In-Chang Hwang, Yong-Jin Kim, Kyung-Hee Kim, Dong-Ho Shin, Seung-Pyo Lee, Hyung-Kwan Kim, Dae-Won Sohn
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.007
Published online: October 21 2013
xThis study investigated the diagnostic yield of invasive coronary angiography (CAG) and the impact of noninvasive test (NIV) in patients presented to emergency department (ED) with acute chest pain.
Antonia L. Vilella, Charles F. Seifert
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.008
Published online: October 21 2013
xTo determine the effectiveness of antibiotic regimens and time to antibiotics in septic patients admitted to an intensive care unit from the emergency department.
Kalkan Asim, Ersunan Gokhan, Bilir Ozlem, Yavasi Ozcan, Ozel Deniz, Kayayurt Kamil, Ziyan Murat, Coskun Aydın, Yeniocak Selman
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.010
Published online: October 18 2013
xWe assessed out-of-hospital cardiac arrest patients’ cerebral oxygenation during cardiopulmonary resuscitation (CPR) using near infrared spectrophotometry (NIRS). We evaluated the relation between a rise in patients’ cerebral saturation values between the start and end of CPR and return of spontaneous circulation.
Chih-Yuan Fu, Shang-Yu Wang, Yu-Pao Hsu, Chien-Hung Liao, Being-Chuan Lin, Shih-Ching Kang, Kuo-Ching Yuan, I-Ming Kuo, Chun-Hsiang Ouyang, Shang-Ju Yang
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.011
Published online: October 24 2013
xA pelvic x-ray (PXR) can be used as an effective screening tool to evaluate pelvic fractures and stability. However, associated intra-abdominal/retroperitoneal organ injuries and hemorrhage should also be considered and evaluated in patients with major torso injuries. An abdominal/pelvic computed tomographic (CT) scan may provide higher resolution and more information than a PXR. The role of conventional PXRs was delineated in the current study in the context of the development of the CT scan.
Jolene H. Nakao, Farrukh N. Jafri, Kaushal Shah, David H. Newman
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.012
Published online: October 18 2013
xJolt accentuation or exacerbation of a baseline headache with horizontal rotation of the neck is a physical finding believed to assess for meningeal irritation. We conducted a prospective observational study of neurologically intact emergency department (ED) patients undergoing lumbar puncture in 2 inner city academic EDs to validate the sensitivity and specificity of jolt accentuation and to assess the sensitivity and specificity of Kernig sign, Brudzinski sign, and nuchal rigidity, in predicting cerebrospinal fluid (CSF) pleocytosis in individuals being assessed for meningitis.
Lisa Calder, Sarah Tierney, Yue Jiang, Austin Gagné, Andrew Gee, Elisabeth Hobden, Christian Vaillancourt, Jeffrey Perry, Ian Stiell, Alan Forster
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.013
Published online: October 21 2013
xFor emergency department (ED) patients with acute exacerbations of heart failure and chronic obstructive pulmonary disease (COPD), we aimed to assess the adherence to evidence-based care and determine the proportion that experienced adverse events.
Shuaib Waqas, Jamlik-Omari Johnson, Ninad Salastekar, Kiran K. Maddu, Faisal Khosa
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.019
Published online: October 28 2013
xThe objective of the study is to determine the prevalence and significance of incidental findings in patients with a chief complaint of abdominal pain presenting to the emergency department (ED) who received abdomino-pelvic multidetector computed tomography.
Takahiro Arima, Osamu Nagata, Takeshi Miura, Katsuki Ikeda, Tomoya Mizushima, Azusa Takahashi, Koji Sakaida
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.026
Published online: October 30 2013
xThis study sought to determine and compare the utility of the Airway scope (AWS; Pentax Corporation, Tokyo, Japan) and the conventional Macintosh laryngoscope (MLS) for intubation in the prehospital setting.
Mohammad Naffaa, Badira F. Makhoul, Amjad Tobia, Mishel Jarous, Marielle Kaplan, Doron Aronson, Walid Saliba, Zaher S. Azzam
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.002
Published online: November 8 2013
xBrain natriuretic peptide (BNP) is well established in detecting acute decompensation of heart failure (ADHF). The role of BNP at discharge in predicting mortality is less established. Accumulating evidence suggests that inflammatory cytokines play an important role in the development of heart failure. We aimed to examine the contribution of BNP, interleukin 6, and procalcitonin to mortality in ADHF.
