Min Hee Jung, Je Hyeok Oh, Chan Woong Kim, Sung Eun Kim, Dong Hoon Lee, Wen Joen Chang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.016
Published online: April 15 2015
xWe investigated whether visual feedback from an accelerometer device facilitated high-quality chest compressions during an in-hospital cardiac arrest simulation using a manikin.
Marc A. Probst, Hemal K. Kanzaria, Misato Gbedemah, Lynne D. Richardson, Benjamin C. Sun
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.030
Published online: April 24 2015
xOver the last 20 years, numerous research articles and clinical guidelines aimed at optimizing resource utilization for emergency department (ED) patients presenting with syncope have been published.
Onder Limon, Deniz Oray, Cem Ertan, Erkan Sahin, Aslı Aydınoğlu Ugurhan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.029
Published online: April 23 2015
xComputed tomography (CT) is invaluable for the diagnosis of acute appendicitis (AA) in the emergency setting when used appropriately with proper risk stratification. The aim of this study is to investigate the capability and accuracy of emergency physicians (EPs) at recognizing AA criteria in intravenous contrast-enhanced abdominal CT and to investigate the level of interobserver agreement among them.
Hao Wang, Vicki A. Nejtek, Dawn Zieger, Richard D. Robinson, Chet D. Schrader, Chase Phariss, Jocelyn Ku, Nestor R. Zenarosa
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.026
Published online: April 20 2015
Open AccessxHomeless patients are a vulnerable population with a higher incidence of using the emergency department (ED) for noncrisis care. Multiple charity programs target their outreach toward improving the health of homeless patients, but few data are available on the effectiveness of reducing ED recidivism. The aim of this study is to determine whether inappropriate ED use for nonemergency care may be reduced by providing charity insurance and assigning homeless patients to a primary care physician (PCP) in an outpatient clinic setting.
Shan W. Liu, Ziad Obermeyer, Yuchiao Chang, Kalpana N. Shankar
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.023
Published online: April 20 2015
xFalls among older adults (aged ≥65 years) are the leading cause of both injury deaths and emergency department (ED) visits for trauma. We examine the characteristics and prevalence of older adult ED fallers as well as the recurrent ED visit and mortality rate.
Lukasz Szarpak, Andrzej Kurowski, Lukasz Czyzewski, Antonio Rodríguez-Núñez
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.054
Published online: April 29 2015
xEndotracheal intubation (ETI) is an essential resuscitation procedure in children. Video laryngoscopes have been developed to avoid intubation failures in a variety of scenarios, including cardiopulmonary resuscitation. We hypothesized that the video laryngoscope RIFL (AI Medical Devices, Inc, Williamston, MI) offers advantages in the ETI of a pediatric manikin while performing chest compressions (CCs).
Nathalie Génot, Nathan Mewton, Didier Bresson, Oualid Zouaghi, Laurent Francois, Benjamin Delwarde, Gilbert Kirkorian, Eric Bonnefoy-Cudraz
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.021
Published online: April 20 2015
xThe aim of this study was to evaluate bioimpedance vector analysis (BIVA) for the diagnosis of acute heart failure (AHF) in patients presenting with acute dyspnea to the emergency department (ED).
Mazen El Sayed, Hani Tamim, N. Clay Mann
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.035
Published online: April 25 2015
xEmergency medical services (EMS) preparedness is essential to reduce morbidity and mortality from mass casualty incidents (MCIs).
Soo Hoon Lee, Dong Hoon Kim, Tae-Sin Kang, Changwoo Kang, Jin Hee Jeong, Seong Chun Kim, Dong Seob Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.034
Published online: April 24 2015
xThis study was conducted to evaluate the appropriateness of the chest compression (CC) depth recommended in the current guidelines and simulated external CCs, and to characterize the optimal CC depth for an adult by body mass index (BMI).
Alten Oskay, Oktay Eray, Selcan Enver Dinç, Alp Giray Aydın, Cenker Eken
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.033
Published online: April 24 2015
xCritically ill patients have high mortality and admission rates requiring early recognition and a rapid management. In the present study, we evaluated the prognostic parameters in these patients and the value of perfusion index measurement as a novel tool for accomplishing emergency department (ED) triage.
