Nimrod Ophir, Erez Ramaty, Inbal Rajuan-Galor, Yossi Rosman, Ophir Lavon, Shai Shrot, Arthur Shiyovich, Michael Huerta-Hartal, Michael Kassirer, Sonia Vaida, Luis Gaitini
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.067
Published online: August 29 2014
xEarly respiratory support and airway (AW) control with endotracheal intubation (ETI) are crucial in mass toxicology events and must be performed while wearing chemical personal protective equipment (C-PPE).
Chia-Hung Yo, Meng-Tse Gabriel Lee, Weng-Tein Gi, Shy-Shin Chang, Kuang-Chau Tsai, Shyr-Chyr Chen, Chien-Chang Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.071
Published online: August 29 2014
xThe objective of the study is to describe the epidemiology and outcome of community-acquired bloodstream infection (BSI) in type 2 diabetic patients in emergency department (ED).
Ming-Yuan Hong, Jui-Yi Tsou, Pai-Chin Tsao, Chih-Jan Chang, Hsiang-Chin Hsu, Tsung-Yu Chan, Sheng-Hsiang Lin, Chih-Hsien Chi, Fong-Chin Su
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.074
Published online: September 6 2014
xIncreasing chest compression rate during cardiopulmonary resuscitation can affect the workload and, ultimately, the quality of chest compression. This study examines the effects of compression at the rate of as-fast-as-you-can on cardiopulmonary resuscitation (CPR) performance.
Victoria C. Weston, William J. Meurer, Shirley M. Frederiksen, Allison K. Fox, Phillip A. Scott
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.073
Published online: September 6 2014
xCluster randomized trials (CRTs) are increasingly used to evaluate quality improvement interventions aimed at health care providers. In trials testing emergency department (ED) interventions, migration of emergency physicians (EPs) between hospitals is an important concern, as contamination may affect both internal and external validity. We hypothesized that geographically isolating EDs would prevent migratory contamination in a CRT designed to increase ED delivery of tissue plasminogen activator (tPA) in stroke (the INSTINCT trial).
Alan T. Chiem, Connie Hai-Yee Chan, Deena Y. Ibrahim, Craig L. Anderson, Daniel Sampson Wu, Chris J. Gilani, Zulmy Jasmine Mancia, John Christian Fox
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.006
Published online: September 6 2014
xWe compared emergency physician–performed pelvic ultrasonography (EPPU) with radiology department–performed pelvic ultrasonography (RPPU) in emergency department (ED) female patients requiring pelvic ultrasonography and their outcomes in relation to ED length of stay, ED readmission, and alternative diagnosis, within a 14-day follow-up period.
Andrew B. Rosenkrantz, Nadia H. Bilal, Danny R. Hughes, Richard Duszak Jr.
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.002
Published online: September 6 2014
xTo assess recent national specialty trends in the use of diagnostic ultrasound (US) services in the Emergency Department (ED) setting.
Nazire Belgin Akilli, Mehmet Yortanlı, Hüseyin Mutlu, Yahya Kemal Günaydın, Ramazan Koylu, Hatice Seyma Akca, Emine Akinci, Zerrin Defne Dundar, Basar Cander
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.001
Published online: September 6 2014
xThe number of critically ill patients admitted to the emergency department increases daily. To decrease mortality, interventions and treatments should be conducted in a timely manner. It has been found that the neutrophil-lymphocyte ratio (NLR) is related to mortality in some disease groups, such as acute coronary syndrome and pulmonary emboli. The effect of the NLR on mortality is unknown in critically ill patients who are admitted to the emergency department. Our aim in this study is to evaluate the effect of the NLR on mortality in critically ill patients.
