Junya Tsurukiri, Shiro Mishima, Shoichi Ohta
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.014
Published online: May 15 2013
xWe speculated that initial middle latency auditory evoked potentials index (MLAEPi) can indicate cerebral function and predict the restoration of spontaneous circulation (ROSC), postresuscitation survival or of neurologic outcomes among patients with cardiac arrest.
John C. Birchak, Lynne M. Rochette, Gary A. Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.039
Published online: April 19 2013
xSoftball is a popular participant sport in the United States. This study investigated the epidemiology of softball injuries with comparisons between children and adults.
Michael W. Sauer, Sujit Sharma, Daniel A. Hirsh, Harold K. Simon, Beesan S. Agha, Jesse J. Sturm
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.043
Published online: May 15 2013
xSuperficial neck infections including lymphadenitis and abscesses are commonly encountered in pediatric emergency departments (PEDs). It is often unclear which patients are likely to develop an abscess that necessitates surgical drainage. In evaluating these patients, computed tomography (CT) and ultrasound are often used to identify/confirm abscess formation. The criteria for determining the need for imaging studies are not well defined.
Jesús Ruiz, Unai Ayala, Sofía Ruiz de Gauna, Unai Irusta, Digna González-Otero, Elisabete Aramendi, Erik Alonso, Trygve Eftestøl
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.044
Published online: May 15 2013
xFiltering the cardiopulmonary resuscitation (CPR) artifact has been a major approach to minimizing interruptions to CPR for rhythm analysis. However, the effects of these filters on interruptions to CPR have not been evaluated. This study presents the first methodology for directly quantifying the effects of filtering on the uninterrupted CPR time.
Sheng-Hung Kuo, Yuan-Ti Lee, Chi-Rong Li, Chien-Jen Tseng, Wai-Nang Chao, Po-Hui Wang, Ruey-Hong Wong, Chun-Chieh Chen, Shiuan-Chih Chen, Meng-Chih Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.045
Published online: April 26 2013
xThe purpose of this study was to explore the predictor index of mortality in patients with pyogenic liver abscess (PLA).
Abdul Moiz Hafiz, Srihari S. Naidu, Joshua DeLeon, Shahidul Islam, Basil Alkhatib, Miguel Lorenz, Alexis D’Elia, Barry Rosenthal, Kevin Marzo
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.005
Published online: April 26 2013
xTo determine effect of first medical contact type on symptom onset–to-door time (SODT).
Sharon E. Mace, George Harb, Keith Friend, Robin Turpin, Edward P. Armstrong, Francois Lebel
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.006
Published online: May 20 2013
xTo evaluate the cost-effectiveness of recombinant human hyaluronidase–facilitated subcutaneous (rHFSC) fluid administration compared to intravenous (IV) fluid administration in children with mild to moderate dehydration in the emergency department (ED).
Chin-Wei Yu, Ling-I Juan, Shou-Chien Hsu, Chun-Kuei Chen, Chun-Wei Wu, Chien-Chang Lee, Jiunn-Yih Wu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.008
Published online: April 18 2013
xInfective endocarditis (IE) is a diagnostic challenge. We aimed to systemically summarize the current evidence on the diagnostic value of procalcitonin (PCT) in identifying IE.
Kaushal Shah, Joshua Quaas, Daniel Rolston, Shalu Bansal, Theodore Bania, David Newman, Dan Wiener, Jarone Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.009
Published online: May 20 2013
xThe objective of this study is to determine whether the magnitude of the d-dimer correlates with a higher likelihood of pulmonary embolus (PE).
Xue Tang, Ruilan Wang, Hui Xie, Jiachang Hu, Wenbiao Zhao
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.012
Published online: May 15 2013
xThis study aimed to clarify the efficacy of 2 therapies for patients with severe acute organophosphorus pesticide poisoning, including atropine adverse effects, the length of intensive care unit (ICU) stay, complications, and mortality.