Nian-Fang Lu, Rui-Qiang Zheng, Hua Lin, Jun Shao, Jiang-Quan Yu, De-Gang Yang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.031
Published online: April 25 2015
xSepsis bundles can decrease mortality in patients with severe sepsis or septic shock. However, current methods of measuring pressure, such as central venous pressure, are inadequate. This study investigated the effect of improved sepsis bundles informed by pulse-indicated continuous cardiac output.
Dominik Roth, Christina Hafner, Werner Aufmesser, Kurt Hudabiunigg, Christian Wutti, Harald Herkner, Wolfgang Schreiber
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.048
Published online: April 29 2015
xVentilation is still one key element of advanced life support. Emergency medical technicians (EMTs) without training in advanced airway management usually use bag valve mask ventilation (BVM). Bag valve mask ventilation requires proper training and yet may be difficult and ineffective. Supraglottic airway devices, such as the laryngeal tube (LT), have been proposed as alternatives. Safety and feasibility are unclear if used by EMTs with limited training only. We compared efficacy of the LT to BVM for out-of-hospital cardiac arrest in a primarily volunteer-based emergency medical services.
E. Melinda Mahabee-Gittens, Jane C. Khoury, Mona Ho, Lara Stone, Judith S. Gordon
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.058
Published online: May 1 2015
xThere is a high prevalence of smoking among caregivers who bring their children to the pediatric emergency department (PED) and even higher rates of tobacco smoke exposure (TSE) and related morbidity among their children. The PED visit presents an opportunity to intervene with caregivers, but it is unknown whether they are more likely to quit if their child has a TSE-related illness. We sought to examine a PED-based smoking cessation intervention and compare outcomes based on children’s TSE-related illness.
Seon Hee Woo, Jeong Ho Park, Seung Pill Choi, Jung Hee Wee
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.051
Published online: April 29 2015
xDrowning may happen by accident or as a method of committing suicide. The aim of this study was to determine some characteristics of drowning patients who committed intentionally.
Waqas Shuaib, Javier N. Acevedo, Muhammad Shahzeb Khan, Luis J. Santiago, Theodore J. Gaeta
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.047
Published online: April 29 2015
xOur objective was to identify trends and examine the characteristics of the top 100 cited articles in emergency medicine (EM) journals.
Qing Shangguan, Jing-song Xu, Hai Su, Ju-xiang Li, Wen-ying Wang, Kui Hong, Xiao-shu Cheng
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.066
Published online: April 30 2015
xThe aim of this study was to compare the predictive values of modified shock index (MSI) and shock index (SI) for 7-day outcome in patients with ST-segment elevation myocardial infarction (STEMI).
Anand M. Prabhakar, Alexander S. Misono, H. Benjamin Harvey, Brian J. Yun, Sanjay Saini, Rahmi Oklu
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.025
Published online: April 22 2015
xThis study aims to determine the use of diagnostic imaging in emergency department (ED) observation units, particularly relative to inpatients admitted from the ED.
James Kempema, Marc D. Trust, Sadia Ali, Jose G. Cabanas, Paul R. Hinchey, Lawrence H. Brown, Carlos V.R. Brown
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.046
Published online: April 29 2015
xThe objective of the study is to compare outcomes in blunt trauma patients managed with prehospital insertion of an extraglottic airway device (EGD) vs endotracheal intubation (ETI). The null hypothesis was that there would be no difference in mortality for the 2 groups.
Łukasz Szarpak, Andrzej Kurowski, Zenon Truszewski, Oliver Robak, Michael Frass
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.050
Published online: April 29 2015
xEnsuring an open airway during cardiopulmonary resuscitation is fundamental. The aim of this study was to determine the success rate of blind intubation during simulated cardiopulmonary resuscitation by untrained personnel.
John R. Richards, Kelsey A. Gaylor, Ashley J. Pilgrim
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.063
Published online: May 3 2015
xAcute otitis media (AOM) is a common diagnosis under age 5 years. The primary objective was to determine if the CellScope Oto (CSO) improves tympanic membrane (TM) visualization and diagnostic precision compared to traditional otoscope. The secondary objective was to determine physician, patient, and parent device preference.
