Deborah B. Diercks, Michael C. Kontos, Judd E. Hollander, Bryn E. Mumma, DaJuanicia N. Holmes, Stephen Wiviott, Jorge F. Saucedo, James A. de Lemos
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.001
Published online: May 22 2013
xAmerican Heart Association/American College of Cardiology guidelines recommend that patients with definite unstable angina or non–ST-segment elevation myocardial infarction (NSTEMI) receive dual antiplatelet therapy on presentation to the hospital when undergoing early invasive management or “as soon as possible” after admission when being managed conservatively. The guidelines do not specify whether these medications should be administered in the emergency department (ED). Our aim was to determine whether ED administration of a thienopyridine was associated with clinical outcomes among patients with NSTEMI.
Yuri van der Does, Lex M. van Loon, Jelmer Alsma, Annebel Govers, Benno Lansdorp, Pleunie P.M. Rood, Stephanie C.E. Schuit
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.004
Published online: May 20 2013
xEmergency department (ED) patients are triaged to determine the urgency of care. The Finapres Portapres (FP) measures blood pressure (BP) and cardiac output (CO) non-invasively, and may be of added value in early detection of patients at risk for hemodynamic compromise.
Yun-Xia Chen, Chun-Sheng Li
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.017
Published online: May 20 2013
xThe aims of the present study were to evaluate the prognostic value of adrenomedullin (AM) in septic patients in the emergency department (ED) and to compare it with procalcitonin (PCT) and Mortality in Emergency Department Sepsis (MEDS) score.
Huang Yu, He Qing, Zhan Lei
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.018
Published online: May 20 2013
xCytidine diphosphate choline (CDP-choline) is a cholinergic agent that can both stimulate the cholinergic pathway and increase blood pressure. We aimed to investigate the effects of CDP-choline on the outcome of cardiac arrest in comparison with epinephrine.
Michael J. Ward, Craig M. Froehle, Kimberly W. Hart, Christopher J. Lindsell
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.027
Published online: May 28 2013
xOperational data are often used to make systems changes in real time. Inaccurate data, however, transiently, can result in inappropriate operational decision making. Implementing electronic health records (EHRs) is fraught with the possibility of data errors, but the frequency and magnitude of transient errors during this fast-evolving systems upheaval are unknown. This study was done to assess operational data quality in an emergency department (ED) immediately before and after an EHR implementation.
Taylan Kılıç, Erkan Goksu, Dilek Durmaz, Günay Yıldız
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.029
Published online: May 22 2013
xPrevention of secondary neurologic injury is critical during the airway management of a trauma patient. Trauma patients are assumed to have an unstable cervical spine (C-spine) until proven otherwise: orotracheal intubation during airway management may result in a certain amount of C-spine movement. This study, therefore, aimed to compare C-spine movement within different advanced airway devices (Macintosh blade, McCoy Blade, LMA, I-LMA, and Combitube) during airway management.
Sheng-Hung Kuo, Chin-Feng Tsai, Chi-Rong Li, Shih-Jei Tsai, Wai-Nang Chao, Khee-Siang Chan, Yuan-Ti Lee, Ruey-Hong Wong, Chun-Chieh Chen, Shiuan-Chih Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.030
Published online: May 22 2013
xVibrio vulnificus causes potentially life-threatening and rapidly progressing infections. Therefore, the severity-of-illness assessment appears to be important for V vulnificus–infected patients at the time of admission. The aim of our study was to evaluate the performance of the severity-of-illness scoring model on admission in V vulnificus–infected patients.
Margarita E. Pena, James M. Fox, Anthony C. Southall, Robert B. Dunne, Susan Szpunar, Stephen Kler, Robert B. Takla
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.035
Published online: May 23 2013
xTo compare efficiency and cost-effectiveness of an observation unit (OU) when managed as a closed unit vs an open unit.
R. Andrew Taylor, Neel S. Iyer
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.039
Published online: May 22 2013
xThe objective of this study is to determine at what probability of thoracic aortic dissection (TAD) to use a computed tomographic angiography (CTA) or a d-dimer test.