Joseph V. Portale, Logan J. Harper, J. Matthew Fields
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.014
Published online: May 20 2013
xThis study aimed to evaluate emergency medical physician's knowledge of the charges for the entirety of medical care provided to patients they treated and discharged from the emergency department (ED).
Mustafa Yilmaz, Ahmet Sebe, Mehmet Oguzhan Ay, Umut Gumusay, Metin Topal, Mesude Atli, Ferhat Icme, Salim Satar
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.016
Published online: May 20 2013
xWe aimed to determine effectiveness of therapeutic plasma exchange (TPE) in patients with intermediate syndrome (IMS) due to organophosphate (OP) intoxication.
Dana F. Thambiraj, Thiphalak Chounthirath, Gary A. Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.023
Published online: April 22 2013
xThe widespread availability of microwave ovens has sparked interest in injuries resulting from their use.
Alicia B. Minns, Anesia McIlvoy, Alycia Clark, Richard F. Clark, F. Lee Cantrell
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.038
Published online: April 19 2013
xThis retrospective study aims to review California Poison Control System data to qualitatively describe reported methyl acetate (MA) exposures and determine if a metabolic acidosis develops.
David C. Lee, David A. Peak, Jeffrey S. Jones, Robert M. Domeier, Phyllis L. Hendry, Niels K. Rathlev, Robert A. Swor, Samuel A. McLean
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.003
Published online: April 26 2013
xIn the United States, institutional review boards (IRBs) oversee the scientific, ethical, and regulatory aspects of research conducted on human subjects. Institutional variations in the interpretation and application of federal and local regulations concerning genetic testing can have significant impact on the implementation of such studies.
Leonie Calver, Geoffrey K. Isbister
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.026
Published online: May 20 2013
xThis study aimed to investigate sedation of elderly patients with acute behavioral disturbance (ABD) in the emergency department (ED), specifically the safety and effectiveness of droperidol.
Christopher K. Mehta, Kami M. Hu, Jose V. Nable, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.028
Published online: March 28 2013
xSpecial attention to post–cardiac arrest management is important to long-term survival and favorable neurological outcome in patients resuscitated from cardiac arrest. The use of emergent percutaneous coronary intervention in resuscitated patients presenting with ST-segment elevation myocardial infarction has long been considered an appropriate approach for coronary revascularization. Recent evidence suggests that other subsets of patients, namely, post–cardiac arrest patients without ST-segment elevation myocardial infarction, may benefit from immediate percutaneous coronary intervention following resuscitation.
James Hartline, Chris Mierek, Tristan Knutson, Christopher Kang
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.001
Published online: May 15 2013
xThe recent outbreak of hantavirus in Yosemite National Park has attracted national attention, with 10 confirmed cases of hantavirus cardiopulmonary syndrome and thousands of more people exposed. This article will review the epidemiology, presentation, workup, and treatment for this rare but potentially lethal illness. The possibility of infection with hantavirus deserves consideration in patients with severe respiratory symptoms with rodent exposure or rural/wilderness travel. Accurate diagnosis requires a high index of suspicion.
John Paul Magenis, Scott C. Sherman,
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.004
Published online: April 12 2013
xThe Affordable Healthcare Act intends to provide basic medical services to all Americans and must do so at minimal cost of implementation and over a relatively short period. The reality that it takes the better part of a decade to develop a physician through medical school and postgraduate training, along with the current physician shortage in the United States, requires us to look outside of this traditional pool of providers to meet the needs of the expected number of new patients [1]. It has become apparent that successful implementation of the Affordable Healthcare Act will depend on the addition of a large number of midlevel medical providers to the workforce and will likely require increasing the scope of practice and clinical acumen of these providers to keep pace with the needs of the multitude of new patients.
Subramanian Senthilkumaran, Suresh S. David, Namasivayam Balamurugan, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.016
Published online: April 19 2013
xThe article by Dikici et al [1] is interesting. There are increasing reports regarding adverse effect of energy drink (ED) in current literature. Energy drink use has been anecdotally linked with seizure, and there is paucity of evidence-based literature in support of this association. This raises a debate whether the risk is negligible or it is underestimated, due to inadequate reporting [2].
