Aveh Bastani, Blerina Shaqiri, Kristen Palomba, Dominic Bananno, William Anderson
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.040
Published online: March 17 2014
xAt our institution, we previously described the detrimental effect of computerized physician order entry (CPOE) on throughput time and patient satisfaction (Ann of Emer Med, Vol 56, P S83-S84). To address these quality metrics, we conducted a pilot program using scribes in the emergency department (ED).
Özcan Yavaşi, Erden Erol Ünlüer, Kamil Kayayurt, Selim Ekinci, Caner Sağlam, Nebi Sürüm, Mehmet Hicri Köseoğlu, Murat Yeşil
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.046
Published online: January 6 2014
xOur aim was to determine if N-terminal pro-brain natriuretic peptide (NT-proBNP) or sonographic measurements of inferior vena caval (IVC) diameters and collapsibility index (IVC-CI) have a role in the monitoring of acute heart failure (AHF) therapy.
Nurettin Özgür Doğan, Alp Şener, Gül Pamukçu Günaydın, Ferhat İçme, Gülhan Kurtoğlu Çelik, Havva Şahin Kavaklı, Tuğba Atmaca Temrel
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.001
Published online: January 16 2014
xThe end-tidal carbon dioxide (ETCO2) measurement was considered as an essential tool for the assessment of several conditions in emergency medicine. However, the diagnostic role of capnography in dyspneic patients still remains unclear. We aimed to analyze the alteration of the ETCO2 levels in chronic obstructive pulmonary disease (COPD) exacerbations and its role in the decision-making process.
Hangyul Chung-Esaki, Robert M. Rodriguez, Harrison Alter, Bitou Cisse
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.008
Published online: January 21 2014
xInfectious endocarditis (IE) in febrile injection drug users (IDUs) is a critical diagnosis to identify in the emergency department (ED). A decision tool that identifies patients at very low risk for endocarditis using readily available clinical data could reduce admissions and cost.
Shou-Chien Hsu, Chih-Yu Chen, Yi-Ming Weng, Shou-Yen Chen, Chi-Chun Lin, Jih-Chang Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.009
Published online: January 22 2014
xWe aimed to compare the performance of Glasgow-Blatchford, preendoscopic Rockall, and model for end-stage liver disease (MELD) scores in cirrhotic patients with unstable upper gastrointestinal bleeding (UGIB) in the emergency department (ED).
Hsien-Yen Chang, Matthew Daubresse, Stefan P. Kruszewski, G. Caleb Alexander
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.015
Published online: January 23 2014
xTo describe changes in the prevalence and severity of pain and prescribing of non-opioid analgesics in US emergency departments (EDs) from 2000 to 2010.
Sevcan Baki Baskın, Neşe Çolak Oray, Sedat Yanturalı, Başak Bayram
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.020
Published online: January 23 2014
xThe arterial blood gas measurement process is a painful and invasive procedure, often uncomfortable for both the patient and the physician. Because the patient-related factors that determine the difficulty of the process cannot be controlled, the physician-related factors and blood gas measurement techniques are a modifiable area of improvement that ought to be considered. Many hospitals use insulin syringes or syringes washed with heparin for the purpose of blood gas measurement because they do not have blood gas–specific syringes.
Laure Alhanati, Stéphane Dubourdieu, Clément Hoffmann, Francis Béguec, Stéphane Travers, Hugues Lefort, Olga Maurin, Daniel Jost, Laurent Domanski, Jean-Pierre Tourtier
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.034
Published online: February 3 2014
xImproving access to thrombolytic therapy for patients with ischemic stroke is challenging. We assessed a prehospital process based on firemen rescuers under strict medical direction, aimed at facilitating thrombolysis of eligible patients.
Bharath Chakravarthy, Shannon Toohey, Yalda Rezaimehr, Craig L. Anderson, Wirachin Hoonpongsimanont, Michael Menchine, Shahram Lotfipour
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.044
Published online: December 30 2013
xMany suicidal and depressed patients are seen in emergency departments (EDs), whereas outpatient visits for depression remain high.
