Pauline Alexander, Lora Alkhawam, Jason Curry, Phillip Levy, Peter S. Pang, Alan B. Storrow, Sean P. Collins
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.009
Published online: September 17 2014
xThere are nearly 700,000 annual US emergency department (ED) visits for acute heart failure (AHF). Although blood pressure is elevated on most of these visits, acute therapy remains focused on preload and not afterload reduction. Data from recent prospective studies suggest that patients with AHF with concomitant acute hypertension benefit from intravenous (IV) vasodilators. To better understand the use of vasodilators for such patients, we conducted a systematic review of (1) currently available intravenous vasodilators for ED patients with AHF, or (2) intravenous vasodilators that are not yet available, but have completed phase III clinical trials in AHF, and may be available for ED use in the future.
Naoya Miura, Takeshi Saito, Takayuki Taira, Rimako Umebachi, Sadaki Inokuchi
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.048
Published online: October 3 2014
xAntipsychotic/Antidepressant use is a risk factor for QT interval (QT) prolongation and sudden cardiac death. However, it is unclear which drugs are risk factors for QT prolongation and torsades de pointes in cases of psychotropic drug overdose.
Marc-Alexander Ohlow, Vincent Wong, Michele Brunelli, Hubertus von Korn, Ahmed Farah, Nedim Memisevic, Stefan Richter, Ketevan Tukhiashvili, Bernward Lauer
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.048
Published online: November 8 2014
xAbsence of significant epicardial coronary artery stenosis in patients with acute onset of chest pain and elevation of myocardial necrosis markers is occasionally observed. The aim of this study was to retrospectively analyze the clinical characteristics and the outcome of such patients.
Mariano E. Menendez, David Ring
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.045
Published online: November 8 2014
xThe number of inpatient admissions for proximal humerus fracture is increasing, but the factors that determine hospitalization are not well documented. We sought to identify predictors of hospital admission among individuals presenting to the emergency department (ED) with a fracture of the proximal humerus.
Sean Shao Wei Lam, Ji Zhang, Zhong Cheng Zhang, Hong Choon Oh, Jerry Overton, Yih Yng Ng, Marcus Eng Hock Ong
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.044
Published online: November 8 2014
xDynamically reassigning ambulance deployment locations throughout a day to balance ambulance availability and demands can be effective in reducing response times. The objectives of this study were to model dynamic ambulance allocation plans in Singapore based on the system status management (SSM) strategy and to evaluate the dynamic deployment plans using a discrete event simulation (DES) model.
Julie Contenti, Hervé Corraze, Fabien Lemoël, Jacques Levraut
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.003
Published online: November 8 2014
xWe evaluate the capacity of arterial (ABL), peripheral venous (VBL), and capillary (CBL) blood lactate concentration to early detect the presence of severe sepsis in patients admitted to the emergency department for a septic syndrome.
Arne O. Budde, Adam Schwarz, Priti G. Dalal, Elizabeth H. Sinz, Sonia J. Vaida
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.007
Published online: November 13 2014
xLaryngeal tubes (LT) are often used as rescue airway devices. Among prehospital medical personnel, the success rates are high and significantly faster compared to an endotracheal tube (ETT). Therefore, LTs are increasingly used in the prehospital setting. The exchange of an LT for an ETT may often be desirable. Two fiberoptic bronchoscope–facilitated techniques have been described to exchange an LT for an ETT: an intraluminal technique using an Aintree intubating catheter and an extraluminal technique using a nasal route alongside the LT.
Oh Sung Kwon, Gyu Chong Cho, Choong Hyun Jo, Young Suk Cho
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.004
Published online: November 13 2014
xInserting a nasogastric tube (NGT) in intubated patients may be difficult because they cannot follow swallowing instructions, resulting in a high rate of first-attempt failure. We introduce a simple technique for inserting an orogastric tube in an emergency department (ED).
Alexander T. Janke, Aaron M. Brody, Daniel L. Overbeek, Justin C. Bedford, Robert D. Welch, Phillip D. Levy
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.006
Published online: November 13 2014
xAmericans who received public insurance under the Affordable Care Act use the emergency department (ED) more frequently than before they were insured. If newly enrolled patients cannot access primary care and instead rely on the ED, they may not enjoy the full benefits of health care services.
