Andrew L. Bozarth, Navin Bajaj, Margaret R. Wessling, Dustin Keffer, Shais Jallu, Gary A. Salzman
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.010
Published online: March 4 2015
xThe pulmonary embolism rule-out criteria (PERC) is an 8-variable clinical decision rule that identifies patients at low risk for pulmonary embolism (PE) to prevent unnecessary diagnostic testing in the evaluation of suspected PE in the emergency department (ED). The objective of this study was to determine PERC's safety and diagnostic use in our institution's ED population.
Ahmet Baydin, Ramazan Amanvermez, Özgür Korhan Tuncel, Metin Ocak, Murat Meric, Cengiz Cokluk
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.007
Published online: October 10 2014
xThe aims were to investigate the role of serum ischemia-modified albumin (IMA), tumor necrosis factor α (TNF-α), and myeloperoxidase (MPO) and to evaluate the relationship between IMA and cardiac markers (creatine kinase myocardial isoenzyme [CK-MB] and cardiac troponin I [cTnI]) related to cardiac abnormalities in adult patients after nontraumatic subarachnoid hemorrhage (SAH).
Syed Imran Ayaz, Craig Thomas, Andrew Kulek, Rosa Tolomello, Valerie Mika, Duane Robinson, Patrick Medado, Claire Pearson, Leslie S. Prichep, Brian J. O’Neil
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.015
Published online: November 19 2014
xWe compared the performance of a handheld quantitative electroencephalogram (QEEG) acquisition device to New Orleans Criteria (NOC), Canadian CT Head Rule (CCHR), and National Emergency X-Radiography Utilization Study II (NEXUS II) Rule in predicting intracranial lesions on head computed tomography (CT) in acute mild traumatic brain injury in the emergency department (ED).
Mustafa Karabacak, Mehmet Yigit, Kenan Ahmet Turkdogan, Mehmet Sert
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.014
Published online: November 20 2014
xHypertensive crises, divided depending on the presence of target organ damage (TOD), are associated with increased cardiovascular mortality and morbidity. Monocyte chemoattractant protein-1 (MCP-1) is responsible for the recruitment of monocytes to sites of vascular inflammation. The aim of this study was to evaluate the role of vascular inflammation in development of TOD.
Mehmet Ali Aslaner, Meltem Akkaş, Sercan Eroğlu, Nalan M. Aksu, Mehmet Mahir Özmen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.006
Published online: December 15 2014
xMany emergency departments (EDs) have established units capable of providing critical care because of increasing need for critical care, called as ED intensive care unit (EDICU). However, prolonged critical care leads to crowding, resulting in poor quality of care and high mortality rates. We aimed to determine which type of critically ill patients play a main role for crowding in the EDICU, and how to manage these patients.
Matthew E. Prekker, Brandi M. Gary, Roma Patel, Travis Olives, Brian Driver, Stephen J. Dunlop, James R. Miner, Sarah Gordon, Ronald Schut, Richard O. Gray
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.057
Published online: January 2 2015
xThe Centers for Disease Control and Prevention recommends routine opt-out HIV screening in health care settings. Our goal was to evaluate the feasibility and yield of this strategy in the emergency department (ED) and to compare it to the expected yield of physician-directed testing.
Kazuma Nakagawa, Alexandra Galati, Deborah Taira Juarez
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.001
Published online: January 23 2015
xCurrently, intracerebral hemorrhage (ICH) patients from neighbor islands are air transported to a higher-level facility on Oahu with neuroscience expertise. However, the majority of them do not receive subspecialized neurosurgical procedures (SNP) upon transfer. Hence, their transfer may potentially be considered as excess cost.
Ronald Maag, Susie Sun, Michael Hannon, Rhian Davies, Peter Alagona, Andrew Foy
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.003
Published online: February 10 2015
xCardiac troponin testing is used to aid the diagnosis of myocardial infarction (MI) in the emergency department (ED) for patients who present with a range of symptoms. From a clinical perspective, the distinction between MI due to acute coronary artery thrombosis (type I MI) and other forms of direct and secondary myocardial injury (type II MI) is very important. However, the positive predictive value (PPV) of an elevated troponin for diagnosing type I MI, based on clinical history, has not been described.
