache and blurry vision after recently doubling the dose of topiramate earlier that day. After complete neurologic and ophthalmologic evaluation, she was found to have elevated intraocular pressures and was diagnosed with topiramate-induced bilateral acute angle-closure glaucoma, which is a rare side effect of this commonly prescribed medication. She was treated with timolol, brimonide, and prednisolone drops to reduce intraocular pressure as well as cessation of topiramate and was discharged home.
Indu Bhushan Dubey, Debajyoti Mohanty, Bhupendra Kumar Jain
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.027
Published online: May 13 2011
xThe objective of the study was to highlight diagnostic dilemmas and suggest pointers toward early diagnosis of spontaneous rupture of urinary bladder based on case study of 2 patients diagnosed as a case of spontaneous rupture of urinary bladder. A 26-year-old man presented with painless progressive abdominal distension of 1-week duration. In absence of acute abdominal symptoms and signs, the diagnosis of chronic liver disease with ascites was entertained. Peritoneal fluid aspirate demonstrated high urea and creatinine levels.
Marios Karvouniaris, John Papanikolaou, Demosthenes Makris, Epameinondas Zakynthinos
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.030
Published online: May 2 2011
xSepsis is a stressful physical condition, and at the acute phase, overstimulation of the sympathetic nervous system may occur; these events have the potential to induce cardiomyopathy. Takotsubo cardiomyopathy (TTC) is a form of catecholamine-induced cardiomyopathy, which occurs very rarely in sepsis. However, TTC management in critically ill patients with sepsis may be challenging because the use of exogenous catecholamines for circulatory support might augment further TTC. Herein, we report a rare case of TTC after urosepsis; and we point out that cardiac function may improve after catecholamine withdrawal and the application of calcium channel sensitizer levosimendan.
Chung-Wei Yang, Ching Lu, Chih-Cheng Wu, Szu-Chi Wen
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.031
Published online: April 25 2011
xNeuroleptic malignant syndrome (NMS) is a rare idiosyncratic disorder characterized by muscle rigidity, hyperthermia, autonomic dysfunction, and altered consciousness. Although the incidence of NMS is low, it may be fatal if early recognition is delayed. There are a variety of precipitating factors for NMS including systemic illness and dehydration. The combination of NMS with systemic illness can be difficult to diagnose because the systemic illness may mask the coexistence of NMS. We report a patient with hyperosmolar hyperglycemic state with coexistent NMS to remind physicians that hyperosmolar hyperglycemic state may precipitate the development of NMS in patients receiving neuroleptics.
Mary T. Ryan, Nicholas D. Caputo, Viraj Lakdawala, Fernando Jara
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.032
Published online: April 29 2011
xThe aim of this study was to describe a case of a large traumatic pneumothorax (>55%) that resolved completely without intervention. A pneumothorax is the accumulation of air between the visceral and parietal pleura. It can occur spontaneously or be traumatic. Spontaneous pneumothoraces can occur with no underlying lung disease or secondary in nature. The emergency department (ED) treatment of pneumothoraces depends on their size, their etiology, and clinical stability of the patient. The current recommendation is observation in stable patients with <15% pneumothorax and tube thoracostomy in patients with >15% pneumothorax.
Mamatha Punjee Raja Rao, Prashanth Panduranga, Mohammed Al-Mukhaini, Mahmood Al-Jufaili
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.001
Published online: May 13 2011
xA 51-year-old man presented to the emergency department with sustained hemodynamically unstable wide QRS tachycardia and was revived successfully by immediate direct current (DC) cardioversion. There was evidence of previous open heart surgery, possibly atrial septal defect closure. Transthoracic echocardiography showed severe Ebstein anomaly with severe tricuspid regurgitation, no residual atrial septal defect, but with severe right ventricular dysfunction. Subsequent electrocardiograms showed transient atrial fibrillation with no manifest Wolff-Parkinson-White (WPW) accessory pathway during sinus rhythm.