Josep-Maria Sirvent, Cristina Ferri, Anna Baró, Cristina Murcia, Carolina Lorencio
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.016
Published online: November 19 2014
xThe objective was to assess whether fluid balance had a determinant impact on mortality rate in a cohort of critically ill patients with severe sepsis or septic shock.
Lawrence H. Brown, Ian E. Blanchard
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.011
Published online: November 14 2014
xModern emergency medical service (EMS) systems are vulnerable to both rising energy prices and potential energy shortages. Ensuring the sustainability of EMS systems requires an empirical understanding of the total energy requirements of EMS operations. This study was undertaken to determine the life cycle energy requirements of US EMS systems.
Terence L. Ahern, Andrew A. Herring, Erik S. Anderson, Virat A. Madia, Jahan Fahimi, Bradley W. Frazee
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.010
Published online: November 14 2014
xThe objective of this study is to describe the clinical use and safety profile of low-dose ketamine (LDK) (0.1-0.3 mg/kg) for pain management in the emergency department (ED).
Leigh Ann Diggs, Sameera D. Viswakula, Manasi Sheth-Chandra, Gianluca De Leo
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.020
Published online: November 19 2014
xWe sought to evaluate the success of prehospital, non–drug-assisted endotracheal intubation (ETI) performed by Virginia prehospital care providers and to develop a model designed to predict the probability of success of ETI.
Jungyoup Lee, Kyuseok Kim, You Hwan Jo, Jae Hyuk Lee, Joonghee Kim, Heajin Chung, Ji Eun Hwang
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.019
Published online: November 19 2014
xThis study aimed to investigate the probability of 30-day mortality based on body mass index (BMI) assessment combined with pneumonia severity index (PSI) in patients with community-acquired pneumonia (CAP) and to determine whether being underweight is an independent risk factor contributing to 30-day mortality.
Çağdaş Akgüllü, İmran Kurt Ömürlü, Ufuk Eryılmaz, Mücahit Avcil, Evrin Dağtekin, Mehmet Akdeniz, Hasan Güngör, Cemil Zencir
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.022
Published online: November 25 2014
xWe aimed to determine the predictors of early death in the course of acute pulmonary embolism (APE).
Chih-Chia Hsieh, Ching-Chi Lee, Tsung-Yu Chan, Ming-Yuan Hong, Chih-Hsien Chi, Wen-Chien Ko
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.024
Published online: November 28 2014
xThe objectives were to investigate the clinical characteristics of community-onset bacteremia in cirrhotic adults visiting the emergency department (ED), as well as the clinical impact of empirical antibiotics on their outcome.
Alexander Sasha Dubrovsky, Elise Mok, Suk Yee Lau, Mohammad Al Humaidan
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.028
Published online: November 29 2014
xOur goal was to determine whether the combination of tenderness at 1 of 5 commonly fractured sites and elbow extension accurately predicts the presence of acute elbow fractures or isolated effusions in children.
Karen Greenberg, Christina R. Maxwell, Keisha D. Moore, Michael D’Ambrosio, Kenneth Liebman, Erol Veznedaroglu, Geri Sanfillippo, Cynthia Diaz, Mandy J. Binning
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.025
Published online: November 28 2014
xThe neurologic emergency department (neuro ED) at our medical center is staffed by emergency medicine physicians who have specialized neuroscience training and give intravenous (IV) tissue plasminogen activator (tPA) independently for acute ischemic stroke patients. Door-to-needle (DTN) times, discharge location, and discharge National Institute of Health Stroke Scale (NIHSS) scores were studied between the neuro ED and main emergency department (ED) with the hypothesis that all measures would be better in the neuro ED group.
Aaron M. Smith, Brandon A. Wuerth, Timothy L. Wiemken, Forest W. Arnold
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.023
Published online: November 25 2014
xThe objective of the study is to determine the prevalence of Clostridium difficile infection (CDI) presenting to emergency departments (EDs) in the United States. Secondary objectives included defining the burden of CDI.
M. Fernanda Bellolio, Erik P. Hess, Waqas I. Gilani, Tyler J. VanDyck, Stuart A. Ostby, Jessica A. Schwarz, Christine M. Lohse, Alejandro A. Rabinstein
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.049
Published online: December 2 2014
xWe aim to externally validate the Ottawa subarachnoid hemorrhage (OSAH) clinical decision rule. This rule identifies patients with acute nontraumatic headache who require further investigation. We conducted a medical record review of all patients presenting to the emergency department (ED) with headache from January 2011 to November 2013. Per the OSAH rule, patients with any of the following predictors require further investigation: age 40 years or older, neck pain, stiffness or limited flexion, loss of consciousness, onset during exertion, or thunderclap.