Zhixin Wu, Mingming Zhao, Mingfeng He, Hongke Zeng, Feng Tan, Kuangyi Li, Shenglong Chen, Qianpeng Han, Qiaosheng Wang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.013
Published online: January 16 2015
xThe aim of the study is to validate of the use of plasma B-type natriuretic peptide (BNP) point-of-care test platform in preliminary recognition of cardioembolic stroke patients in the emergency department (ED).
Michael P. Wilson, Jesse J. Brennan, Lucia Modesti, James Deen, Laura Anderson, Gary M. Vilke, Edward M. Castillo
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.017
Published online: January 20 2015
xPsychiatric patients experience longer treatment times (length of stay [LOS]) in the emergency department (ED) compared to nonpsychiatric patients. Although patients on involuntary mental health holds are relatively understudied, common wisdom would hold that times for these patients can only be affected by addressing systems issues because they are not free to leave. The objective of this study was to determine whether both selected ED and patient-specific factors were associated with longer LOS.
Jie Jiang, Yaru Zou, Wen Shi, Ying Zhu, Ranjun Tao, Ying Jiang, Yiming Lu, Jianjing Tong
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.025
Published online: January 21 2015
xThe 2010 guidelines recommend new requirements of the chest compression depth for infant. The compression technique recommendation for infant remains the 2-finger (TF) technique for lone rescuer and the 2-thumb–encircling hands technique for 2 rescuers. We hypothesized that the TF technique cannot result in an enough compression depth to meet the guideline requirements and that the 2-thumb–encircling hands technique will not affect the ventilation.
Yaru Zou, Wen Shi, Ying Zhu, Ranjun Tao, Ying Jiang, Shanfeng Li, Jing Ye, Yiming Lu, Jie Jiang, Jianjing Tong
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.024
Published online: January 21 2015
xThe quality of cardiopulmonary resuscitation (CPR) is a very important prognostic factor for cardiac arrest. Chest compression is thought to be one of the most important aspects of high-quality CPR. Recent studies have prompted that there may be an interaction between chest compression rate and other factors related to the quality of chest compression. We aimed to investigate the effect of different compression rates on chest compression depth, recoil, and rescuers' fatigue point during CPR.
Erin L. Simon, Mitch Kovacs, Zhenyu Jia, Dave Hayslip, Kseniya Orlik, Nicholas Jouriles
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.021
Published online: January 20 2015
xFreestanding emergency departments (FEDs) have grown in popularity. They often provide emergent care in areas distant from other EDs. Investigations and research to characterize the operation and dynamics of FEDs are needed. This study characterizes the severity of illness seen at FEDs and compares it with a hospital-based urban tertiary care ED using the emergency severity index (ESI), a quantification of patient acuity.
Frances M. Russell, Christopher L. Moore, D. Mark Courtney, Christopher Kabrhel, Howard A. Smithline, Kristen E. Nordenholz, Peter B. Richman, Brian J. O'Neil, Michael C. Plewa, Daren M. Beam, Ronald Mastouri, Jeffrey A. Kline
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.026
Published online: January 22 2015
xMany patients have unexplained persistent dyspnea after negative computed tomographic pulmonary angiography (CTPA). We hypothesized that many of these patients have isolated right ventricular (RV) dysfunction from treatable causes. We previously derived a clinical decision rule (CDR) for predicting RV dysfunction consisting of persistent dyspnea and normal CTPA, finding that 53% of CDR-positive patients had isolated RV dysfunction. Our goal is to validate this previously derived CDR by measuring the prevalence of RV dysfunction and outcomes in dyspneic emergency department patients.