Chen-June Seak, Chip-Jin Ng, David Hung-Tsang Yen, Yon-Cheong Wong, Kuang-Hung Hsu, Joanna Chen-Yeen Seak, Chen-Ken Seak
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.011
Published online: September 18 2014
xThis study aims to evaluate the performance of Simplified Acute Physiology Score II (SAPS II), the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and the Sequential Organ Failure Assessment (SOFA) score for predicting illness severity and the mortality of adult hepatic portal venous gas (HPVG) patients presenting to the emergency department (ED). This will assist emergency physicians in risk stratification.
Takeshi Takabayashi, Toshiaki Mochizuki, Norio Otani, Kei Nishiyama, Shinichi Ishimatsu
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.010
Published online: September 17 2014
xThe prevalence of anisakiasis is rare in the United States and Europe compared with that in Japan, with few reports of its presentation in the emergency department (ED). This study describes the clinical, hematologic, computed tomographic (CT) characteristics, and treatment in gastric and small intestinal anisakiasis patients in the ED.
Andrzej Kurowski, Dariusz Timler, Togay Evrin, Łukasz Szarpak
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.007
Published online: September 17 2014
xThe study was designed to investigate the success rate and time of insertion intraosseous access during simulated resuscitation.
Zlata Vlodaver, Henry W. Ortega, Joseph Arms, Heidi Vander Velden, Gary A. Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.024
Published online: September 25 2014
xVarious characteristics of floors and floor coverings are well established as injury hazards. Loose carpeting, such as rugs, is often cited as a hazard leading to injury.
Anurag Gupta, Ali S. Raja, Ivan K. Ip, Ramin Khorasani
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.027
Published online: September 25 2014
xValidate the sensitivity and specificity of 2 age adjustment strategies for d-dimer values in identifying patients at risk for pulmonary embolism (PE) compared with traditional d-dimer cutoff value (500 ng/mL) to decrease inappropriate computed tomography pulmonary angiography (CTPA) use.
Shahriar Zehtabchi, Samah G. Abdel Baki, Louise Falzon, Daniel K. Nishijima
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.023
Published online: September 25 2014
xThe antifibrinolytic agent tranexamic acid (TXA) has demonstrated clinical benefit in trauma patients with severe bleeding, but its effectiveness in patients with traumatic brain injury (TBI) is unclear. We conducted a systematic review to evaluate the following research question: In ED patients with or at risk of intracranial hemorrhage (ICH) secondary to TBI, does TXA compared to placebo improve patients' outcomes?
Nir Samuel, Tova Hershkovitz, Riva Brik, Avraham Lorber, Itai Shavit
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.005
Published online: September 6 2014
xThe objective of this study is to examine if the B-type natriuretic peptide (BNP) can be used in diagnosing heart failure (HF) in children with congenital heart disease (CHD) who present to the emergency department (ED) with acute bronchiolitis.
Terrell S. Caffery, J. Nelson Perret, Mandi W. Musso, Glenn N. Jones
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.014
Published online: September 18 2014
xThe purpose of this study was to determine if patients with nontraumatic causes of elevated intracranial pressure (ICP) could be identified by ultrasound measurement of optic nerve sheath diameter (ONSD). It was hypothesized that an ONSD greater than or equal to 5 mm would identify patients with elevated ICP.
Eric Boccio, Benjamin Wie, Susan Pasternak, Anabella Salvador-Kelly, Mary Frances Ward, Jason D'Amore
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.025
Published online: September 26 2014
xCertain patient populations may be unable to communicate their needs in the emergency department (ED) setting, and the ability to communicate varies between age groups. We aim to determine if there are differences in pain management of acute long-bone fracture (ALBF) among age groups presenting to the ED.
Michael E. Winters, Joseph P. Martinez, Haney Mallemat, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.052
Published online: October 3 2014
xOver the past decade, the annual number of hours of that critical care has been provided in emergency departments (EDs) has increased dramatically [1]. In addition to increases in the number of ED patients admitted to an intensive care unit (ICU), it is clear that critically ill patients are staying longer in the ED. In fact, more than 33% of critically ill patients now remain in the ED for more than 6 hours [1]. Delays in ICU admission can have disastrous outcomes. In a single-center cohort of critically ill patients, Cardoso et al demonstrated an increase in mortality of 1.5% per hour that ICU admission was delayed [2].