Mohammad Bagher Heydari, Hamed Ghoddusi Johari, Shima Eskandari,
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.017
Published online: May 15 2013
xWe read with great interest the article by Singla et al [1]. “Wandering spleen presenting as bleeding gastric varices,” which describes about a rare clinical manifestation of wandering spleen. In this letter, we want to describe another extremely rare presentation of this entity.
Vui Heng Chong
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.020
Published online: April 19 2013
xI read with interest the article by Dicu et al [1], which reported on the clinical utility of the admission Rockall Score (RS), full RS, and the Glasgow-Blatchford Bleeding score in Romanian patients presenting with upper gastrointestinal bleeding. Their findings supported what is already known with regard to the 2 scoring systems; Glasgow-Blatchford Bleeding score is useful for predicting the need for interventions and transfusion [2] and, hence, admission, whereas RS is useful for predicting mortality [3].
Daniela Dicu, Daniela Ionescu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.019
Published online: April 10 2013
xWe are pleased to receive the point of view regarding the utility of risk scoring systems used in evaluating upper gastrointestinal bleeding patients raised by Dr Vui Heng Chong on our article [1], and we would like to thank for this comment. We share the same point of view and agree with the author regarding the 30-day outcome. It is well known that most studies on the predictive value of these scoring systems have been done taking into consideration 30-day [2,3] or even in-hospital outcome [4] of upper gastrointestinal bleeding patients.
Nicholas J. Connors, Tanya Bajaj, Michael D’Angelo, MaryAnn Howland, Robert S. Hoffman
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.025
Published online: March 25 2013
xWe read with interest the recent report concerning the use of β adrenergic antagonists (BAAs) in patients with chest pain and recent cocaine [1]. We feel that several clarifications are required, however, before the authors' conclusions can be accepted.
Morhaf Ibrahim, Diego J. Maselli, Reham Hasan
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.026
Published online: April 19 2013
xDr Connors mentions legitimate limitations of our study; however, a few concepts deserve further discussion [1]. First, it was noted that, in patients with cocaine-associated chest pain, evidence suggests that β-blockers (BB) should be withheld at least in the majority of them in the first hours after presentation. Nevertheless, there is limited evidence about this, with the exception of single case reports and studies done in the laboratory setting [2,3]. The American Heart Association (AHA) considered this evidence “Level of Evidence C” in their statement [4].
Wui Ling Chan, Alison M. Dines, Melvin Lipi, David M. Wood, Paul I. Dargan
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.024
Published online: May 15 2013
xWe read with interest the observational study by Dr Morhaf Ibrahim et al [1] on the use of β-blockers in the management of cocaine-associated chest pain. However, we feel that before concluding that β-blockers are “safe” in this setting, a number of issues regarding this study need to be considered.
Morhaf Ibrahim, Diego J. Maselli, Reham Hasan
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.022
Published online: May 15 2013
xWe agree with Dr Chan that our study has several limitations, and we acknowledge the comments from the above authors. We have several remarks for clarification. First, because of the retrospective nature of our study the exact timing of performing urine drug-screen and correlating its result with the β-blocker (BB) administration is a difficult variable to control [1]. We agree that the highest risk is within the first hour after exposure to cocaine, but the exact timing would be difficult to determine reliably in this patient population, where denial is common.
Sevket Balta, Sait Demirkol, Mustafa Hatipoglu,, Sukru Ardic, Zekeriya Arslan, Turgay Celik
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.031
Published online: April 15 2013
xWe have read with great interest the recently published article titled “Red cell distribution width is a prognostic factor in severe sepsis and septic shock” by Jo et al [1]. In that very well-presented article, they aimed to evaluate the relationship between red cell distribution width (RDW) at admission and 28-day mortality in patients with severe sepsis and septic shock. They concluded RDW of nonsurvivors was higher than that of survivors in severe sepsis and septic shock, and there was a graded association between RDW and 28-day mortality.
