Stephanie J. Fessler, Harold K. Simon, Arthur H. Yancey II, Michael Colman, Daniel A. Hirsh
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.018
Published online: December 26 2013
xThe use of Emergency Medical Services (EMS) for low-acuity pediatric problems is well documented. Attempts have been made to curb potentially unnecessary transports, including using EMS dispatch protocols, shown to predict acuity and needs of adults. However, there are limited data about this in children. The primary objective of this study is to determine the pediatric emergency department (PED) resource utilization (surrogate of acuity level) for pediatric patients categorized as “low-acuity” by initial EMS protocols.
Yong Hwan Kim, Jun Ho Lee, Chong Kun Hong, Kwang Won Cho, Yong Hwan Park, Yang Weon Kim, Seong Youn Hwang
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.025
Published online: December 23 2013
xGlyphosate-surfactant herbicide is promoted by the manufacturer as having no risks to human health. Glyphosate surfactant has recently been used with increasing frequency in suicide attempts, so clinical toxicologists occasionally encounter cases of severe systemic toxicity. The purpose of this study was to identify the early predictive factors of patients at risk for mortality and the usefulness of the corrected QT interval (QTc interval) for predicting mortality from glyphosate-surfactant intoxication.
Chen-Chen Hang, Chun-Sheng Li, Cai-Jun Wu, Jun Yang
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.043
Published online: November 6 2013
xThe purposes of the study are to investigate the renal function in ventricular fibrillation (VF) and asphyxiation cardiac arrest in a swine model and to estimate the value of novel biomarkers in the acute kidney injury (AKI) after cardiac arrest.
Jui-Yi Tsou, Fong-Chin Su, Pai-Chin Tsao, Ming-Yuan Hong, Su-Chun Cheng, Hsun-Wen Chang, Jin-Shiou Yang, Chih-Hsien Chi
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.044
Published online: November 4 2013
xUnderstanding trunk muscle activity during chest compression may improve cardiopulmonary resuscitation (CPR) training strategies of CPR or prevent low back pain. This study investigates the trunk muscle activity pattern of chest compression in health care providers to determine the pattern alternation during chest compression.
Cindy A. Cheung, Melanie Rogers-Martel, Liliya Golas, Anna Chepurny, James B. Martel, Joseph R. Martel
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.015
Published online: November 18 2013
xOcular trauma is recognized as the leading cause of unilateral blindness. However, few studies to date have focused on the clinical features of hospital-based ocular emergencies. Effectiveness of trauma centers in treating ocular emergencies was compared with treatment in traditional community hospital emergency departments. Demographics, causes, and nature of ocular emergencies, as well as visual outcome in community hospitals emergency departments and trauma centers, were also examined.
Valéry Soulleihet, François Nicoli, Jacques Trouve, Nadine Girard, Laurent Jacquin
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.018
Published online: November 18 2013
xThe aim of this study is to evaluate the efficiency of a specific organizational model for early stroke management associated with repeated public awareness campaigns on stroke warning signs.
Brian C. Geyer, Maria Xu, Christopher Kabrhel
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.019
Published online: November 18 2013
xShared decision making (SDM) is a process whereby patients and clinicians work together to make informed medical decisions that incorporate patient values. Recent data suggest that, for patients with low pretest probability of pulmonary embolism (PE), doubling the standard d-dimer cutoff may reduce the need for imaging with minimal increase in missed PE diagnoses. We used an SDM approach to determine patient preferences regarding this diagnostic approach.
Min-Soo Kim, Jeong-Rim Lee, Yang-Sik Shin, Ji-Won Chung, Kyu-Ho Lee, Ki Ryang Ahn
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.029
Published online: November 25 2013
xThis single-center, prospective, randomized, double-blind, 2-arm, parallel group comparison trial was performed to establish whether the adult-sized laryngeal mask airway (LMA) Classic (The Laryngeal Mask Company Ltd, Henley-on-Thames, UK) could be used safely without any consideration of cuff hyperinflation when a cuff of the LMA Classic was inflated using half the maximum inflation volume or the resting volume before insertion of device.