Charles V. Pollack Jr.
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.075
Published online: September 6 2014
xVenous thromboembolism (VTE) is a disease spectrum that ranges from deep vein thrombosis (DVT) to pulmonary embolism (PE). Rapid diagnosis and treatment of VTE by emergency care providers are critical for decreasing patient mortality, morbidity, and the incidence of recurrent events. Recent American College of Chest Physicians guidelines recommend initial treatment with unfractionated heparin, low–molecular weight heparin, or fondaparinux overlapped with warfarin for a minimum of 5 days for the treatment of VTE in most cases.
Yu-Hsiang Hsieh, Richard E. Rothman, Jason S. Haukoos
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.016
Published online: September 18 2014
xWe appreciate the correspondence and interest in our study. However, in spite of the concerns raised, we believe our data and findings as reported demonstrate the potential value of an empirically developed clinical prediction instrument (in this case, an abbreviated version of the Denver human immunodeficiency virus [HIV] risk score) for identifying patients at increased risk for undiagnosed HIV infection in an urban emergency department (ED) [1]. The Denver HIV risk score was not developed as an instrument to precisely quantify a patient's HIV risk but rather to categorize patients into differing risk strata to help clinicians identify patients who should or should not be offered HIV testing.
Gary S. Collins
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.008
Published online: September 17 2014
xIn their recent article, Hsieh et al [1] validated an abbreviated version of the Denver human immunodeficiency virus risk score for predicting human immunodeficiency virus infection in an urban emergency department. Conducting an external validation of a risk score on patients separate from those used to derive the model is an important and vital step in demonstrating whether the risk score has promise to be used in clinical practice. The more external validation studies in different but plausibly related settings, the more likely the model will be useful in untested settings and therefore more likely to be useful in clinical practice.
Majid Hajimaghsoudi, Fatemeh Mojallal Najjar
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.020
Published online: September 25 2014
xWe firstly appreciate the study conducted by Doğan et al [1], “The accuracy of mainstream end-tidal carbon dioxide levels to predict the severity of chronic obstructive pulmonary disease exacerbations presented to the ED.” They find that pretreatment end-tidal carbon dioxide (ETCO2) in acute chronic obstructive pulmonary disease (COPD) exacerbation was higher in patients with severe exacerbation and may predict admission.
Nurettin Özgür Doğan
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.019
Published online: September 25 2014
xWe thank to the authors for their interest and comments regarding our recently published article, which deals with the diagnostic value of end-tidal carbon dioxide (ETCO2) measurement in chronic obstructive pulmonary disease (COPD) exacerbation. The primary outcome of the study was determined as the values of ETCO2, which were used to predict hospital admission in COPD exacerbations [1]. Eventually, we found that the ETCO2 levels during an acute exacerbation are higher in admitted patients, when compared with the levels in discharged patients upon arrival to the emergency department (ED).
Libing Jiang, Mao Zhang, Yuefeng Ma
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.002
Published online: October 7 2014
xWe read with great interest the article by Weng et al [1] who studied the association between red cell distribution width (RDW) and mortality in patients with necrotizing fasciitis (NF). The authors concluded that elevated RDW is a significant and independent predictor of in-hospital mortality for patients with NF. Thanks to the authors for their contribution.
Hong-Mo Shih
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.001
Published online: October 7 2014
xWe thank Prof Yuefeng Ma for his interest and comments on our article. Although several factors increased red blood cell distribution width (RDW), anemia, chronic kidney disease, and liver cirrhosis were taken into account in our study. When considering about time elapsed between blood sampling and RDW measuring, the complete cell count from emergency department in our hospital was always reported within 1 hour.
