Lukasz Szarpak, Zenon Truszewski, Lukasz Czyzewski, Andrzej Kurowski, Lukasz Bogdanski, Piotr Zasko
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.003
Published online: June 6 2015
xThe main cause of cardiac arrest in pediatric patients is respiratory failure.
Elke Platz, Emanuele Pivetta, Allison A. Merz, Julie Peck, Jose Rivero, Susan Cheng
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.002
Published online: June 6 2015
xPulmonary edema is a common sign of heart failure and can be quantified by counting vertical artifacts (B-lines) on lung ultrasound (LUS). The primary aim of this study was to compare a pocket size ultrasound device to high-end ultrasound systems on the measured number of B-lines. We also compared the impact of different-length ultrasound clips on the measured number of B-lines.
Mohamed Habib Grissa, Hamdi Boubaker, Asma Zorgati, Kaouthar Beltaïef, Wafa Zhani, Mohamed Amine Msolli, Nasri Bzeouich, Wahid Bouida, Riadh Boukef, Semir Nouira
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.014
Published online: June 13 2015
xOur aim was to compare the efficacy and safety of intravenous (IV) titrated morphine with nebulized morphine given at 2 different doses in severe traumatic pain.
Cassie A. Barton, Nathan B. Johnson, Jon Case, Bruce Warden, Darrel Hughes, Jason Zimmerman, Gregory Roberti, Wesley D. McMillian, Martin Schreiber
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.010
Published online: June 13 2015
xBleeding events and life-threatening hemorrhage are the most feared complications of warfarin therapy. Prompt anticoagulant reversal aimed at replacement of vitamin K–dependent clotting factors is essential to promote hemostasis. A retrospective cohort study of warfarin-treated patients experiencing a life-threatening hemorrhage treated with an institution-specific warfarin reversal protocol (postimplementation group) and those who received the prior standard of care (preimplementation group) was performed.
Harun Kundi, Ihsan Ates, Emrullah Kiziltunc, Mustafa Cetin, Hulya Cicekcioglu, Salim Neselioglu, Ozcan Erel, Ender Ornek
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.016
Published online: June 13 2015
xThe aim of this study was to investigate a novel oxidative stress marker (thiol/disulphide homeostasis) in patients with acute myocardial infarction (AMI) and compare the results with healthy controls for the first time in literature.
Benjamin A. White, Jason M. Baron, Anand S. Dighe, Carlos A. Camargo Jr., David F.M. Brown
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.013
Published online: June 13 2015
xIncreasing the value of health care delivery is a national priority, and providers face growing pressure to reduce cost while improving quality. Ample opportunity exists to increase efficiency and quality simultaneously through the application of systems engineering science.
Yoon Jung Hwang, Sung Phil Chung, Yoo Seok Park, Hyun Soo Chung, Hye Sun Lee, Jong Woo Park, Jong Wook Lee, Jung Hwa Hong, Je Sung You, Incheol Park
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.012
Published online: June 13 2015
xWe evaluated the ratio of delta neutrophil index (DNI) to albumin (A) in patients receiving early goal-directed therapy (EGDT) to determine the prognostic significance of the DNI/A ratio as a marker of early mortality in critically ill patients with suspected sepsis.
Gustavo J. Rodrigo, Hugo Neffen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.022
Published online: June 16 2015
xAssessment of acute asthma severity in the emergency department (ED) determines the appropriate initial therapy. The aim of this study was to evaluate the usefulness of heart and respiratory rates as determinants of severity of asthma exacerbations.
Paul A. Jennings, Bill Lord, Karen Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.026
Published online: June 17 2015
xPediatric pain is a common presenting symptom in the prehospital setting; however, there is a lack of data identifying factors associated with effective pain management in this population. We sought to identify the factors associated with clinically meaningful pain reduction in children.
Tae Gyun Kim, Sang Do Shin, Kyoung Jun Song, Yu Jin Lee, Eui Jung Lee, Young Sun Ro, Ki Ok Ahn
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.046
Published online: June 22 2015
xThis study aimed to investigate the association between time to percutaneous coronary intervention (PCI) and hospital mortality in non–ST-elevation myocardial infarction (NSTEMI).