Timothy P. Young, Brian G. Chen, Tommy Y. Kim, Andrea W. Thorp, Lance Brown
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.034
Published online: December 2 2013
xWe compared the accuracy of a conceptually simple pediatric weight estimation technique, the finger counting method, with other commonly used methods.
Daniel Ortiz, Marcelo Barros, Su Yan, Pedro Cabrales
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.045
Published online: December 9 2013
xThe development of an alternative to blood transfusion to treat severe hemorrhage remains a challenge, especially in far forward scenarios when blood is not available. Hemoglobin level (Hb)–based oxygen (O2) carriers (HBOCs) were developed to address this need. Hemopure (HBOC-201, bovine Hb glutamer-250; OPK Biotech, Cambridge, MA), one such HBOC, has been approved for clinical use in South Africa and Russia. At the time of its approval, however, few studies aimed to understand Hemopure's function, administration, and adverse effects compared to blood.
Maria Studer, Dorothea Hempel, Shada Rouhani, Hana Dubsky, Emanuele Pivetta, Heidi H. Kimberly
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.031
Published online: December 30 2013
xFull visualization of the abdominal aorta using the standard midline view is often inadequate for the detection of abdominal aortic aneurysm. We evaluated whether the addition of a lateral midaxillary right upper quadrant view could improve visualization of the abdominal aorta.
Sameir A. Alhadi, Rawnica Ruegner, Brandy Snowden, Gregory W. Hendey
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.045
Published online: November 6 2013
xHematuria by urine dipstick with absent red blood cells (RBCs) on microscopy is indicative of rhabdomyolysis. We determined the sensitivity of this classic urinalysis (UA) finding in the diagnosis of rhabdomyolysis.
Hidetaka Tamune, Hiroaki Takeya, Wakako Suzuki, Yasuaki Tagashira, Takaie Kuki, Hitoshi Honda, Mitsuhiro Nakamura
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.030
Published online: December 2 2013
xBacterial meningitis is an emergent disease requiring prompt diagnosis and treatment with appropriate antimicrobials. Although the lumbar puncture is widely used as a diagnostic tool for bacterial meningitis, it remains unclear which value in cerebrospinal fluid (CSF) analysis in emergency laboratory tests precisely predicts the presence of bacterial meningitis.
Robert Stuntz, Erik Kochert, Thompson Kehrl, Walter Schrading
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.032
Published online: December 2 2013
xTranstracheal ultrasound has been described as a method to evaluate endotracheal tube placement. Correlation between sonologist experience and the successful use of transtracheal ultrasound to identify endotracheal tube location has not been examined. Our objectives were to evaluate emergency physicians' ability to correctly identify endotracheal tube location using transtracheal ultrasound and to evaluate the role operator experience plays in successful identification of tube placement.
Takashi Suto, Shigeru Saito
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.007
Published online: November 14 2013
xWith the development of transportation technologies, elderly people with chronic diseases are increasingly enjoying trekking and tours of nature resorts that include mountain highlands. Because of problems related to circulation, respiration, metabolism, and/or the musculoskeletal system in this population, the impact of high altitude on cardiopulmonary function is increased. Alpine accidents, therefore, tend to be more common in this population, and cases of cardiopulmonary arrest (CPA) at high altitudes seem to be increasing.
Richard M. Sobel, Daniel T. Wu, Kristina Hester, Kim Anda
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.046
Published online: November 6 2013
xStroke is a leading cause of both morbidity and mortality in the United States affecting over 795,000 patients each year, of which 130,000 will die [1,2]. Thrombolytic therapy, given within published and on-label guidelines, has been shown to be an effective intervention that improves both morbidity and mortality in ischemic stroke patients. Inclusion and exclusion criteria for use of thrombolytic therapy are generally well-defined. However, these criteria are dynamic, as evidenced by the recently expanded treatment time window for selected patients [3].