Krittapoom Akrawinthawong, Pornchai Leelasinjaroen, Yee Seng Ng, Marissa N. Dean, Chatchawan Piyaskulkaew, Saif Al-najafi, Sula E. Mazimba
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.008
Published online: August 7 2014
xTo the best of our knowledge, there are no reports demonstrating the occurrence of coronary thrombus after complicated seizures without an underlying pathology (eg, atherosclerosis, vasculitis) upon coronary vessels. Acute coronary syndrome (ACS) occurring after seizures is a rare and perhaps unrecognized. It is therefore not surprising that the consensus or practice guidelines on ACS are silent on this clinical entity. Thus, we demonstrated the value of a simple screening tool of serial cardiac enzymes and electrocardiograms (ECGs), which are readily available in the hospital to tease out this rare entity that can prove fatal if not detected early.
Onur Polat, Ahmet Burak Oğuz, Ayhan Cömert, Arda Demirkan, Müge Günalp, Eray Tüccar
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.018
Published online: September 19 2014
xSuccess rate and time need for vascular access are crucial in the emergency patient. However, in many cases, peripheral intravenous access might be difficult [1]. Intraosseous (IO) infusion is the quickest way to establish access for rapid administration of medications and liquids in emergency situations, where vascular access is difficult to achieve. In recent years, it has been widely used in pediatric population. Intraosseous infusion is now recommended in adult resuscitation by the American Heart Association [2] and the European Resuscitation Council [3].
Meera Ekka, Sashi Bhusan Lakra, Praveen Aggarwal, Nayer Jamshed
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.031
Published online: September 25 2014
xWe read the original article by Lin et al [1] with great enthusiasm. The authors have revealed the role of simple hydration therapy to prevent stroke in evolution (SIE) after acute ischemic stroke (AIS), which was done according to World Health Organization hydration protocol 2005 for diarrhea. They have concluded that providing hydration therapy to patients who present with a blood urea nitrogen/creatinine (BUN/Cr) ratio greater than or equal to 15 after ischemic stroke may help prevent the development of SIE, and such prevention is likely to improve prognosis given that SIE is a key indicator of poor prognosis after stroke.
Giovanni Volpicelli
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.028
Published online: September 25 2014
xThe reply to our letter “Questioning ultrasound diagnosis of pneumothorax: based on what?” by Rea et al [1] is appreciated, but the question included in the title and the technical issues raised in our letter still remain not responded. Rather, the new letter of Rea et al once more reports opinions and, in the two-thirds of the text, opinions of others. The BTS experts did not question the usefulness of ultrasound for trauma and post-procedural pneumothorax in emergency, but they pointed out the lack of evidences on the superiority of ultrasound over chest radiography only in spontaneous pneumothorax.
Eric M. Rottenberg
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.022
Published online: September 25 2014
xDr Wang and colleagues [1] studied the physiological effects and quality of chest compressions during cardiopulmonary resuscitation (CPR) at sea level and high altitude. Thirty-eight participants were asked to perform continuous chest compression CPR (CCC-CPR) for 5 minutes at sea level and at high altitude. They quantified the quality of the chest compressions and measured the rescuers' blood oxygen saturation, systolic blood pressure, diastolic blood pressure, heart rate, and fatigue, as measured with the Borg score, after CCC-CPR compared with resting levels.
Neal J. Cohen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.045
Published online: October 2 2014
xRecently in American Journal of Emergency Medicine, Capp et al [1] published an article regarding the risk-standardized admissions rates from emergency departments. The authors adjusted for patient variables as well as hospital variables. Hospital variables included region, yet not state. State-to-state differences likely encompass a large portion of the institutional effect that they claim to have found. It is well known in the economics literature that state adoption of malpractice reform reduces cost of care [2] and admission rate [3].
