Anna Marie Chang, Catherine T. Ginty, Harold I. Litt, Judd E. Hollander
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.018
Published online: July 16 2012
xPatients who present to the emergency department (ED) with symptoms of potential acute coronary syndrome (ACS) can be safely discharged home after a coronary computed tomographic angiography (CTA) with a negative result. However, the duration of time for which a negative coronary CTA scan result can be used to inform decision making when patients have recurrent symptoms is not known.
Neil B. Hampson
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.026
Published online: May 25 2012
xPulse CO-oximetry (Rad-57; Masimo Corp, Irvine, CA) has been available since 2005. To date, all published clinical studies have focused on clinical reliability and whether the device enhances case finding through screening of various populations. This study examines whether use of pulse CO-oximetry shortens the time to diagnosis and treatment of patients with carbon monoxide (CO) poisoning.
Sunanda Nanduri, Ashis H. Tayal, Gajanan G. Hegde, Jennifer Shang, Arvind Venkat
DOI: http://dx.doi.org/10.1016/j.ajem.2012.04.003
Published online: July 16 2012
xOur objective was to identify demographic, clinical, and operational variables associated with discrepancy between point-of-care (POC) and central laboratory international normalized ratio (INR) results in emergency department (ED) patients with acute cerebrovascular disease.
Fabrizio Elia, Francesco Panero, Paola Molino, Giovanni Ferrari, Franco Aprà
DOI: http://dx.doi.org/10.1016/j.ajem.2012.04.008
Published online: July 16 2012
xEmergency medicine setting is intrinsically prone to a greater risk of medical errors than other specialties. Cognitive errors are particularly frequent when the clinical decision-making process heavily relies on heuristics. These could be defined as “mental shortcuts,” which enable physicians to rapidly overcome both time and efforts required by the normative reasoning. Our article demonstrates how emergency physicians' thinking may be affected by failed heuristics, through the description of 3 real clinical cases.
Erik Kochert, Lawrence Goldhahn, Ian Hughes, Kirsten Gee, Barbie Stahlman
DOI: http://dx.doi.org/10.1016/j.ajem.2012.04.012
Published online: July 16 2012
xApproximately 5% of all US emergency department (ED) visits are for chest pain, and coagulation testing is frequently utilized as part of the ED evaluation.
Wei Gu, Chun Sheng Li, Wen Peng Yin, Zhi Jun Guo, Xiao Min Hou, Da Zhang
DOI: http://dx.doi.org/10.1016/j.ajem.2012.04.031
Published online: August 6 2012
xPostresuscitation myocardial dysfunction contributes to the low survival rate after successful resuscitation, but its mechanism remains poorly understood. This study investigated whether caspase 3–mediated apoptosis is activated in the heart after postresuscitation myocardial dysfunction.
Charles V. Pollack Jr.
DOI: http://dx.doi.org/10.1016/j.ajem.2012.04.005
Published online: July 16 2012
xEmergency department (ED) clinicians are not typically involved in the long-term management of patients' anticoagulation therapy, but they are responsible for decision making for emergency conditions requiring anticoagulation, such as acute venous thromboembolism (VTE). In addition, emergency physicians are often faced with patients who present first to the ED with conditions that may prompt long-term anticoagulation upon hospital discharge, such as atrial fibrillation (AF), or who have acute or potential bleeding complications from anticoagulation.
Nicolas Kluger
DOI: http://dx.doi.org/10.1016/j.ajem.2012.06.014
Published online: September 3 2012
xPermanent decorative tattooing involves the introduction of exogenous pigments and/or dyes into the dermis to produce the permanent design. Despite improved hygiene in the tattoo parlors of Western countries, this procedure still carries risk. Various complications may occur right after tattooing, from benign complications such as transient limb edema, palpable lymph nodes, and contact eczema, to more severe ones such as the inoculation of virulent microorganisms into the dermis, potentially life-threatening cellulitis, and necrotizing fasciitis or cutaneous vasculitis.
Shamai A. Grossman, Matthew Babineau, Laura Kulchycki, Larry Mottley, Adarsh Kancharla, Andrea Nencioni, Nathan Shapiro
DOI: http://dx.doi.org/10.1016/j.ajem.2012.05.035
Published in issue: November 2012
xWe greatly appreciate the interest expressed in our study well articulated in the above letter. To review, our objective was to determine the incidence of critical interventions or adverse outcomes associated with near syncope and to compare these outcomes with those patients with true syncope [1].