Sabine Schuh, Gregor Lindner, Aristomenis K. Exadaktylos, Kathrin Mühlemann, Martin G. Täuber
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.042
Published online: May 22 2013
xThe purpose was to study the emergency management of patients with suspected meningitis to identify potential areas for improvement.
Chun-Yu Chen, Yan-Ren Lin, Lu-Lu Zhao, Wen-Chieh Yang, Yu-Jun Chang, Han-Ping Wu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.047
Published online: May 22 2013
xThis study aimed to determine the clinical factors in predicting acute renal failure (ARF) in rhabdomyolysis and investigate the potential risk of renal replacement therapy (RRT).
Changwoo Kang, Kyuseok Kim, Soo Hoon Lee, Chanjong Park, Joonghee Kim, Jae Hyuk Lee, You Hwan Jo, Joong Eui Rhee, Dong Hoon Kim, Seong Chun Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.048
Published online: April 29 2013
xThere are no guidelines regarding the hospitalization of female patients with acute pyelonephritis (APN); therefore, we performed a retrospective analysis to construct a clinical prediction model for hospital admission.
Andreas Claesson, Henrik Druid, Jonny Lindqvist, Johan Herlitz
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.004
Published online: May 22 2013
xThe aim of this study is to determine the prevalence of cardiac disease and its relationship to the victim's probable intent among patients with cardiac arrest due to drowning.
Yahya Kemal Gunaydin, Yavuz Katirci, Hikmet Duymaz, Kubilay Vural, Huseyin Cahit Halhalli, Mehtap Akcil, Figen Coskun
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.006
Published online: May 22 2013
xThe aim of this study was to compare the hyperpronation (HP) and the supination-flexion (SF) reduction techniques for reducing nursemaid's elbow in terms of efficacy and pain.
Dustin D. French, Curtis E. Margo
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.052
Published online: May 20 2013
xThis work aimed to study the demographic features of patients with emergency department (ED) visits for ulcerative keratitis, including information on insurance coverage and on-site consultant support.
Yongzhen Zhao, Chunsheng Li, Yumei Jia
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.008
Published online: May 22 2013
xTo determine an effective method for predicting severity of sepsis and 28-day mortality of emergency department (ED) patients, we compared the Mortality in Emergency Department Sepsis (MEDS) score with procalcitonin (PCT), interleukin-6 (IL-6), and C-reactive protein (CRP) and evaluated the MEDS score combined with relevant biomarkers.
Jeong Ho Park, Jung Hee Wee, Seung Pill Choi, Kyu Nam Park
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.012
Published online: May 22 2013
xPredicting medical outcomes for acute pyelonephritis (APN) in women is difficult. Delay in diagnosis and treatment often results in rapid progression to circulatory collapse, multiple-organ failure, and death. The aim of this study was to investigate the value of procalcitonin (PCT) level in women with APN at ED.
Ryan E. Wilson, Herman S. Kado, Robert F. Percy, Ryan C. Butterfield, Joseph Sabato Jr, Joel A. Strom, Lyndon C. Box
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.013
Published online: May 24 2013
xST-elevation myocardial infarction (STEMI) identification by emergency medicine services (EMS) leading to pre-hospital catheterization laboratory (CL) activation shortens ischemic time and improves outcomes. We examined the incremental value of addition of a screening clinical tool (CT), containing clinical information and a Zoll electrocardiogram (ECG)-resident STEMI identification program (ZI) to ZI alone.
Jaimi H. Greenslade, Louise Cullen, Martin Than, Sally Aldous, Kevin Chu, Anthony F.T. Brown, A. Mark Richards, Christopher J. Pemberton, Peter George, William A. Parsonage
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.016
Published online: May 22 2013
xThe objective of this study is to evaluate the accuracy of the Vancouver Chest Pain Rule using troponin as the only biomarker in an emergency department (ED) setting.
C. Anthoney E. Lim, Bradley J. Kaufman, John O’Connor Jr., Sandra J. Cunningham
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.018
Published online: May 23 2013
xMost medications administered to children are weight-based, and inaccurate weight estimation may contribute to medical errors. Previous studies have been limited to hypothetical patients and those in cardiopulmonary arrest. We aim to determine the accuracy of weight estimates by Emergency Medical Services (EMS) personnel of children receiving medications and to identify factors associated with accuracy.
