Rui-Xue Xu, Ye-Kuo Li, Ting Li, Sha-Sha Wang, Gui-Zhong Yuan, Qun-Fang Zhou, Hai-Rong Zheng, Fei Yan
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.013
Published online: August 21 2013
xThe objective of this study is to evaluate the diagnostic value of real-time 3-dimensional contrast-enhanced ultrasound in the hemorrhage of blunt renal trauma.
Chih-Yuan Fu, Yu-Tung Wu, Chien-Hung Liao, Shih-Ching Kang, Shang-Yu Wang, Yu-Pao Hsu, Being-Chuan Lin, Kuo-Ching Yuan, I-Ming Kuo, Chun-Hsiang Ouyang
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.044
Published online: August 23 2013
xPatients with pelvic fracture usually require transfers to trauma centers for additional advanced treatment. Patient safety during the transfer should always be a priority. The noninvasive pelvic circumferential compression device (PCCD) can reportedly provide a tamponade effect, which reduces hemorrhage. In the present study, we evaluated the feasibility and efficiency of PCCD in patients with pelvic fracture who required transfer to trauma centers.
Matthew B. Levine, Andrew B. Moore, Chris Franck, Jie Li, Damon R. Kuehl
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.003
Published online: September 3 2013
xVariation in computed tomography (CT) use between emergency medicine (EM) physicians may delineate appropriate or inappropriate use. We hypothesize that variation in all types of CT use exists between providers and their use in patients with common chief concerns. We determine EM physicians' variability in CT use of all types and whether high use in one area predicts use of other CT types.
David Hörburger, Istepan Kurkciyan, Fritz Sterz, Andres Schober, Mathias Stöckl, Peter Stratil, Thomas Uray, Christoph Testori, Christoph Weiser, Moritz Haugk
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.005
Published online: September 9 2013
xThe aim of the study was to evaluate the epidemiology and outcome after cardiac arrest caused by intoxication.
Jeffrey Wiswell, Kenyon Tsao, M. Fernanda Bellolio, Erik P. Hess, Daniel Cabrera
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.018
Published online: August 23 2013
xSystem 1 decision-making is fast, resource economic, and intuitive (eg, “your gut feeling”) and System 2 is slow, resource intensive, and analytic (eg, “hypothetico-deductive”). We evaluated the performance of disposition and acuity prediction by emergency physicians (EPs) using a System 1 decision-making process.
Yunsur Çevik, Nurettin Özgür Doğan, Murat Daş, Onur Karakayalı, Orhan Delice, Cemil Kavalcı
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.021
Published online: September 9 2013
xThe aim of this study was to investigate the factors affecting in-hospital mortality among geriatric trauma patients who presented to the emergency department (ED) following a motor vehicle collision.
Clément Buléon, Jean-Jacques Parienti, Laurent Halbout, Xavier Arrot, Hélène De Facq Régent, Dan Chelarescu, Jean-Luc Fellahi, Jean-Louis Gérard, Jean-Luc Hanouz
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.029
Published online: September 13 2013
xCardiac arrest survival depends on celerity and efficiency of life support action. Guidelines emphasized the chest compression (CC) quality and feedback devices are encouraged. The purpose is to study the impact of the CPRmeter feedback device on resuscitation performed by untrained rescuers.
Athanasios Chalkias, Nikolaos Vogiatzakis, Konstantinos Tampakis, Maria Kalafati, Lila Papadimitriou, Theodoros Xanthos
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.030
Published online: September 12 2013
xTo evaluate the effect of one-hand chest compression while continuously maintaining an open airway (OCOA) on rescue breath-associated hands-off time (RAHO) during single-lay rescuer cardiopulmonary resuscitation (CPR).
Yoshio Tanaka, Hiroshi Yamada, Shuji Tamasaku, Hideo Inaba
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.031
Published online: September 12 2013
xAmbulance response time is a major factor associated with survival in out-of-hospital cardiac arrests (OHCAs); the fast emergency vehicle pre-emption system (FAST™) aids response time by controlling traffic signals. This eight-year observational study investigated whether FAST™ implementation reduced response times and improved OHCA outcomes.