Giulia Cernuschi, Mattia Bonzi, Elisa Fiorelli, Simone Birocchi
DOI: http://dx.doi.org/10.1016/j.ajem.2012.05.036
Published online: August 6 2012
xWe read with great interest the article by Grossman et al [1] on the incidence of critical interventions or adverse outcomes associated with near syncope comparing these outcomes with the ones of patients with true syncope. It deals with a clinically relevant problem because even in the most recent guidelines, there is not a consensus on the definition of near syncope and its clinical consequences [2]. Thereby, many studies evaluating the prognosis of syncope enrolled patients with near syncope, whereas others did not [3,4].
Ayhan Saritas, Gokhan Celbek, Behic Volkan Boz, Sabri Onur Caglar, Leyla Yilmaz Aydin, Hayati Kandis
DOI: http://dx.doi.org/10.1016/j.ajem.2012.06.005
Published online: September 3 2012
xWe thank Dr Uzun and his colleagues for their interest in our article. It is obvious that the patient had paroxysmal atrial fibrillation (AF) attack twice after hyperbaric oxygen therapy (HBO). We accept Dr Uzun's objection that hyperoxia lasts only several minutes. However, we do not know its effects after several hours on conduction paths. Of course, AF might have been associated with carbon monoxide poisoning, which we could not differentiate. We discussed this possibility in our article.
Günalp Uzun, Mesut Mutluoglu, Murat Eroglu, Ömer Uz
DOI: http://dx.doi.org/10.1016/j.ajem.2012.06.006
Published online: September 13 2012
xWe have read the article by Celbek et al, in which they reported the occurrence of paroxysmal atrial fibrillation (AF), 4 to 6 hours after hyperbaric oxygen (HBO) therapy in a patient with severe carbon monoxide (CO) poisoning [1]. After failing to identify any plausible explanation for the development of AF in this patient, the authors concluded that HBO therapy was responsible for AF. We think that this observational conclusion is not correct and that the author's overly broad recommendation to monitor each patient with electrocardiogram before and after HBO therapy is quite assertive.
Steven L. Bernstein, Nina Cooperman, Saba Jearld, Alyson Moadel, Polly Bijur, E. John Gallagher
DOI: http://dx.doi.org/10.1016/j.ajem.2012.06.011
Published online: September 24 2012
xAdequate subject follow-up is integral to the success of clinical trials. Losses to follow-up pose threats to internal and external validity [1]. Emergency department (ED) populations are often highly mobile, with unstable housing and numerous unmet social needs [2]. Emergency department–based clinical trials that focus on risky health behaviors are at particular risk for loss to follow-up. Often, follow-up is completed by telephone, but some studies require in-person assessment, often to collect biological samples for confirmatory testing.
Subramanian Senthilkumaran, Namasivayam Balamurugan, Ritesh G. Menezes, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2012.06.019
Published online: September 3 2012
xWe read the interesting case report by Choi et al [1]. At this juncture, we would like to recall the importance of 2 clinical signs such as Carnett sign (abdominal wall test) and Fothergill sign, which may help to distinguish rectus sheath hematoma (RSH) from intra-abdominal pathology at the bedside. In addition, limitations in the diagnosis, diagnostic methods, and aspects related to medical education and training are highlighted.
Hossein Sanaei-Zadeh
DOI: http://dx.doi.org/10.1016/j.ajem.2012.06.029
Published online: September 3 2012
xI read with interest the interesting case report by Al et al [1] recently published online in your journal. The authors have presented a 15-year-old adolescent boy who had experienced compartment syndrome (CS) of the left forearm due to acute carbon monoxide (CO) poisoning. Although the patient's consciousness was recovered by 1 session of hyperbaric oxygen therapy, progression of CS could not be prevented, and the authors were to perform fasciotomy. With respect to the supine position of the patient at the time of discovery, the authors could not determine a traumatic reason for the development of CS in their patient after explaining the CS and its probable causes and mechanisms.