R. Gentry Wilkerson, Kenneth H. Butler, Michael D. Witting
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.032
Published online: May 15 2013
xIn 2 recent articles, published in this journal [1] and The Scandinavian Journal of Surgery [2], King and colleagues observed that surgeons performed almost all of the 54 cricothyroidotomies documented in the patient records they collected in a retrospective medical record review at 2 trauma centers. Their conclusion caught our attention and prompted this response because we, as emergency physicians, have demonstrated our competency to teach this rare and lifesaving procedure in our emergency medicine training program and are confident that our graduates are proficient in it.
Sevket Balta, Sait Demirkol, Mustafa Cakar, Sukru Ardic, Turgay Celik, Seref Demirbas
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.037
Published online: April 19 2013
xWe have read with great interest the recently published article entitled “Red cell distribution width as a predictor of mortality in acute pancreatitis” by Senol et al [1]. In that very well-presented article, they aimed to evaluate whether red cell distribution width (RDW) on admission could be a predictor of mortality in patients with acute pancreatitis (AP). They concluded elevated RDW at admission is an independent risk factor for mortality in AP. This is the first study to show this significant association between RDW and mortality in patients with AP.
David G. Grenache, Ann M. Gronowski, Corinne R. Fantz
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.041
Published online: April 3 2013
xWe read with interest the case report by Habboushe and Walker [1] that described the use of whole blood instead of urine or serum for the qualitative detection of human chorionic gonadotropin (hCG) in a patient with a ruptured ectopic pregnancy.
Joseph P. Habboushe, Graham Walker
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.040
Published online: April 15 2013
xWe appreciate the writer’s comments. However, we question their applicability to the physician at the bedside. There are numerous examples of unapproved uses of medications, devices, and diagnostics immediately familiar to the practicing physician. Physicians' judgment is relied upon to determine when benefit to the patient outweighs the risk of inaccuracy of unapproved use.
Juan Pablo Costabel, Diego Conde
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.002
Published online: May 15 2013
xThe Chest Pain Unit was designed to improve the management of patients with acute chest pain in the Emergency Department (ED) [1].
Gregor Lindner, Carmen Pfortmüller, Aristomenis K. Exadaktylos
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.022
Published online: March 13 2013
xWe describe the case of a 28-year-old otherwise healthy woman who presents to our emergency department with nausea for 2 days and severe vomiting for 1 day. She has no history of travel, and her medical history is unremarkable. The physical examination shows a soft and nontender abdomen.
Tomohiro Sonoo, Tomoki Wada, Ryota Inokuchi, Kensuke Nakamura, Susumu Nakajima, Naoki Yahagi
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.023
Published online: May 15 2013
xThis case report describes a 60-year-old man found unresponsive on the road. He was later admitted to our emergency department (ED) with consciousness disturbance and decorticate rigidity. Computed tomographic imaging revealed coexisting left putamen hemorrhage and Stanford type A acute aortic dissection. Decompressive craniectomy and hematoma evacuation were performed, but he died during his second hospital day. Morbid anatomy proved aortic dissection from the ascending aorta to left common iliac artery with pericardial effusion up to 500 mL.
Roxana-Nicoleta Siliste, Ilinca Savulescu-Fiedler, Calin Siliste
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.024
Published online: April 19 2013
xWe present the case of a 46-year-old woman with Prinzmetal's angina and syncope due to severe bradyarrhythmias. Dynamic electrical changes were documented on 12-lead 24-hour electrocardiographic (ECG) monitoring. We highlight the importance of continuous ECG monitoring in making the diagnosis and the indication for permanent cardiac pacing in this case.
Bruce M. Lo
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.034
Published online: March 4 2013
xAn algorithmic approach to testing utilizing risk stratification and quantitative d-dimer has been considered an acceptable approach to ruling out pulmonary embolism (PE). When d-dimer is elevated, further testing for PE is indicated. However, no evidence exists to guide practitioners when patients return after a recent negative workup for PE who previously had an elevated d-dimer. This case describes a patient who initially had an elevated d-dimer with negative workup for PE who, on repeat visit, had a decreasing d-dimer but was diagnosed with a PE.