Mohammad Naffaa, Badira F. Makhoul, Amjad Tobia, Marielle Kaplan, Doron Aronson, Zaher S. Azzam, Walid Saliba
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.058
Published online: January 6 2014
xProcalcitonin and interleukin 6 (IL-6) are well-known predictors of blood culture positivity in patients with sepsis. However, the association of procalcitonin and IL-6 with blood culture positivity was assessed separately in previous studies. This study aims to examine and compare the performance of procalcitonin and IL-6, measured concomitantly, in predicting blood culture positivity in patients with sepsis.
Ian D. Chong, Benjamin J. Sandefur, Dorothy E. Rimmelin, Christian Arbelaez, Calvin A. Brown III, Ron M. Walls, Daniel J. Pallin
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.002
Published online: January 16 2014
xNeuromuscular paralysis without sedation is an avoidable medical error with negative psychologic and potentially physiologic consequences. We determine the frequency of long-acting paralysis without concurrent sedation among patients intubated in our emergency department (ED) or before arrival.
Timothy Jang, Vijai Chauhan, Christopher Cundiff, Amy H. Kaji
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.004
Published online: January 21 2014
xThe objective of this pilot study was to lay the groundwork for future studies assessing the impact of emergency physician–performed ultrasound (EPUS) on diagnostic testing and decision making in emergency department (ED) patients with nonspecific abdominal pain (NSAP).
Matej Samoš, Radoslava Šimonová, Frantisek Kovář, Lukas Duraj, Jana Fedorová, Peter Galajda, Jan Staško, Marian Fedor, Peter Kubisz, Marian Mokáň
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.006
Published online: January 21 2014
xStent thrombosis is a morbid complication after percutaneous coronary intervention. Dual antiplatelet therapy significantly reduces stent thrombosis risk and forms currently the basis in acute ST elevation myocardial infarction pharmacologic treatment. The introduction of clopidogrel has made a major advance in the acute coronary syndrome treatment. However, there is growing evidence about failure in antiplatelet response after clopidogrel, which may lead to subsequent risk of future thrombotic events.
Ross MacDonald, Zachary Rosner, Homer Venters
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.051
Published online: March 20 2014
xRhabdomyolysis is a serious medical condition associated with skeletal muscle damage, potentially leading to renal failure and death. Causes of rhabdomyolysis include drugs, trauma, infection, exercise, heat, and toxins [1–3].
Diego Conde, Pablo Elissamburu, Nicolas Lalor, Leandro Rodriguez
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.040
Published online: December 30 2013
xTroponin I (TnI) and high-sensitivity troponin T after acute myocardial infarction have proven useful for estimation of the complex and extension of coronary lesions in acute coronary syndromes, and TnI has proven useful for estimation of the infarct size in patients with a non–ST-elevation myocardial infarction [1-4].
Daniel Cabrera, Jeffrey L. Wiswell, Vernon D. Smith, Andy Boggust, Annie T. Sadosty
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.051
Published online: January 6 2014
xOne of the fundamental problems of emergency care is the ability to allocate resources, particularly staffing, that match patient volumes and demand [1]. Patient volumes can vary greatly by the day and/or by the hour, so planning for this complicated variability makes staffing decisions challenging for administrators and medical directors [2].
Narat Srivali, Patompong Ungprasert, Lee C. Edmonds
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.054
Published online: January 6 2014
xWe thank Samadov et al [1] for their article titled “Acute proximal left anterior descending artery occlusion with de Winter sign,” which was published in The American Journal of Emergency Medicine.
Emre Yalcinkaya, Murat Celik
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.057
Published online: January 6 2014
xWe have read with great interest the recently published article by Samadov et al [1] entitled “Acute proximal left anterior descending artery occlusion with de Winter sign.” In that well-described case report, the authors [1] reported a 41-year-old man with an acute thrombotic occlusion of proximal left anterior descending artery (LAD). The authors mentioned that an acute occlusion of coronary arteries could be recognized by ST-segment elevation myocardial infarction equivalents in patients presenting with an atypical electrocardiographic (ECG) manifestation.
Emre Yalcinkaya, Murat Celik
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.005
Published online: January 17 2014
xWe read the recently published article by Zarar et al [1] entitled “Anaphylactic shock associated with intravenous thrombolytics” with great interest. In that well-described case report, the authors [1] presented a case of an anaphylactic reaction directly attributable to intravenous recombinant tissue plasminogen activator (r-tPA). Although we commend the authors for their valuable article, some comments may be beneficial.