Chih-Hung Wang, Chien-Hua Huang, Wei-Tien Chang, Min-Shan Tsai, Sot Shih-Hung Liu, Cheng-Yi Wu, Yi-Chia Lee, Zui-Shen Yen, Cheng-Chung Fang, Wen-Jone Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.033
Published online: September 13 2013
xBiphasic defibrillation is more effective than monophasic one in controlled in-hospital conditions. The present review evaluated the performance of both waveforms in the defibrillation of patients of out-of-hospital cardiac arrest (OHCA) with initial ventricular fibrillation (Vf) rhythm under the context of current recommendations for cardiopulmonary resuscitation.
Ethan J. Halpern, Jacob P. Deutsch, Maria M. Hannaway, Adrian T. Estepa, Anand S. Kenia, Kenneth J. Neuburger, David C. Levin
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.001
Published online: September 12 2013
xThe objective of the study is to evaluate cardiac risk factors and risk scores for prediction of coronary artery disease (CAD) and adverse outcomes in an emergency department (ED) population judged to be at low to intermediate risk for acute coronary syndrome.
Kensuke Nakamura, Kiyomi Yamane, Kazuaki Shinohara, Kent Doi, Ryota Inokuchi, Takahiro Hiruma, Susumu Nakajima, Eisei Noiri, Naoki Yahagi
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.003
Published online: September 4 2013
xIt is known that patients with convulsion often present hyperammonemia. The elevation of ammonia levels in convulsion is considered to occur along with extensive muscle contractions, but the details remain unclear. In emergency pathologies, such as cardiopulmonary arrest or hemorrhagic shock without muscle contraction, red blood cells are known to produce ammonia through acidosis, leading to hyperammonemia. A similar effect would be considered to be involved in idiopathic epileptic seizure patients as well.
Shih-Yu Cheng, Hui-Ting Wang, Chi-Wei Lee, Tsung-Cheng Tsai, Chi-Wei Hung, Kuan-Han Wu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.004
Published online: September 11 2013
xThe aims of this study were (1) to identify the characteristics of patients who return to the emergency department (ED) within 72 hours and are admitted to the hospital and (2) to identify the characteristics and predictors of in-hospital mortality subgroup.
Frank C. Messina, Michele A. McDaniel, Adam C. Trammel, Denise R. Ervin, Mary Ann Kozak, Christopher S. Weaver
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.007
Published online: September 12 2013
xMany patients discharged from the emergency department (ED) require urgent follow-up with specialty providers. We hypothesized that a unique specialty referral mechanism that minimized barriers would increase follow-up compliance over reported and historical benchmarks.
Ming-Ling Wu, Jou-Fang Deng, Yi Chen, Wei-Lan Chu, Dong-Zong Hung, Chen-Chang Yang
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.001
Published online: August 8 2013
xRactopamine is a leanness-enhancing agent approved in the United States and 26 other countries to reduce body fat content, increase muscle mass, and improve growth rate of certain food-producing animals. Other β-agonists with stronger pharmacologic effects, especially clenbuterol, had been illegally used as leanness-enhancing agents in the United States, China, and the European Union, and foodborne poisonings related to clenbuterol residue in meat or liver were rarely reported in the European Union and China.
Yasuaki Koyama, Takafumi Wada, Brandon D. Lohman, Yuka Takamatsu, Junichi Matsumoto, Shigeki Fujitani, Yasuhiko Taira
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.002
Published online: August 21 2013
xThe objective of the study is to demonstrate the utility of near-infrared spectroscopy (NIRS) in evaluating chest compression (CC) quality in cardiac arrest (CA) patients as well as determine its prognosis predictive value.
Arif Akkaya, Murat Yesilaras, Ersin Aksay, Mustafa Sever, Ozge Duman Atilla
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.006
Published online: September 6 2013
xUltrasonography (US) has gained popularity in the emergency medicine to assess intravascular volume status in critically ill patients. However, there are a limited number of studies on the interrater reliability of US examination of the inferior vena cava (IVC) by emergency residents.
Shan W. Liu, John T. Nagurney, Yuchiao Chang, Blair A. Parry, Peter Smulowitz, Steven J. Atlas
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.006
Published online: September 12 2013
xTo determine whether frequent emergency department (ED) users are more likely to make at least one and a majority of visits for mental health, alcohol, or drug-related complaints compared to non-frequent users.
