Petra E. Duran-Gehring, Faheem W. Guirgis, Kristin C. McKee, Susan Goggans, Huynh Tran, Colleen J. Kalynych, Robert L. Wears
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.010
Published online: October 10 2014
xThe objective was to determine if ultrasound (US) can more rapidly confirm central venous catheter (CVC) position in comparison to chest radiography (CXR) in the emergency department.
Ivan K. Ip, Ali S. Raja, Anurag Gupta, James Andruchow, Aaron Sodickson, Ramin Khorasani
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.005
Published online: November 13 2014
xReduction of unnecessary head computed tomographies (CTs) in patients with mild traumatic brain injury (MTBI) was recently endorsed by American College of Emergency Physicians (ACEP) in the “Choosing Wisely” campaign. We examined the impact of computerized clinical decision support (CDS) on head CT utilization in MTBI emergency department (ED) visits.
Anne Marie Dupuy, Jean Paul Cristol, Nils Kuster, Robin Reynier, Sophie Lefebvre, Stéphanie Badiou, Riad Jreige, Mustapha Sebbane
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.012
Published online: November 14 2014
xWe sought to evaluate the added value of heart fatty acid protein assay (HFABP) for rapid diagnosis of acute myocardial infarction in a prospective cohort of emergency department (ED) patients with acute chest pain.
Cenker Eken
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.013
Published online: November 14 2014
xMigraine is one of the most common causes of headache presentations to emergency departments (EDs). Patients with migraine attack need rapid pain relief rather than diagnostic modalities. Metoclopramide, a dopamine antagonist with a primary use of antiemetic, has been used commonly in ceasing migraine attack. An earlier meta-analysis favors metoclopramide over placebo but includes studies with significant methodological errors and heterogeneity. The present article aimed to review the literature to reveal studies comparing metoclopramide to either placebo or active comparators.
Lizhu Zhi, Xinlei Hu, Jun Xu, Chaoheng Yu, Huawei Shao, Xuanliang Pan, Hang Hu, Chunmao Han
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.026
Published online: November 28 2014
xBoth the ischemia-reperfusion injury and the abnormal changes of redox status are the important pathologic changes in the burn shock stage for severe burns. The study of clinical dynamic, quantitative relevance about them was performed.
Asim Kalkan, Ozlem Bilir, Gokhan Ersunan, Deniz Ozel, Mahmut Tas, Mehmet Erdem Memetoglu
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.029
Published online: November 28 2014
xWe used near-infrared spectrophotometry to assess the initial and final abdominal and cerebral saturations during cardiopulmonary resuscitation (CPR) of patients with out-of-hospital cardiac arrest to determine if there is a correlation between increase in these saturation values and return of spontaneous circulation.
Paul E. Stromberg, Michele H. Burt, S. Rutherfoord Rose, Kirk L. Cumpston, Michael P. Emswiler, Brandon K. Wills
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.044
Published online: December 2 2014
xSingle-use laundry detergent pods (LDPs) were introduced to the United States in 2010 but had been available in Europe as early as 2001. Case reports of unintentional exposures noted vomiting, ocular injuries, respiratory depression, and central nervous system depression. We summarize clinical effects from unintentional LDP exposures reported to a single poison center over 15 months.
Emeric Gallard, Jean-Philippe Redonnet, Jean-Eudes Bourcier, Dominique Deshaies, Nicolas Largeteau, Jeanne-Marie Amalric, Fouad Chedaddi, Jean-Marie Bourgeois, Didier Garnier, Thomas Geeraerts
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.003
Published online: December 11 2014
xThe etiologic diagnosis of acute dyspnea in the emergency department (ED) remains difficult, especially for elderly patients or those with previous cardiorespiratory medical history. This may lead to inappropriate treatment and potentially a higher mortality rate. Our objective was to evaluate the performance of cardiopulmonary ultrasound compared with usual care for the etiologic diagnosis of acute dyspnea in the ED.