Cheng-Hsuan Ho, Yu-long Chen, Yen-Yue Lin, Wen-I Liao, Chih-Yuan Lin, Chin-Wang Hsu, Shih-Hung Tsai
DOI: http://dx.doi.org/10.1016/j.ajem.2012.06.031
Published online: September 13 2012
xThe clinical presentations of acute aortic dissection (AAD), a great masquerader, are diverse. Timely thrombolytic therapy is the current standard treatment for acute ischemic stroke (AIS) [1]. However, up to 29.4% of patients with AAD present with neurologic manifestations, including AIS, spinal cord ischemia, hypoxic encephalopathy, and syncope. In addition, 6% of AIS cases are actually caused by AAD, and AAD is the true etiology in 1% of patients who are eligible for thrombolytic therapy for AIS [2,3].
Suresh S. Pujar, Rod C. Scott, Richard F.M. Chin
DOI: http://dx.doi.org/10.1016/j.ajem.2012.07.005
Published online: September 13 2012
xWe read with interest a recently published article by Ismail et al [1] reporting the lack of efficacy of phenytoin in children presenting with febrile status epilepticus (FSE). The authors, by retrospective medical record review, conclude that phenytoin is rarely effective in controlling FSE in children and that exposure to phenytoin results in increased seizure duration and risk of brain injury. We would like to comment on a few issues:
Oscar M.P. Jolobe
DOI: http://dx.doi.org/10.1016/j.ajem.2012.07.009
Published online: September 3 2012
xOver and above the fact that the old definition of transient ischemic attack (TIA) was sometimes associated with “waiting to determine whether symptoms resolve in less than 24 hours to rule out stroke” and that this could delay treatment for stroke prevention [1], there was also the danger that stroke patients who experienced rapid symptomatic improvement that fell short of full resolution of symptoms could misdiagnosed as TIA, thereby being denied thrombolytic treatment. This was the case in 12912 of 93517 patients who arrived in hospital within 2 hours of the onset of focal neurological symptoms, but did not receive thrombolytic treatment.
Peter D. Panagos
DOI: http://dx.doi.org/10.1016/j.ajem.2012.07.012
Published online: September 24 2012
xWith the advancements of acute stroke systems of care and stroke teams, there has been an increasing demand for the development of better diagnostics and therapies in the identification and treatment of both ischemic and hemorrhagic stroke patients presenting to the emergency department (ED). Although the progress for treating acute ischemic and hemorrhagic stroke has been slow, the advancements in imaging techniques have been substantial. Traditionally, a simple computed tomographic (CT) scan has been used to differentiate an ischemic from a hemorrhagic stroke, but the inherent physiologic limitations of this “static” imaging technique are now apparent.
Yi Li, Shigong Guo, Shengyong Xu, Zhong Wang, Xuezhong Yu
DOI: http://dx.doi.org/10.1016/j.ajem.2012.07.011
Published online: September 24 2012
xIn mainland China, formal emergency departments (EDs) were not established until the mid 1980s [1]. Numerous problems in the field of emergency medicine became apparent, which will be discussed in this article.
Francisco J. Toledano, José Suárez de Lezo, José Segura, Javier Suárez de Lezo, Dolores Mesa
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.010
Published online: December 26 2011
xLung cancer is one of the most common neoplasms associated with cardiac metastasis, and the pericardium is often affected. However, isolated myocardial involvement in these patients is very uncommon. Most tumor invasions into the heart are nonspecific and clinically silent. Myocardial metastasis rarely mimics an acute myocardial infarction. We report a case of a 59-year-old man with a metastatic lung cancer into the myocardium mimicking an acute myocardial infarction.
Bo-Lin Ho, Chiou-Lian Lai, Chung-Yao Hsu
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.011
Published online: December 8 2011
xAbrupt headaches with focal neurologic deficits usually indicate medical emergencies that require advanced investigations and prompt treatment. The distinct syndrome of “headache with neurologic deficits and cerebrospinal fluid lymphocytosis” (HaNDL) is infrequent and considered a benign, self-limited disorder. We illustrated a 29-year-old man with HaNDL atypically presenting as episodic altered consciousness rather than sensorimotor prodromes. The diagnosis was made carefully by exclusion of other likely entities.