Yi-Ming Weng, Yu-Hui Chiu, Jiun-Jen Lynn, Wen-Cheng Li, Shih-Hao Wang, Wei-Fong Kao, Tai-Yi Hsu, Te-Fa Chiu, Yu-Jr Lin, Chang-Wei Chan
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.028
Published online: May 20 2013
xThe objective of this study is to determine the association between the duration of high-altitude (>3000 m) pre-exposure and acute mountain sickness (AMS) incidence.
Akira Mikami, Sachiko Ohde, Gautam A. Deshpande, Toshiaki Mochizuki, Norio Otani, Shinichi Ishimatsu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.034
Published online: May 20 2013
xWe aimed to generate equation to predict arterial lactate (a-Lac) using venous lactate (v-Lac) and other lab data.
Jonathan G. Rogg, J. Tyler Rubin, Paul Hansen, Shan W. Liu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.037
Published online: May 22 2013
xHealth care costs continue to rise; reducing unnecessary laboratory testing may reduce costs. The goal of this study was to calculate the frequency and estimated costs of repeat normal laboratory testing of patients transferred to a tertiary care emergency department (ED).
Brian Price, Annette O. Arthur, Michael Brunko, Pam Frantz, Joshua O. Dickson, Tom Judge, Stephen H. Thomas
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.041
Published online: May 22 2013
xRecent drug shortages have required the occasional replacement of etomidate for endotracheal intubation (ETI) by helicopter emergency medical services (HEMS), with ketamine. The purpose of this study was to assess whether there was an association between ketamine vs etomidate use as the main ETI drug, with hemodynamic or clinical (airway) end points.
Burkhard Simma, Jürg Lütschg, James M. Callahan
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.007
Published online: May 22 2013
xMild head injury is of interest because of a history of under diagnosis and underestimated clinical importance. Half of the patients with mild head injuries or concussions have sport-related injuries. Knowledge of symptoms and appropriate management can be improved and is a matter of practical interest. Several algorithms exist for discharge, admission or for cranial computed tomography (CT).These employ different risk factors and calculate their sensitivity of correctly identifying children with traumatic brain injury (TBI).
Goran P. Koracevic
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.015
Published online: May 20 2013
xTroponins are proteins of a tropomyosin complex of striate muscle myocytes. The troponin complex consists of 3 specific proteins: troponin C (calcium-binding subunit), troponin T (tropomyosin-binding subunit), and troponin I (actin-binding subunit, which inhibits contraction) [1]. Cardiac troponins (cTn) I and T are crucial for the diagnosis of Acute Myocardial Infarction (AMI), allowing for the diagnosis of AMI to occur earlier than was possible. This is particularly the case in the setting of non–ST-elevation myocardial infarction.
Subramanian Senthilkumaran, Ritesh G. Menezes, Narendra Nath Jena, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.032
Published online: May 24 2013
xThe case report by Bauer et al is indeed interesting [1]. Rapid reversal of marked respiratory distress following methylene blue (MB) administration in a normotensive patient is of recent information. However, few aspects of the report require contemplation.
Cindy S. Bauer, Peter Vadas, Kevin J. Kelly
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.031
Published online: May 15 2013
xWe wish to thank the authors for their comments concerning our report [1] about the use of methylene blue to treat refractory anaphylaxis. We are entirely in agreement with the need to balance the potential risks and benefits of interventions, particularly in life-threatening situations. Given the limited experience with the use of methylene blue as a salvage medication in refractory anaphylaxis, we would emphasize that the decision to use this drug must be deliberated carefully only after other, more conventional, treatment options have been considered [2].
Diego Conde, Juan Pablo Costabel, Roberto Campos, Marcelo Trivi
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.036
Published online: May 20 2013
xHigh-sensitive troponin T (hsTnT) has been associated with diagnosis and prognostic of acute coronary syndromes, and it is useful in the chest pain unit, but its relationship with the extension and severe coronary lesions in the acute coronary syndromes is not well established [1-5].