Sevket Balta, Mustafa Aparcı, Cengiz Ozturk, Sait Demirkol, Turgay Celik
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.040
Published online: October 2 2014
xWe read with great interest the article “Prognostic ımportance of neutrophil-lymphocyte(N/L) ratio in critically III patients: short and long term outcomes” by Akilli et al [1]. They aimed to evaluate the effect of the N/L ratio on mortality in critically ill patients. They concluded that The N/L ratio is a simple, cheap, rapidly available, independent indicator of short- and long-term mortalities.
Anna Yvonne Kempinska, Farhan Bhanji, Sandie Larouche, Alexander Sasha Dubrovsky
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.038
Published online: October 2 2014
xPoint-of-care ultrasound can be used to identify long-bone fractures and may improve the quality of care for patients undergoing closed-reductions of angulated or displaced fractures [1-3]. Heiner and McArthur [4] developed a simulation model consisting of fractured turkey bones embedded in a gelatin matrix, which was found to be useful to learn how to identify fractures [5,6]. However, it was not aimed at assessing adequacy of ultrasound-guided reductions. We therefore designed a 1-hour educational program consisting of 4 components with the objective of training physicians to assess for successful realignment of fractures using a high-frequency linear ultrasound probe (L14-3 linear transducer, z.one ultra system; Zonare, Mountain View, CA):
Narat Srivali, Vareena Laohaphan, Charat Thongprayoon
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.033
Published online: October 2 2014
xWe thank Bologa et al [1] for their article entitled “Unusual cause of spontaneous unilateral intracerebral hematoma—acute methanol poisoning: case report” which was published in the American Journal of Emergency Medicine.
Andrea F. Dugas, Bradley Monteforte, Aditi Puri, Mohamed Awad, Yu-Hsiang Hsieh, Richard Rothman
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.032
Published online: October 2 2014
xStudies indicate that antiviral treatment improves clinical outcomes for patients at increased risk for, or with existing influenza complications, and is thus recommended by the Centers for Disease Control and Prevention (CDC), World Health Organization, and Infectious Disease Society of America [1–3]. However, despite growing evidence that antiviral medications reduce influenza-related morbidity and mortality, there continues to be a discordance between recommendations and clinical practice [4].
Alissa Genthon, Sarah Frasure, Karen Kinnaman, Calvin Huang, Vicki Noble
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.015
Published online: April 23 2014
xEmergency physicians (EPs) can use bedside ultrasound to diagnosis of intraabdominal free fluid in a variety of clinical scenarios.
Bhawna Sharma, Rahul Handa, Swayam Prakash, Kadam Nagpal, Indu Bhana, Pankaj Kumar Gupta, Sunil Kumar, Mahendra Singh Sisodiya
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.046
Published online: April 28 2014
xAlexia without agraphia (pure alexia) was the first of the disconnection syndromes to be described by Dejerine who reported a patient of alexia without agraphia secondary to an embolic occipital lobe infarct. We herein report a 55-year-old man who presented with alexia without agraphia with magnetic resonance imaging suggestive of left posterior cerebral artery infarct involving left occipital lobe and splenium of corpus callosum. Alexia without agraphia is a relatively uncommon clinical condition, which should always be thought in a patient presenting with difficulty in reading with normal visual acuity.
Yale A. Fillingham, Brandon J. Erickson, Gregory L. Cvetanovich, Craig J. Della Valle
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.045
Published online: April 28 2014
xDislocation is one of the most common complications of total hip arthroplasty (THA). Because of the growing number of patients undergoing THA annually and the immense number of patients who have previously undergone the procedure, familiarity with the diagnosis and treatment of this complication is critical. Although the most common direction of dislocation is posterior, anterior dislocations do occur, and correctly identifying the direction of dislocation is important before attempted closed reduction as both the reduction maneuvers used and the postoperative instructions afterward are distinct for an anterior as opposed to a posterior dislocation.