Manoj K. Mittal, David B. Burkholder, Eelco F. Wijdicks
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.015
Published online: December 28 2011
x“Blood/fluid level” represents interface between the plasma and sedimented blood and is defined radiologically as presence of area of low computed tomography (CT) attenuation above and high CT attenuation below a discrete line of separation in an area of intraparenchymal hemorrhage. It is a rare finding seen in association with large clot volume of intraparenchymal hemorrhage. We present a case of warfarin-related intraparenchymal hemorrhage presenting with a classic sign of “blood/fluid level” on CT head with small clot volume.
Ping Song Chou, Chien Hung Lin, Hai Lun Chao, A Ching Chao
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.016
Published online: December 28 2011
xIntravenous recombinant tissue plasminogen activator (IV rt-PA) is the only established thrombolytic therapy for acute ischemic stroke. However, secondary embolism after IV rt-PA for acute ischemic stroke is recognized as an uncommon complication, and the pathophysiology is unclear. We describe a 72-year-old man with acute infarction in the territory of left anterior cerebral artery who developed new infarction in the territory of right middle cerebral artery and acute peripheral arterial occlusion after IV rt-PA therapy.
Nishaki Kiran Mehta, Sarah Doaty, Sian Spurney, Jalil Ahari
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.020
Published online: December 8 2011
xThirty-year-old woman with history of AIDS and anxiety presented with palpitations. Although clinically euvolemic, she was aggressively fluid resuscitated in lieu of sinus tachycardia. She developed unilateral pulmonary edema on account of left decubitus positioning and volume resuscitation. Given her normal cardiac, renal, and liver status, she spontaneously cleared the extra fluid, and the pulmonary edema resolved. This case highlights the importance of recognizing transient unilateral pulmonary edema and need for early radiographs to document clearance and prevent unnecessary testing.
Pierre-Marie Brun, Jacques Bessereau, Nicolas Cazes, Emgan Querellou, Hichem Chenaitia
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.023
Published online: December 28 2011
xEndotracheal intubation is the “gold standard” of the control of airway patency but is associated with nonnegligible morbidity rates. A rapid detection of esophageal intubation is essential. Capnography is considered the reference technique for correct endotracheal tube (ETT) positioning confirmation. However, capnography can provide false-positive and false-negative results in some situations. Recently, the ultrasound assessment has been studied for confirming ETT placement. Despite of few trials, the ultrasound procedure may enhance physician confidence and decision making in airway management.
Hesham R. Omar
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.024
Published online: December 28 2011
xAmiodarone is a widely used antiarrythmic drug for various atrial and ventricular arrhythmias. It has the potential to cause prolongation of the QT interval, which, in turn, can increases the incidence of torsade de pointes. Amiodarone is also one of the causes of prominent U waves. The presented case exemplifies the phenomenon of amiodarone-induced T-U fusion and QT prolongation. Other causes of QT prolongation as electrolyte abnormalities or administration of other drugs that prolong the QT interval were excluded.
Onder Limon, Erden Erol Unluer, Fulya Cakalagaoglu Unay, Orhan Oyar, Aslı Sener
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.030
Published in issue: November 2012
xSpontaneous urinary bladder perforation is a rare and life-threatening condition similar to traumatic and iatrogenic perforation. The connection with the underlying bladder damage due to previous radiotherapy, inflammation, malignancy, obstruction, or other causes can be found in almost all cases. The symptoms are often nonspecific, and misdiagnosis is common. Here, we present a case of spontaneous urinary bladder perforation due to bladder necrosis in a diabetic woman. She presented to the emergency department with abdominal pain.
Charles Haviland Moore, Jonathan Snashall, Keith Boniface, James Scott
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.031
Published online: December 26 2011
xDabigatran etexilate (Pradaxa; Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT) is an oral anticoagulant that produces a reliable, dose-dependent anticoagulant effect without the need for routine laboratory monitoring. Dabigatran is a direct thrombin inhibitor, acting like other members in its class (bivalirudin, argatroban) to impede the clotting process through selective and reversible binding with both free and clot-bound thrombin. Dabigatran anticoagulates rapidly: plasma levels peak 2 hours after absorption, with a half-life that ranges between 12 and 17 hours.