Guy Rubin, Kobi Peleg, Adi Givon, Israel Trauma Group, Nimrod Rozen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.048
Published online: December 3 2014
xUpper extremity fractures (UEFs) associated with road traffic accidents (RTAs) may result in long-term disability. Previous studies have examined UEF profiles with small patient populations. The objective of this study was to examine the injury profiles of UEFs in all mechanisms of injury related to RTAs.
Shwetha Edla, Andrew T. Reisner, Jianbo Liu, Victor A. Convertino, Robert Carter III, Jaques Reifman
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.046
Published online: December 2 2014
Open AccessxDuring initial assessment of trauma patients, metrics of heart rate variability (HRV) have been associated with high-risk clinical conditions. Yet, despite numerous studies, the potential of HRV to improve clinical outcomes remains unclear. Our objective was to evaluate whether HRV metrics provide additional diagnostic information, beyond routine vital signs, for making a specific clinical assessment: identification of hemorrhaging patients who receive packed red blood cell (PRBC) transfusion.
Suha Turkmen, Umut Eryigit, Yunus Karaca, Ahmet Mentese, Uzun Aysegul Sumer, Esin Yulug, Nurhak Aksut, Sibel Gazioglu, Abdulkadir Gunduz
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.051
Published online: December 2 2014
xThis study was intended to examine possible diagnostic value of plasma Signal Peptide-Cub-Egf domain-containing protein-1 (SCUBE1) levels in an experimental model of acute ischemic stroke.
Piyaporn Apisarnthanarak, Voraparee Suvannarerg, Poompis Pattaranutaporn, Aphinya Charoensak, Steven S. Raman, Anucha Apisarnthanarak
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.056
Published online: December 3 2014
xThe objective of the study is to assess the utility of Alvarado score in the diagnosis of acute appendicitis and the utility of computed tomographic (CT) scan for evaluation of acute appendicitis when stratified by Alvarado scores.
Jay G. Ladde, Sara Baker, C. Neil Rodgers, Linda Papa
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.014
Published online: October 16 2014
xThis study assesses outcome in pediatric patients with skin abscess using the LOOP compared to the standard incision and drainage (I&D) with packing method.
Toru Hifumi, Ippei Jinbo, Ichiro Okada, Nobuaki Kiriu, Hiroshi Kato, Yuichi Koido, Junichi Inoue, Kenya Kawakita, Satoshi Morita, Yasuhiro Kuroda
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.046
Published online: November 8 2014
xThere is no consensus on whether mechanical ventilation should be initiated for advanced age with community-acquired pneumonia (CAP). This study investigated the effects of age on the outcomes of mechanical ventilation in the emergency department (ED) for advanced age with CAP.
Kazuhiko Omori, Kouhei Ishikawa, Mariko Obinata, Kentaro Mishima, Shin Fukusato, Hiromichi Ohsaka, Yasumasa Oode, Youichi Yanagawa
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.055
Published online: December 3 2014
xSeverely traumatized patients undergo whole-body computed tomography (WCT) to detect lethal anatomical injuries. When checking the images, we have sometimes recognized minute gas (the vacuum phenomenon [VP]) near the traumatized lesions. Accordingly, we investigated the significance of the VP in patients with trauma.
Eric M. Rottenberg
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.015
Published online: October 15 2014
xA recent commentary, “Resuscitation That's (Un)Shockable: Time to Get the Adrenaline Flowing”, published in the New England Journal of Medicine Journal Watch called attention to a relatively recent study showing that a large and increasing percentage of patients with in-hospital cardiac arrests exhibit initial nonshockable rhythms (asystole or pulseless electrical activity [PEA]; 82% in 2009 vs 69% in 2000) and a most recent study that concluded that neurologically intact survival to hospital discharge after in-hospital cardiac arrest was significantly more likely after earlier epinephrine administration.
Pen-Yuan Liao, Cheng-Yu Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.024
Published online: October 24 2014
xWe thank Smith et al [1] for presenting the case of tumefactive multiple sclerosis (MS). The diagnosis of tumefactive demyelinating lesion (TDL) remains a challenge to most clinicians. The expanded use of magnetic resonance imaging (MRI) in the field of emergency medicine not only enables early diagnosis in emergency department but also increases the burden of medial liability for emergency physicians. The case is classic and worth further discussions.