Zhengfei Yang, Heng Li, Tao Yu, Changwei Chen, Jiefeng Xu, Yueyong Chu, Tianen Zhou, Longyuan Jiang, Zitong Huang
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.043
Published online: November 8 2013
xThe latest guidelines both increased the requirements of chest compression rate and depth during cardiopulmonary resuscitation (CPR), which may make it more difficult for the rescuer to provide high-quality chest compression. In this study, we investigated the quality of chest compressions during compression-only CPR under the latest 2010 American Heart Association (AHA) guidelines (AHA 2010) and its effect on rescuer fatigue.
Byung Kook Lee, Kyung Woon Jeung, Hyoung Youn Lee, Seung Joon Lee, Yong Hun Jung, Wang Ki Lee, Tag Heo, Yong Il Min
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.044
Published online: November 8 2013
xStudies investigating the relationship between blood gas tension and outcome in cardiac arrest survivors have reported conflicting results. This might have resulted from the use of a blood gas value at a single time point and the difference in the proportion of patients treated with therapeutic hypothermia (TH). We investigated the association of the mean blood gas tensions calculated from blood gas values obtained between restoration of spontaneous circulation and end of TH with the outcome in cardiac arrest patients treated with TH.
Michael Mallin, Keith Curtis, Matthew Dawson, Patrick Ockerse, Matthew Ahern
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.004
Published online: October 28 2013
xInterest in the use of dynamic ultrasound (US) for cricothyrotomy has sparked a debate regarding its applicability in a crash airway situation. Ultrasound-guided marking of the cricothyroid membrane (CTM) as a preintubation procedure may be better than the dynamic method. No prior study has evaluated the accuracy of using US to premark the CTM before attempted intubation.
Judith S. Sittig, Erica D.M. Post, Ingrid M.B. Russel, Ingrid A.G. van Dijk, Edward E.S. Nieuwenhuis, Elise M. van de Putte
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.038
Published online: October 7 2013
xEmergency departments (EDs) are important to detect child physical abuse. A structured approach will contribute to an adequate detection of abused children at the ED. The American Academy of Pediatrics (AAP) provided guidance in the clinical approach to the evaluation of suspected physical abuse in children. In the Netherlands, these American Academy of Pediatrics guidelines have been adopted for the clinical process of child abuse detection. Here, we describe the outcome of the clinical process in the year 2010 with 65 cases of suspected child abuse out of 3660 children presenting at an ED, and we discuss the strengths and pitfalls of this current clinical approach.
John Morrison, Rebecca Jeanmonod
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.062
Published online: October 7 2013
xIn spite of general acceptance and validation of NEXUS (National Emergency X-Radiography Utilization Study) in the clearance of cervical spine (C-spine) immobilized patients, clinicians often elect to image NEXUS-negative patients in clinical practice.
Michael Levine, Benjamin Wyler, Frank LoVecchio, Pedro Roque, Ali S. Raja
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.063
Published online: October 10 2013
xClopidogrel is an adenosine diphosphate receptor antagonist. The risk of intracranial hemorrhage following minor head trauma in patients with pre-injury use of clopidogrel has not been fully determined.
Takeshi Yamagiwa, Seiji Morita, Mari Amino, Naoya Miura, Takeshi Saito, Sadaki Inokuchi
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.006
Published online: October 17 2013
xEperisone hydrochloride is a centrally acting muscle relaxant prescribed for muscle stiffness that acts by depressing the activities of α and γ efferent neurons in the spinal cord and supraspinal structures. Although a case of eperisone-induced severe QT prolongation had been reported, the relationship between serum eperisone concentration and QT interval remains obscure.
Francesca Cortellaro, Luca Mellace, Stefano Paglia, Giorgio Costantino, Sara Sher, Daniele Coen
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.001
Published online: November 4 2013
xWe aimed to analyze the diagnostic accuracy of contrast enhanced ultrasonography (CEUS), compared with chest x-ray (CXR), in the detection of correct central venous line (CVL) placement. Our hypothesis was to verify whether CEUS could substitute CXR as a reference standard for correct placement of CVL or function as a triage test to limit the execution of CXR only for selected patients.