Victoria L. Migdal, W. Kelly Wu, Drew Long, Candace D. McNaughton, Michael J. Ward, Wesley H. Self
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.048
Published online: June 22 2015
xThe objective of the study is to compare the risks and benefits of lumbar puncture (LP) to evaluate for subarachnoid hemorrhage (SAH) after a normal head computed tomographic (CT) scan.
Jianjun Gui, Jiongguang Guo, Fengqiu Nong, Dongxin Jiang, Anding Xu, Fan Yang, Qiaozhu Chen, Youping Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.047
Published online: June 22 2015
xThe inferior vena cava (IVC) parameters, including its diameter and collapsibility index have been evaluated for fluid status for over 30 years, but little is known about the impacts of patient characteristics on IVC parameters. The purpose of this study was to explore the relationships between individual patient characteristics and IVC parameters in healthy Chinese adult volunteers.
Yuki Akihisa, Hiroshi Hoshijima, Koichi Maruyama, Yukihide Koyama, Tomio Andoh
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.049
Published online: June 22 2015
xThe purpose of this meta-analysis was to validate the efficacy of the sniffing position in the performance of intubation with direct laryngoscopy.
Fanny Le Querrec, Vincent Bounes, Maryse Lapeyre Mestre, Olivier Azema, Nicolas Longeaux, Jean-Christophe Gallart
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.068
Published online: July 6 2015
xThe objectives of this study are to describe an emergency department (ED) adult population with the chief complaint of mental and behavioral disorders due to psychoactive substance use and to investigate sex- and age-related differences.
Karsten Keller, Johannes Beule, Jörn Oliver Balzer, Wolfgang Dippold
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.009
Published online: July 16 2015
xRisk stratification of patients with acute pulmonary embolism (PE) is crucial in deciding appropriate therapy management. Blood pressure (BP) is rapidly available and a reliable parameter. We aimed to investigate BP for short-term outcome in acute PE.
Thomas J. Abramo, Z. Leah Harris, Mark Meredith, Kristen Crossman, Rawle Seupaul, Abby Williams, Sheila McMorrow, Jennifer Dindo, Angela Gordon, Maria Melguizo-Castro, Zhuopei Hu, Todd Nick
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.037
Published online: July 22 2015
xDespite pediatric stroke awareness and pediatric stroke activation systems, recognition and imaging delays along with activation inconsistency still occur. Reliable objective pediatric stroke detection tools are needed to improve detection and activations. Regional cerebral oxygen saturation (rcso2) with cerebral blood volume index (CBVI) can detect abnormal cerebral physiology.
Matthew Lyon, LaShon Sturgis, Darren Lendermon, Ann Marie Kuchinski, Taylor Mueller, Patrick Loeffler, Hongyan Xu, Robert Gibson
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.050
Published online: July 28 2015
xOur objectives were to determine the frequency of patient transfers to a tertiary care emergency department (Tertiary ED) due to a lack of radiology services in rural hospital EDs (Rural EDs), and examine the community and patient attributes that are associated with these transfers.
Daniel Evans, Jonathan Pester, Luis Vera, Donald Jeanmonod, Rebecca Jeanmonod
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.044
Published online: July 28 2015
xFalls in the elderly are a significant cause of morbidity and mortality. We sought to better categorize this patient population and describe factors contributing to their falls.
Anand M. Prabhakar, Thang Q. Le, Hani H. Abujudeh, Ali S. Raja
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.078
Published online: July 29 2015
xThe aim of this study was to assess the outcomes, incidental findings, recommendations, and adherence to recommendations on computed tomography angiography (CTA) studies obtained in the emergency department (ED) to evaluate for aortic dissection.