Libing Jiang, Mao Zhang, Yuefeng Ma
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.014
Published online: April 15 2015
xI read the article published by Huang et al [1] with a great interest. In this well-written article, the authors investigate the value of changes of platelet indexes, including platelet count, platelet distribution width, and mean platelet volume (MPV) in diagnosing pulmonary embolism (PE). They found that MPV was significantly higher in patients with PE than in the controls and remained statistically significant after multivariate logistic regression analysis. In addition, the receive operation characteristic curve analysis showed that the sensitivity, specificity, positive predictive value, and negative predictive value in diagnosing PE were 88.7%, 50%, 61.9%, and 78.7%, respectively.
Jianqiang Huang, Yanyan Chen, Zhixiong Cai, Ping Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.013
Published online: April 15 2015
xFirst, we really appreciate to get the author's interest about our article [1]. We have read very carefully the letter and the references given by the author. We are honored to discuss the questions mentioned.
Somsri Wiwanitkit, Viroj Wiwanitkit
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.059
Published online: April 30 2015
xThe report on “dengue myocarditis and profound shock” by Lin et al [1] is very interesting. Dengue infection can be severe and result in shock. Indeed, clinically, shock is possible in any dengue case, whereas the systemic complications of dengue myocarditis are not related to shock [2]. In the present case [1], it might be only concomitant. Focusing on myocarditis, it is a rare clinical manifestation of dengue [3]. It is usually not a fatal problem [3]. The fatality in the present case [1] could be directly related to dengue shock, not myocarditis.
Subramanian Senthilkumaran, Shah Sweni, Namasivayam Balamurugan, Narendra Nath Jena, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.072
Published online: May 1 2015
xThe importance of recognizing pseudosubarachnoid hemorrhage (PSAH) in a case of dialysis disequilibrium syndrome was “illustrated” by Tsai et al [1]. However, the appearance of PSAH within the basal cisterns, in conjunction with diffuse cerebral edema, has received limited attention in medical literature. We would like to stress the usefulness of Hounsfield units (HU) to distinguish PSAH from SAH with reference to the report published [1].
Thibault Martinez, Pierre Pasquier, Astrée Swiech, Kevin Kearns, Clément Dubost, Stéphane Mérat
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.022
Published online: April 20 2015
xWe read with interest the observational study by Matsumoto et al [1] identifying the incidence and corresponding risk factors for traumatic pneumothoraxes in the presence of a hemothorax, which should be monitored. This secondary end point was designed to identify the incidence of malpositioned chest tubes based on different insertion directions using computed tomography (CT). The analysis of 78 chest tubes insertions revealed that posterior insertion for monitoring of hemothoraces is more often useless than anterior position.
Kseniya Orlik, Christina M. Campana, Michael S. Beeson, Erin L. Simon
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.081
Published online: April 30 2015
xThe goal of emergency medicine (EM) residency training is to prepare physicians for independent practice. This includes all practice environments from the tertiary care center to rural emergency departments (EDs) with limited resources. The EM resident must be effectively taught the fundamental skills, knowledge, and humanistic qualities that make up the foundation of EM practice [1,2].
Zenon Truszewski, Lukasz Szarpak, Lukasz Czyzewski, Togay Evrin, Andrzej Kurowski, Jolanta Majer, Katarzyna Karczewska
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.078
Published online: May 1 2015
xThe well-known blind nasotracheal intubation (NTI) is an advanced airway management technique, which involves “blindly” passing an endotracheal tube through the vocal cords. This technique is favored in difficult airway circumstances, especially when oral access is limited, or patient has a jaw injury [1]. Furthermore, to apply blind NTI, the patient should indicate spontaneous respiration. However, in the case of sudden cardiac arrest, when there is total cessation of respiration, the use of blind NTI can be problematic.
Birdal Yildirim, Volkan Dogan, Mustafa Ozcan Soylu, Murat Biteker
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.045
Published online: April 29 2015
xWe read with interest the review article recently published by McGregor et al [1] entitled “The pregnant heart: cardiac emergencies during pregnancy.” However, we have some concerns about the definition of peripartum cardiomyopathy (PPCM), which is a rare obstetric emergency. Presentation of PPCM in the emergency department is similar to that of patients presenting with heart failure due to other causes [2]. Diagnosis of PPCM is often missed or delayed because most of the signs and symptoms of normal pregnancy are similar to those of heart failure [2].