Philipp Adams, Ralf Schmitz, Dominik Laister, Matthias Rüther, Dennis Happe, Peter Sommerfeld, Guido Hartmann, Sascha Wecker
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.040
Published online: September 30 2013
xThe current resuscitation guidelines of the European Resuscitation Council do not include automatic chest compression devices (ACDs) as standard equipment to support cardiopulmonary resuscitation attempts. One possible reason could be the lack of a list of indications and contraindications for the use of ACD systems. This review should give a summary of current studies and developments according to ACD systems and deliver a list of possible applications. Furthermore, we discuss some ethical problems with cardiopulmonary resuscitation attempts and, in particular, with ACD systems.
Subramanian Senthilkumaran, Ritesh G. Menezes, Syed Mohamed Mohamed Ibrahim, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.058
Published online: October 7 2013
xWe read the article by Tummala et al [1] with great interest. Apart from the type II Kounis syndrome and iatrogenic administration of excess doses of epinephrine, other mechanisms could contribute to acute ST-segment elevation myocardial infarction in this patient. During anaphylaxis, there will be rapid shift of intravascular fluid into the extravascular compartment, which can trigger the rennin-angiotensin-aldosterone system resulting in compensatory catecholamine release [2]. In addition, histamine could stimulate the release of catecholamines by a direct action on adrenal medulla [3], which initiates the coronary spasm or could rupture the atheroma plaque and causes platelet aggregation in patients with atherosclerotic coronary disease.
Karthik Tummala, Vijay K. Maniyal
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.059
Published online: October 30 2013
xAcute myocardial infarction is multifactorial in the setting of anaphylaxis. The relative risk of low- and high-dose diclofenac without medical prescription causing myocardial infarction is well described [1].
Benjamin D. Kessler, Maneesha Sabharwal, Carol Pak-Teng, Robert S. Hoffman
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.014
Published online: October 28 2013
xWe read with great interest the recent report regarding the use of therapeutic plasma exchange in patients with intermediate syndrome due to organophosphate poisoning [1]. Physicians in Turkey have a unique population of patients with frequent exposure to organophosphates that presents an exceptional opportunity for research. The strength of this cohort is demonstrated by the ability to identify 17 individuals with intermediate syndrome over a 2-year enrollment period. Although it is certain that the initial data were robust, the presentation was questionable and we ask the authors to consider the following concerns.
Mehmet Oguzhan Ay
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.015
Published online: October 17 2013
xThe purpose of therapeutic plasma exchange (TPE) procedure is to reduce harm to organism caused by pathologic process or return back these damages to a certain extent by reducing plasma components, which are known to be effective in pathogenesis of a variety of diseases. In this study, we aimed at the removal of organic phosphate compounds, especially in blood circulation, not stored in adipose tissue. The organic phosphate compounds are recirculated back into circulation again and again from adipose tissue and cause the development of intermediate syndrome (IMS).
Diego Conde, Nicolas Lalor, Leandro Rodriguez, Pablo Elissamburu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.035
Published online: October 31 2013
xB-type natriuretic peptide (BNP) has been associated with diagnosis, prognosis, and infarct size in acute coronary syndrome with ST elevation (ST-segment elevation myocardial infarction [STEMI]) and without ST elevation (non-STEMI). It was associated in 1 study with the extension and severe coronary lesions in patients with STEMI and non-STEMI together, but the relationship with the extension and severe coronary lesions in patients with only STEMI is not well established [1-4].
David Cheng, Joseph Stone
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.042
Published online: November 6 2013
xLast year, due to increasing volume and staffing demands, we chose to geographically divide our mid-sized urban ED clinical space into two halves regarding attending coverage. The resident, physician assistant, and nurse practioner coverage remained undivided due to clinical work experience variation among providers and scheduling complexities.
Elizabeth Barlow-Savko, Brett Forehand, Jestin N. Carlson
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.004
Published online: November 4 2013
xWhile antiemetic medications are frequently administered in US emergency departments (EDs) [1-3], concerns have recently been raised over the safety profile of some of these medications, ondansetron (Zofran) for prolonged QT [4,5] and promethazine (Phenergan) for tissue necrosis [6] and extrapyramidal symptoms, which can be lasting and devastating to the patient [7]. Recent nation drug shortages of other antiemetics, prochlorperazine (Compazine) and metoclopramide (Reglan), may alter physician practices and disproportionately impact specific populations [8].
