Lin Zhang, Xiaoming Fan, Zhiyue Zhong, Guoxiong Xu, Jie Shen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.047
Published online: February 2 2015
xThe aim of this study was to describe the role of intestinal fatty acid–binding protein (iFABP) and allergy-related diamine oxidase (DAO) in patients with heat stroke (HS).
Łukasz Szarpak, Andrzej Kurowski, Łukasz Czyżewski, Marcin Madziała, Zenon Truszewski
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.018
Published online: February 19 2015
xThe aim of the study was to compare the efficacy of the TruView EVO2, TruView PCD, and Miller laryngoscopes for tracheal intubation during cardiopulmonary resuscitation with and without chest compressions (CCs) by paramedics in an infant manikin model.
Eileen Shi, Gary M. Vilke, Christopher J. Coyne, Leslie C. Oyama, Edward M. Castillo
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.035
Published online: March 19 2015
xAlthough an elevated white blood cell count is a widely utilized measure for evidence of infection and an important criterion for evaluation of systemic inflammatory response syndrome, its component band count occupies a more contested position within clinical emergency medicine. Recent studies indicate that bandemia is highly predictive of a serious infection, suggesting that clinicians who do not appreciate the value of band counts may delay diagnosis or overlook severe infections.
Elizabeth A. Mayhall, Robyn Gray, Vrishali Lopes, Kristen A. Matteson
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.032
Published online: March 19 2015
xTo compare time from medication administration to disposition from the Emergency Department (ED) between women treated for nausea and vomiting of pregnancy with different antiemetic agents.
Ari R. Cohen, Paul Caruso, Ann-Christine Duhaime, Jean E. Klig
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.052
Published online: March 25 2015
xThe objective was to determine the feasibility of “rapid” magnetic resonance imaging (rMRI) versus noncontrast computed tomography (NCCT) for pediatric patients with possible traumatic brain injury and to compare the populations receiving imaging in an urban tertiary care emergency department ED.
Margaret Hauck, Jonathan Studnek, Alan C. Heffner, David A. Pearson
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.050
Published online: March 25 2015
xCardiac arrest is a leading cause of death in the United States, with pulseless electrical activity (PEA) as a common initial arrest rhythm. We sought to determine if rate of electrical activity and QRS width correlate with survival in patients who present with PEA out-of-hospital cardiac arrest.
Neslihan Sayrac, Firat Bektas, Secgin Soyuncu, Vefa Sayrac
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.063
Published online: April 6 2015
xThe aim of study was to determine the impact of "goal-directed transvaginal ultrasonography" (TVUSG) on real-time clinical decision making of attending emergency physicians evaluating their level of certainty for preliminary diagnosis, admission, surgery, treatment, additional laboratory, and discharge in patients presenting with acute pelvic pain to the emergency department (ED). This prospective cross-sectional clinical study was conducted on sexually active female patients older than 18 years who presented with acute pelvic pain in the ED.
Michael J. Ward, Sean P. Collins, Jesse M. Pines, Curt Dill, Gary Tyndall, Chad S. Kessler
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.062
Published online: April 6 2015
xWe describe emergency physician staffing, capabilities, and academic practices in US Veterans Health Administration (VHA) emergency departments (EDs).
Mustafa Serinken, Cenker Eken
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.061
Published online: April 6 2015
xKetamine is a dissociative anesthetic agent that has an increased frequency of usage in the last years particularly in emergency departments. In the present study, we aimed to determine whether ketamine is related to myocardial injury in children undergoing minor procedures.
Ching-Chi Lee, Chih-Chia Hsieh, Nan-Yao Lee, Tsung-Yu Chan, Ming-Yuan Hong, Chih-Hsien Chi, Wen-Chien Ko
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.058
Published online: April 6 2015
xTo analyze the differences in clinical presentation and characteristics of community-onset bacteremia between neutropenic and nonneutropenic adults visiting the emergency department.
James R. Langabeer II, Sapna Prasad, Munseok Seo, Derek T. Smith, Wendy Segrest, Theophilus Owan, Daniela Gerard, Michael D. Eisenhauer
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.009
Published online: April 9 2015
xRegional myocardial infarction systems of care have been shown to improve timely access to primary percutaneous coronary intervention (PCI). However, there is a relatively sparse research on rural “frontier” regions. Arrival mode, high rates of interhospital transfers, long transport times, low population density, and mostly volunteer emergency medical services (EMS) distinguish this region from metropolitan systems of care. We sought to assess the effect of interhospital transfers, distance, and arrival mode on total ischemic times for patients with ST-elevation myocardial infarctions undergoing primary PCI.