Ashley Strobel, Daniel B. Gingold, Emilie J.B. Calvello
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.044
Published online: April 28 2014
xThrombotic thrombocytopenic purpura (TTP) is a challenging diagnosis to make in the emergency department. We present a case of TTP initially presenting with refractory hypoglycemia in a woman with thromboangiitis obliterans (Buerger's disease). To our knowledge, this is the first description of the association of hypoglycemia and thromboangiitis obliterans with TTP. We briefly review key aspects of the acute diagnosis and management of hypoglycemia and TTP pertinent to the emergency physician.
T. Karabuga, O. Yoldas, I. Ozsan, U.M. Yıldırım, U. Aydin
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.042
Published online: April 28 2014
xPneumatosis intestinalis (PI) is a rare clinical condition, which is commonly associated with mesenteric vascular ischemia, bowel obstruction, and chemotherapy. Although the pathophysiology of PI remains unclear, 2 theories, one mechanical and the other bacterial, have been proposed. Nonoperative medical treatment and observation should be considered in mild cases, but occasionally, the situation requires emergency surgical intervention. In cases of suspectful complicated PI, the clinician should not avoid performing diagnostic laparoscopy to rule out bowel ischemia and perforation.
Ivana Štětkářová, Lenka Jelínková, Vaclav Janík, Tomas Peisker
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.039
Published online: April 28 2014
xSpontaneous spinal epidural hematoma (SSEH) is a rare neurologic condition with threatening consequences when spinal cord compression is present. The diagnosis must be performed quickly using magnetic resonance imaging (MRI), which shows collection of blood in the epidural space. With spinal cord compression, there is an indication for urgent surgical decompression. Here, we present a 64-year-old woman who developed sudden thoracic and lower back pain accompanied by severe paraparesis and urinary retention after sneezing abruptly.
Gustavo Avegliano, Diego Conde, Luciano Battioni, Paola Kuschnir, Florencia Castro, Ricardo Ronderos
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.038
Published online: April 28 2014
xEssential thrombocytosis (ET) falls under the umbrella of myeloproliferative disorders, which also includes chronic myelogenous leukemia, polycythemia vera, and myelofibrosis with myeloid metaplasia. Essential thrombocytosis results from a clonal proliferation of megakaryocites within the bone marrow, leading to an absolute elevation of platelets that can cause both hemorrhagic and thrombotic complications.
Rajendra Singh Jain, Kadam Nagpal, Rahul Jain, Swayam Prakash, Rahul Handa
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.006
Published online: May 12 2014
xAtrial myxomas are the most common benign cardiac tumors. Neurological manifestations associated with left atrial myxoma are seen infrequently in the form of embolic stroke of intracranial hemorrhage. Psychiatric manifestations are however exceedingly rare. We hereby present a case who presented with acute psychosis as a sole manifestation of an underlying left atrial myxoma.
Cuneyt Toprak, Anil Avci, Burak Ozturkeri, Mehmet Mustafa Tabakci, Gokhan Kahveci
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.022
Published online: May 21 2014
xA 55-year-old man presented with the emergency department after having a short syncopal episode and angina during the exertion for 1 month. His initial electrocardiogram showed minimal ST-segment changes on precordial leads. While waiting for the laboratory tests, abruptly, the patient went into cardiopulmonary arrest. After a short resuscitation, a new electrocardiogram revealed ST-segment elevations in leads V1-3 and AVR, mimicking an anteroseptal myocardial infarction. Although, the angiography showed severe coronary artery disease, coronary flow was normal and main branches of pulmonary artery were almost fully occluded by large pulmonary emboli.
Elie Dan Schouver, Patricia Panaia Ferrari, Olivier Chiche, Pamela Moceri, Emile Ferrari
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.018
Published online: May 21 2014
xThe specific kinetic of copeptin secretion during the course of an acute coronary syndrome (ACS) had poorly been studied, with most studies assessing copeptin levels in the very first hours of chest pain onset and not ACS itself. To overcome this issue, we took advantage of septal embolization technique for hypertrophic obstructive cardiomyopathy (HOCM) treatment, a unique situation during which myocardial infarction (MI) is provoked, to measure plasmatic copeptin levels variation.