Carolyn L. Gardiner, Krista Handyside, Justin Mazzillo, Mandy J. Hill, Eric F. Reichman, Yashwant Chathampally, Brent R. King
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.027
Published online: September 6 2013
xEmergency physicians may have difficulty removing modern rings made of hard metals such as titanium and tungsten carbide. These metals are exceptionally difficult or impossible to remove using standard ring cutters. Numerous alternative techniques for removal have been described, including the “umbilical tape” or “string technique” and, in the case of tungsten carbide, breaking the ring using locking pliers.
Arjun K. Venkatesh, Jeremiah D. Schuur
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.019
Published online: September 3 2013
xUnited States health care costs are growing at an unsustainable rate; one significant contributor has been the overuse of health services. Physicians have a professional ethical obligation to serve as stewards of society’s resources and take responsibility for health care costs. We propose a framework for identifying overused services and a research and implementation agenda to guide stewardship efforts to demonstrate the value of emergency care. Examples of interventions to reduce the cost of emergency care along six value streams are discussed: laboratory tests, high-cost imaging, medication administration, intravenous fluids and medications, hospital admissions and post-discharge care.
Kimitoshi Kimura, Hitoshi Mori, Hiroshi Kitaguchi, Fusae Yamao, Katsuro Shindo
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.024
Published online: August 12 2013
xPulmonary embolism (PE) is not rare, with an overall annual incidence of 60 to 70 cases per 100 000 [1]. Pulmonary embolism presents typically with cardiopulmonary symptoms. In some cases, however, patients present with neurologic symptoms such as syncope and a convulsion [2], which makes clinical evaluation compromised and results in delayed diagnosis. There are only a few case reports about seizures related to PE. The clinical characteristics of such cases remain unclear. The objective of this study is to elucidate them.
Donald Byars, Alicia Devine, Christopher Maples, Alexander Yeats, Krista Greene
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.042
Published online: September 3 2013
xThe use of the focused assessment with sonography for trauma (FAST) examination has become standard practice over the past 10 years in the evaluation of patients with suspected abdominal trauma. It is generally accepted in trauma algorithms as an extension of the physical examination. Currently, it is used primarily to identify the need for an expedited emergency laparotomy in the hemodynamically unstable patient, unable to tolerate a computed tomographic (CT) scan. In hemodynamically stable patients, however, especially those with low-risk injury by history and physical examination, the role of the FAST examination to exclude further diagnostic testing is less studied.
Diego Conde
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.045
Published online: August 2 2013
xMost coronary artery anomalies are discovered accidentally during coronary angiography or autopsy [1-4]. As coronary angiography is routinely used to evaluate coronary morphology for diagnostic and treatment of coronary disease, it is important to be aware of these anatomical variants. In the present study, we examined the overall frequency in an Argentinean population and described the different forms of anomalous aortic origins of coronary arteries and the association with the coronary arteriosclerosis disease in the anomalous coronary arteries.
Hesham R. Omar, Collin Sprenker, Rachel Karlnoski, Devanand Mangar, Jordan Miller, Enrico M. Camporesi
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.009
Published online: August 16 2013
xThe incidence of retained guidewire (GW) after central vein catheterization with a central venous catheter (CVC) or Swann-Ganz catheter (SGC) is unknown and likely underreported. Missing part of or the whole GW during CVC placement has previously been described [1-6]. In an attempt to study the magnitude of this complication, an institutional review board–approved retrospective study of patients admitted to our 1018-bed facility between January 2011 and February 2013 was conducted. All interventional radiology (IR) reports that were coded for a “retained foreign body” were reviewed, and only cases with retained GWs were included.
Yusuf Emrah Eyi, Yakup Aksoy, Emre Zorlu, Abdullah Kaya, Kadir Ozturk, Kadir Colakoglu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.015
Published online: August 19 2013
xWe read with great interest the article “Neuron-specific enolase and S100B protein in children with carbon monoxide poisoning: children are not just small adults” written by Akelma et al [1]. The authors aimed in this study to evaluate the role of S100B protein and neuron-specific enolase (NSE) in children with carbon monoxide (CO) poisoning. They concluded that NSE levels increase in CO-associated hypoxic brain damage in accordance with clinical findings and contrary to the studies conducted on adults, S100B protein levels do not increase in response to hypoxic brain damage.