Hooman Hossein-nejad
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.052
Published online: November 6 2013
xWe are pleased to respond to the reader's comments. As a matter of fact, esophageal intubation cannot be detected by chest x-ray (CXR), yet there are other possibilities of endotracheal tube (ETT) misplacement, such as inappropriate depth of the tube or bronchial intubation. End tidal CO2 (ETCO2) or ultrasonography is used to distinguish between esophageal and tracheal intubation. Nevertheless, they have not been useful for the direct confirmation of the appropriate tracheal depth of ETT [1,2]. References, including American Heart Association and American College of Emergency Physician guidelines , do not consider these methods alternatives to CXR to confirm the appropriate depth of the tube.
Narat Srivali, Patompong Ungprasert, Lee C. Edmonds
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.033
Published online: December 2 2013
xWe thank Viren et al [1] for their article entitled “Negative anion gap metabolic acidosis in salicylate overdose—a zebra!” which was published in The American Journal of Emergency Medicine.
William Durston
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.035
Published online: December 2 2013
xIn November 2008, Northern California Kaiser Permanente (KP), which is the largest health maintenance organization in the United States, adopted a regional sepsis protocol [1] based on a study published by Rivers et al [2] in 2001 in which it was reported that “early goal-directed therapy” (EGDT) led to a 16% absolute reduction in sepsis mortality. Subsequent to adoption of the EGDT protocol, KP representatives have published claims of even greater reductions in sepsis mortality than originally reported in the study of Rivers et al [1,3-6].
Sébastien Champion
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.041
Published online: December 2 2013
xWe are grateful to the thoughtful authors who took time and great effort to ponder the use of sidestream darkfield imaging in the evaluation of acutely decompensated heart failure (HF) in the emergency department setting. Our work evaluating perfused capillary density (PCD) represented an initial attempt at defining this population [1], which is infamously variable.
Huseyem Narci
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.042
Published online: December 2 2013
xI thank Dr Balta for his comments on our article title “Diffuse thrombosis secondary to Behçet's disease: a case report.” Our patient was evaluated by the rheumatologist for further research. Screening tests for hypercoagulability were performed. Protein C, protein S, homocysteine and antiphospholipid antibodies were negative. Factor V Leiden and the prothrombin gene mutation test were performed. Prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, and antithrombin III were normal.
Nicholas D. Caputo, Marc Kanter
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.048
Published online: December 9 2013
xThe “Golden Hour” is a concept developed by Cowley and taught in advanced trauma life support (ATLS), which states that traumatically injured patients who receive resuscitation within the first hour of injury will have increased chance of survivability [1]. Patients with trauma generally died of injuries because of hemorrhagic shock leading to sepsis, multiorgans dysfunction syndrome, or other physiologic abnormalities that are not correctable in the late stages. To help determine the presence of major injury, ATLS teaches a classification of hemorrhagic shock that is heavily dependent on vital signs and other clinical signs (see Table 1).
Sevket Balta, Sait Demirkol, Cengiz Ozturk, Mustafa Demir, Atila Iyisoy
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.050
Published online: December 9 2013
xWe read the article “Heart rate variability (HRV) risk score for prediction of acute cardiac complications in the emergency department (ED) patients with chest pain” by Ong et al with interest [1]. They aimed develop a risk score incorporating HRV and traditional vital signs for the prediction of early mortality and complications in patients during the initial presentation to the ED with chest pain. They concluded that heart rate variability and vital signs performed well in predicting mortality and other complications within 72 hours after arrival at ED in patients with chest pain.
Marcus Eng Hock Ong, Nan Liu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.049
Published online: December 9 2013
xIn “Heart rate variability in patients with chest pain at the ED”, the authors mentioned that heart rate variability (HRV) has been used to assess autonomic function in different pathological conditions and to investigate the autonomic effects of drugs, etc. HRV has also been reported as a sensitive indicator of autonomic dysfunction in alcoholics and in smokers. These are interesting points that indicate the potential utility of HRV and its association with various diseases.