Tyler J. Harris, Jason P. Seamon
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.029
Published online: May 23 2014
xSpontaneous epidural abscess formation is a rare finding in all populations and even more so in the pediatric population. Its rarity and varied presentations often lead to misdiagnosis. We present a pediatric case in which the diagnosis of spontaneous spinal epidural abscess was missed upon initial presentation and subsequently identified at a later visit to the emergency department. Literature suggests utilizing three simple physical exam findings that may improve the first visit diagnosis of spontaneous epidural abscesses in children.
Jae-hyung Kim, Sang Yoon Hyun, Ju Byung Chae, Sang Min Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.028
Published online: May 23 2014
xWe report a 53-year-old woman who had acute visual loss 10 days after cardiopulmonary cerebral resuscitation performance. Immediately after she had performed cardiopulmonary cerebral resuscitation, she developed floater symptoms in her left eye, which persisted for 2 hours, and she was diagnosed as having Valsalva retinopathy. Ten days later, she had an acute painless visual loss in the same eye (visual acuity 20/1000). On fundus examination, optic disk edema, peripapillary hemorrhage, and retinal artery occlusion were detected in the superior half of her left retina and she was diagnosed as having branch retinal artery occlusion.
Nikolaos S. Salemis, Ioannis Oikonomakis, Emanuel Lagoudianakis, Georgios Boubousis, Christos Tsakalakis, Sotirios Sourlas, Stavros Gourgiotis
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.026
Published online: May 23 2014
xSpontaneous retroperitoneal hematoma (SRH) is a severe and potentially fatal complication of anticoagulation therapy. We describe a case of fatal spontaneous massive retroperitoneal hematoma in a female patient receiving bridging therapy with enoxaparin for atrial fibrillation. Physicians should be cautious when prescribing enoxaparin in elderly patients, in patients with impaired renal function, and in patients receiving concomitant oral anticoagulants. Emergency physicians should always consider SRH in the differential diagnosis in patients under enoxaparin therapy presenting with abdominal pain.
Juron S. Foreman, Lauren M. Daniels, Edward A. Stettner
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.050
Published online: June 11 2014
xAlthough rare, heparin-induced anaphylactic and anaphylactoid reactions have been previously described in the literature. We present a case of a patient who presented to the emergency department with dyspnea and was subsequently diagnosed with an acute pulmonary venous thromboembolism. Shortly after being started on intravenous unfractionated heparin, she developed sudden cardiovascular collapse leading to a cardiopulmonary arrest. She was successfully resuscitated and, after further diagnostic evaluation, was found to have developed a heparin-induced anaphylactoid reaction.
Georges Mion, Jean Marie Rousseau, Dominique Selcer, Charles-Marc Samama
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.046
Published online: May 31 2014
xA patient scheduled for a laparoscopic cholecystectomy had an anaphylactic shock during induction of anesthesia. After the injection of vecuronium, an unusual fall of arterial pressure occurred, with bradycardia, enlargement of the QRS complex, then a circulatory arrest. Chest compressions were initiated, while intravenous epinephrine 1 mg was administered. The cardiac rhythm turned into a ventricular fibrillation (VF). Despite continuous chest compressions with repeated boluses of epinephrine and several external electric shocks, the patient remained in VF.
Rushikesh Shah, Mili Shah, Nidhi Bansal, Divey Manocha
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.045
Published online: May 31 2014
xInfliximab is a commonly used biologic agent in the treatment of various autoimmune diseases. Although it is generally well tolerated in most patients, infliximab has been associated with some rare but serious adverse events. Aseptic meningitis is one such distinctly uncommon side effect. We present the case of middle-aged white patient, who presented with fever and headache within a few days of starting the infliximab therapy and was diagnosed with infliximab-induced aseptic meningitis after a complete workup.