Dimitrios Ntelios, Eleftheria Mpei, Eleftheria Gousi, Evangelos Potolidis, Panagiotis Fanourgiakis, Charalampos Mandros
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.035
Published online: March 13 2013
xTroponin (I or T) is the principal marker of myocardial injury used in clinical practice. Although immune-based methods to determine troponin I levels are generally reliable, the presence of human antibodies interfering with the assays components could lead to erroneous results. In this report, we will discuss the case of a patient with misleadingly elevated troponin I due to high rheumatoid factor titer and provide an insight into the responsible molecular mechanisms.
Cagdas Can, Umut Gulactı, Aydin Sarıhan, Hakan Topacoglu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.036
Published online: March 13 2013
xTenderness over the sternum is a clue for possible sternal fracture. Sternal fractures usually occur at the body or manubrium. Lateral chest radiography could detect a sternum fracture, but the diagnosis is usually made by chest tomography. Traumatic sternum fracture considered as a marker of seriously life-threatening, high-energy injury. In hyperlipidemia, oxidized lipids accumulate in vascular tissues and trigger atherosclerosis. Such lipids also deposit in bone tissues where they may promote osteoporosis.
Subramanian Senthilkumaran, Ramachandran Meenakshisundaram, Andrew D. Michaels, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.002
Published online: March 7 2013
xThe referred pain of angina to upper half of the body is well known. However, isolated pain in the thigh as a presenting symptom in myocardial infarction is neither considered nor discussed at all. Here, we report a middle-aged man without demonstrable risk factors who presented to the emergency department for isolated bilateral anteromedial thigh pain. He was diagnosed with acute inferior wall myocardial infarction. After thrombolysis, the thigh pain improved. The probable mechanism for this is attributable to radiation of pain via sensory cardiac fibers that is present in the lumbar sympathetic ganglia, which resulted in pain.
Neil J. Pathak, Lorraine Ng, Turandot Saul, Resa E. Lewiss
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.003
Published online: March 13 2013
xEndocarditis is a serious infection of the innermost muscle layer of the heart and can lead to significant mortality and morbidity. Echocardiography is instrumental to the timely diagnosis of this disease entity. We discuss the case of a patient presenting to the emergency department (ED) with fever of unclear etiology. The diagnosis of right-sided endocarditis was made using focused cardiac ultrasound. A 46-year-old man with a history of intravenous drug abuse presented to the ED complaining of fevers and headaches.
Chung-Cheng Wang, Chip-Jin Ng, Chen-Ken Seak, Chen-June Seak
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.037
Published online: March 4 2013
xMassive spontaneous hemothorax following combined thrombolytic and anticoagulant therapy for pulmonary embolism (PE) is a rare event that is little documented in the literature. Here, we describe a rare case of spontaneous hemothorax in a 23-year-old woman with underlying systemic lupus erythematosus following combined administration of tissue plasminogen activator and low-molecular-weight heparin for massive PE. This report of our successful treatment of this case by video-assisted thoracoscopic thoracotomy demonstrates that although the occurrence is rare, massive hemothorax following anticoagulant and/or thrombolytic therapy for PE should be suspected if patients experience chest pain, dyspnea, or signs of anemia, and follow-up physical examination and hemogram should be performed to facilitate diagnosis of this life-threatening complication.
Saranya Buppajarntham, Parichart Junpaparp, Pongsathorn Kue-A-Pai
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.038
Published online: March 13 2013
xWarburg effect is a rare metabolic complication in hematologic malignancies, commonly presented with lactic acidosis and hypoglycemia. Mechanism explained by abnormality of mitochondrial oxidative phosphorylation in cancer cells and energy production is mostly dependent on anaerobic respiration or glycolysis pathway to meet large tumor demand. We present a case with history of lymphoplasmacytic lymphoma and Waldenstörm macroglobulinemia, partial response to chemotherapy. Lymphoplasmacytic lymphoma transformed to diffuse large B-cell lymphoma, which is aggressive and rapid progression, leading to Warburg effect.