Stefano Coli, Francesco Mantovani, Jayme Ferro, Gianluca Gonzi, Marco Zardini, Diego Ardissino
DOI: http://dx.doi.org/10.1016/j.ajem.2011.11.005
Published online: December 16 2011
xAdenosine is widely used for the treatment of supraventricular tachycardias for its efficacy and excellent safety, but it has been reported to precipitate severe bronchospasm in patients with pulmonary disease. The drug is therefore contraindicated in asthmatic subjects and should be used with caution in patients with chronic obstructive pulmonary disease. Nevertheless, true bronchospasm is rare and should be distinguished from the much more common occurrence of dyspnea, only as a symptom and without respiratory compromise, which is benign and transient.
Wen-Sou Lin, Yueh-Feng Sung
DOI: http://dx.doi.org/10.1016/j.ajem.2011.11.006
Published online: December 28 2011
xNeurogenic stunned myocardium is defined as a myocardial injury or dysfunction after neurological insults. It is most commonly reported in patients with subarachnoid hemorrhage, and the presenting symptoms may mimic an acute myocardial infarction or myocarditis. In severe cases, cardiogenic shock and acute pulmonary edema may occur and lead to a devastating event. Therefore, it requires prompt recognition and proper intervention. We herein report the case of a 25-year-old woman who presented to our hospital with the symptoms of acute pulmonary edema, shock, and consciousness disturbance.
Youichi Yanagawa, Manabu Tajima, Keiichiro Ohara, Koichiro Aihara, Shigeru Matsuda, Toshiaki Iba
DOI: http://dx.doi.org/10.1016/j.ajem.2011.11.011
Published online: December 16 2011
xA 62-year-old man with local recurrence of pancreatic cancer underwent his 17th infusion of contrast medium. He had no history of allergy and had not experienced any side effects from the contrast medium during any of the previous examinations. During infusion, he complained of nausea, followed by a loss of consciousness. He was injected intramuscularly with 0.3 mg adrenalin; however, he temporally went into cardiopulmonary arrest. He was therefore injected with 100 mg hydrocortisone and the continuous infusion of dopamine for shock.
Hans Rosenberg, Khaled Al-Rajhi
DOI: http://dx.doi.org/10.1016/j.ajem.2011.11.012
Published online: January 13 2012
xAortic dissection (AD) is one of the most challenging diagnoses in emergency medicine. This is due, in part, to its variable presentation, ranging from abrupt tearing chest pain in a hemodynamically unstable patient to back pain in a stable patient, as well as its high mortality rates. (1) With the expanding role of ultrasound (U/S) performed by emergency physicians, it is possible to make the diagnosis of AD at the bedside before any other imaging modality has been accessed. (2) In this case report, we describe the use of emergency department (ED) bedside U/S and specifically highlight the use of the suprasternal view in the diagnosis of AD.
Roisin T. Dolan, Ammar Al Khudairy, Paul Mc Kenna, Joseph S. Butler, Joseph O'Beirne, John F. Quinlan
DOI: http://dx.doi.org/10.1016/j.ajem.2011.11.015
Published online: March 2 2012
xMetacarpal fractures are common injuries, accounting for approximately 30% to 40% of all hand fractures and with a lifetime incidence of 2.5%. Traditionally regarded as an innocuous injury, metacarpal fractures tend to be associated with successful outcomes after closed reduction and immobilization.
Cherng-Jyr Lim, Jiann-Hwa Chen, Wei-Lung Chen, Ying-Sheng Shen, Chien-Cheng Huang
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.003
Published online: February 10 2012
xWe described a 14-year-old boy with initial presentation of recurrent intermittent abdominal pain, with subsequent development of jejunojejunum intussusception. The characteristic purpuric skin rash of Henoch-Schönlein purpura appeared later after the surgical manual reduction. When abdominal pain is the single initial manifestation in patients with undiagnosed Henoch-Schönlein purpura, emergency physicians should evaluate if the patient required early surgical intervention such as intussusception or perforation and always keep Henoch-Schönlein purpura as a possibility in mind.