Joon Bum Park, Young Shin Cho, Hyuk Joong Choi
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.015
Published online: January 20 2015
xTo assess whether inverted grayscale rib series, used alone or as an additional imaging modality, improves diagnostic accuracy of rib fractures of emergency medicine (EM) residents in minor chest trauma.
Je Sung Park, Byung Kook Lee, Kyung Woon Jeung, Sung Soo Choi, Sang Wook Park, Kyung Hwan Song, Sung Min Lee, Tag Heo, Yong Il Min
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.014
Published online: January 22 2015
xWe investigated the use of blood color brightness and blood gas variables for discriminating arterial from venous puncture during cardiopulmonary resuscitation (CPR). The study's aims were to determine if discrimination using Po2 is superior to using blood color brightness, and if blood color brightness, Po2, and acid-base variables derived from blood gas analysis accurately discriminate arterial from venous blood during CPR.
Medley O. Gatewood, Lindsay Grubish, Janet M. Busey, William P. Shuman, Jared Strote
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.010
Published online: January 16 2015
xThe radiation risk posed by diagnostic computed tomography (CT) is a growing concern. The use of model-based iterative reconstruction (MBIR) technology reduces radiation exposure but requires additional processing time. The goal of this study was to compare MBIR and a standard CT reconstructive protocols in terms of emergency department (ED) visit duration and reduction in radiation exposure.
Sotirios Kakavas, Aggeliki Papanikolaou, Evangelos Ballis, Nikolaos Tatsis, Christina Goga, Georgios Tatsis
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.046
Published online: February 2 2015
xCarboxyhemoglobin (COHb) and methemoglobin (MetHb) levels have been associated with a poor outcome in patients with various pathological conditions including cardiovascular diseases. Our aim was to retrospectively assess the prognostic value of arterial COHb and MetHb in patients with acute pulmonary embolism (PE).
Michael Secko, Adam Sivitz
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.031
Published online: January 23 2015
xPeritonsillar abscess (PTA) is one of the most common deep neck space infections that can potentially have life-threatening complications if inadequately diagnosed and not treated promptly. The ability of clinicians to reliably differentiate PTA from peritonsillar cellulitis by physical examination alone is limited and blind needle aspiration, the typical method of diagnosis of PTA, is also unreliable. We review the available evidence supporting the use of ultrasound, either intraoral ultrasound or transcutaneous ultrasound to be the initial imaging modality of choice for evaluation of PTA and be used for real-time needle guidance.
Alyson J. McGregor, Rebecca Barron, Karen Rosene-Montella
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.046
Published online: March 6 2015
xCardiovascular emergencies in pregnant patients are often considered a rare event; however, heart disease as a cause of maternal mortality is steadily increasing.
Hesham R. Omar, Devanand Mangar, Enrico M. Camporesi
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.036
Published online: December 1 2014
xA 57-year-old man recently diagnosed with stage 4 colonic adenocarcinoma was admitted to the hospital for management of large bowel obstruction. During his hospitalization, he developed an episode of profuse sweating during which he had no chest pain and was hemodynamically stable. An electrocardiogram (ECG) was performed (Fig. 1), which showed Q waves and subtle ST-segment elevation (STE) in the inferior leads without reciprocal ST-segment depression. The low suspicion for STE myocardial infarction (STEMI), the presence of risk factor for pulmonary embolism, and awareness that inferior STE is one of the rare ECG manifestations of acute pulmonary embolism (APE) prompted us to perform a computed tomographic (CT) pulmonary angiography, which showed a right main pulmonary artery embolus (Fig. 2).
Asha A. Roy, Lara DeNonno, Ivan Becerra, Roger Chirurgi, Peter McCorkell, Getaw Worku Hassen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.028
Published online: December 18 2014
xThe rise in recreational drug abuse and corresponding increases in the production of newer and more potent synthetic drugs are alarming [1]. Our institution has experienced periodic increases in emergency department (ED) visits from synthetic drug use at music festivals [2,3]. However more recently, daily visits have increased significantly due to synthetic cannabinoid (SC) abuse. The Substance Abuse and Mental Health Services Administration reported 11 406 SC ED visits in 2010 increasing to 28 531 in 2012 [4].