Alyson J. McGregor, Rebecca Barron, Karen Rosene-Montella
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.044
Published online: April 29 2015
xWe thank the writers of the correspondence regarding the recently published review article “The pregnancy heart: cardiac emergencies during pregnancy” for their interest and comments [1]. The main purpose of this article was to summarize diagnostic and clinical management recommendations essential for acute care clinicians to consider for 3 common cardiovascular emergencies in the pregnant patient: peripartum/postpartum cardiomyopathy (PPCM), acute myocardial infarction, and cardiac resuscitation.
Darren P. Mareiniss
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.080
Published online: April 30 2015
xIn October 2014, Waxman et al [1] published an article in The New England Journal of Medicine that attempted to measure how new legal protections in South Carolina, Texas, and Georgia affected resource use and defensive practices in the emergency department (ED). Lawmakers in these jurisdictions had changed the standard of negligence in the ED from simple negligence to gross negligence. The new standard essentially requires that providers be consciously indifferent to be negligent of malpractice and is considered near immunity from suit.
İbrahim Arziman, Günalp Uzun
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.076
Published online: April 30 2015
xThe March issue of The American Journal of Emergency Medicine includes a study by Lee et al [1], which investigated the factors associated with residual symptoms after recompression in type I decompression sickness (DCS). This article is of a good quality, and its results emphasize the importance of early recompression therapy in emergency management of DCS. Despite almost all divers (95%) had musculoskeletal pain, Lee et al state that the divers were not allowed to have any analgesics during the study.
Pei-Ling Tang, Jin-Shiung Cheng, Wei-Chun Huang, Hao-Sheng Chang, Hung-Chih Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.077
Published online: May 4 2015
xHead and neck cancer (HNC) is the sixth most common cancer in the world [1], and a trend of rising incidence has been noted worldwide [2]. In 2011, there were 6955 new oral cavity, oropharynx, and hypopharynx cancer patients diagnosed in Taiwan, representing approximately 6.93% of all cancer cases [3]. To date, little data have been available on emergency department (ED) use by cancer patients. Bozdemir et al [4] found that 38% of those cancer patients had more than 1 ED visit, 37.3% of patients were admitted to the hospital, and 49.4% of those patients died within 3 months after their ED visit.
Soheila Talebi, Sameer Chaudhari, Hans Reyes, Ferdinand Visco, Gerald Pekler, Getaw Worku Hassen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.075
Published online: May 7 2015
xWe report the usefulness of a new approach in evaluating the 12-lead electrocardiogram (ECG) in patients suspected of having an acute coronary syndrome. We wish to highlight the diagnostic significance of ST-segment changes in some of the unique reciprocal leads in the setting of acute coronary syndrome.
Piroddi Ines Maria Grazia, Karamichali Sofia, Esquinaz Antonio, Banfi Paolo, Barlascini Cornelius, Nicolini Antonello
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.056
Published online: May 1 2015
xWe have read the study regarding the impact of age on outcomes of elderly patients admitted to emergency department (ED) because of severe community acquired pneumonia (CAP) and treated with invasive mechanical ventilation (IMV) by Hifumi et al [1] with great interest. The authors investigated patients older than 65 years who were divided in 3 groups (65-74, 75-84, and 85 years or older). No significant differences were observed among the 3 groups on mechanical ventilation (MV), hospital mortality, ventilator-free days, or intensive care unit (ICU) days.
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.2015.04.055
Published online: April 30 2015
xWe thank for the comments on our article.
Toru Hifumi, Hiroaki Takada, Daisuke Ogawa, Kenta Suzuki, Hideyuki Hamaya, Natsuyo Shinohara, Yuko Abe, Koshiro Takano, Kenya Kawakita, Masanobu Hagiike, Yuichi Koido, Yasuhiro Kuroda
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.002
Published online: January 27 2015
xThe American Heart Association/American College of Cardiology Foundation recommends vitamin K1 for warfarin-related coagulopathy. In Japan, vitamin K2 is used more commonly for such purpose. The difference between vitamins K1 and K2 in reversing warfarin-related coagulopathy has not been discussed. Herein, we report a case that was reversed with vitamin K2; alterations in vitamins K1 and K2 levels and coagulation markers are also presented.