Michelle D. Eckerle, Madjimbaye Namde, Carolyn K. Holland, Andrew H. Ruffner, Kim W. Hart, Christopher J. Lindsell, Jennifer L. Reed, Michael S. Lyons
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.006
Published online: April 9 2015
xEmergency department (ED) HIV screening is recommended but challenging to implement and of uncertain effectiveness in pediatric EDs (PEDs). We sought to determine whether there were opportunities for earlier HIV diagnosis in the PED for a cohort of young adults diagnosed with HIV.
S. Braunecker, B. Douglas, J. Hinkelbein
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.018
Published online: April 15 2015
xSince astronauts are selected carefully, are usually young, and are intensively observed before and during training, relevant medical problems are rare. Nevertheless, there is a certain risk for a cardiac arrest in space requiring cardiopulmonary resuscitation (CPR). Up to now, there are 5 known techniques to perform CPR in microgravity. The aim of the present study was to analyze different techniques for CPR during microgravity about quality of CPR.
Khrongwong Musikatavorn, Saranpat Thepnimitra, Atthasit Komindr, Patima Puttaphaisan, Dhanadol Rojanasarntikul
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.010
Published online: April 9 2015
xOur study aims to investigate the role of initial venous lactate in predicting the probability of clinical deterioration and 30-day mortality in nonelderly sepsis patients with acute infections, without hemodynamic shock.
Juan Wang, Ce Tang, Lei Zhang, Yushun Gong, Changlin Yin, Yongqin Li
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.007
Published online: April 9 2015
xThe question of whether the placement of the dominant hand against the sternum could improve the quality of manual chest compressions remains controversial. In the present study, we evaluated the influence of dominant vs nondominant hand positioning on the quality of conventional cardiopulmonary resuscitation (CPR) during prolonged basic life support (BLS) by rescuers who performed optimal and suboptimal compressions.
Yuan Zhang, Xue Tang, Hui Xie, Rui Lan Wang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.005
Published online: April 9 2015
xThe objective of this study is to compare the clinical efficacy of surgical fixation and nonsurgical management of flail chest and pulmonary contusion (FC-PC) and to compare the diverse timings of surgery to discuss case management in FC-PC.
Mu Jin Kim, Kyung Woon Jeung, Byung Kook Lee, Sung Soo Choi, Sang Wook Park, Kyung Hwan Song, Sung Min Lee, Yong Il Min
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.004
Published online: April 9 2015
xCentral venous oxygen saturation has been shown to reflect the adequacy of tissue oxygenation during cardiopulmonary resuscitation (CPR), thereby enabling the assessment of CPR quality and the prediction of restoration of spontaneous circulation (ROSC). The femoral vein can be easily accessed during CPR. We determined if femoral venous oxygen saturation (SFVO2) values obtained during CPR could reliably predict ROSC in a pig model.
Lukasz Szarpak, Katarzyna Karczewska, Togay Evrin, Andrzej Kurowski, Lukasz Czyzewski
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.017
Published online: April 21 2015
xAdvanced airway management and endotracheal intubation (ETI) during cardiopulmonary resuscitation (CPR) is more difficult than, for example, during anesthesia. However, new devices such as video laryngoscopes should help in such circumstances. The aim of this study was to compare the performance of 4 intubation devices in pediatric manikin-simulated CPR.
Łukasz Szarpak, Katarzyna Karczewska, Łukasz Czyżewski, Andrzej Kurowski
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.015
Published online: April 15 2015
xWe hypothesized that the Laryngoscope with Fiber Optic Reusable Flexible Tip English Macintosh blade (TMAC) is beneficial for the intubation of child manikins while performing cardiopulmonary resuscitation (CPR). In the present study, we evaluated the effectiveness of the conventional Macintosh laryngoscope (MAC) and TMAC in 3 simulated CPR scenarios.