Shu Zhang, Da Zhu, Zhi Wan, Yu Cao
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.009
Published online: November 11 2013
xEarthquake could leads to massive casualty and injury in a short period [1-3]. Rapid screening and proper initial management and transfer triage are critical for improving survival during earthquake [1,4,5]. Point-of-care (POC) ultrasound is a newly diagnostic method that has been widely applied during emergency practice [6,7]. Several reports have shown the potential role of POC ultrasound in evaluation earthquake injury [8-10]. In April 20, 2013, a 7.3 magnitude earthquake struck the Sichuan Lu-Shan city (Epicenter location), causing more than 200 deaths and 10 000 injuries.
Khalid Bashir, Galal S. Alessai, Waleed Awad Salem, Furqan B. Irfan, Peter A. Cameron
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.012
Published online: November 11 2013
xBenign paroxysmal positional vertigo (BPPV) is a common clinical condition. Most patients experience short episodes of vertigo associated with certain positions such as looking up, changing position in the bed, bending down and straightening up from bending down. Its incidence varies between 11 and 64 per 100,000 and lifetime prevalence in general practice is 2.4%. [1]. The most common age group is 50 to 55 years in the idiopathic group [2] and is uncommon in children [3].
Nayer Jamshed, Fouzia F. Ozair, Meera Ekka, Praveen Aggarwal
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.013
Published online: November 11 2013
xThe article by Hossain Nejad et al is encouraging in view of their conclusion that in more than 85% cases, emergency physicians are putting the endotracheal tube (ETT) in the appropriate position [1]. The study was based on clinical examination and chest radiography to ascertain the proper position of the endotracheal tube. According to studies clinical examination and chest radiography are not reliable methods to confirm tracheal intubation. Their sensitivity to detect esophageal intubation is also low [2].
Javier García-Niebla, Jorge Díaz-Muñoz, Miquel Fiol
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.014
Published online: November 14 2013
xWe have read with great interest the article by Celik [1] et al in the American Journal of Emergency Medicine. The authors present a clinical case report involving a 23-year-old man attended in the emergency department 30 minutes after an episode of syncope. The initial electrocardiogram (ECG) showed rSr′ morphology in the precordial lead V1 and a saddleback pattern in V2, which the authors describe as Brugada type 2 ECG pattern. From this, they conclude that the patient had Brugada syndrome and make much of having obtained this early ECG since no further ECGs showed the patterns which characterize this syndrome [2].
Mary Ryan, Nicholas D. Caputo, Oliver M. Berrett
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.015
Published online: November 14 2013
xInfanticide is defined as the killing of a child in the first 12 months of life, while neonaticide refers to the killing of a child in the first 24 hours of life [1,2]. The tragedy of abandoned or murdered newborns continues to be a reality in our society [3-7].
Yalcin Golcuk, Murat Ozsarac, Burcu Golcuk, Erkan Gunay
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.016
Published online: November 11 2013
xTo the Editor,
Sujay Samanta, Sukhen Samanta
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.018
Published online: November 11 2013
xCorrect placement of central venous catheter (CVC) should be confirmed radiologically before using it. It is always a challenge to place CVC at a right anatomical position. Malposition of CVC varies widely, ranging from less than 1% to more than 60% [1]. Cannulation by the right subclavian vein is associated with the highest risk of malposition of approximately 9.1%, most commonly in the ipsilateral internal jugular vein [2]. We had encountered a case where we failed to insert the catheter through the right internal jugular vein, and it went into ipsilateral internal jugular vein when cannulation tried by the right subclavian vein.
John E. Madias
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.023
Published online: November 14 2013
xTo the Editor,
Goran P. Koracevic
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.027
Published online: November 11 2013
xHigh admission blood glycemia (ABG), that is, stress hyperglycemia (SH), is an important prognostic indicator in a variety of diseases, including acute myocardial infarction (AMI) [1]. Although this has been known for decades [2], there is, to date, no universal consensus about ABG concentration(s) required for SH in AMI patients [1,3-5]. Indeed, it is intrinsically difficult to define SH in patients with diabetes mellitus (DM) because basal glycemia is not known and could vary significantly in this patient population [6].