Quqntai Xing, Peixiang Xing
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.006
Published online: March 13 2013
xMumps-associated hemophagocytic syndrome (HPS) is exceptionally rare. Here, we report a fatal case of concurrent mumps and HPS. A previously healthy 21-year-old male patient was admitted to the Department of Infectious Diseases on October 18, 2011, with complaints of parotid gland pain for 30 days and persistent fever (38.3°C-40°C) for 15 days. Admission examinations showed severe pancytopenia, liver dysfunction, hyperferritinemia, fibrinopenia, elevated lactalase dehydrase, bilateral pulmonary inflammation and pleural effusion, abdominal lymphadenopathy, and splenomegaly.
Hsiao-Chia Wang, Jiann-Hwa Chen, Chieh-Chien Hsiao, Chin-Ming Jeng, Wei-Lung Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.007
Published online: March 4 2013
xEpigastralgia is a common chief compliant in the emergency department. Most of them are not fetal events, but some are life threatening such as aortic dissection or abdominal aneurysm rupture. Spontaneous visceral artery dissection is an uncommon occurrence with an unpredictable natural history and is rarely considered in the diagnosis of acute abdominal pain; however, it is as critical as aortic dissection and even easier to be ignored because of its rarity. We present a case of a 48-year-old man who presented to our emergency department with the chief concern of epigastric pain and diagnosed as having isolated spontaneous celiac artery dissection involving the hepatic artery, gastroduodenal artery, and splenic artery.
Ishwarya Balasubramanian, John P. Burke, Eoghan Condon
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.011
Published online: May 15 2013
xPigmented lymph nodes are traditionally associated with melanoma and metastatic malignancy. This report describes the case of 22-year-old white man, who presented with painful right groin lymphadenopathy. Groin ultrasound and computed tomography confirmed an enlarged (2 cm) right inguinal lymph node. Elective excision of this lymph node was conducted due to unresolving pain, and a pigmented node was retrieved. Although a suspicious finding, histologic examination demonstrated black pigment infiltration from a decorative tattoo on the right leg.
Amil Rafiq
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.012
Published online: April 19 2013
xMeningococcal meningitis has been known to have a high fatality rate. A high degree of suspicion is required for early recognition and timely intervention. In this report, a case of a young male is presented who came to the emergency department with predominately lower gastrointestinal symptoms but was diagnosed with meningococcal meningitis and managed accordingly.
Sarah E. Frasure, Turandot Saul, Resa E. Lewiss
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.013
Published online: April 22 2013
xWe report a case where an emergency physician using bedside ocular ultrasound was able to diagnose vitreous hemorrhage and lens dislocation in an elderly patient. Bedside ultrasound performed by a physician trained in this imaging modality can diagnose ocular emergencies, facilitating appropriate consultation and treatment.
Matthew M. Fort, Rob Gathings, Mark C. Domanski
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.015
Published online: May 13 2013
xA 58-year-old man presented to the emergency department with a persistent left-sided sore throat of 2-month duration. The sore throat had not responded to antibiotic therapy. Over the past week, the soreness had increased and was aggravated by opening the mouth. He denied fever but admitted to a 10-lb weight loss. His social history was significant for alcohol and tobacco use. Physical examination revealed a bulging and erythematous left soft palate with a deviated uvula. Areas of the tonsil were noted to be ulcerating through the soft palate.
Terman Gümüş, Düzgün Yıldırım, Gökhan Uçar,
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.018
Published online: April 19 2013
xMany patients present for emergency services after electric injuries or require defibrillation during emergency services. Although the defibrillation process is safe, skin burns and myocardial injuries are reported after defibrillation procedures. There are limited data about the complications of defibrillation. In the case reported here, a lung injury and a small pneumothorax were observed after defibrillation. To the best of our knowledge, this is the first reported case in which computed tomography is used to demonstrate that a trace of electric current passed through the lung.