Jennifer L. White, Michael B. Heller, Robert J. Kahoud, Daniel Slade, John D. Harding
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.059
Published online: April 6 2015
xA standard approach to recent onset atrial fibrillation (AF) in the emergency department (ED) in the United States has not been established.
Seung Min Ha, Young Suk Cho, Gyu Chong Cho, Choong Hyun Jo, Ji Young Ryu
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.011
Published online: April 10 2015
Open AccessxThe aim of this study was to ascertain if a modified carotid sinus massage (CSM) using ultrasonography is superior to the conventional CSM for vagal tone generation.
Diwura K. Owolabi, Richard Rowland, Lauren King, Rick Miller, Gajanan G. Hegde, Jennifer Shang, John Lister, Arvind Venkat
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.028
Published online: April 23 2015
xWe compared the quality of care in admitted febrile neutropenic cancer patients presenting through the emergency department (ED) vs those directly admitted (DA) from the clinic or infusion center. We hypothesized that the quality of care would be comparable between these 2 pathways.
Sezai Çubuk, Orhan Yücel
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.014
Published online: February 13 2015
xWe read the article of Vinson et al [1] titled “Pneumothorax is a rare complication of thoracic central venous catheterization in community EDs.” We thank the authors about their well-designed study.
David R. Vinson, Dustin W. Ballard, Dustin G. Mark
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.013
Published online: February 13 2015
xWe thank Drs. Sezai and Yücel for their interest in our central venous catheterization research and welcome this opportunity to respond to their recommendation to routinely obtain a postprocedural chest radiograph after an unsuccessful thoracic central venous catheterization before attempting a contralateral thoracic central line. Although the intention is very well placed—avoiding iatrogenic bilateral pneumothoraces—we are not sure the incidence of this rare complication is sufficiently high to warrant a policy of universal postattempt radiography.
Jyoti Matalia, Sheetal Shirke, Minal Kekatpure
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.027
Published online: March 17 2015
xWe read with great interest the article entitled “Real-time optic nerve sheath diameter reduction measured with bedside ultrasound after therapeutic lumbar puncture in a patient with idiopathic intracranial hypertension” by Singleton et al [1]. They have described the use of ocular ultrasound in a case of idiopathic intracranial hypertension and demonstrated real-time change in the size of the optic nerve sheath diameter after a lumbar puncture.
Stefano Bambi, Alberto Lucchini
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.043
Published online: April 18 2015
xWe read with interest the article of Kwon et al [1] about the insertion of orogastric tube using an endotracheal tube as a guide to ease the procedure. We have some major concerns about this study. The first of all is related to the indications. The authors wanted to compare the insertion of a nasogastric tube with an orogastric tube in intubated patients maintaining a neutral position of the patients’ head [1]. However, we cannot understand the clear implications for clinical practice because the main reasons for orogastric intubation are usually maxillofacial injuries involving the skull base structures or anatomical or surgical hindrances to the passage of nasogastric tube through the nostrils [2,3].
John F. Kragh Jr., James K. Aden, John Steinbaugh, Mary Bullard, Michael A. Dubick
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.048
Published online: March 25 2015
xHemorrhage is the primary cause of mortality on the battlefield [1,2], and packing of subfascial, cavitary wounds by US combat medics is a common way to control out-of-hospital hemorrhage. The objectives of the present study are 2-fold: (1) to improve awareness of the mechanics of wound packing for hemorrhage control, and (2) to compare wound packing with standard gauze vs a new product of expanding sponges.
Ronghua Fang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.068
Published online: April 6 2015
xAbstract: Acute mountain sickness (AMS) refers to cerebral and pulmonary syndromes that can develop in unacclimatized persons shortly after ascent to high altitude. No currently used methods are effective or practical for AMS prevention in emergency personnel, such as those who perform earthquake rescues. These workers cannot take time for rest and acclimation. Experiments have shown that carrying oxygen can prevent AMS. Here, we suggest that creation of an artificial pneumoperitoneum by injection of oxygen into the peritoneal cavity may be used to prevent AMS in emergency personnel.
Sadiye Yolcu
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.060
Published online: April 6 2015
xForeign bodies in the soft tissue are a common cause of emergency service admission. Plain radiographs are usually the first form of examination used to detect foreign bodies [1-5]. In cases where the object cannot be detected on plain radiographs or the exact location of the object needs to be identified, computed tomographic (CT) scans are helpful. Because CT scans are multiplanar and have high contrast, this method is the criterion standard in the detection of foreign bodies [6]. Most foreign bodies are pieces of metal, wood, and glass [7].