Sahar Mansoor, Majid Afshar, Matthew Barrett, Gordon S. Smith, Erik A. Barr, Matthew E. Lissauer, Michael T. McCurdy, Sarah B. Murthi, Giora Netzer
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.001
Published online: December 9 2014
xThe purpose of this study is to assess the case rate of acute respiratory distress syndrome (ARDS) after near hanging and the secondary outcomes of traumatic and/or anoxic brain injury and death. Risk factors for the outcomes were assessed.
Jungyoup Lee, Kyuseok Kim, Sunkyun Park
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.011
Published online: December 18 2014
xThe aim of this study is to investigate factors associated with residual symptoms after hyperbaric oxygen therapy (HBOT) in type I decompression sickness (DCS).
Catherine Pradeau, Virginie Rondeau, Emilie Lévèque, Pierre-Yves Guernion, Eric Tentillier, Michel Thicoipé, Patrick Brochard
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.007
Published online: December 15 2014
xThe association between air pollution exposure and cardiovascular events is well established, and the effect of short-term exposure on out-of-hospital cardiac arrest (OHCA) has received some attention. The effect of air pollution exposure and the activation of mobile intensive care units (MICUs) for cardiac arrest have never been studied.
Sung Soo Choi, Seong-Woo Yun, Byung Kook Lee, Kyung Woon Jeung, Kyoung Hwan Song, Chang-Hee Lee, Jung Soo Park, Ji Yeon Jeong, Sang Yeol Shin
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.005
Published online: December 15 2014
xTo improve the quality of chest compression (CC), we developed the assistant-push method, whereby the second rescuer pushes the back of the chest compressor during CC. We investigated the effectiveness and feasibility of assistant push in achieving and maintaining the CC quality.
Elvira-Markela Antonogiannaki, Ioanna Mitrouska, Vassilis Amargianitakis, Dimitris Georgopoulos
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.010
Published online: December 22 2014
xThe aim of this study is to evaluate the value of physicochemical, base excess (BE), and plasma bicarbonate concentration ([HCO3-]) approaches on the assessment of acid-base status in patients presented to the emergency department (ED).
David M. Schreck, Robert D. Fishberg
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.029
Published online: December 20 2014
xThe objective of this study us to stratify by gender a new cardiac electrical biomarker (CEB) diagnostic accuracy for detection of acute myocardial ischemic injury (AMII).
Łukasz Szarpak, Łukasz Czyżewski, Andrzej Kurowski
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.020
Published online: December 19 2014
xThe study was designed to compare the effectiveness of 3 video laryngoscopes with the Miller laryngoscope during pediatric resuscitation.
Adnan Yamanoğlu, Nalan G. Çelebi Yamanoğlu, İsmet Parlak, Pelin Pınar, Ali Tosun, Burak Erkuran, Alper Akgür, Neslihan Satılmış Siliv
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.032
Published online: December 26 2014
xWe aimed to determine the role of inferior vena cava (IVC) diameter in making a differentiation between dyspnea of cardiac (acute heart failure [AHF]) and pulmonary origin. We also attempted to determine the best sonographic method for the measurement of IVC diameter.
Joshua P. Miller, Steven G. Schauer, Victoria J. Ganem, Vikhyat S. Bebarta
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.058
Published online: January 6 2015
xTo compare the maximum change in numeric rating scale (NRS) pain scores, in patients receiving low-dose ketamine (LDK) or morphine (MOR) for acute pain in the emergency department.
Mustafa Yilmaz, Mehtap Gurger, Metin Atescelik, Mustafa Yildiz, Sukru Gurbuz
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.056
Published online: December 31 2014
xMigraine is common in society and is one of the primary causes of chronic headache with episodes. In this study, we aimed to determine the role of meteorologic parameters and moon phase on triggering migraine attacks and effects on the number of patients presenting to the emergency department with migraine headaches.
Erin Schlemmer, James C. Mitchiner, Michael Brown, Elizabeth Wasilevich
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.060
Published online: December 30 2014
xLow back pain (LBP) is a common reason for emergency department (ED) visits. This study aimed to determine the frequency and type of nonindicated imaging during LBP ED visits and to describe demographic and prior health care use characteristics among the nonindicated population.