Getaw Worku Hassen, Hossein Kalantari
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.047
Published online: December 30 2014
xWe read the letter to the editor with interest, and we thank the author(s) for the information on the different causes of anterior chamber diameter (ACD) size variations and different causes of increased intraocular pressure (IOP). We agree that increased IOP results from several causes including trauma and traumatic or spontaneous hemorrhage within the anterior chamber and glaucoma. As it was stated in the letter, IOP can be elevated without change in the ACD. In cases of trauma to the eye, where it is not possible to measure the IOP, ultrasound can be used for detection of retinal detachment, globe rupture (IOP measurement contraindicated in this case), lens dislocation, hyphema, and optic nerve sheath diameter (ONSD) to indirectly assess the intracranial pressure (ICP).
Ümit Yolcu, Abdullah Ilhan, Fatih Ç. Gundogan
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.046
Published online: December 30 2014
xWe have read the article entitled “Anterior chamber depth measurement using ultrasound to assess elevated intraocular pressure” with great interest
[1]. The authors reported 2 cases with glaucoma and a case of trauma. They measured the anterior chamber depth (ACD) of patients and compared the results with the intraocular pressure (IOP) measurements using a tonometer.
Brent Passarello, Zachary Levy, Brian Levine, Mia Papas, Neil Jasani
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.039
Published online: December 26 2014
xSuper users who frequent the emergency department (ED) with recurring pain complaints pose a number of challenges for ED staff. Our system defines super users as patients with greater than 20 ED visits annually. In 2013, there were 144 super users in our 2 hospital system, accounting for 4405 visits.
Turandot Saul, Sebastian D. Siadecki, Rachel Berkowitz, Gabriel Rose, Danielle Matilsky
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.034
Published online: December 26 2014
xIntraosseous infusion (IO) is a critical resuscitation procedure, providing rapid and reliable vascular access in patients with difficult intravenous access or in time-critical situations. Correct placement of the IO needle can be confirmed in several ways including the needle standing firmly upright, aspiration of bone marrow, and the infusion of fluid without visible or palpable soft tissue swelling. In addition to the importance of ensuring intravascular delivery, there are complications of fluid extravasation from malpositioning, including compartment syndrome [1,2] and tissue necrosis [3,4].
Shiro Gonai, Kenji Doi, Kei Noguchi, Kunio Kanao, Satoshi Gommori, Yutaka Saito, Kenichi Oshiro, Shunsuke Takahashi, Soichi Ito, Kiyotsugu Takuma
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.011
Published online: January 16 2015
xSome patients experience recurrent temporomandibular joint (TMJ) dislocation, which typically requires them to visit the emergency department (ED) for reduction each time. Although techniques for autoreduction of TMJ dislocation have been developed, reports in the literature are scarce, and patients who wish to perform autoreduction require training from physicians to use an intraoral autoreduction approach. Therefore, we developed a new autoreduction technique using the extraoral approach.
Laura E. McLean, Sean Elwell, Andrew DePiero
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.020
Published online: January 20 2015
xUtilization of electronic medical records (EMRs) has resulted in a corresponding decline in the use of paper records in many patient care areas. Evidence suggests that EMRs improve patient safety, increase information accessibility, increase workflow efficiency, and minimize documentation time
[1]. However, despite the advantages, very few hospitals have implemented the EMR during pediatric trauma resuscitations
[2,3].
Scott Oglesbee, David Riss, Amy A. Ernst, Steven J. Weiss, William H. Brady, Nicholas W. Brady, Stephine L. Otero
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.023
Published online: January 21 2015
xAccording to the National Highway Traffic Safety Administration (2011), there were an estimated 956454 emergency medical services (EMS) workers in the United States who responded to more than 36698670 events in 2009, using their skills within the crossroads of health care, public health, and public safety [1]. Paramedics and emergency medical technicians are exposed to risks such as infectious diseases, needle stick injuries, emotional stress, fatigue, physical violence, motor vehicle crashes, flight medicine, disciplinary action, and legal liability.