Ahmet Zulfikar Akelma, Aydin Celik,, Osman Ozdemir, Fatma Kavak Akelma
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.014
Published online: August 12 2013
xS100B has been shown to increase in patients with cardiac arrest, stroke, subarachnoid hemorrhage, and traumatic and hypoxic brain damage [1-4]. In contrast to adult studies, we found that serum S100B protein levels did not increase in pediatric patients with carbon monoxide (CO) poisoning [5]. Patients with a positive history of CO exposure and elevated blood carboxyhemoglobin (>10%) levels associated with relevant clinical findings were diagnosed with CO poisoning. The most common complaints were headache (n = 27), dizziness (n = 27), nausea and vomiting (n = 28), syncope (n = 7), and convulsion (n = 2).
Subramanian Senthilkumaran, Ritesh G. Menezes, Srinivasan Jayaraman, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.016
Published online: August 19 2013
xWith reference to the case of Gümüş et al [1], we would like to share our experience on isolated undisplaced sternal fracture, a yet another complication after cardioversion less often recognized and/or documented. A 38-year-old man was referred to emergency department (ED) from a peripheral hospital after an episode of sustained monomorphic ventricular tachycardia, which was converted to sinus rhythm with amiodarone. Before this event, he had dizziness associated with profuse sweating, nausea, and palpitation.
Sevket Balta, Sait Demirkol, Ugur Kucuk, Murat Unlu, Zekeriya Arslan, Turgay Celik
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.022
Published online: September 9 2013
xWe read the article “Predictive cutoff point of admission N-terminal pro–B-type natriuretic peptide (NT-proBNP) testing in the emergency department (ED) for prognosis of patients with acute heart failure (HF)” by Golcuk et al with interest [1]. The authors aimed to determine a cutoff level of plasma NT-proBNP that could successfully predict the short- and long-term prognosis of patients with acute heart failure at the time of admission to the ED. They concluded that elevated NT-proBNP levels at the time of admission are a strong and independent predictor of all-cause mortality in patients with acute heart failure at 30 days and 1 year after admission.
Diego Conde, Florencia Castro, Milagros Caro
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.024
Published online: September 9 2013
xHypertensive urgencies are a frequent cause for consultation at the emergency department (ED). There are multiple approaches to treating this presentation, and we endeavored to assess the safety and efficacy of an oral treatment with 10 mg of ramipril and 12.5 mg of hydrochlorothiazide to treat hypertensive urgencies (which we define as systolic blood pressure of >180 mmHg and/or diastolic blood pressure of >120 mmHg with absence of acute target organ disease in the ED) [1].
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.003
Published online: July 25 2013
xThe article “Occipital lobe epilepsy presenting with visual hallucinations (Charles Bonnet syndrome)” (Am J Emerg Med 2013; 2013 Mar;31(3):624–5) contained an error in the byline. The last author name was transposed. The correct name is Wei Kiong Ngo [Comp: Note surname is Ngo].
Gregor Lindner
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.020
Published online: August 26 2013
xIn the article, “A patient presenting with metabolic acidosis despite severe vomiting—correct diagnosis by use of the physical-chemical approach” in Am J Emerg Med 2013;31:995.e1–995.e2, there was an error in the Table. For the initial base excess, it should be −17.9 (negative).
Mohan Punja, Stewart G. Neill, Stella Wong,
DOI: http://dx.doi.org/10.1016/j.ajem.2013.05.009
Published online: August 12 2013
xIntravenous lipid rescue therapy (LRT) may be implemented to attenuate drug toxicity. Little is known about LRT interference with laboratory tests in overdose settings. A 54-year-old man with a history of depression consumed unknown amounts of diphenhydramine, amitriptyline, and acetaminophen (APAP). Initial workup showed aspartate aminotransferase (AST) of 138 U/L, APAP of 177 μg/mL, and a QRS interval of 136 milliseconds. N-acetylcysteine, sodium bicarbonate, and 20% intravenous LRT were initiated.