Katarina E. Göransson, Umut Heilborn, Josefin Selberg, Susanna von Scheele, Therese Djärv
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.069
Published online: January 6 2015
xPain is common at an emergency department (ED). Two common scales used to rate intensity are the visual analog scale (VAS) and the numeric rating scale (NRS), but it remains unknown which is superior to use in the ED.
Michael J. Ward, Sunil Kripalani, Alan B. Storrow, Dandan Liu, Theodore Speroff, Michael Matheny, Eric J. Thomassee, Timothy J. Vogus, Daniel Munoz, Carol Scott, Joseph L. Fredi, Robert S. Dittus
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.067
Published online: January 6 2015
xMost US hospitals lack primary percutaneous coronary intervention (PCI) capabilities to treat patients with ST-elevation myocardial infarction (STEMI) necessitating transfer to PCI-capable centers. Transferred patients rarely meet the 120-minute benchmark for timely reperfusion, and referring emergency departments (EDs) are a major source of preventable delays. We sought to use more granular data at transferring EDs to describe the variability in length of stay at referring EDs.
Michael Mallin, Philip Craven, Patrick Ockerse, Jacob Steenblik, Brayden Forbes, Karl Boehm, Scott Youngquist
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.004
Published online: October 9 2014
xComputed tomography (CT) has largely become standard of care for diagnosing appendicitis at the expense of increased patient radiation exposure, cost, and time to surgical intervention. To date, there are very limited data on the accuracy of bedside ultrasound (BUS) for the diagnosis of appendicitis in adults.
Nalan Gökçe Çelebi Yamanoğlu, Adnan Yamanoğlu, İsmet Parlak, Pelin Pınar, Ali Tosun, Burak Erkuran, Gizem Aydınok, Fatih Torlak
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.014
Published online: December 18 2014
xThis study aims to determine the site of and the best sonographic method for measurement of inferior vena cava (IVC) diameter in volume status monitoring.
Faheem W. Guirgis, Deborah J. Williams, Matthew Hale, Abubakr A. Bajwa, Adil Shujaat, Nisha Patel, Colleen J. Kalynych, Alan E. Jones, Robert L. Wears, Sunita Dodani
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.013
Published online: December 18 2014
xPrevious studies suggest a relationship between chloride-rich intravenous fluids and acute kidney injury in critically ill patients.
Shujun Xia, Shaun Persaud, Adrienne Birnbaum
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.008
Published online: December 18 2014
xThe objective of this study is to provide information on distribution of important single-nucleotide polymorphisms (SNPs) and evaluate their associations with clinical response to intravenous hydromorphone in emergency department.
Kees H. Polderman, Joseph Varon
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.051
Published online: February 4 2015
xAdministering intravenous fluids to support the circulation in critically ill patients has been a mainstay of emergency medicine and critical care for decades, especially (but not exclusively) in patients with distributive or hypovolemic shock. However, in recent years, this automatic use of large fluid volumes is beginning to be questioned. Analysis from several large trials in severe sepsis and/or acute respiratory distress syndrome have shown independent links between volumes of fluid administered and outcome; conservative fluid strategies have also been associated with lower mortality in trauma patients.
Nir Samuel, Ivan P. Steiner, Itai Shavit
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.012
Published online: December 18 2014
xInjury is a common cause of acute pain in children. The objective of this study was to analyze the available evidence in prehospital pain management of injured children.
Ümit Yolcu, Abdullah Ilhan, Salih Altun, Fatih Ç. Gundogan
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.011
Published online: October 15 2014
xWe have read the “Fluorescein-related extensive jaundice” titled article with great interest [1]. We want to thank the author for their contribution to the literature. The authors concluded that generalized jaundice is developed by increased vascular permeability due to immunoglobulin E–mediated mast cell activation with fluorescein.
Asim Kalkan, Suleyman Turedi, Ibrahim Aydin
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.012
Published online: October 15 2014
xWe thank the writers for their interest and comments regarding our recently published article about fluorescein-related extensive jaundice. In our article, we emphasize that fluorescein dye can cause jaundice and that emergency physicians need to investigate whether fluorescein angiography has been performed when taking anamnesis from patients presenting with jaundice symptoms. Although the exact mechanism by which fluorescein dye causes jaundice is unclear, it is thought to color the skin by escaping outside the blood vessels [1-3].