Marilyn Franchin, Daniel Jost, Hugues Lefort, Stephane Travers, Jean-Pierre Tourtier
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.001
Published online: April 6 2015
xWe read with great interest the article by Edla et al [1] comparing heart rate variability (HRV) metrics vs routine vital signs as diagnostic tests to improve trauma patient management focusing on the identification of trauma patients with major hemorrhage. They conducted a multivariate analysis using routine vital signs (heart rate, respiratory rate, systolic blood pressure, and pulse pressure) as the comparator to test the hypothesis that HRV metrics can improve the identification of patients with major hemorrhage.
Shwetha Edla, Andrew T. Reisner, Jianbo Liu, Victor A. Convertino, Robert Carter III, Jaques Reifman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.002
Published online: April 6 2015
xWe wish to thank the correspondents for their interest and comments regarding our report [1]. We agree that multivariate vital-sign analysis is a powerful tool. The Shock Index (SI), which scales the heart rate (HR) to the systolic blood pressure (SBP), is attractive because it can be computed mentally at the bedside. At least in theory, by examining multiple vital signs, one may better distinguish abnormal vital signs due to psychological distress (typically tachycardia with hypertension) vs blood loss and shock (relative tachycardia with normal or reduced blood pressure).
Subramanian Senthilkumaran, Florence Benita, Gore B. Sandeep, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.008
Published online: April 9 2015
xThe article by Roseman et al [1] is indeed interesting, as the authors had brought peritoneal dialysis (PD) back to frontline and as an option for patients with severe hyperkalemia in resource-limited emergency department. However, few aspects of this article need contemplation based on our experiences with regard to potassium clearance [2]. It is well known that potassium clearance achieved by PD is markedly lower than hemodialysis.
Daniel A. Roseman, Elissa M. Schechter-Perkins, Jasvinder S. Bhatia
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.027
Published online: April 23 2015
xWe thank the readers for their interest in our case report and for highlighting their own experiences using peritoneal dialysis (PD) in the emergency department (ED) for treatment of severe hyperkalemia. They offer a brief review of potassium exchange rates in PD that providers must consider when writing dialysis orders; we acknowledge that potassium clearance rates using PD have important limitations when compared to alternatives such as hemodialysis. However, our patient was already dialysis dependent with a functioning in-dwelling PD catheter as noted in the original report [1].
Lukasz Szarpak, Andrzej Kurowski, Lukasz Czyzewski, Lukasz Bogdanski, Piotr Zasko
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.049
Published online: April 29 2015
xThe recent article by Budde et al [1], which compares 2 techniques of laryngeal tube (LT) exchange by 30 anesthesia providers, was of great interest to us. Two fiberoptic bronchoscope–facilitated techniques for exchanging an LT for an endotracheal tube (ETT) were compared: an intraluminal technique using an Auntree intubating catheter and an extraluminal technique using a nasal route alongside the laryngeal tube disposable (LT-D) (size 4; VBM Medizintechnik GmbH, Noblesville, IN). The article suggests that the intraluminal technique may be a suitable alternative for fiberoptic-guided rapid exchange of the LT for an ETT.
Andrzej Kurowski, Lukasz Szarpak, Lukasz Czyżewski, Katarzyna Karczewska
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.042
Published online: April 24 2015
xThe recent article by Zhang et al [1] concerning successful resuscitation using extracorporeal membrane oxygenation (ECMO) was of great interest to us. The use of ECMO as an element of Advanced Life Support has recently become an important issue. The authors of these case reports used ECMO during cardiac arrest with anaphylactic shock due to application of iodine contrast. The first effective attempt at using prolonged, 72-hour extracorporeal circulation in adult patients was carried out and described by Hill et al in 1972 [1].
Graziapia Casavecchia, Matteo Gravina, Antonio Totaro, Riccardo Leva, Roberta Vinci, Luca Macarini, Matteo Di Biase, Natale Daniele Brunetti
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.040
Published online: December 8 2014
xTakotsubo cardiomyopathy (TTC) is a transient form of acute heart failure triggered by stressful events and associated with a typical left ventricular ballooning. Cardiac magnetic resonance imaging may be helpful in the diagnosis of this syndrome, particularly when differential diagnosis with acute coronary syndrome (ACS) is not easy. We report 2 cases in which the distinction between TTC and ACS was required because of overlapping clinical presentation and presence of normal coronary angiography.