Richard S. MacKenzie, David B. Burmeister, Jennifer A. Brown, Melissa Teitsworth, Christopher J. Kita, Megan J. Dambach, Shaheen Shamji, Marna Rayl Greenberg
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.039
Published online: October 29 2014
xCrowding plagues US emergency departments (EDs) [1-6]. As a countermeasure to crowding, we developed a new entry process (rapid assessment unit [RAU]) and hypothesized it would reduce the median length of stay (LOS) for ED patients, reduce door-to-treatment times, the left without being seen (LWBS) proportion, diversion hours, and door-to-provider times.
Łukasz Szarpak, Łukasz Czyżewski, Andrzej Kurowski
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.052
Published online: November 13 2014
xEndotracheal intubation (ETI) is a life-saving procedure performed daily in emergency medicine. The European Resuscitation Council 2010 cardiopulmonary resuscitation (CPR) guidelines suggest that intubators should be able to secure the airway without interrupting chest compression [1,2]. The placement of an endotracheal tube can accomplish stable ventilation support without additional pauses in chest compression during CPR [1]. However, ETI with uninterrupted chest compression in pediatric patients can be a very difficult skill to acquire [3].
Feriyde Çalışkan Tür, Özge Duman Atilla, Zeynep Temizyürek, Murat Yeşilaras, Ersin Aksay
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.047
Published online: November 10 2014
xAnterior shoulder dislocation is the most common injury of the shoulder joint [1,2]. Acupuncture is an alternative method of analgesia and may be chosen for soft tissue shoulder problems such as impingement and adhesive capsulitis [3,4]. We have used local acupuncture points as an adjunctive analgesic method for reducing anterior glenohumeral dislocations.
Marie Thuresson, Pernilla Haglund, Britta Ryttberg, Johan Herlitz, Ulrica Nilsson
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.001
Published online: November 8 2014
xThe initiation of early reperfusion treatment is crucial for the outcome in acute coronary syndrome (ACS) [1,2]. One major obstacle to early treatment is related to the patient's decision-making process [3,4]. An information campaign designed to inform the public about how to act when faced by an ACS was conducted in a county in Sweden in 2005. We evaluated the long-term effects of the intervention in terms of patient decision time, prehospital delay, and ambulance use in ACS. We did also describe the number of patients seeking the emergency department (ED) for acute chest pain.
Narat Srivali, Vareena Laohaphan
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.018
Published online: November 19 2014
xWe read with great interest the article by Dr Bouabdallaoui et al [1] on “Cardiogenic shock, asthma, and hypereosinophilia” published in The American Journal of Emergency Medicine. The authors described a case of eosinophilic granulomatosis with polyangiitis (EGPA) or formerly known as Churg-Strauss syndrome presenting with cardiogenic shock. The patient's condition was markedly improved with high doses of corticosteroids and intravenous cyclophosphamide (CYP).
Jennifer R. Marin, Frances S. Shofer, Ivy Chang, Angela M. Mills
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.017
Published online: November 19 2014
xIncreases in emergency department (ED) computed tomography (CT) use have raised concern over potential overutilization [1,2]. Evidence-based guidelines, such as the American College of Emergency Physicians (ACEP) clinical policy on neuroimaging for adult traumatic brain injury (TBI) [3] are designed to reduce unnecessary imaging. Our primary objective was to assess adherence to the ACEP policy (meeting either level A or B recommendations). Our secondary objective was to compare lengths of stay for those who received and did not receive a head CT that was not recommended by the policy.
Po-An Su, Che-Kim Tan, Chien-Chin Hsu, Kuo-Tai Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.035
Published online: December 1 2014
xDengue is the most common arthropod-borne viral disease and is prevalent in tropical and subtropical areas. The typical manifestations of dengue include fever, headache and myalgia, and these symptoms are commonly present in various inflammatory and infectious diseases. Therefore, the accurate diagnosis of dengue relies on laboratory studies [1]. Currently, capture enzyme-linked immunosorbent assay for dengue immunoglobulin M antibody (dengue IgM) is the most widely applied test. However, dengue IgM antibodies cross-react with other flaviviruses, and a number of non-dengue diseases have been reported to produce positive reactions in dengue serological tests [1–5].