Shih-Hao Wang, Kuo-Feng Huang
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.043
Published online: May 22 2013
xSchool-aged children high-altitude traveling has become more and more popular in recent years. The incidence of acute mountain sickness (AMS) for school-aged children was reported to be 37.5% after traveling for 3450 m, and children with AMS rarely need emergency evacuation [1]. However, many children may develop AMS in a large children group high-altitude trekking activity, and the emergency physicians may manage many ill children during the trekking at daytime or in a high-altitude sleeping hut at night.
Sevket Balta, Sait Demirkol, Mustafa Hatipoglu, Sukru Ardic, Mehmet Aydogan, Turgay Celik
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.045
Published online: May 22 2013
xWe have read with great interest the recently published article entitled “Red cell distribution width (RDW) as a prognostic marker in patients with community-acquired pneumonia (CAP)” by Jae Hyuk Lee and coworkers [1]. In that very well-presented article, they aimed to evaluate the association of RDW with mortality and to determine the prognostic significance of RDW in patients with CAP. They concluded that a higher RDW was associated with increased 30-day mortality in patients with CAP, and this effect was especially pronounced in patients with an RDW greater than 15.2%.
Diego Conde, Juan Pablo Costabel, Gustavo Pedernera, Marcelo Trivi
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.046
Published online: May 22 2013
xHigh-sensitive troponin T (hsTnT) has been associated with diagnosis and prognostic of acute coronary syndromes, and it was associate in some studies with the extension and severe coronary lesions in the acute coronary syndromes without ST elevation, but it is not well established the relationship with the extension and severe coronary lesions in patients with an acute coronary syndrome with ST elevation (STEMI) [1-5].
John E. Madias
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.049
Published online: May 28 2013
xPhysicians who have encountered in the emergency department (ED) patients with chest pain and/or palpitations, subsequently proven to be due to panic attacks (PAs), have a first-hand experience of the difficulties in differentiating PAs from acute coronary syndromes (ACSs) or Takotsubo syndrome (TTS). Past history identifies patients who have been admitted with 1 of the above 3 conditions, although this does not exclude that 1 of the other 2 is responsible for the index presentation. Based on the electrocardiogram (ECG) findings, the present and past history, and the course of symptoms, the patients enter 3 different diagnostic/management pathways of the “single pathology” model, discounting that often “mixed pathologies” precipitate an illness.
Rui Providência, Sérgio Barra, Luís Paiva
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.001
Published online: May 22 2013
xWe have read with great interest the article by Conti et al [1] concerning the role of elevated cardiac troponin I (cTnI) as a predictor of poor outcome in patients presenting to the emergency department (ED) with atrial fibrillation (AF) lasting for less than 12 hours.
Alberto Conti, Yuri Mariannini, Erica Canuti
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.002
Published online: May 22 2013
xThe role of new onset atrial fibrillation (AF) as a marker of thromboembolic risk has been demonstrated in the setting of acute myocardial infarction [1-3]. Thus, someone might inquire the role of acute AF in patients with abnormal troponin not fulfilling criteria of acute myocardial infarction and might question if the minor reported range of troponin I (cTn-I) values in the study population of Conti et al [4] (from 0.15 to 7.0 ng/mL) may not be linked with a secondary ischemic mechanism, likely an imbalance between demand and supply [5].
Hatice Tatar Aksoy, Zeynep Eras, Emre Canpolat, Uğur Dilmen
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.003
Published online: May 24 2013
xWe read with great interest the recent original article by Jo et al [1] published recently in this journal, which demonstrated that red cell distribution width (RDW) was associated with 28-day mortality in patients with severe sepsis and septic shock. The authors stated that 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. In addition, RDW had a relationship with the severity of the patients and was an independent prognostic factor of 28-day mortality in patients with severe sepsis and septic shock.
Xiequn Xu, Tao Hong, Binglu Li, Wei Liu, Chaoji Zheng, Xiaodong He
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.023
Published online: April 22 2013
xThis report presents the case of a 59-year-old man with sudden severe pain in the right lower abdomen after manually reducing the right indirect inguinal hernia who had bilateral indirect inguinal hernia for 5 years. A subsequent contrast computed tomography scan with contrast of the abdomen and pelvis revealed a significant extensive retroperitoneal hematoma at the abdomen and pelvis of the right side. There was contrast leaked out, which was suspected from inferior epigastric artery. He underwent successful laparotomy.