Byuk Sung Ko, Ryeok Ahn, Seung Mok Ryoo, Shin Ahn, Chang Hwan Sohn, Dong Woo Seo, Kyoung Soo Lim, Won Young Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.083
Published online: August 4 2015
xEmergency endotracheal intubation–related cardiac arrest (CA) is not well documented. This study compares the clinical features and outcomes of intubation-related CA and other causes of inhospital CA.
Aaron Nathan Barksdale, Jeff Lee Hackman, Monica Gaddis, Matt Christopher Gratton
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.082
Published online: August 4 2015
xTo determine the effect of abdominal computed tomographic (CT) scan results on diagnosis and disposition of patients with non-traumatic abdominal pain who were evaluated by board-certified emergency physicians (EPs).
Xiao-shuang Li, Li Liu, Yu-lian Jin, Fei-fei Luo, Lin Li, Jingfeng Zhu, Qilian Xie
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.003
Published online: August 5 2015
xSome patients with sepsis are found with accompanying mild hypothermia (ACMH); however, the effects of ACMH on the patients with sepsis are poorly understood.
Jiwon Kang, Joonghee Kim, You Hwan Jo, Kyuseok Kim, Jae Hyuk Lee, Taeyun Kim, Jungyoup Lee, Ji Eun Hwang, Euigi Jung
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.002
Published online: August 4 2015
xEmergency department (ED) overcrowding is a worldwide problem associated with adverse outcomes. This study was performed to investigate the association between ED overcrowding and the outcomes and quality of cardiopulmonary resuscitation for out-of-hospital cardiac arrest (OHCA).
Xi Xing, Ronglin Jiang, Lingcong Wang, Shu Lei, Yihui Zhi, Yanchun Wu, Meifei Zhu, Liquan Huang, Guolian Xia, Zheqi Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.001
Published online: August 4 2015
xShenfu injection (SFI) promotes tissue microcirculation and oxygen metabolism. We aimed to assess its effects on intestinal epithelial damage in septic rats.
Salim Surani, Joseph Varon
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.008
Published online: August 11 2015
xSepsis remains one of the leading causes of death among hospitalized patients [1]. The emergency department (ED) is the portal of entry for many of these patients. In the acute care setting, a variety of clinical trials have attempted to identify the ideal diagnostic test, which can help the early detection of sepsis. Biomarkers and polymerase chain reaction assays have been used to help differentiate between the systemic inflammatory response syndrome and sepsis [2]. Of them, procalcitonin (PCT) has been shown to be a reliable biomarker that can help detect sepsis as early as 8 hours after its onset [3].
Birdal Yıldırım, Funda Sungur Biteker, Özcan Başaran, Ömer Doğan Alataş, Ethem Acar, Hamdi Sözen, Volkan Doğan, Halil Beydilli, Selmin Dirgen Çaylak
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.036
Published online: June 18 2015
xThe role of echocardiography in adult patients with community-acquired pneumonia (CAP) has not been tested in a clinical trial. The aim of the study was to assess the cardiac changes secondary to CAP by echocardiography and to find out the correlation between echocardiographic findings and the severity of CAP.
Tammy T. Nguyen, Michelle Troendle, Kirk Cumpston, S. Rutherfoord Rose, Brandon K. Wills
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.031
Published online: July 21 2015
xFlumazenil is an effective benzodiazepine (BZD) antagonist. Empiric use of flumazenil in the emergency department (ED) is not widely recommended due to concerns of seizures, which are commonly associated with coingestants and BZD withdrawal.
Bernard P. Chang, Timothy M. Tan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.013
Published online: August 10 2015
xThe goal of this study was to evaluate the relationship between various suicide screening tools and clinical impression with subsequent patient psychiatric admission and near-term adverse emergency department (ED) events.
Margaret Lin, Richard E. Wolfe, Nathan I. Shapiro, Victor Novack, Yotam Lior, Shamai A. Grossman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.010
Published online: August 10 2015
xRising health care costs demands justifying prolonged hospitalization for syncope, yet predictors of shorter length of stay (LOS) have not been identified.