Fatih Yilmaz, Gamze Babur Guler, Oguz Karaca, Ekrem Guler, Filiz Kizilirmak, Baris Sensoy
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.005
Published online: May 13 2011
xMyocardial dissection is a rare but fatal complication of myocardial infarction requiring urgent surgical treatment to avoid complete rupture. We report a case of intramyocardial dissecting hematoma treated with supportive pharmacologic therapy for 9 months of follow-up without surgical intervention.
Nikolaos Katsoulas, Senthil Ganapathi, Robert Hagger
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.006
Published online: May 18 2011
xThe management of penetrating abdominal trauma has evolved considerably over the last 30 years. The goal of any algorithm for penetrating abdominal trauma should be to identify injuries requiring surgical repair and avoid unnecessary laparotomy with its associated morbidity. We describe a case where the infusion of povidone-iodine (Videne) and air into the wound uncovered the peritoneal breach clinically and guided the radiologist to the site of the internal injury. This case report raises an intriguing possible role for povidone-iodine and air to be used both for wound toilet and to aid identification of occult wound tracks on computed tomography imaging.
Nicholas D. Caputo, Robert M. Fraser, Jumana Abdulkarim
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.016
Published online: June 6 2011
xPosterior reversible encephalopathy syndrome (PRES) is a central nervous system pathology characterized by headaches, altered mental status, seizures, and visual loss. The syndrome is a clincoradiologic diagnosis, which mandates neuroimaging.
Christopher O. Hoyte, Tracy A. Cushing, Kennon J. Heard
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.017
Published online: June 6 2011
xBlack widow spider envenomation is commonly reported to poison centers. Black widow spider envenomation produces a clinical syndrome, known as latrodectism, characterized by headache, nausea, vomiting, several muscle cramping and pain, joint stiffness, hypertension, and regional diaphoresis. Black widow spider antivenom (Merck & Co, Inc, West Point, PA USA) is an effective and relatively safe treatment option. There is 1 clear case of anaphylaxis secondary to black widow spider antivenom reported in the medical literature.
Shunsuke Tanoue, Youichi Yanagawa
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.018
Published online: November 18 2011
xAn 82-year-old woman with consciousness disturbance, left hemeparesis, and dysarthria was discovered at home by her family and was transported to a hospital. On arrival, she remained in a sleepy and disorientated and shock state. She complained of nausea but no chest or back pain. She obtained stable circulation after infusion. Her chest roentgen results showed widening of the mediastinum and the existence of a separation of the intimal calcification from the outer aortic soft tissue border, thus suggesting a Stanford A–type aortic dissection.
Joanne C. Witsil, Michele Zell-Kanter, Mark B. Mycyk
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.019
Published online: June 6 2011
xZiprasidone has been rarely associated with QT prolongation especially in patients (1) with no underlying cardiac or metabolic disorders, (2) who are receiving no concomitant medications known to prolong the QT interval, and (3) whom therapy is being initiated at a low dose. We report a 47-year-old patient who was agitated with suicidal ideation. He had a history of cocaine use, the last time being 72 hours before emergency department (ED) presentation. His electrocardiogram (ECG) on arrival in the ED showed a QT of 484 milliseconds and a QTc of 475 milliseconds with a pulse of 58 beats per minute.
Yoon Hee Choi, Duk Hee Lee, Soon Young Yun, Jae Hee Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.020
Published online: June 6 2011
xRectus sheath hematoma (RSH) is generally not considered a reason for abdominal pain and its incidence as a cause of abdominal pain is unknown. RSH is a rarely seen but nonetheless an important disease causing abdominal pain. During contractions of the rectus abdominis muscle, the inferior epigastric artery must glide with the muscle to avoid tearing. When the inferior epigastric artery is torn, blood dissects along the rectus sheath leading to hematoma formation. We report a case of spontaneous rectus sheath hematoma due to Foley catheterization after acute urinary retention.
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00219-7
Published in issue: June 2012
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00220-3
Published in issue: June 2012