Neeraj Chhabra, Scott C. Sherman, Jan P. Szatkowski
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.029
Published online: April 12 2013
xCalcaneal fractures account for 60% of all tarsal bone fractures. Tongue-type calcaneus fractures are longitudinal fractures that exit the calcaneal tuberosity posteriorly and involve a portion of the articular surface. They are often superiorly displaced because of the insertion of the Achilles tendon and pull of the gastroc-soleus complex. Skin compromise complicates a large percentage of these injuries because of the thin layer of soft tissue and superficial nature of the fracture. Early recognition by the emergency physician and prompt operative repair prevent further injury and obviate the need for surgical soft tissue coverage or potential amputation.
Yosuke Matsumura, Taka-aki Nakada, Yoshiro Kobe, Noriyuki Hattori, Shigeto Oda
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.030
Published online: May 20 2013
xThe major symptoms of median arcuate ligament syndrome, celiac axis stenosis, or occlusion compressed by the median arcuate ligament include eating-associated abdominal pain and weight loss. Because celiac stenosis increases retrograde collateral blood flow from the superior mesenteric artery to the celiac artery via the pancreaticoduodenal arcade, a pancreaticoduodenal artery aneurysm could occur at a low incidence rate. Rupture of the pancreaticoduodenal artery aneurysm and hemorrhagic shock are rare.
Fabienne Jenni, Bernd Yuen, Barbara Lienhardt, Gabriela Fahrni
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.033
Published online: April 19 2013
xWe report on a 35-year-old man who presented to the emergency department with acute abdominal pain, postural hypotension, and tachycardia after having been diagnosed with Epstein-Barr virus infection 1 week before. Abdominal ultrasound and computed tomography revealed splenic rupture, and the patient underwent successful proximal angiographic embolization of the splenic artery. The course was complicated by painful splenic necrosis and respiratory insufficiency due to bilateral pleural effusions.
Thuy V. Pham, Jose V. Nable
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.034
Published online: April 19 2013
xAortic dissections can be challenging to diagnose in the emergency department (ED) because patients can present with a variety of complaints. We present a case involving a woman with multiple comorbidities, who had experienced intermittent abdominal pain for several months, which worsened in the days leading up to her ED visit. She was diagnosed with pancreatitis based on her history and blood work but, incidentally, on computed tomographic scan, also was found to have a Stanford type B aortic dissection.
Jin-Li Chen, Tai-Lung Cha, Sheng-Tang Wu, Shou-Hung Tang, Chih-Wei Tsao, En Meng
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.036
Published online: May 15 2013
xRenal infarction is an uncommon condition that resulted from inadequate perfusion of the kidney and is easily missed diagnosed due to its nonspecific clinical presentations. Major risk factors for renal infarction are atrial fibrillation, previous embolism, and ischemic and valvular heart disease. Progressive decrease in renal function or even death can occur if renal infarction is not diagnosed accurately and promptly. Ketamine abuse may cause variable urinary tract injury. However, renal infarction caused by ketamine abuse has never been reported.
Kovid Trivedi, Vesna Borovnik-Lesjak, Raúl J. Gazmuri
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.007
Published online: May 20 2013
xThe 2010 guidelines for cardiopulmonary resuscitation recommends that the chest be compressed at least 5 cm, with evidence that depths exceeding 5 cm may further aid resuscitation. The current piston-based mechanical device LUCAS 2TM is programmed to deliver a compression depth of 5 cm. We report 2 cases in which the LUCAS 2TM device failed to generate physiological surrogates of blood flow (ie, end-tidal carbon dioxide tension and aortic diastolic blood pressure) at levels indicative of effective chest compressions.
Cristina Bologa, Catalina Lionte, Adorata Coman, Laurentiu Sorodoc
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.010
Published online: May 20 2013
xWe present a case of diltiazem overdose in which the patient ingested 5.6 g in an apparent suicide attempt. She was admitted in the emergency department 2 hours postingestion with cardiodepressive syndrome. She was treated with gastric lavage, activated charcoal, intravenous fluids, calcium, and epinephrine, without improvement in vital signs. We gave her an infusion of 20% intralipid, leading to a favorable evolution. The patient was stable hemodynamically and metabolic in the following 24 hours.