Mary Colleen Bhalla, Jennifer Frey, Cody Rider, Michael Nord, Mitch Hegerhorst
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.021
Published online: August 13 2015
xTwo common mass casualty triage algorithms are Simple Triage Algorithm and Rapid Treatment (START) and Sort, Assess, Lifesaving, Interventions, Treatment, and Transportation (SALT). We sought to determine the START and SALT efficacy in predicting clinical outcome by appropriate triage.
Michael Mouw, Tatiana Balatiouk-Lance, Lawrence H. Brown
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.027
Published online: August 18 2015
xMinor musculoskeletal injury is one of the most common presentations to the emergency department (ED). The majority (85%-90%) of those presenting for minor injury do not have a fracture [1], and presumably, many others never seek medical attention. The need to image patients with obvious signs of fracture is never in question—but it is much less clear who needs imaging when those signs are absent. This leads to considerable practice variability1 and, in the United States, is complicated further by the need to address patient satisfaction.
Reza Farahmand Rad, Fatemeh Mojallal Najjar, Akram Zolfaghari Sadrabad
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.021
Published online: August 6 2015
xThe Editor of American Journal of Emergency Medicine
Sevket Balta, Ali Osman Yildirim, Mustafa Demir, Cengiz Ozturk, Mustafa Aparci, Turgay Celik
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.019
Published online: July 21 2015
xWe read the article “Brain natriuretic peptide (BNP): the reason of respiratory distress is heart disease or lung disease?” by Sahingozlu et al [1]. The authors investigated whether plasma levels of amino-terminal BNP could differentiate between heart failure and lung disease among infants with acute bronchiolitis. They concluded that plasma BNP levels were affected much more in cardiac disease rather than lung disease. Among infants with respiratory distress, plasma BNP measurements can differentiate congenital heart disease and lung disease and can be used to monitor the effects of treatment for infants with heart failure.
Alfredo De Giorgi, Fabio Fabbian, Ruana Tiseo, Elisa Misurati, Benedetta Boari, Beatrice Zucchi, Fulvia Signani, Raffaella Salmi, Massimo Gallerani, Roberto Manfredini
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.068
Published online: July 29 2015
xAn association between weekend (WE) admission and worst patients' outcomes has been reported, independently from countries and health system organizations. Bell and Redelmeier [1] found a higher inhospital mortality (IHM) in patients admitted during WE for more than 20 of 100 different considered diseases. Similar results were reported in many different clinical trials, independently from reason of hospital admissions, medical or surgical or intensive care unit, and emergency or elective hospitalization [2-5].
Ayşe Kefeli, Adem Akturk, Sebahat Başyiğit
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.084
Published online: August 4 2015
xWe read with interest the article by Antopolsky et al [1] on renal infarct (RI). They have reviewed 38 cases with RI from 1999 to 2010 and recorded possible etiologies. Eosinophilic colitis (EC) has not been reported as a cause of RI in their study. Moreover, reviewing the literature, EC associated with RI has never been reported.
Subramanian Senthilkumaran, Namasivayam Balamurugan, Srinivasan Jayaraman, Sambathkumar Sasikumar, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.016
Published online: August 10 2015
xWe read the report on neurologic complications of central origin by Rahman et al [1] with great interest. We would like to share our observations on isolated peripheral nervous system involvement after lightning strike being an extremely rare event and certain aspects related to the clinical practice.
Narat Srivali, Charat Thongprayoon, Patompong Ungprasert
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.015
Published online: August 10 2015
xWe read the article “Eosinophilic colitis complicated with renal infarction” by Kefeli et al [1] in the American Journal of Emergency Medicine with great interest. The authors described a very interesting case of eosinophilic colitis that developed renal infarction and thought to be from systemic inflammatory process. The patient was successfully managed with anticoagulation. Delay in treatment and diagnosis renal infarction is not uncommon, as physicians are less familiar with this finding, and the initial presentation could be very nonspecific.