Siamak Sabour
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.012
Published online: January 30 2014
xI was interested to read the article by Yesilaras and colleagues [1] published in November 2013 issue of The American Journal of Emergency Medicine. The authors aimed to determine the reliability of ultrasonography for the diagnosis of fractures of the fifth metatarsal [1].
Mustafa Hatipoglu, Asim Ulcay, Deniz Eray Gokce, Vedat Turhan
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.014
Published online: January 22 2014
xWe have read with interest the recently published article titled “Cerebrospinal fluid (CSF)/blood glucose ratio as an Indicator for Bacterial Meningitis” by Tamune et al [1]. Cerebrospinal fluid/blood glucose ratio with high sensitivity and specificity has been found as a good marker in predicting bacterial meningitis. Although these results are classic information, it may be important to test the information about significance of CSF/blood glucose ratio by current study.
Hidetaka Tamune, Takaie Kuki
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.013
Published online: January 23 2014
xWe thank Dr Hatipoglu for opening the discussion related to our article on cerebrospinal fluid (CSF)/blood glucose ratio and bacterial meningitis [1,2]. Although coagulase-negative staphylococci (CNS) are uncommon in community-acquired meningitis, we included the patient with the positive CNS CSF culture in the bacterial meningitis group because he met the inclusion criteria in accordance with previous studies. No other pathogens were identified in this case. Given his substantial improvement without antimicrobials, he could have been suffering from aseptic meningitis rather than bacterial meningitis.
Marcelo Trivi, Lujan Forti, Diego Conde, Mirta Diez
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.017
Published online: January 23 2014
xElevated heart rate (HR), reflecting sympathetic hypertony, had been associated to reduced survival in several entities, mainly in heart failure (HF) and in coronary heart disease (CAD). To reduce HR, β blockers are the first option, but they have some limitations. Although β blockers may be used in a majority of the patients, target HR is infrequently achieved [1,2].
Umit Kaldirim, Salim Kemal Tuncer, Yusuf Emrah Eyi, Yakup Aksoy
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.021
Published online: January 23 2014
xWe read with a great interest the article, “Lung ultrasound associated to capnography to verify correct endotracheal tube positioning in prehospital” written by Brun et al [1]. We appreciate the authors sharing their enlightening study with us. We believe that their article will lead to many studies confirming the success of endotracheal intubation (ETI). The authors reported to determine the success of ETI in 52-year-old female patient presenting cardiorespiratory failure by ultrasound revealing bilateral pleural sliding and the method to be applicable and useful.
Rui-Ping Li, Fu-Shan Xue, Shi-Yu Wang, Xin-Long Cui
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.023
Published online: January 27 2014
xThe recent article by Arima et al [1] comparing the Pentax-AWS Airwayscope (AWS) and Macintosh laryngoscope (MLS) for tracheal intubation in 109 prehospital patients with primarily cardiac arrest was of great interest to us. They found that the AWS did not show superior efficacy to the MLS in relation to intubation time, ultimate or first-attempt success rate, and difficulty of intubation. Moreover, initial intubation with the AWS failed in 20 cases but was followed by successful intubation with the MLS.
T. Ted Song
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.025
Published online: January 27 2014
xI read with interest the article, “Predictors of epinephrine autoinjector needle length inadequacy” by Bhalla et al [1]. The authors report finding from a study assessing adequacy of epinephrine needle length by measuring muscle depth at the recommended site of injection. There are some limitations in the study worth noting.
Mary Colleen Bhalla
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.030
Published online: January 30 2014
xDr Song, thank you for your interest in our article, “Predictors of epinephrine autoinjector needle length inadequacy.” [1] I also read with interest your study on delivery depth of epinephrine autoinjector into the subcutaneous tissue of pig [2]. The finding that the depth of the injected material was 2.78 cm or 94.4% beyond the depth of the 1.43-cm needle used in the study was helpful. I agree that further research needs to assess the depth of drug penetration at different pressures, and I also think more research needs to be done on drug absorption at different anatomic locations.
Serife Ulusan
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.031
Published online: January 30 2014
xI read an interesting article by Ogul et al [1] entitled “The pelvic digit anomaly in a patient with multiple fractures: does it mimic the fracture?” in your journal published on 2013 Oct; 31(10):1537. The patient in this report had a successful outcome. Nevertheless, I want to share more information about this rare anomaly. I treated a patient with a pelvic digit with no joint nor pseudo-articulation.