Sedat Işıkay, Kutluhan Yılmaz, Akgün Ölmez
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.004
Published online: January 13 2012
xBrucellosis is a zoonotic infectious disease that is common around the world. Its clinical course demonstrates great diversity as it can affect all organs and systems. However, the central nervous system is rarely affected in the pediatric population. Neurobrucellosis is most frequently observed with meningitis and has numerous complications, including meningocephalitis, myelitis, cranial nerve paralyses, radiculopathy, and neuropathy. Neurobrucellosis affects the second, third, sixth, seventh, and eighth cranial nerves.
Kuang-Chung Liou, Shu-Fan Kuo, Lu-An Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.013
Published online: February 10 2012
xWernicke encephalopathy (WE) is a medical emergency caused by thiamine (vitamin B1) deficiency. Typical clinical manifestations are mental change, ataxia, and ocular abnormalities. Wernicke encephalopathy is an important differential diagnosis in all patients with acute mental change. However, the disorder is greatly underdiagnosed. Clinical suspicion, detailed history taking, and neurologic evaluations are important for early diagnosis. Magnetic resonance imaging (MRI) is currently considered the diagnostic method of choice.
Ayhan Akoz, Atif Bayramoglu, Mustafa Uzkeser, Mecit Kantarci, Enbiya Aksakal, Mucahit Emet
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.016
Published online: March 2 2012
xKounis syndrome (KS) is an acute coronary vasospasm after exposure to an allergen due to mast cell degranulation and existing mediators. Various drugs, conditions, and environmental exposures can cause KS. We presented 2 cases, 1 of whom had taken an antiflu drug (containing paracetamol, pseudoephedrine, and dextromethorphan). His electrocardiogram (ECG) showed inferior ST elevations (2 mm) with normal cardiac biomarkers. His cardiac magnetic resonance imaging showed hypokinesis and myocardial hibernation on apical septum and on the left ventricle.
Matthew T. Heller, Matthew Hartman, Benjamin McGreevy
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.017
Published online: March 2 2012
xA seminal vesicle cyst is a rare etiology of pelvic pain. However, its rarity may result in oversight or misinterpretation if the radiologist or emergency physician is unfamiliar with this entity. Seminal vesicle cysts may cause pelvic pain because of mass effect, infection, internal hemorrhage, or urinary and bladder obstruction. Because seminal vesicle cysts rarely result in physical examination findings or laboratory abnormalities, pelvic computed tomography plays a pivotal role in their diagnosis and in evaluating patients with pelvic pain.
Ming-Hua Chen, Chun-An Cheng
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.021
Published online: February 10 2012
xAlcoholism is the major cause of electrolyte and acid-base imbalance and nutrition deficiency. Ketoacidosis is one of major advised effect on alcoholism. Marchiafava-Bignami disease, a rare alcohol-related disorder, characterized by altered mental status, seizure, and multifocal central nervous system signs, which results from progressive demyelination and necrosis of corpus callosum. Here, we presented a 53-year-old man presented as decreased conscious level and 4 extremity rigidity on admission.
Marie Knorr, David Evans
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.025
Published online: March 2 2012
xMost complications from traumatic isolated adrenal hemorrhage are thought to be minor and do not require specific treatment. However, there are often additional intra-abdominal organ injuries, such as liver and ipsilateral kidney, associated with adrenal injury. It is, therefore, important to identify these injuries as early as possible, preferably on initial assessment. We describe a case of a 43-year-old man who presented to the emergency department after sustaining blunt force trauma to the flank during a soccer match and was subsequently diagnosed with acute adrenal injury by use of bedside ultrasonography.
Scott Bomann, Iain O. Davies
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.026
Published online: February 10 2012
xTako-tsubo transient cardiomyopathy (TCM) is a syndrome of specific myocardial wall motion abnormalities that appear in response to extreme physiological or emotional stress. The patients have normal coronary arteries and usually present as new-onset heart failure or acute coronary syndrome. We report on a 48-year-old woman with post–community cardiac arrest presenting as an acute myocardial infarction. An emergency physician–performed echocardiogram showed significant wall motion abnormalities, suggesting myocardial infarction.
Min-Po Ho, Yuan-Hui Wu, Kaung-Chau Tsai, Jiann-Ming Wu, Wing-Keung Cheung
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.027
Published online: February 10 2012
xRight diaphragmatic hernia is a rare injury (0.25%-1%) after blunt abdominal trauma. The diagnosis may be delayed and achieved years after the trauma. We currently report a case of a 48-year-old man who presented to the emergency department at Far Eastern Memorial Hospital, New Taipei City, Taiwan, demonstrating signs of herniation of the right diaphragm. The herniation was confirmed using a chest radiograph. The patient reported falling 3 years before the current evaluation and was symptom-free before arrival in the emergency department.