Felipe Fernández Méndez, Roberto Barcala-Furelos, Ramón Fungueiriño-Suárez, Marcos Mecías-Calvo, Cristian Abelairas-Gómez, Antonio Rodríguez-Núñez
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.018
Published online: August 12 2015
xFishing is one of the most dangerous jobs and hardest occupations [1,2]. It is estimated that fishing has a mortality rate all over the world of approximately 24000 deaths per year and 24 million nonfatal accidents every year [3]. The causes of prevalent deaths as a consequence of these incidents were drowning, heart attack, hypothermia, fatal injuries, asphyxia, and burns [4].
Murat Yalcin, Omer Uz, Murat Eroglu, Zafer Isilak, Ugur Kucuk
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.025
Published online: August 17 2015
xWe read with great interest the article by Klein et al [1] entitled, “Electrocardiographic criteria to differentiate acute anterior ST-elevation myocardial infarction from left ventricular aneurysm.” The authors have investigated some rules to differentiate the ST elevation of the electrocardiogram (ECG) in patients attending the emergency department (ED) with chest pain, presenting a left ventricular aneurysm, from that of patients with acute myocardial infarction (AMI). This is a very important issue in clinical practice because the inability to differentiate between these 2 clinical states can result in either a critical delay in reperfusion therapy or unnecessary invasive interventions.
Catherine A. Marco, Andy Davis, Sylvia Chang, Dennis Mann, James E. Olson
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.023
Published online: August 17 2015
xPatient satisfaction is associated with improved patient compliance with therapy, reduced malpractice risk, and improved job satisfaction among the emergency department (ED) staff [1]. Previous studies have shown numerous factors to be associated with improved patient satisfaction, including effective pain management, effective communication, timeliness of care, empathy, and technical competence [2-5]. This study was undertaken to measure patient satisfaction among ED patients and to assess the relationship between patient and physician demographic factors and patient satisfaction.
Birdal Yıldırım, Ozcan Basaran, Omer Dogan Alatas, Emine Nese Yeniceri, Omer Dogan Alatas, Emine Nese Yeniceri, Ibrahim Altun, Ozgur Tanriverdi, Volkan Dogan, Ethem Acar, Murat Biteker
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.040
Published online: August 26 2015
xChest tube insertion is an essential skill for health professionals dealing with pleural diseases. YouTube is a social sharing network that provides easily accessible content with the possibility of hosting incorrect information regarding streaming video that can rapidly spread misinformation [1,2]. We aimed to investigate the compliance of chest tube insertion techniques illustrated on YouTube videos with the current practice guidelines.
Kazuhiko Omori, Youichi Yanagawa, Teruhiro Inoue, Ken Okamoto, Hiroshi Ito
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.010
Published online: July 20 2015
xA 32-year-old male worker was working in a food processing plant to scrape off powder that was stuck to the wall of a tank used to store cornstarch. He was buried alive by a large amount of powder that had suddenly peeled off from the wall. He was rescued from under the tank in a state of cardiopulmonary arrest. When a helicopter carrying doctors arrived on the scene, the patient was found to be in a continued state of cardiopulmonary arrest. The doctor secured the airway by creating an incision in the cricothyroid ligament in the field.
Daniel Evans, Anthony Luizza, Thomas Zanders, Rebecca Jeanmonod
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.025
Published online: November 25 2013
xAn 85-year-old man with multiple comorbidities presented with dysphagia and developed stridor and respiratory distress, ultimately resulting in intubation due to an anterior, cervical osteoarthritic osteophyte. The osteophyte had eroded into his esophagus and compromised his airway. To our knowledge, this is the only documented case of stridor and respiratory failure in this etiologic situation. We review the common risk factors and presenting symptom patterns for this disease and cite recommendations for diagnosis, management, and disposition in the emergency department and critical care setting.
Yu-Tzu Tsao, Jui-Chang Chen, Wei-Chi Tsai
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.015
Published online: March 17 2015
xCardiac tamponade is a constellation of hemodynamic crises, usually characterized by an increase in pericardial pressure due to aberrant accumulation of various fluid components. Even with expeditious intervention, it will carry a high risk of in-hospital morbidity and mortality if the corresponding etiology is not recognized. Herein, we describe a 38-year-old woman with severe cardiac tamponade caused by paradoxical immune reconstitution inflammatory syndrome. Corticosteroid therapy combined with echo-guided subxiphoid percutaneous pericardiocentesis achieved a favorable outcome.