Murat Yesilaras
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.037
Published online: January 30 2014
xWe thank Dr Sabour for his comments about “The accuracy of bedside ultrasonography as a diagnostic tool for the fifth metatarsal fractures.” The aim of our research, as stated in the full text of the article, was to determine the diagnostic reliability of ultrasonography for the diagnosis of fracture in patients who were admitted to the emergency department with acute foot trauma and fifth metatarsal tenderness on physical examination. Comparing the results of ultrasonography and direct radiography, the sensitivity and specificity of ultrasonography in the diagnosis of fracture were detected.
Toshiki Uchihara
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.052
Published online: February 6 2014
xI read with interest two recent clinical studies in this journal, which reported that jolt accentuation is not sensitive enough to rule out cerebrospinal fluid (CSF) pleocytosis [1,2]. Predicting pleocytosis in emergency setting is still a matter of considerable debate [3]. At least in Japan, jolt accentuation is now considered one of the most useful signs to make a decision either to perform or to withhold a lumbar puncture. After publication of our initial study on jolt accentuation as a potential predictor of CSF pleocytosis [4], I have been anxious about potential misinterpretation as if jolt accentuation were an independent indicator of pleocytosis regardless of the clinical background of patients.
Hidetaka Tamune, Takaie Kuki
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.047
Published online: February 5 2014
xWe thank Dr. Uchihara [1] for opening the discussion concerning our article and the report by Nakao et al [2,3] on jolt accentuation of headache, in which Uchihara expresses his concern about potential misinterpretation of the inclusion criteria for jolt accentuation [1]. Although we agree with the idea that the finding of jolt accentuation should be considered in the context of the clinical background of the patients, 1 point that concerned us is that physicians might conclude that the absence of jolt accentuation in itself rules out meningitis.
Efthymios Giotakis, Athanasios Chalkias, Kyriakos Tarantinos, Maaret Castrén, Georgios Papadopoulos, Nicoletta Iacovidou, Theodoros Xanthos
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.051
Published online: February 6 2014
xThe American Heart Association Advanced Cardiovascular Life Support (ACLS) courses intend to train health care professionals in the management of cardiac or respiratory arrest and all periarrest arrhythmias [1,2]. Despite the intense training during the courses, resuscitation skills and knowledge degrade quickly over time, although theoretical knowledge is retained longer than skills [3-5]. Of note, our experience has shown that students with similar ACLS background communicate more effectively with each other, and this helps them to construct their ACLS knowledge.
James R. Hupp
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.056
Published online: February 12 2014
xI thought the following amended excerpts from a recent editorial in my publication would be of interest to your readers [1].
Dimitrios Barmperis, Konstantina Bouki, Thomas Apostolou, Athanasios Chalkias, Theodoros Xanthos
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.057
Published online: February 10 2014
xThe risk of myocardial infarction or death in diabetic patients is similar to that of patients with a history of heart attack with coronary artery calcification being an independent predictor of mortality [1,2]. Optical coherence tomography (OCT) is one of the most precise tools in the description of the morphology of the culprit lesion, allowing for the in vivo characterization of the atherosclerotic plaques [3,4]. The purpose of this study was to compare the calcification of the culprit lesion between diabetic and non-diabetic patients who present with acute coronary syndrome (ACS).
Yakup Aksoy, Kadir Colakoglu, Taner Kar, Abdullah Kaya, Yusuf Emrah Eyi
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.002
Published online: February 12 2014
xWe read with great interest the article “Vogt-Koyanagi-Harada disease: presentation and implications in undocumented immigrants” written by Manizate et al [1]. The authors report a 32-year-old immigrant who presented to the emergency department asking for a second opinion for loss of vision and progressive hearing loss and discuss the issue of limited access to health care for a vulnerable population such as undocumented immigrants. We appreciate the authors sharing their interesting case with us which can be seen only rarely in an emergency department.
Daniel B. Park, Adam K. Berkwitt, Rachel E. Tuuri, W. Scott Russell
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.007
Published online: February 19 2014
xAlthough the role of cognitive biases has received significant attention in recent years as the worlds of behavioral economics and patient safety have collided, emotional influences may play a more crucial function in the outcomes of medical decision making [1]. In 1979, Groves [2] published a controversial article in the New England Journal of Medicine titled “Taking Care of the Hateful Patient,” in which he described the powerful effect a provider's emotional state can have on patient care. Current work explores how such a phenomenon can contribute to the formation of negative emotional influences (affect bias) that may cloud clinical judgment [3-6].