Mustafa Hatipoglu, Asim Ulcay, Ergenekon Karagoz, Vedat Turhan
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.004
Published online: December 9 2013
xWe have read with interest the recently published article titled “Role of procalcitonin (PCT) in the diagnosis of infective endocarditis (IE): a meta-analysis” by Yu et al [1]. They aimed to evaluate the diagnostic value of PCT in describing IE. They only included 6 studies in their meta-analysis. They found different and heterogeneous results in every study included in their analysis: there were variable results with respect to PCT sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios.
Antonio Mirijello, Emanuele Rinninella, Francesca De Leva, Alberto Tosoni, Gabriele Vassallo, Mariangela Antonelli, Giovanni Addolorato, Raffaele Landolfi
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.033
Published online: October 30 2013
xHypokalemia is a common biochemical abnormality. Severe hypokalemia can produce cardiac rhythm alterations and neurologic manifestations. Early detection and treatment allow clinician to prevent morbidity and mortality from cardiac arrhythmias and respiratory failure. Here, we describe a case of severe hypokalemia inducing pseudoischemic electrocardiographic (ECG) alterations and quadriplegia, in a patient affected by chronic diarrhea. Electrocardiographic alterations and neurologic manifestations completely disappeared after potassium replacement; however, prolonged potassium supplementation was required to achieve the normalization of plasmatic potassium levels.
Anna Battimelli, Maria Vincenza Polito, Marco Di Maio, Susanna Poto, Luciana Pierro, Domenico Caggiano, Federico Piscione
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.034
Published online: November 8 2013
xClinical presentation of pheochromocytoma can vary, and it can sometimes mimic other diseases. Some patients with pheochromocytoma may have atypical presentations, such as clinical features consistent with an acute coronary syndrome, that only later suggest a classical picture of stress-related cardiomyopathy. To our best knowledge, pheochromocytoma has been incidentally revealed in a few cases of catecholamine-induced cardiomyopathy and in only 1 case of peripheral arterial thrombosis. This is the first case of pheochromocytoma revealed after left ventricular dysfunction caused by stress-related cardiomyopathy associated with inferior limb artery thrombosis in a patient with a complex cardiovascular history.
Andrew A. Herring, Bella Liu, Matthew V. Kiefer, Arun D. Nagdev, Ban C.H. Tsui
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.036
Published online: November 18 2013
xRegional nerve blocks provide superior analgesia over opioid-based pain management regimens for traumatic injuries such as femur fractures. An ultrasound-guided regional nerve block is placed either as a single-shot injection or via a perineural catheter that is left in place. Although perineural catheters are commonplace in the perioperative setting, their use by emergency physicians (EPs) for emergency pain management in adults has not been previously described. Perineural catheters allow prolonged and titratable delivery of local anesthetic directly targeted to the injured extremity, resulting in opioid sparing while maintaining high-quality pain relief with improved alertness.
Mathew Goebel, Joseph Bledsoe, James L. Orford, Amal Mattu, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.037
Published online: October 30 2013
xCertain acute coronary syndrome electrocardiographic (ECG) patterns, which do not include ST-segment elevation, are indicative of acute coronary syndrome caused by significant arterial occlusion; these patterns are, of course, associated with significant risk to the patient and mandate a rapid response from the health care team. One such high-risk ECG pattern includes the association of the prominent T wave and J-point depression producing ST-segment depression seen in the precordial leads coupled with ST-segment elevation in lead aVr.
Miroslav Durila, Martin Malošek
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.038
Published online: November 27 2013
xMassive posttraumatic bleeding is the leading cause of potentially preventable death among patients with severe trauma. Immediate diagnosis and treatment of traumatic coagulopathy and its differentiation from surgical bleeding after major trauma are critical in the management of such patients. In this case report, we present a 33-year-old woman who had multiple injuries to the head and trunk in motor vehicle collision, resulting in severe bleeding and necessitating emergency surgery. We demonstrate how repeated rotational thromboelastometry and thromboelastography analyses were used to direct the choice of therapy to stabilize her circulatory system for surgery and to differentiate surgical bleed from coagulopathy.