Christopher S. Sampson, Starr-Mar’ee Bedy, Terry Carlisle
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.025
Published online: March 15 2015
xThe recent rise in the abuse of synthetic cannabinoid receptor agonists (Spice, K2) has led to an increase of patients presenting to emergency departments (EDs) with complications stemming from their abuse. We present a case of withdrawal seizures seen in a chronic abuser of these herbal mixtures who stopped using them abruptly. Seizures have been reported in the literature in the setting of abuse, but not during withdrawal [1].
Nadia Bouabdallaoui, Ciro Mastroianni, Luca Revelli, Pierre Demondion, Guillaume Lebreton
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.014
Published online: March 17 2015
xPeripartum cardiomyopathy (PPCM) refers to the development of heart failure (HF) in the last month before or within 5 months after delivery in the absence of preexisting heart disease. In critically ill PPCM patients unresponsive to medical therapy, extracorporeal membrane oxygenation (ECMO) may be considered even before delivery as a bridge to recovery or as a bridge to heavier mechanical support. We describe the case of a 29 year-old White patient admitted for severe HF developed during the last month of pregnancy.
Ryan P. Austin, Adam G. Field, William M. Beer
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.028
Published online: March 17 2015
xA previously healthy, 33-year-old man presented to our emergency department complaining of right lower quadrant abdominal pain with anorexia, nausea, vomiting, diarrhea, and fever. Physical examination revealed hypotension, with rebound tenderness in the right lower quadrant. A computed tomography scan of the abdomen and pelvis revealed a normal appendix but showed findings suggestive of inflammation within the retroperitoneum. The initial suspected diagnosis was appendicitis with dehydration, but after not responding to initial fluid resuscitation and obtaining a computed tomography scan with only retroperitoneal inflammation, other etiologies of sepsis were considered.
Sheffield Kent, Greg Mehaffey
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.024
Published online: March 15 2015
xPostdural puncture headache (PDPH), also known as spinal headache, is a common complication associated with neuraxial anesthesia and diagnostic lumbar puncture. Autologous epidural blood patch is considered the definitive treatment for PDPH with efficacy greater than 75%; but it is an invasive procedure that carries the same risks as other epidural procedures, including dural puncture, infection, and neurologic complications [1–3]. Transnasal sphenopalatine ganglion block (SPGB) has been traditionally used to treat chronic conditions such as migraine, cluster headache, trigeminal neuralgia, and atypical facial pain [4], and has also been used with good results in a recent case series to treat acute PDPH headache in obstetric patients [5].
Dallas Wright, Jessica Sop
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.042
Published online: March 19 2015
xSalicylates are a common component of a wide variety of over-the-counter products. Ingesting these salicylate-containing products improperly can be fatal. Classically, physicians recognize the increased anion gap metabolic acidosis that develops when salicylate poisoning occurs. This is certainly true in most cases, but caution is still warranted. There are reports that salicylates have caused laboratory errors in some commonly used analyzers resulting in false-negatives putting the patient at risk for significant morbidity and mortality.
Mahmut Yesin, Macit Kalçık, Mustafa Ozan Gürsoy, Süleyman Karakoyun, Emrah Bayam, Mehmet Altuğ Tuncer, Mehmet Özkan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.041
Published online: March 19 2015
xPeriannular extension of infection is a rare but potentially fatal complication of infective endocarditis. The accurate detection and delineation of periannular complications are crucial in patient management, which may also provide guidance for surgical interventions. Potential complications from a periannular extension of infective endocarditis include periannular abscess, pseudo-aneurysm formation, and subsequent development of aortocavitary fistula. Here, we present a case of a 46-year-old man with prosthetic aortic valve endocarditis complicated with perivalvular abscess formation that was managed with aortic homograft implantation.