Viren Kaul, Syed Haider Imam, Harvir Singh Gambhir, Arindam Sangha, Sravanthi Nandavaram
DOI: http://dx.doi.org/10.1016/j.ajem.2013.05.031
Published online: July 18 2013
xSalicylate poisoning classically results in an increased anion gap metabolic acidosis. We discuss a case of normal anion gap metabolic acidosis despite elevated serum salicylate concentration. This diagnostic dilemma stemmed from aberrant reading of salicylate ions by analyzer electrodes as chloride ions leading to falsely negative anion gap. On review, this phenomenon is found to be possible with a number of commonly used analyzers. In emergency department settings, high level of clinical suspicion for salicylate poisoning should be maintained, and metabolic acidosis with normal anion gap should not be used to rule out salicylate overdose.
Hayri Ogul, Berhan Pirimoglu, Berhan Genc, Ummugulsum Bayraktutan, Mecit Kantarci
DOI: http://dx.doi.org/10.1016/j.ajem.2013.05.033
Published online: June 27 2013
xPelvic digit is a rare congenital anomaly where bone develops in the soft tissue adjacent to normal skeletal bone. Pelvic digits are most often associated with the ilium but may also pseudoarticulate with other pelvic bones or the abdominal wall. Its importance lies in its differentiation from acquired abnormalities due to trauma such as myositis ossificans and avulsion injuries of pelvis. In this article, we present a case of pelvic digit with multiple fractures. To avoid unnecessary investigation methods and treatment, this entity should be kept in mind when an atypical bone structure is noted around the pelvis.
Koichi Sasaki, Masaya Yamato, Keiko Yasuda, Hiromi Rakugi, Yoshitaka Isaka
DOI: http://dx.doi.org/10.1016/j.ajem.2013.05.034
Published online: June 28 2013
xWe report a rare case of rhabdomyolysis caused by peripheral T-cell lymphoma (PTCL) in skeletal muscle. A 62-year-old man was admitted with complaints of sudden muscle weakness. Laboratory abnormalities were identified including markedly elevated creatinine-phosphokinase, peaking at 62,640 IU/L and serum creatinine (Cr) at 5.0 mg/dL. Computed tomography scans revealed tumorous swelling of the right psoas major muscle and the obturator internus muscles. Consequently, he was diagnosed with acute renal failure caused by rhabdomyolysis and was treated with hydration and continuous hemodiafiltration, which resulted in significant improvement in renal function (Cr 1.79 mg/dL).
Carlos J. Roldan, Peter J. Carlson
DOI: http://dx.doi.org/10.1016/j.ajem.2013.05.035
Published online: August 12 2013
xNumerous pathologies diagnosed in the emergency department (ED) are treated with invasive procedures involving anesthetic and surgical risks. Retropharyngeal abscess is a serious condition requiring emergent treatment, often in need of trans-oral incision and drainage under general anesthesia. A misdiagnosis, especially after surgical treatment, might generate undesirable consequences, more so if the final diagnosis is a non-surgical pathology such as longus colli (LC) tendonitis. To discuss the etiology, differential diagnosis and treatment of LC tendonitis, a clinical condition still misdiagnosed despite advanced imaging techniques.
En-Li Shiau, Fu-Zong Wu, Yi-Luan Huang, Ming-Ting Wu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.05.036
Published online: June 21 2013
xA 59-year-old woman presented to emergency department with sudden onset of chest tightness and shortness of breath. Laboratory test revealed elevated d-dimer (1558 ng/mL). The electrocardiogram revealed right axis deviation, S1Q3T3 pattern, and T-wave inversion in leads V1 to V6. Computed tomographic angiography (CTA) was performed with 64-slice computed tomography for suspicious of pulmonary embolism. Contrast-enhanced CTA showed no filling defect in the pulmonary arteries; however, luminal narrowing of the right pulmonary artery was noted.
DOI: http://dx.doi.org/10.1016/S0735-6757(13)00581-0
Published in issue: October 2013
DOI: http://dx.doi.org/10.1016/S0735-6757(13)00582-2
Published in issue: October 2013
DOI: http://dx.doi.org/10.1016/S0735-6757(13)00583-4
Published in issue: October 2013
DOI: http://dx.doi.org/10.1016/S0735-6757(13)00584-6
Published in issue: October 2013