Baiqiang Li, Lu Ke, Xiao Shen, Zhihui Tong, Gang Li, Jing Zhou, Dongliang Yang, Xianghong Ye, Jieshou Li, Weiqin Li
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.004
Published online: January 16 2015
xSevere acute pancreatitis (SAP) is a critical illness in clinical practice, which is characterized by intensive inflammatory response in the early phase and infected pancreatic necrosis in the later phase. Despite the knowledge of SAP and critical care support technology got significant progress in recent years, SAP still carries approximately 30% mortality rate. Some SAP patients also have many other kinds of underlying disease such as hyperlipidemia, hypertension, coronary atherosclerotic heart disease, and heart rhythm abnormalities, which are related to cardiopulmonary arrest to some extent.
F. Rademacher, J. Reichert, T.A. Schildhauer, J. Swol
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.008
Published online: January 16 2015
xWe report about a 54-year-old male patient who was involved in a motorcycle accident. On day 15 after trauma, a tension pneumothorax was suspected based on radiography because of the right-side shift of the heart. A computer tomographic scan detected a pneumothorax on the left side and pneumopericardium. A chest drain was inserted on the left side. The postinterventional radiograph showed a further dislocation of the heart to the right side. The diagnosis of luxatio cordis was suspected. The patient was taken into the operating theater in a hemodynamic stable state.
Neha Kumar, Mary Colleen Bhalla, Jennifer A. Frey, Alison Southern
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.007
Published online: January 16 2015
xHeroin-associated stroke is a rare complication of use. Various proposed mechanisms of heroin-associated ischemic stroke have been proposed, including the following: cardioembolism in the setting of infective endocarditis, hypoxic ischemic brain injury in the setting of hypoxemia and hypotension, and infective arteritis or vasculitis from drug adulterants. A previously healthy 28-year-old woman presented to the emergency department with altered mental status and normal vitals after she was found wandering outside her apartment.
John P. Sarwark, Danielle M. McCarthy, Charles Pearce, Akhil Seth, Nabil Issa
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.006
Published online: January 16 2015
xAlthough abdominal impalement injuries are less common than other types of penetrating trauma (eg, gunshot wounds), these injuries present providers with a unique set of challenges.
Daniel Ng, Jahan Fahimi, H. Gene Hern
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.005
Published online: January 16 2015
xStatus asthmaticus is both a common and dangerous cause of acute dyspnea in the emergency department (ED) setting. Although most cases respond favorably to standard treatment, there are rare cases in which therapy beyond traditional treatment is needed. One of these treatment modalities includes inhalational anesthesia. We present a case in which inhaled sevoflurane was initiated out of the ED for a life-threatening asthma exacerbation refractory to conventional treatment. To our knowledge, this is only the second case to report the use of inhaled anesthetics initiated out of the ED for status asthmaticus and is the first report of its kind to thoroughly detail the respiratory response noted while inhalation anesthesia was being implemented.
Jeremiah T. Escajeda, Ken D. Katz, Jon C. Rittenberger
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.012
Published online: January 16 2015
xβ-Adrenergic antagonist toxicity causes cardiovascular collapse often refractory to standard therapy. Alternative therapies include high-dose insulin, lipid emulsion, and venoarterial extracorporeal membrane oxygenation (VA-ECMO). A 47-year-old man ingested 10 g of metoprolol tartrate in a suicide attempt. Upon emergency department presentation, he was comatose, bradycardic, and hypotensive. Glucagon (14 mg IV) and vasopressor/inotropic support (epinephrine 0.1 μg/[kg min], dobutamine 10 μg/[kg min]) were administered.
Kapil Dev Soni, Devi Prasad Dash, Richa Aggrawal, Narendra Kumar, Niraj Kumar
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.009
Published online: January 16 2015
xAcute respiratory distress syndrome (ARDS) is a common clinical problem prevalent in intensive care settings. It can complicate many critical illnesses. The general treatment is mainly supportive. Mechanical ventilation, low tidal volume strategy, and control of plateau pressure form the basis of current management. No specific treatment exists for ARDS. Various interventions have been tested for the lethal condition including steroids, fluid restriction, statins, high-frequency ventilation, nitric oxide, and prone ventilation strategy.