Charat Thongprayoon, Vareena Laohaphan, Narat Srivali
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.022
Published online: January 21 2015
xWe thank Strobel et al
[1] for their interesting case study, “A case of thrombotic thrombocytopenic purpura presenting as refractory hypoglycemia in a patient with thromboangiitis obliterans” published in
The American Journal of Emergency Medicine.
Sezai Çubuk, Orhan Yücel
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.027
Published online: January 21 2015
xWe read the article of Matsumoto et al
[1] with great interest. We thank them for the topic that is generally overlooked.
Giuseppe De Matteis, Mariella Fuorlo, Massimo Montalto, Raffaele Landolfi
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.019
Published online: January 20 2015
xCarbon monoxide (CO) is a colorless, tasteless, odorless, and nonirritating gas formed when carbon in fuel is not burned completely. It enters the bloodstream through the lungs and attaches to hemoglobin (Hb) forming carboxyhemoglobin (CO-Hb). High CO-Hb combination is poisonous
[1-3]. Indeed, during CO poisoning, oxygen delivery to the body’s organs and tissues is decreased. The effects of CO poisoning can be seen in many systems including the cardiovascular, pulmonary, visual, auditory, neuropsychiatric, dermatologic, and hematologic.
Memduh Yetim, Sukru Tekindur, Y. Emrah Eyi
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.033
Published online: January 22 2015
xWe read the article “A modified paravertebral block (PVB) to reduce risk of mortality in a patient with multiple rib fractures” written by Yoshida et al
[1] with a great interest. They disclose that retrolaminar block/costovertebral canal block can be applicable at multiple rib fractures with coagulopathy. We would like to thank the authors for their contribution. We believe that these findings will enlighten further studies about the concentrations of PVB in emergency department and also at postoperative analgesia.
Hasan Tahsin Gozdas
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.037
Published online: January 30 2015
xI read the recently appeared case report in your journal by Jain et al
[1] with great interest. The authors considered paralytic rabies and postvaccination myelitis as the possible diagnosis of this interesting case. Although the case received postexposure rabies prophylaxis, rabies infection might have developed because of failure in the prophylaxis.
Denise Fernández, Mark Su
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.045
Published online: February 6 2015
xWe read with great interest the study by Kim et al on the potential benefits of therapeutic hypothermia (TH) in the treatment of intentional overdoses
[1]. Based on the findings of this study, the authors conclude that poisoned patients with out-of-hospital cardiac arrest (OHCA) treated with TH have higher survival-to-discharge rates. We commend the authors for studying the effects of this therapy on poisoned patients because literature on interventions for poisoning-induced OHCA is uncommon. However, we have reservations regarding their interpretation of the results.
Cem Ozgonul, Gokcen Gokce, Tarkan Mumcuoglu, Onder Ayyildiz
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.040
Published online: January 30 2015
xWe read with great interest the recent published article by Caffery et al
[1] in which authors aimed to determine whether patients with nontraumatic causes of elevated intracranial pressure (ICP) measured by manometry on lumbar puncture could be identified using optic nerve sheath diameter (ONSD). It was reported that, with ONSD of 5 mm as the cutoff, the sensitivity of this method was 0.75, with the specificity of 0.44. The authors stated that ONSD measurements did not yield acceptable sensitivity for such a high-stakes diagnosis such as elevated ICP, suggesting that ultrasound measurement of ONSD was not an appropriate screen in that population.
Terrell S. Caffery, Mandi W. Musso
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.039
Published online: January 30 2015
xWe thank the authors for their interest in our paper. The authors recommend using a 30-degree test to detect increased subarachnoid fluid in the optic nerve, citing Ossoinig et al
[1]. Although this test is beyond the scope of our study
[2], we offer several considerations to physicians. First, Ossoinig et al
[1] focus primarily on differentiating various solid optic nerve tumors, optic nerve sheath enlargement, or separation of the optic nerve and sheath by increased fluid in the subarachnoid space.