Slavco Toncev, Sasa Sretenovic, Slobodanka Mitrovic, Gordana Toncev
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.011
Published online: May 22 2013
xWe present an unusual case of tibial nerve compression caused by a true tibial posterior artery aneurysm. A 61-year-old man was admitted to the emergency department due to suspected muscle rupture. He had experienced a sudden, intense right calf pain and swelling that had begun during walking. He had a 6-month-long history of symptoms suggestive to the tibial nerve dysfunction and a month-long history of neurologic finding consistent with the right tibial nerve paresis. An examination of the legs revealed a painful mass in the posterior-medial compartment of the right calf.
Wen-Sou Lin, Hung-Wen Kao, Chun-An Cheng
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.013
Published online: May 20 2013
xPanspinal epidural abscess is an extremely rare condition that can potentially lead to major permanent neurological deficits if treatment is delayed or suboptimal. Most patients with spinal epidural abscess have a short segment of vertebrae involved and classically present with fever, low back pain, and focal neurologic deficit. In severe cases, meningitis and septic shock may occur and lead to death. Therefore, the condition requires prompt recognition and proper intervention. Herein, we report the case of a 41-year-old diabetic man who presented at our hospital with the symptoms of headache, quadriplegia with respiratory distress and low back pain.
Ye Xin-He, Yang Cheng-Jian, Jin Yan, Xu Xin, Cao Jia-Ning, Yang Zhen-Jie, Dong Feng
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.019
Published online: May 20 2013
xSpontaneous coronary artery dissection (SCAD) is a rare and lethal myocardial ischemic event, which usually causes acute coronary syndrome and sudden death. Emergency management of SCAD includes medical treatment, percutaneous coronary interventions, and coronary artery bypass grafting. Here, we report 1 case of 37-year-old young woman who was found to have a mid-distal SCAD of the left anterior descending artery, taking conservative management decision. In another case of a 50-year-old woman who was found to have a proximal-middle spiral SCAD of the right coronary artery, she underwent coronary angioplasty.
Patompong Ungprasert, Kunatum Prasidthrathsint, Nitipong Permpalung, Narat Srivali, Quanhathai Kaewpoowat
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.024
Published online: May 20 2013
xNon–type B Haemophilus influenzae emerges as a new pathogen in the post H. influenzae serotype b vaccine era. We describe a case of polyarticular septic arthritis caused by H. influenzae serotype f in an adult. The patient was successfully treated with surgical debridement and antibiotic. To the best of our knowledge, this is the fourth reported case of H. influenzae serotype f septic arthritis in adults.
Karthik Tummala, Vijay K. Maniyal, Rajiv Chandrashekaran, Navin Mathew, Gaurav Ganeshwala
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.025
Published online: May 23 2013
xA 62-year-old male smoker with no other comorbidities presented to emergency department with systemic anaphylaxis, due to oral diclofenac for toothache. He developed acute anterior wall myocardial infarction following IM epinephrine 1 mg 1:1000. Primary percutaneous coronary intervention was done, which showed a thrombus in the mid left anterior descending artery with no evidence of obstructive coronary artery disease after thrombus aspiration.
Naoko Ohashi, Kensuke Nakamura, Ryota Inokuchi, Hajime Sato,, Kurato Tokunaga, Tatsuma Fukuda, Susumu Nakajima, Naoki Yahagi
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.033
Published online: May 22 2013
xEDTA-dependent pseudothrombocytopenia (EDTA-PTCP) is a phenomenon that occurs in vitro when EDTA reacts with harvested blood. EDTA-dependent pseudothrombocytopenia usually does not indicate thrombocytopenia in vivo. Here, we report the first case of EDTA-PTCP complicated by eosinophilic pneumonia. A 70-year-old man with rectal cancer was admitted to the hospital for a liver abscess and rectal cancer. At the time of admission, his platelet count was 20000/μL, but a peripheral blood smear showed platelet aggregation and the platelet count for a kanamycin-added EDTA blood sample was 180000/μL.