Ramazan Buyukkaya, Ayla Buyukkaya, Beyhan Ozturk, Ayhan Sarıtas
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.058
Published online: November 11 2013
xClivus fracture (CF), which is usually reported to accompany with head trauma, has high mortality rates. Early diagnosis of CF is rare because of high mortality rates and inadequate urgent radiologic techniques; however, diagnosis rates are increasing with computed tomography images obtained in high resolution and thin sections. In this article, radiologic and clinical features of 2 patients who were detected to have longitudinal CF after head trauma are presented and accompanying pathologies and its importance for prognosis are discussed under the light of literature data composed of a small number of reports.
Jianpeng Hao, Junchao Yao, Dawei Guo, Wenyu Sun, Jian Liang, Xiaofeng Jiang
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.003
Published online: November 11 2013
xThe presence of appendix within a femoral hernia is a rare condition in an incarcerated femoral hernia. It has a characteristic groin mass, and the diagnosis of appendicitis is mainly made intraoperatively. A specific imaging appearance (ultrasonography, computed tomography [CT]) allows accurate prospective diagnosis. The recognition of this rare femoral hernia helps us to choose appropriate therapeutic approach. We report a case of an 81-year-old woman who present with painful and nonreducible groin mass.
Suzanne Moore Shepherd, William H. Shoff
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.004
Published online: November 11 2013
xIndividuals who live and work in the Southeastern coastal range of the 3 US crocodilian carnivores, American alligators, American crocodiles, and caiman, understand the risks of reptile-human encounters. Individuals who live in other parts of the country may be exposed through contact with exotic pets at private homes, small menageries, or petting zoos or from escaped or abandoned animals. During these encounters, individuals may be severely injured. Emergency medical services, law enforcement, and animal welfare workers in nonhabitat areas are usually not trained in the handling and safe removal of injured individuals from the scene when the reptile is present.
Umut Ocak, Levent Avşaroğulları, Mehmet Güngör Kaya, Yavuz Özmen, Bahadır Taşlıdere, Erkan Abdullah Güldeste, Şule Yakar
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.059
Published online: November 11 2013
xChest pain and discomfort are regarded as the hallmark symptoms of acute coronary syndrome, and the absence of these symptoms are described as “atypical” presentation. In this case, we aimed to report an acute coronary syndrome–diagnosed patient who was admitted to our emergency service with unilateral earache.
Olufolahan J. Lawal, Harinder S. Dhindsa, Joshua W. Loyd
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.010
Published online: November 18 2013
xAortic dissection occurs when a tear occurs in the inner muscle wall lining of the aorta, allowing blood to split the muscle layers of the aortic wall apart. It is classically characterized by pain that starts in the upper chest, which then radiates to the upper back and is tearing or ripping in quality. Our objective is to present a case followed by a brief literature review of aortic dissection and uncommon but important features that may be demonstrated. In this report, we present the case of a 57-year-old woman who was transported to the emergency department with an acute episode of altered mental status, presenting as a possible stroke with possible seizures.
Carrie Ng, James W. Tsung
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.011
Published online: November 18 2013
xThere is controversy regarding needle aspiration for primary spontaneous pneumothorax (PSP), with contradictory recommendations between the American College of Chest Physicians consensus statement (2001), which suggests that needle aspiration has little place in the management of PSP, and the British Thoracic Society guidelines (2010), which recommend that needle aspiration be attempted first for all cases of PSP where drainage is deemed necessary. Studies have shown that there is no significant difference between needle aspiration and tube thoracostomy with regard to safety, rates of immediate success, and early failure and has the advantages of decreasing pain and reducing rates of hospital admission and duration of hospital stay compared with tube thoracostomy.
Mohammadmahdi Forouzanfar, Pauline Haroutunian, Alireza Baratloo, Behrooz Hashemi
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.013
Published online: November 18 2013
xPosterior reversible encephalopathy syndrome is a clinicoradiologic syndrome characterized by seizure, headache, nausea, vomiting, altered mental status, visual disturbance, or visual loss, together with radiologic findings.