Wen Zheng, Yu-Jiao Zhang, Shu-Yan Li, Lu-Lun Liu, Jian Sun
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.071
Published online: February 3 2015
xAcute myocardial infarction (AMI) is a common life-threatening disease in the emergency department. However, it is rare that AMI is induced by painless thyroiditis in an individual with normal coronary arteries. Here, we describe a very rare case of thyroiditis-induced AMI and review the literature concerning patients with thyrotoxicosis-related AMI.
Seyed Hesam Rahmani, Gholamreza Faridaalaee, Samira Jahangard
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.031
Published online: December 18 2014
xAccording to data from the National Oceanic and Atmospheric Administration, in the years from 1959 to 1994, lightning was responsible for more than 3000 deaths and nearly 10,000 casualties. The most important characteristic features of lightning injuries are multisystem involvement and widely variable severity. Lightning strikes are primarily a neurologic injury that affects all 3 components of the nervous system: central, autonomic, and peripheral. Neurologic complications of lightning strikes vary from transient benign symptoms to permanent disability.
Mert İlker Hayıroğlu, Emrah Bozbeyoğlu, Şükrü Akyüz, Özlem Yıldırımtürk, Mehmet Bozbay, Nijad Bakhshaliyev, Emir Renda, Gülay Gök, Mehmet Eren, Seçkin Pehlivanoğlu
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.025
Published online: January 16 2015
xAcute myocardial infarction (MI) and pulmonary embolism can alone lead to life-threatening conditions such as sudden cardiac death and congestive heart failure. We discuss a case of a 74-year-old man presented to the emergency department with acute dyspnea and chest pain. Acute anterior MI and pulmonary embolism concomitantly were diagnosed. Primary percutaneous coronary intervention performed because of preliminary acute anterior MI diagnosis. Transthoracic echocardiography was performed to determine further complications caused by acute MI because patient had a continuous tachycardia and dyspnea although hemodynamically stable.
Scott Edward Sparks, Michael Kurz, Doug Franzen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.024
Published online: December 20 2014
xThoracic aortic dissection is a lethal disease, and emergency department diagnosis is limited by imperfect diagnostic testing and limited resources; however, this case report illustrates the nonspecific presentation of thoracic aortic dissection and the use of emergency physician use of transthoracic echocardiography with the addition of suprasternal notch views to help differentiate all-cause chest pain and aid in accurate diagnosis, as well as earlier surgical correction for best patient outcomes in cases of thoracic aortic dissection.
Charles W. O'Connell, Roy R. Gerona, Matthew W. Friesen, Binh T. Ly
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.023
Published online: December 22 2014
xIbogaine, a psychotropic indole alkaloid, is gaining popularity among medical subcultures for its purported antiaddictive properties. Its use has been associated with altered mental status, ataxia, gastrointestinal distress, ventricular arrhythmias, and sudden and unexplained deaths. Its pharmacokinetics in toxic states is not well understood. Case report: A 33-year-old man overdosed on ibogaine in an attempt to quit his use of heroin. He developed altered state of consciousness, tremor, ataxia, nausea, vomiting, and transient QT interval prolongation, which all remitted as he cleared the substance.
Nicholas Arnold, Amy A. Ernst
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.022
Published online: December 22 2014
xSeparately, diverticulitis and inguinal hernias are both common findings in emergency medicine. However, diverticulitis within a reducible hernia has not been previously reported. We present a case of sigmoid diverticulitis within a nonincarcerated easily reducible hernia treated with conservative management. Our review of literature did not reveal any previously documented cases of this type of presentation.
Graham Brant-Zawadzki, Andrew Herring
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.036
Published online: December 26 2014
xTrauma in the emergency department may present providers with a myriad of unforeseen clinical scenarios. We present an example of how an urgent nerve block facilitated rapid management of a luxatio erecta shoulder fracture-dislocation without sedation. A 20-year-old female pedestrian presented to our level II trauma center after being stuck by a motor vehicle. At arrival, she had clinical indications of severe blunt trauma as well as a left-sided luxatio erecta shoulder dislocation and fracture.