Michael C. Nguyen, David M. Richardson, Steven G. Hardy, Rachel M. Cookson, Richard S. Mackenzie, Marna Rayl Greenberg, Bernadette Glenn-Porter, Bryan G. Kane
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.029
Published online: November 11 2013
xImproving physician compliance with physician quality reporting systems is challenging. Barriers exist that keep physicians from participating [1], and the existence of published guidelines does not guarantee physician compliance [2,3]. Reminder systems, outside the emergency department (ED) setting, have been shown to change physician behavior by promoting adherence to guidelines [4-8]. In the ED and intensive care unit settings, reminder letters have been used to improve care in pneumonia, sepsis, unstable angina, and transient ischemic attack [9-12].
Yu-Hsiang Juan, Sachin S. Saboo, Naman S. Desai, Kanika Khandelwal, Ashish Khandelwal
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.012
Published online: September 23 2013
xWe present a case of a 71-year-old woman with an unusual complication of aortic intramural hematoma and hepatic artery pseudoaneurysm following cardiopulmonary resuscitation and thrombolysis done for sudden cardiopulmonary arrest and pulmonary embolism. Patient was on Warfarin treatment for a prior history of pulmonary embolism and experienced recurrent cardiac arrests, which finally resolved after intravenous administration of thrombolytic agents. However, follow-up computed tomographic angiography revealed descending aortic intramural hematoma with intramural blood pool and concomitant liver laceration with hepatic artery pseudoaneurysm.
Michael A. Miller, Michael Menowsky, Kimberly Leeson, Ben Leeson
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.015
Published online: September 23 2013
xWe report a case of a 22-year-old man who presented to the emergency department (ED) with altered mental status and was diagnosed with eosinophilic meningitis due to Angiostrongylus cantonensis (AC) acquired in the United States after exposure to snails.
Camilla Zawaideh, Milena Aste, Ombretta Cutuli, Irilda Budaj, Gian Paolo Bezante, Claudio Brunelli, Manrico Balbi, Alberto Valbusa
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.016
Published online: September 30 2013
xA 59-year-old woman was referred to our emergency department because of epigastric pain and incoercible vomit. Electrocardiogram showed ST-segment elevation in anterior-lateral leads, but coronary angiogram revealed normal coronary tree and left ventricular angiography showed apical and midventricular akinesis with preserved basal systolic function: a diagnosis of apical ballooning syndrome was made. During the following days, the patient complained about persistent abdominal pain, and a nasogastric tube drained more than 1000 cc of dark fecaloid material.
Juliana Minak, Kristin Carmody
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.021
Published online: September 12 2013
xCerebrospinal fluid (CSF) rhinorrhea is rarely seen in the emergency department (ED) and most often occurs after a traumatic event. Spontaneous CSF leaks are much less common and are often the result of benign intracranial hypertension. If not recognized early on, CSF infections are the most serious consequence of this condition and therefore its early diagnosis and treatment are essential. This case report describes a patient who presented to the ED with a CSF leak not caused by a traumatic event.
Ryan T. Edwards, Catherine McCormick-Deaton, Avinash Hosanagar
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.022
Published online: October 14 2013
xUrinary retention is associated with buprenorphine, particularly with epidural/intrathecal delivery. However, it is rare with oral administration. This case report illustrates an occurrence of acute urinary retention after initiation of oral buprenorphine/naloxone.
Christian James Turner, Hans Van Lancker
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.023
Published online: September 27 2013
xA small truck collided with a 67-year-old female pedestrian. She sustained blunt, closed trauma to her right knee, and developed a prepatellar Morel-Lavallée lesion (MLL). A MLL is a closed soft tissue degloving injury, resulting from high-energy shearing forces, which separate the skin and subcutaneous tissue from the underlying fascia. The resultant space collects fluid and is prone to infection, tissue necrosis, and symptoms of ongoing mass effects. The diagnosis is elusive because of its rarity and often subtle initial symptoms.
Fuad Samadov, Dursun Akaslan, Altug Cincin, Kursat Tigen, Ibrahim Sarı
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.024
Published online: September 18 2013
xPrompt recognition of electrocardiographic signs of acute coronary occlusion is essential for timely restoration of flow. ST-segment elevation or new onset left bundle-branch block are the most common electrocardiographic changes seen in acute phase of coronary occlusion. However, some patients may present with atypical electrocardiographic signs, and early diagnosis of these patients may constitute a clinical challenge. Here, we report a 41-year-old man presenting with an atypical electrocardiographic manifestation despite angiographically confirmed acute thrombotic occlusion of proximal left anterior descending artery.