Mary Colleen Bhalla, Michael U. Ruhlin, Jennifer A. Frey, Scott T. Wilber
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.030
Published online: October 25 2014
xSince the implementation of the Patient Self Determination Act of 1990, every patient that comes to the hospital must be asked about their advanced directive status and be provided with information about different options [1]. There are currently 2 types of do-not-resuscitate (DNR) orders in Ohio: “DNR Comfort Care (CCO)” and “DNR Comfort Care Arrest (CCA)” [2]. The DNR orders are separate from any “living will” that the patient may elect to draft for the purpose of withdrawing or withholding care in case they are ever in a permanently unconscious state [3].
Shahriar Zehtabchi, Samah G. Abdel Baki, Louise Falzon, Daniel K. Nishijima
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.009
Published online: November 14 2014
xWe appreciate the comments by Piper et al [1] about the low rate of thromboembolic events reported in the trials included in our systematic review, evaluating the use of tranexamic acid in traumatic brain injury [2]. This low rate has generated both reassurance and skepticism at the same time. The trials included in our systematic review were largely conducted in developing countries [3,4], where follow-up and assessment of complications or side effects might have been very difficult. However, a large body of literature, in both injured and noninjured patients [5,6], has shown that the use of tranexamic acid is not associated with significant (clinically or statistically) increase in the risk of thromboembolic events compared with placebo or standard therapy.
Benjamin J. Piper
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.008
Published online: November 14 2014
xThe use of tranexamic acid in trauma has been well studied, and its application to subgroups as well as nontrauma patients is growing. However, there must be consideration and concern with regard to the tranexamic acid data presented in the recent systematic review and meta-analysis by Zehtabchi et al [1]. The concern is that the safety data that are cited, with regard to thrombotic complications, have an incredibly low event rate. The data presented suggest that of the 510 patients observed, only 3 had thrombotic events documented and none of these were in the tranexamic acid arms of either study.
Catherine A. Marco, Terry Kowalenko
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.037
Published online: December 1 2014
xIn 2003, the Accreditation Council for Graduate Medical Education implemented standards on duty hours, to promote resident learning and patient safety [1]. In 2008, the Institute of Medicine released a report “Resident Duty Hours: Enhancing Sleep, Supervision, and Safety [2].” In 2011, the Accreditation Council for Graduate Medical Education implemented additional regulations on duty hours and supervision [3]. Emergency medicine (EM) has additional duty hour requirements, including a maximum of 12 continuous scheduled hours and a maximum 60 scheduled hours per week in the emergency department [4].
Łukasz Szarpak, Andrzej Kurowski, Zenon Truszewski, Łukasz Czyżewski
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.039
Published online: December 1 2014
xThe recent European Resuscitation Council guidelines for infant cardiopulmonary resuscitation (CPR) emphasizes the importance of minimizing the interruption of chest compression (CC) to maximize cardiopulmonary and cerebral perfusion pressure [1]. These guidelines also suggest that the rescuer should secure the airway without interrupting CC [1,2]. The criterion standard for securing the airway is endotracheal intubation, which allows for continuous ventilation of the patient without interrupting CC and allows the use of positive pressure in the airways.
Ayhan Saritas, Suber Dikici, Harun Gunes
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.054
Published online: December 3 2014
xEnergy drinks are very popular among young people, and these drinks are marketed to college students, athletes, and active individuals. Energy drinks typically contain high levels of caffeine, sugar, and other ingredients such as taurine, B-complex vitamins, ginseng, and guarana seed extract [1-3]. To the best of our knowledge, the first case of ischemic stroke after intake of energy drink was reported in 2013 by us. In that case, we reported a 37-year-old patient presenting with epileptic seizure and ischemic stroke [2].
Charat Thongprayoon, Vareena Laohaphan, Narat Srivali
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.052
Published online: December 2 2014
xWe thank Dikici et al [1] for their interesting case study, “Does an energy drink cause a transient ischemic attack?” published in The American Journal of Emergency Medicine.