Jamie M. Rosini, Suraj Rajasimhan, Shawn E. Fellows, Jason T. Nomura
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.037
Published online: December 26 2014
xA 51-year-old woman with relapsing-remitting multiple sclerosis was initiated on fingolimod. She developed a Mobitz Type I (Wenckebach) second-degree atrioventricular (AV) heart block during the initial 6-hour monitoring. She was transferred to the emergency department for further monitoring, where she went into a junctional tachycardia then went back into a Mobitz Type I AV block. The patient was symptomatic with a heart rate nadir of 38 beats per minute and treated with atropine. Junctional tachycardia has not been previously reported with fingolimod use.
Zhuo Yin, J.R. Yang, Y.S. Wei, B.L. Liang, Y.B. Wei, K.Q. Zhou, Z. Wang, B. Yan, Y.L. Gao
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.045
Published online: December 30 2014
xAortic dissection is a life-threatening emergency. Well-established risk factors include systemic hypertension, hereditary connective tissue diseases (Marfan syndrome and Ehlers-Danlos syndrome), coarctation of the aorta, bicuspid aortic valve, aortitis, and arch hypoplasia. Ischemia of the viscera, the kidneys, the spinal cord, or the lower extremities due to malperfusion constitutes life-threatening complications that have to be considered in the treatment strategy. We report a rare case of symptomatic ischemia of the lower extremities due to aortic dissection.
Chris Lee, Richard Lynch
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.038
Published online: December 26 2014
xWe present an interesting radiologic finding in a 65-year-old gentleman who attended our emergency department (ED) with sudden-onset severe abdominal pain. Non–contrast-enhanced computed tomography of the abdomen revealed a 7-cm abdominal aortic aneurysm (AAA) which demonstrated the high-attenuation crescent sign (HACS).
Maki Yasuda, Ryota Inokuchi, Kazuma Ohshima, Miyuki Yamamoto, Kurato Tokunaga, Tatsuma Fukuda, Kensuke Nakamura
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.035
Published online: January 6 2015
xSeptic pulmonary embolism (SPE) is an uncommon and severe infectious disease that requires early diagnosis and proper antibiotic therapy. We present the case of a healthy 14-year-old girl with a history of atopic dermatitis, who developed SPE caused by Staphylococcus aureus bacteremia. We initially administered intravenous doripenem and vancomycin. Four days after her admission, blood and urine cultures yielded penicillinase nonproducing, methicillin-sensitive S aureus, with a minimum inhibitory concentration less than 0.06 μg/mL.
Aiman Smer, Mahesh Anantha Narayanan, Toufik Mahfood Haddad, Harish Devineni, Venkata Alla
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.053
Published online: December 29 2014
xCocaine use has been associated with several cardiovascular events. However, isolated right ventricular infarction because of cocaine use has never been reported before. We report a case of isolated right ventricular infarction secondary to cocaine use in a young male with no previous coronary artery disease. To our knowledge, this is the first report of cocaine-induced right ventricular infraction.
Michael D. April, Kurt Fossum, Charles Hounshell, Katherine Stolper, Leigh Spear, Kevin Semelrath
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.052
Published online: December 29 2014
xAortic dissection is a frequently devastating diagnosis classically associated with severe chest pain. We present a case of painless aortic dissection with anterograde amnesia. An 84-year-old man was brought to the emergency department by ambulance, when his wife noted that he developed acute onset complete loss of short-term memory. Medical history was notable for a 4.5-cm fusiform thoracic aortic root aneurysm. On arrival, he denied pain or syncope. On examination, he was mildly hypotensive (110/59 mm Hg); and there were no murmurs, pulse deficits, or focal neurologic deficits.
Juliana Caierão, Ana Flor Hexel Cornely, Gabriela Rosa da Cunha, Mariana Mott, Alexandre P. Zavascki, Cícero Dias
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.051
Published online: December 29 2014
xStreptococcus pneumoniae is a rare cause of appendicitis. We report a pneumococcal appendicitis with secondary peritonitis in a human immunodeficiency virus–positive adult, with favorable outcome after surgery and antibiotic therapy. Secondary peritonitis is frequently complication of S pneumoniae appendicitis in the few reported cases, and no specific risk factor has been identified so far.