Kseniya Orlik, Gregory D. Griffin
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.025
Published online: September 18 2013
xA 10-month-old male infant presented to the emergency department (ED) with a chief complaint of weakness, decreased mobility, and regression of motor milestones over a period of 6 days. Significant medical history included a Roseola infection 5 weeks before ED presentation. The patient's pediatrician and chiropractor had both previously diagnosed the patient with strains and sprains. After progression of symptoms, the patient presented to the ED and was discharged home to follow up as an outpatient.
Nerys Conway, Shiva Sreenivasan
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.026
Published online: September 19 2013
xWe discuss a 72-year-old woman admitted with acute shortness of breath and severe sharp chest pain several hours after receiving acupuncture therapy. She was subsequently diagnosed as having an iatrogenic pneumothorax secondary to acupuncture. We discuss the complications of acupuncture and why patients should be informed of the risks of such procedures.
Christina Campana, Peter L. Griffin, Erin L. Simon
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.042
Published online: September 30 2013
xDespite the fact that caffeine is the most commonly used stimulant in modern society, cases of caffeine overdose are relatively rare, with fatalities reported from doses of 10 g and higher (Nord J Psychiatry. 2006;60:97-106). Large doses produce symptoms associated with stimulation of the cardiovascular, central nervous, and gastrointestinal symptoms (Associates of the California Poison Control Center, Poisoning and Drug Overdose, pp. 142-143. 5th Ed). We present the first reported case of a man with delayed presentation to the emergency department after ingesting 24 g of caffeine in a suicide attempt who suffered complications of severe rhabdomyolysis and acute renal failure requiring subsequent hemodialysis.
Kseniya Orlik, Gregory D. Griffin, Erick Zoumberakis
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.043
Published online: September 30 2013
xWe present a case of Eagle syndrome in a 77-year-old woman with associated aneurysm and nontraumatic styloid process fracture, without history of tonsillectomy, who presented to the emergency department. The first set of symptoms associated with the elongation of the temporal styloid process and/or the calcification of the stylomandibular or stylohyoid ligaments was described by Eagle in 1937. Classically, unilateral pain in the oropharynx radiating to the neck and face that is exacerbated by head turning and neck rotation is characteristic of Eagle syndrome.
Darrel W. Hughes, Elizabeth VanWert, Lauren LePori, Bruce D. Adams
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.044
Published online: September 27 2013
xLong-term alcohol use confers neurochemical changes in response to alcohol's exogenous inhibitory effects. Downregulation and decreased sensitivity of γ-aminobutyric acid receptors render benzodiazepines less effective at controlling psychomotor agitation. Propofol has been reported to have successfully relieved alcohol withdrawal syndrome (AWS) symptoms in part because of activation of γ-aminobutyric acid channels in combination with antagonism of excitatory amino acids such as N-methyl-d-aspartate.
Michael A. Miller, Michael Menowsky
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.045
Published online: September 30 2013
xA 28-year-old man presented to the emergency department (ED) 20 minutes after injecting 20 mL of an insecticide containing 0.05% β-cyfluthrin. Upon presentation, he had no complaints; and vital signs demonstrated a sinus tachycardia of 150 beats per minute, blood pressure of 140/65 mm Hg, no fever, and a normal respiratory rate. Further physical examination was notable only for the lack of tremor and the presence of a left antecubital recent injection site. The patient denied use of other drugs that day, but admitted to recent use of methamphetamine.
Amna Zarar, Asif A. Khan, Malik M. Adil, Adnan I. Qureshi
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.046
Published online: October 2 2013
xAdverse events including intracerebral hemorrhage and reperfusion arrhythmias are well known to occur with thrombolytic therapy. We report a case report of anaphylactic reaction directly attributable to intravenous (IV) recombinant tissue plasminogen activator and identify additional cases through review of the Food and Drug Administration Adverse Event Reporting System. A systematic review of Adverse Event Reporting System was performed for allergic adverse events occurring in conjunction with IV thrombolytics.
DOI: http://dx.doi.org/10.1016/S0735-6757(13)00787-0
Published in issue: January 2014