Jesse M. Pines, Mark S. Zocchi, Mary-Elizabeth Buchanan, Khaled Alghamdi, Danielle Lazar, Alex Rosenau, Manish Shah, Debbie Travers
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.018
Published online: December 18 2014
xIn recent years, point-of-care (POC) testing has gained popularity in emergency departments (EDs) to facilitate rapid laboratory test results [1-4]. Despite increasing popularity, few studies have addressed POC use early in ED care, specifically around ED triage. Availability of laboratory testing may help risk-stratify patients by providing additional information early in ED care. In a prospective study, triage POC testing changed patient management in 14% of cases, Emergency Severity Index (ESI) triage level in 15%, and 56% found POC testing to be helpful in the triage process [5].
Kelly Gray-Eurom, Matthew Hale, Matthew Thomas, Colleen Kalynych
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.016
Published online: December 18 2014
xHealth care expenditures in the United States have increased from 4.4% of gross domestic product in 1950 to 17.9% in 2011 [1,2]. With health care costs continuing to rise sharply, we are effectively pitting our nation's economic well-being against the health of its citizens. This is the driving factor behind health care reform, which affects all aspects of medicine including emergency care.
Farzan Mohammadi, Adam MacLasco, Frank P. Paloucek
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.015
Published online: December 17 2014
xWe read with concern the case report by Imam et al [1] detailing the use of the Sheiner-Tozer equation to diagnose phenytoin toxicity by calculating a “toxic” free phenytoin concentration. The authors demonstrate how the Sheiner-Tozer equation, , may be used to normalize phenytoin concentrations in a patient with hypoalbuminemia. We agree with the possibility of phenytoin toxicity in this case yet would like to address an error in the actual use of the equation that, if repeated, can lead to erroneous calculations.
Hong-Mo Shih
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.004
Published online: December 15 2014
xWe thank the reader for his interest and comments on our article. The receiver operating characteristic curves of red blood cell distribution width (RDW) levels were used to identify nonsurvivors on a statistically significant level (area under the curve of 0.851; P < .001; 95% confidence interval, 0.772-0.930; Figure). The positive and negative predictive value of RDW with cutoff 14.5 was also evaluated (Table).
Graziapia Casavecchia, Matteo Gravina, Antonio Totaro, Riccardo Ieva, Roberta Vinci, Luca Macarini, Matteo Di Biase, Natale Daniele Brunetti
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.065
Published online: January 6 2015
xWe would thank the colleagues for their kind interest in our work.
Vinod K. Chaubey, Lovely Chhabra, Nirmal J. Kaur
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.064
Published online: January 6 2015
xWe read with great pleasure the work by Casavecchia et al [1]. Cardiac magnetic resonance imaging (CMR) may indeed play an important role in selected patients with suspected Takotsubo cardiomyopathy (TCM) especially when other associated or alternate diagnoses need to be entertained. Recently, associations of TCM with other cardiac conditions such as myopericarditis have been described [2]. In these selected clinical conditions, CMR may play a pivotal role for diagnostic confirmation because the clinical data supported by the standard diagnostic imaging modalities alone sometimes may not be adequate.
Lovely Chhabra, Vinod K. Chaubey
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.041
Published online: January 31 2015
xWe read with great interest the work by Gallard et al [1]. Authors’ work is commendable in triaging and diagnosing patients with acute dyspnea with the use of bedside cardiopulmonary ultrasound. Indeed, the point-of-care (POC) cardiopulmonary ultrasound is not only an important diagnostic modality but also serves as an immensely useful guide during emergent cardiac procedures (such as pericardiocentesis) and resuscitation of critically ill patients [2]. This is especially true with the newest high-quality and easy-to-use handheld cardiac ultrasound devices.