Sofiya Greenberg, Nalini Kanth, Anil Kanth
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.022
Published online: November 18 2013
xBariatric surgery has become the treatment of choice for morbid obesity. This case report aims to increase awareness of the emergency physician of a possible presentation of a gastrobronchial fistula after bariatric surgery. Similar presentation may occur after esophageal or other upper abdominal surgery. Appropriate studies for diagnosis are contrast-enhanced abdominal computed tomography and upper gastrointestinal studies.
Michael Heller, Anthony Faustini
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.040
Published online: March 31 2014
xRapidly expanding masses of the neck leading to serious symptoms, including potential airway compromise, are uncommon in the emergency department. We report a case of a young woman with a previously stable largely intraoral ranula, which progressed in less than 2 hours to severe symptoms including pain, stridor, and inability to handle secretions. Needle aspiration of the ranula from the sublingual approach led to immediate resolution of all symptoms and the extraction of 60 mL of thick, bloody material.
Craig N. Czyz, Phelan G. Piehota, Adam M. Strittmatter
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.063
Published online: August 28 2014
xAcute esotropia after heroin withdrawal was first described in a medical text in 1975. Subsequently, there have been no reported cases or studies involving this dysfunction in American peer-reviewed literature. We describe a case of a 31-year-old white man with acute onset binocular diplopia beginning 3 days after abrupt heroin withdrawal. The patient was given the presumptive diagnosis of acute concomitant esotropia secondary to abrupt heroin withdrawal. He was given the option of patching to alleviate diplopia or use of pilocarpine 2% drops.
Nidhi Bansal, Rushikesh Shah, Arpan Patel, Gaurand Vaidya, Pramod Pantangi, Divey Manocha
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.065
Published online: August 29 2014
xHypercalcemia has been well documented in neoplastic and granulomatous diseases. However, it is a distinctly uncommon manifestation of fungal infections. We report a rare case of an acquired immunodeficiency syndrome patient who was admitted with constipation and anorexia and was found to be having severe hypercalcemia and acute kidney injury with low vitamin D levels. Diagnostic work up of etiology of hypercalcemia revealed recurrent cryptococcal meningitis that responded favorably to medical therapy with normalization of serum calcium and kidney function over next few days.
Kazutoshi Ebisawa, Tatsuma Fukuda, Ryota Inokuchi, Kensuke Nakamura
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.076
Published online: September 6 2014
Open AccessxThe use of plasma exchange for the treatment of thrombotic thrombocytopenic purpura (TTP) has reduced the mortality rate, but it remains high, at 20%. Steroids, rituximab, and eculizumab are sometimes used in addition to plasma exchange, but their use is associated with adverse effects, including immunosuppression. Several studies reported that the concomitant use of recombinant thrombomodulin (rTM) in the treatment of TTP was useful; however, no studies have reported the successful treatment of TTP with rTM alone.
Jae Ho Jang, Yong Su Lim, Jee Yong Jang, Jae Hyug Woo, Won Bin Park
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.004
Published online: September 6 2014
xPeripheral neuropathy as a result of nonfreezing cold injury by therapeutic hypothermia (TH) is extremely rare. We report the case of a 54-year-old woman who suffered from common peroneal nerve palsy caused by inappropriate application of cooling pads for TH after ischemic encephalopathy following hanging injury. When a cooling device is running, cold water rotates through cooling pads just above the skin. Therefore, the patient’s skin and superficial nerves, such as the common peroneal nerve, can be damaged by cold water.
Erin L. Simon, Greg Griffin, Evan Bosman
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.017
Published online: September 18 2014
xWe report a case of a 31-year-old G4P4 woman who was 3-week status post vaginal delivery who presented to the emergency department (ED) with a worsening headache that developed 1 week after delivery. She was initially seen in the ED at 2 weeks postpartum. At that time, a computed tomography (CT) without contrast revealed no significant findings, and she was discharged with hydrocodone/acetaminophen, which provided adequate pain relief. She returned to the ED one week later with an increased headache, left upper and lower extremity numbness, and left facial numbness for 24 hours.