Huseyin Buyukgol, M. Kemal Ilik, Faik Ilik
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.018
Published online: January 21 2015
xSpontaneous spinal epidural hematoma is rarely seen, and it is the important reason for the spinal cord compression. Patients generally visit a doctor due to the acute pain in the neck and interscapular area. A 58-year-old male patient was admitted to the emergency service of our hospital with a sudden-onset neck pain followed by rapid progressive right hemiparesis. He arrived at our hospital 120 minutes after the onset of her symptoms with suspected acute stroke. We assessed for acute stroke performed clinical examinations necessary for intravenous thrombolytic treatment with alteplase.
Zhou Zhang, Jessica Fleisher-Black, Daniel Goldstein, Christine Preblick, Michael Heller
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.016
Published online: January 22 2015
xMastoiditis is a rare but serious complication of otitis media. As otitis media is largely a disease of childhood, most of what is known about mastoiditis and other uncommon pyogenic complications of otitis media are extrapolated from pediatric populations. Even more rare than mastoiditis, intracranial extension of otogenic infection represents the most serious complication, necessitating emergent operative therapy. Most commonly, a history of chronic ear infection or recent skull trauma or surgery is the proximate cause of intracranial empyema.
Rajendra Singh Jain, Pankaj Kumar Gupta, Ishwar Dayal Gupta, Rakesh Agrawal, Sunil Kumar, Shankar Tejwani
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.029
Published online: January 21 2015
xNeuroleptic malignant syndrome (NMS) is a life-threatening neurologic emergency associated with the use of mainly typical antipsychotic drugs. It is characterized by fever, altered mental status, generalized rigidity, autonomic instability, myoclonus, raised creatine phosphokinase, rhabdomyolysis, and leukocytosis. Neuroimaging (brain computed tomography/magnetic resonance imaging [MRI]) is usually normal in most of the cases of NMS. Magnetic resonance imaging findings have not been well elucidated in NMS as yet.
Neal Lyons, Daniel Nejak, Nadine Lomotan, Robert Mokszycki, Stephen Jamieson, Marc McDowell, Erik Kulstad
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.028
Published online: January 21 2015
Open AccessxRoutes of administration for medications and fluids in the acute care setting have primarily focused on oral, intravenous, or intraosseous routes, but, in many patients, none of these routes is optimal. A novel device (Macy Catheter; Hospi Corp) that offers an easy route for administration of medications or fluids via rectal mucosal absorption (proctoclysis) has recently become available in the palliative care market; we describe here the first known uses of this device in the emergency setting.
Yalcin Velibey, Sinan Sahin, Ozan Tanık, Muhammed Keskin, Osman Bolca, Mehmet Eren
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.032
Published online: January 23 2015
xMarijuana (cannabis) is a frequently used recreational drug that potentially imposes serious health problems. We present a case of acute myocardial infarction with chronic total occlusion of left main coronary artery due to marijuana smoking in a 27-year-old man, which was not previously reported. This case illustrate that marijuana abuse can lead to serious cardiovascular events.
Zhong-Qun Zhan, Chong-Quan Wang, Zhi-Xiao Wang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.036
Published online: January 27 2015
xAcute pulmonary embolism (APE) masquerading as inferior myocardial infarction was sporadically reported by several authors. We analyzed the clinical and electrocardiographic characteristics of the 8 patients reported in the English literature. The clinical manifestations included chest pain (37.5%), dyspnea (37.5%), sweating (25%), sinus tachycardia (62.5%), and hemodynamic instability (50%). Most patients (62.5%) presented the right ventricular strain pattern. In conclusion, patients presenting with chest pain and/or dyspnea can be experiencing a range of syndromes, including acute myocardial infarction and APE.
Zerrin Ozergın Coskun, Özcan Yavaşi, Tugba Durakoglugil, Ozlem Celebi Erdivanli, Abdulkadir Ozgur, Suat Terzi, Engin Dursun
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.049
Published online: February 2 2015
xA cervical hematoma secondary to the spontaneous rupture of an aneurysm is an uncommon but catastrophic life-threatening condition because it can potentially obstruct the airway. Inferior thyroid artery aneurysm and rupture is a very rare clinical entity and only a limited number of cases have been reported in the literature. In this article, we present the case of a female patient who suffered from a rapidly enlarging cervical mass followed by a rapid onset of dyspnea as a result of rupture of an inferior thyroid artery aneurysm.