Sukhen Samanta, Sujay Samanta, Kapil Dev Soni
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.014
Published online: November 18 2013
xProne ventilation is usually used for severe acute respiratory distress syndrome. We applied an alternative method to prone position. We described 2 cases of trauma where prone position could not be done. Chest wall compression was performed by 2-kg weight in front of the chest wall bilaterally while the patient was in a supine position. Respiratory mechanics work to improve oxygenation almost as same as the mechanism proposed for prone position without any major adverse effects and serious complications.
Satoshi Matsui, Takashi Kanemura, Yukako Yokouchi, Hideo Kamiichi, Nobuaki Kiriu, Yuji Koike
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.017
Published online: November 18 2013
xIntussusception is a rare condition in adults, representing only 1% of all bowel obstructions. In adult cases, operative explorations are recommended to treat the bowel obstruction and to diagnose underlying diseases. The objective of the current case report was to describe the successful treatment of ileocolic intussusception with air enema reduction in an adult patient. A previously healthy 21-year-old woman had a 20-hour history of colicky abdominal pain and vomiting and was diagnosed as having idiopathic ileocolic intussusception by abdominal computed tomography.
Nataliya Yuklyaeva, Ahmad Chaudhary, Ramakrishna Gorantla, Edward Bischof
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.021
Published online: November 25 2013
xA 43-year-old white woman presented to the emergency department with confusion, agitation, and progressive dyspnea. Chest x-ray revealed pulmonary edema. Initial diagnostic considerations were pneumonia, pulmonary embolism, sepsis, central nervous system infection, substance toxicity, and heart failure. Her salicylate level was 92.6 mg/dL, and an arterial blood gas revealed a respiratory alkalosis and nonanion gap metabolic acidosis, consistent with salicylate poisoning. Noncardiogenic pulmonary edema is an atypical presentation of salicylate toxicity, and this case highlights the importance of an early toxicology screen to make a time-critical diagnosis and provide specific treatment.
Anis Ahmad, Koh Kai Shing, Khim Khee Tan, Mary Krasu, Ian Bickle, Vui Heng Chong
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.024
Published online: November 18 2013
xBowel obstruction is rare in pregnancy, and delay in recognition can lead to serious maternal and fetal complications. Most reported causes of bowel obstruction in pregnancy (adhesions, intussusception, hernia, and carcinoma) require surgical intervention. Sigmoid volvulus is an acute surgical cause that can now be managed successfully without surgery. We report the case of 33-year-old lady who presented with a sigmoid volvulus that was successfully managed with urgent endoscopic decompression.
Seungwoon Choi, Seokyong Ryu, Taekyung Kang, Hyejin Kim, Sungchan Oh, Sukjin Cho
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.026
Published online: November 25 2013
xAbdominal apoplexy was reported by Barber in 1909 [1], and the occurrence rate of the apoplexy is known to be quite rare, but the mortality is high if untreated. We report an unusual case of abdominal apoplexy due to spontaneous rupture of gastric artery. A male patient in his fifth decade with recently diagnosed liver cirrhosis history arrived to the emergency department with severe abdominal pain, which led to abdominal computer tomography indicating spontaneous rupture of gastric artery. Celiac angiogram and embolization were conducted, and exploratory laparotomy was followed.
Nick Kettaneh, Kelly Williamson
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.027
Published online: November 25 2013
xAcute lingual abscess is a rare yet life-threatening clinical entity. Lingual abscess must be appropriately diagnosed and treated in the emergency department to avoid acute airway compromise. A 68-year-old woman on immunomodulatory medication for rheumatoid arthritis presented to the emergency department with left facial pain and swelling. An anterior lingual abscess was diagnosed on computed tomographic scan. The most common cause of lingual abscess is direct trauma, although immunocompromised state is a predisposing risk factor.
A. Brad Hall, David Smith, Jillian Palmer
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.028
Published online: November 25 2013
xThe domesticated pig or boar is ubiquitous to agriculture around the world and is an important food product in most countries. The males that are able to grow tusks that can approach 5 in are the primary contributor to morbidity and mortality from boar attacks. Literature surrounding domesticated boar attacks is sparse. There are no published cases of domesticated boar attacks that describe successful bacterial postexposure prophylaxis. We present a case report of an attack on an adult female by a domesticated boar.