Emeric Gallard, Jean-Eudes Bourcier, Jean-Philippe Redonnet, Didier Garnier
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.042
Published online: January 31 2015
xWe thank you for your interest in our study and agree with you on the importance of thinking about the costs resulting from patient care in the emergency department (ED). Although our study did not focus on this issue, we have demonstrated that, in comparison with the usual procedure, cardiopulmonary ultrasound in the hands of the ED physician succeeds in giving an exact diagnosis for more patients. This allows us nowadays to avoid realizing costly examinations such as N-terminal pro-brain natriuretic peptide or chest x-ray.
Hakan Sarlak, Mustafa Tanrıseven, Eyup Duran
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.004
Published online: February 5 2015
xWe intentionally read the article “Fluid balance in sepsis and septic shock as a determining factor of mortality” written by Sirvent et al [1] with interest. They concluded that a positive fluid balance in the first 4 days was associated with higher mortality in severe sepsis and patients with septic shock [1].
Josep-Maria Sirvent, Cristina Murcia, Carolina Lorencio
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.003
Published online: February 5 2015
xWe have read with attention the letter by Hakan Sarlak with the title “Fluid necessity should be followed by central venous pressure” (CVP) about our recent study published in The American Journal of Emergency Medicine [1]. We agree that the CVP provides valuable information about the interaction of pump function of the heart and venous return when we consider simultaneously your changes and cardiac output. However, the analysis is complex in critically ill patients because, in addition to a technically adequate measurement, the interpretation requires consideration of multiple factors affecting the cardiac pressures [2] (hence, the importance to avoid inadequate venous return in the initial resuscitation of critically ill).
Shintaro Shigesato, Tetsunosuke Shimizu, Tadahiro Kittaka, Hiroshi Akimoto
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.024
Published online: January 27 2014
xClamping the descending aorta by emergency thoracotomy is a well-known effective procedure to stop bleeding from lesions under the diaphragm. We successfully treated a case of cardiopulmonary arrest resulting from a massive duodenal ulcer hemorrhage using an intra aortic balloon occlusion (IABO) catheter instead of the conventional technique. Our experience suggests that IABO catheters can be used to treat patients with hemorrhagic shock regardless of the presence of cardiopulmonary arrest. This can be a life-saving procedure, which prevents ischemic brain injury.
Daniel A. Roseman, Elissa M. Schechter-Perkins, Jasvinder S. Bhatia
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.041
Published online: August 22 2014
xSevere hyperkalemia (serum potassium > 7.0 mmol/L) is an uncommon electrolyte abnormality in patients undergoing maintenance peritoneal dialysis (PD). Hemodialysis (HD) has been suggested as the definitive therapy for severe hyperkalemia in this population, although there is limited data regarding renal replacement options. We report a case of life-threatening hyperkalemia with electrocardiogram changes in a nonadherent PD patient who was successfully treated with standard medical therapy and manual exchanges initiated by emergency department (ED) personnel.
Jiandi Gao, Feng Gao, Fang Hong, Huimin Yu, Peifang Jiang
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.038
Published online: August 22 2014
xOrnithine transcarbamylase deficiency (OTCD) is an X-linked disorder of metabolism of the urea cycle. It usually causes hyperammonemic encephalopathy in males during the neonatal-to-infantile period, whereas female carriers present with variable manifestations depending on their pattern of random chromosome X inactivation in the liver. Early clinical manifestations of hyperammonemia are nonspecific often leading to a delay in the diagnosis of OTCD. Unfortunately, delays in initiating treatment often lead to poor neurologic outcomes and overall survival.
Hsi-Wen Huang, Chun-Chieh Chiu, Hsu-Heng Yen, Yao-Li Chen, Fu-Yuan Siao
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.030
Published online: August 22 2014
xPulseless electrical activity (PEA) can rapidly transform into sudden cardiac death, if the etiology cannot be identified and corrected immediately. The clinical challenge is how to resuscitate the patient with prolonged PEA. We present a case of a 51-year-old man with PEA due to acute myocardial infarction caused by total occlusion of the main coronary artery, which was refractory to prolonged conventional cardiopulmonary resuscitation. Extracorporeal membrane oxygenation was initiated approximately 75 minutes after prolonged cardiopulmonary resuscitation; this achieved a sustained return of spontaneous circulation, which permitted adequate time for subsequent coronary intervention.