Erdim Sertoglu, Metin Uyanik, Huseyin Kayadibi
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.021
Published online: November 24 2014
xWe read with great interest the recently published article by Weng et al [1] in which the authors aimed to assess the association of elevated red blood cell distribution width (RDW) with in-hospital mortality due to necrotizing fasciitis (NF) retrospectively. They concluded that elevated RDW is a significant and independent predictor of in-hospital mortality for patients with NF. However, we think that there are some points that should be emphasized about this study.
Goran P. Koracevic
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.038
Published online: December 1 2014
xIn pulmonary thromboembolism (PTE), there is a high-risk subgroup of patients with a fatal outcome. Most patients (almost one-quarter of all PTE patients) die suddenly within 1 hour of presentation, most commonly without a proper diagnosis [1,2]. At the other end of the spectrum, low-risk patients (around one-third of all admitted to hospital) can be safely treated at home [3]. As an illustration, the risk of fatal PTE is “5.42-fold higher (P < .001)” in patients who are presented with a symptomatic nonmassive PTE in comparison with patients who have deep vein thrombosis (DVT) but who do not have symptomatic PTE [4].
Gao-Pu Liu, Fu-Shan Xue, Rui-Ping Li, Chao Sun, Gui-Zhen Yang
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.050
Published online: December 2 2014
xThe recent article by Kwon et al [1] assessing the performance of endotracheal tube (ETT)–assisted orogastric tube insertion technique in the intubated patients in an emergency department was of great interest. They showed that this technique provided a higher success rate on the first attempt and required a shorter total duration compared with the conventional technique. Their results are in accord with the findings of a previously randomized controlled clinical study in which nasogastric tube insertion was facilitated by using an oroesophageally placed ETT as an introducer [2].
Liang Sun, Guo-qiang Li, Peng-bo Yan, Yang Liu, Guo-feng Li, Lu-Qing Wei
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.057
Published online: June 12 2014
xBackground: Acute organophosphorus pesticide poisoning during pregnancy may lead to spontaneous abortion. Now, there is no definite strategy focused on maintaining pregnancy. Method: This is a retrospective analysis of 2 cases of organophosphorus poisoning during pregnancy. All patients received penehyclidine hydrochloride injection, until the tracheobronchial tree is cleared of the secretions, and most secretions were dried. In addition, magnesium sulfate was used in one woman for the correction of hyperdynamic uterine activity.
Ke-Wei Chen, Wen-Yi Chiu, Yi-Hao Lo
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.024
Published online: June 27 2014
xSpontaneous pneumomediastinum is defined as presence of air in the mediastinum without obvious cause such as esophageal perforation or abscess formation. It is a benign condition and usually resolved by itself in 1 to 2 weeks. The main symptom of spontaneous pneumomediastinum is retrosternal chest pain. Here, we present a young adult who complained about sore throat initially. Marked retropharyngeal emphysema was noted by neck x-ray. Pneumomediastinum was confirmed with chest x-ray and computed tomographic scan later on.
Samantha W. Gee, Todd J. Karsies
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.022
Published online: June 26 2014
xIn the setting of increased intracranial pressure (ICP), various rhythm disturbances have been associated, ranging from tachyarrhythmias to bradyarrhythmias with atrioventricular dissociation. Although most of these observations have been in patients with traumatic brain injuries, it is known that children with acute bacterial meningitis may also have severe intracranial hypertension. We present the case of a previously healthy 2-year-old boy diagnosed with listeria meningitis. Along with clinical signs suggestive of increased ICP and brainstem involvement, our patient had persistent bradyarrhythmia with hemodynamic compromise that was refractory to epinephrine and successfully managed with isoproterenol.
Joseph R. Pare, Elissa M. Schechter-Perkins
DOI: http://dx.doi.org/10.1016/j.ajem.2014.07.016
Published online: July 29 2014
xPyomyositis is a rare disease in temperate climates. This case is a unique presentation of pyomyositis of the rectus abdominal muscle mimicking an acute abdominal process. Most reported cases of pyomyositis are of extremity infections with Staphylococcus aureus. This report presents a case of polymicrobial pyomyositis from Haemophylus parainfluenza and Steptococcus viridians infection.