Sukhen Samanta, Sujay Samanta
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.039
Published online: December 4 2013
xCapnography is commonly used for monitoring purposes. Here, we describe a new application of capnography as a bedside diagnostic modality. In doubtful situations of pneumoperitoneum, intravenous cannula is inserted in abdominal cavity, and capnography wave forms are detected with the help of gas sampling port. Capnography can detect pneumoperitoneum of bowel origin quickly and efficiently when radiology and clinical diagnosis are inconclusive. It can also detect gas in supine position. This technique is useful even in doubtful cases of pneumoperitoneum differentiating from pseudopneumoperitoneum.
Khee-Siang Chan, Kuo-Chen Cheng, Mei-Feng Lee, Wen-Liang Yu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.040
Published online: October 31 2013
xVibrio vulnificus typically causes septicemia and necrotic wound infection. Among V vulnificus–related complications, acute nonthrombotic myocardial damage has not been reported. The most effective antibiotic treatment of V vulnificus infection includes combination of a third-generation cephalosporin and a tetracycline or its analogue. However, recommendations of a fourth-generation cephalosporin-based regimen for treating the disease are not established. A 67-year-old diabetic man acquired V vulnificus infection via a fish-stunning wound on the right foot.
Alan T. Chiem, Elizabeth Turner
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.006
Published online: November 18 2013
xToxin-mediated vasodilation in the sepsis syndrome can lead to end-organ dysfunction and shock. Assessing for fluid responsiveness and preload optimization with intravenous fluids is a central tenet in the management of sepsis. Aggressive fluid administration can lead to pulmonary edema and heart failure, whereas premature inotropic or vasopressor support can worsen organ perfusion. Inferior vena cava ultrasonography is commonly used to assess for fluid responsiveness but has multiple limitations.
Hong Yu, Shuodong Wu, Xiaopeng Yu, Quan Zhang
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.007
Published online: November 11 2013
xThis report presents a 16-year-old adolescent boy with intentional ingestion of a 6-cm-length iron nail in detention center 6 hours ago. There was no symptom and sign of acute abdominal pain. Abdominal computed tomographic scan was performed, and an iron nail was found in the left upper quadrant abdomen. Considering the size, shape, and location of the foreign body, emergency surgery was performed using single-incision laparoscopic surgery approach. Multiple trocars in umbilical incision technique and conventional instruments were used.
Aakash Aggarwal, Viren Kaul, Gurmeen Kaur, Emerald Banas, Praveen Sampath, Ajoy K. Roy
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.017
Published online: November 11 2013
xBotulinum toxin (Botox) injection into the lower esophageal sphincter (LES) has been used for the treatment of achlasia cardia since the 1990s. Currently it is indicated for patients who are not candidates for definitive therapy like Heller's myotomy or pneumatic dilation and in those who have recurrence of symptoms after definitive treatments. We present a case of severe anaphylaxix due to Botox.
Ramazan Buyukkaya, Ömer Aydın, Bahattin Hakyemez, Dogan Seref
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.019
Published online: November 14 2013
xSpontaneous spinal epidural hematoma is a very rare clinical emergency. A permanent neurological deficit or even death may result if diagnosis and treatment are delayed. Many cases can be diagnosed upon detailed neurological examination and magnetic resonance (MR) imaging. Usually, surgery is required, but rarely, the condition may improve spontaneously. A 46-year-old male patient was admitted to our emergency department because of rapidly evolving severe paraplegia following development of sudden-onset neck pain.
Jung-In Ko, Taejin Park
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.022
Published online: November 27 2013
xThe most common manifestations of aortic dissection (AD) are severe chest pain and back pain. However, we experienced a rare case of type I aortic dissection with bilateral common carotid artery involvement, which presented with only a sudden thunderclap bi-frontal headache.
DOI: http://dx.doi.org/10.1016/S0735-6757(14)00041-2
Published in issue: March 2014
DOI: http://dx.doi.org/10.1016/S0735-6757(14)00042-4
Published in issue: March 2014
DOI: http://dx.doi.org/10.1016/S0735-6757(14)00043-6
Published in issue: March 2014
DOI: http://dx.doi.org/10.1016/S0735-6757(14)00044-8
Published in issue: March 2014