Keith A. Corl, Wade N. Sears, Shea C. Gregg, David G. Lindquist
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.015
Published online: September 18 2014
xNontraumatic cardiac tamponade is a life-threatening process, and pericardiocentesis is the established treatment designed to relieve tamponade physiology during a cardiac arrest. We report 2 cases, where after traditional resuscitation including serial pericardiocentesis failed, a resuscitative thoracotomy was performed.
Rajendra Singh Jain, Pankaj Kumar Gupta, Rahul Handa, Shankar Tejwani, Swayam Prakash, Sunil Kumar, Rakesh Agrawal, Mahendra S. Sisodiya
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.026
Published online: September 26 2014
xRabies is a serious health hazard in developing countries like India. Paralytic rabies is difficult to diagnose due to lack of classic manifestations. It poses diagnostic dilemma in patients who have received postexposure prophylaxis, as it is difficult to differentiate it from vaccine-induced Guillain-Barre syndrome, postvaccination myelitis, and acute disseminated encephalomyelitis. Early diagnosis of rabies in such cases is very important for adequate infection control and for institution of public health measures.
Anatoliy Goltser, Emil Soleyman-Zomalan, Frayda Kresch, Sergey Motov
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.029
Published online: September 25 2014
xA convenience sample of 14 patients received an analgesic dose of ketamine infusion for acute pain in the emergency department (ED). Low-dose ketamine (LDK) was defined as the administration of 0.2 to 0.4 mg/kg of ketamine, and infusion was defined as a drip of ketamine diluted in 50 to 100 mL of normal saline piggyback administered over 10 to 15 minutes. Pain intensity was measured using validated numeric rating scale in 8 of the 14 cases, 5 were documented nonquantitatively, and 1 case was not documented.
Mansur Kursad Erkuran, Arif Duran, Bekir Barış Kurt, Tarık Ocak
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.021
Published online: September 25 2014
xLocal anesthetics are drugs that are commonly used by physicians in simple interventional procedures. O-toluidine, a degradation product of the local anesthetic agent prilocaine, oxidizes hemoglobin and may cause methemoglobinemia. Normally, hemoglobin is comprised of 1% to 2% methemoglobin in the human body [1]. In this study, we presented a case of methemoglobinemia after local anesthesia with prilocaine, including clinical findings of respiratory distress in the early period.
Wei-Chi Tsai, Jui-Chang Chen, Yu-Tzu Tsao
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.030
Published online: September 26 2014
xPseudosubarachnoid hemorrhage is a unique appearance of hyperdensity on the computed tomographic scan without blood component in the subarachnoid spaces. It is usually seen in patients with severe brain edema and could be easily mistaken as a hemorrhagic emergency, leading to inappropriate invasive investigation. We describe a case with lithium intoxication in which fatal dialysis disequilibrium syndrome supervened, reflecting the ominous nature of pseudosubarachnoid hemorrhage. This report profiles imaging features, therapeutic strategies, and pathogenetic hypothesis and reinforces the need for physicians to maintain heightened vigilance of this manifestation.
Mustafa Ahmet Afacan, Sahin Colak, Mehmet Ozgür Erdogan, Mehmet Kosargelir, Abdullah Ibrahim, Kemal Tekesin, Hayati Kandis
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.044
Published online: October 2 2014
xLidocaine is an amino amide and among local anesthetics that are commonly used at emergency departments. Although lidocaine has a wide safety range, it may present with various clinical signs such as dizziness, disorientation, blurred vision, numbness around mouth and tongue, irritability, agitation, loss of consciousness, convulsion, coma, respiratory arrest, and cardiovascular collapse. A 29-year-old patient was admitted to the emergency department due to the development of delirium after platelet-rich plasma and ozone therapy, under local anesthesia, to the scalp at a private aesthetic surgery center.