Adnan I. Qureshi, Ahmed A. Malik, Melissa Freese, Michelle J. Thompson, Asif A. Khan, M. Fareed K. Suri
DOI: http://dx.doi.org/10.1016/j.ajem.2014.07.020
Published online: July 30 2014
xBackground: Because of a high risk of recurrence of ischemic events, some patients may be candidates for readministration of intravenous (IV) alteplase. Methods: We performed a single-center review and performed a search on PubMed from January 1966 to April 2014 for cases of readministration of alteplase. Favorable outcome was defined by a modified Rankin scale of 0 to 2 at discharge or at 1 to 3 months, improvement of greater than or equal to 4 points within 24 hours in the National Institutes of Health Stroke Scale score, or as a major improvement in the 72-hour National Institutes of Health Stroke Scale score.
Xavier Muschart, Dominique Blommaert
DOI: http://dx.doi.org/10.1016/j.ajem.2014.07.019
Published online: July 30 2014
xLyme borreliosis is a disease commonly found in humans. Here we report the case of a young, healthy girl presenting with symptomatic first- and second-degree atrioventricular blocks secondary to cardiac myocarditis. The disappearance of the conduction anomaly after antibiotic treatment confirmed Lyme disease before the results from the serology. Therefore, when a healthy, young person suddenly presents with an atrioventricular conduction block, physicians should consider a diagnosis of Lyme disease.
Gaurang Nandkishor Vaidya, Russell Acevedo
DOI: http://dx.doi.org/10.1016/j.ajem.2014.07.039
Published online: August 7 2014
xTumor lysis syndrome (TLS) is an oncologic emergency characterized by spillage of intracellular material into the blood caused by disruption of massive load of tumor cells. It is more commonly reported in hematological cancers and can have fatal consequences due to renal and multi-organ failure and arrhythmias due to electrolyte imbalance. We describe a case with metastatic breast cancer who presented with TLS after a single dose of paclitaxel, second such case in literature. The development of a risk stratification score to assess the need for hospitalization or close observation of these patients and the documentation of appropriate preventive strategies could help prevent such fatal occurrences.
Yasuyuki Shiraishi, Takashi Kohno, Toru Egashira, Yuichiro Maekawa, Yoshitake Yamada, Akihiro Yoshitake, Hideyuki Shimizu, Motoaki Sano, Masahiro Jinzaki, Keiichi Fukuda
DOI: http://dx.doi.org/10.1016/j.ajem.2014.07.040
Published online: August 7 2014
xType B acute aortic dissection (AAD) is often successfully managed with medical therapy, with a lower mortality rate, compared with type A AAD. Although the number of AAD patients complicated with atrial fibrillation (AF) has increased, reflecting an aging society, there have only been a few reports regarding the association of AAD and AF. Furthermore, there is no consensus on anticoagulation therapy in ADD patients complicated with AF, despite the importance of anticoagulation therapy in AF treatment.
Nadia Bouabdallaoui, Jean-Benoît Arlet, Albert A. Hagege
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.019
Published online: August 7 2014
xEosinophilic granulomatosis with polyangiitis (EGPA) (formerly Churg-Strauss) is a multisystem syndrome associating asthma, hypereosinophilia, and signs of peripheral vasculitis. We report the case of a 21-year-old man admitted for cardiogenic shock revealing a severe left and right ventricular dysfunction. Hypereosinophilia, history of asthma, and peripheral neuropathy strongly suggested the diagnosis of EGPA. Cardiac magnetic resonance imaging confirmed heart involvement with a diffuse subendocardial late gadolinium enhancement.
Abeer T. Ammar, Mark Livak, Joanne C. Witsil
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.015
Published online: August 7 2014
xLevamisole is an agent previously used in humans and later withdrawn from the US drug market due to concerns of agranulocytosis. It is currently used as an adulterating agent in cocaine, bringing to light toxicities typically manifested by vasculitis and skin necrosis. We report a case of a 36-year-old crack cocaine user who presented with a purpuric rash on her face and limbs. Levamisole-induced vasculitis was suspected, and she therefore underwent an extensive work-up. In addition to these findings, she also presented with acute kidney injury of unknown etiology, which was later attributed to levamisole-adulterated cocaine.
Diane L. Gorgas, Brian Miller
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.014
Published online: August 7 2014
xBackground: The differential diagnosis for a paratracheal air collection includes Zenker diverticulum, tracheal diverticulum, apical herniation of the lung, and pneumomediastinum. In the setting of trauma, pneumomediastinum is traditionally regarded as an alarm sign that warrants investigation for tracheal or esophageal rupture, both highly morbid conditions.