Luis A. Robles
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.029
Published online: March 2 2012
xTangential gunshots to the head are a special type of injury in which the bullet or bullet fragments do not penetrate the inner table of the skull. Most of patients experiencing this kind of injuries usually have a benign clinical presentation. We describe the case of a 22-year-old soldier who had a tangential gunshot to the head caused by a high-velocity projectile. Initially, the patient was neurologically intact, progressing to profound coma in the next 2 hours. The characteristics of the wound and initial neurologic condition led to first contact physicians to treat this injury as a case of mild head trauma.
Wai-Ming Kong, Cheuk-Kwan Sun, I-Ting Tsai
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.030
Published online: March 19 2012
xAlthough trauma-induced simple pubic ramus fracture is common in the emergency department (ED), it can result in life-threatening hemorrhagic shock. We describe a 58-year-old woman with closed minimally displaced simple pubic ramus fracture. Hemodynamic instability became apparent 2 hours later. She was successfully treated with transarterial embolization and discharged uneventfully 10 days later. Literature review showed involvement of the superior pubic ramus in all reported cases probably because of hemorrhage from “corona mortis” with delay in shock presentation mostly within 6 hours, suggesting at least an equivalent observation period for these patients, particularly those at high risk for hemorrhage.
Jason Folt, Taher Vohra
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.031
Published online: February 10 2012
xKnee dislocations are rare injuries typically associated with severe traumatic mechanisms. We report 2 cases of morbidly obese patients who had complete knee dislocations after falls from standing height. Both cases resulted in significant morbidity secondary to popliteal artery injury. Emergency physicians need to maintain a high index of suspicion for knee dislocations and should be aware of atypical presentations from minor trauma in the obese population.
Sayed Mahdi Jalali, Hassan Emami-Razavi, Asieh Mansouri
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.032
Published online: August 6 2012
xGastric rupture is a rare complication after cardiopulmonary resuscitation (CPR). In most cases, incorrect management of airways during CPR is the main cause. Therefore, a medical emergency becomes a surgical emergency also. We present a case of gastric perforation in a middle-aged patient after CPR performed by his family. He eventually presented with bloody vomitus and a tympanic abdomen. When faced with a patient with abdominal signs post-CPR, surgical complications of CPR should be considered.
Shitij Arora, Hemant Goyal, Prachi Aggarwal, Atul Kukar
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.033
Published online: February 10 2012
xHeart disease is one of the leading causes of death in the United States. With the increase in substance abuse, the incidence of acute myocardial infarction (MI) in younger population has been on the rise. Traditionally, cocaine has been blamed for acute MI; however, recently, there have been more incidences of marijuana as an inciting factor. We present a case of marijuana-induced acute MI and discuss the proposed mechanism.
Hossein Alimohammadi, Ali Abdalvand, Saeed Safari, Alireza Mazinanian
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.034
Published online: March 2 2012
xMyelography has been of great use as a diagnostic modality, especially when other modalities were not conclusive. However, considering the invasive nature of myelography, it should receive the attention of medical personnel for them to be aware of its possible complications, especially when newer agents are applied as the contrast media. Myelography could lead to some common adverse effects and complications, but in this case report, we will present one of the most serious and uncommon complications accompanied with myelography using Omnipaque, a nonionic second-generation contrast agent.
Halil Ibrahim Erdogan, Enes Elvin Gul, Hasan Gok, Kjell C. Nikus
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.035
Published online: March 2 2012
xElectrical storm is a challenging diagnosis for the clinician and requires detailed evaluation of the patient. Amiodarone is frequently used for the cessation of ventricular tachycardia attacks. Within antiarrhythmic effects of amiodarone, there are some harmful effects of the recent drug. Thyroid gland toxicity is one of the most important adverse effects of amiodarone and is called amiodarone-induced thyrotoxicosis. Thyrotoxicosis may alter arrhythmia and lead to frequent ventricular tachycardia attacks.
