David A. Berger, Michael A. Ross, Jay B. Hollander, James Ziadeh, Charity Chen, Raymond E. Jackson, Robert A. Swor
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.006
Published online: August 6 2015
xThe objective of the study is to determine if tamsulosin initiated in the emergency department (ED) decreases the time to ureteral stone passage at 1 week or time to pain resolution, compared to placebo.
Sion Jo, Taeoh Jeong, Young Ho Jin, Jae Baek Lee, Jaechol Yoon, Boyoung Park
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.004
Published online: August 6 2015
xAdverse effects of emergency department (ED) crowding among critically ill patients are not well known.
Chun Tat Lui, Ho Lam, Koon Ho Cheung, Sze Fai Yip, Kwok Leung Tsui, Chak Wah Kam, Ka Lung Chui, Ping Wa Yam, Beata Morawiec, Damian Kawecki
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.011
Published online: August 10 2015
xThe objective of the study is to evaluate the role of copeptin in the diagnosis of acute coronary syndrome (ACS) and its role in dual–cardiac marker diagnostic strategy with troponin.
N.R. Weiss, S.J. Weiss, R. Tate, S. Oglesbee, A.A. Ernst
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.007
Published online: August 6 2015
xThe population of the United States continues to diversify with an increasing percentage of residents with limited English proficiency (LEP). A major concern facing emergency medical services (EMS) providers is increasing scene and transport times. We hypothesized that there would be a significant difference in EMS scene and transport times when comparing LEP and English-speaking (ES) patients and there would be a difference in care, both in and out of hospital.
Gerardo Chiricolo, Andrew Balk, Christopher Raio, Wendy Wen, Athena Mihailos, Samuel Ayala
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.005
Published online: August 6 2015
xThis study compares first pass success rates and patient and physician satisfaction scores of using a guide wire–associated peripheral venous catheter (GAPIV) vs a traditional peripheral venous catheter in difficult to obtain venous access patients.
Rachael M. Billock, Jonathan J. Anderegg, Tracy J. Mehan, Thiphalak Chounthirath, Gary A. Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.022
Published online: August 14 2015
xTo investigate the epidemiology of zipline-related injuries in the United States.
Robert T. Dahlquist, Peter E. Fischer, Harsh Desai, Amelia Rogers, A. Britton Christmas, Michael A. Gibbs, Ronald F. Sing
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.009
Published online: August 10 2015
xThe National Emergency X-Radiography Utilization Study (NEXUS) clinical decision rule is extremely sensitive for clearance of cervical spine (C-spine) injury in blunt trauma patients with distracting injuries.
Che-uk Lee, Ji Eun Hwang, Joonghee Kim, Joong Eui Rhee, Kyuseok Kim, Taeyun Kim, You Hwan Jo, Jae Hyuk Lee, Yu Jin Kim, Jae Yun Jung
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.014
Published online: August 11 2015
xAdequate chest compression (CC) depth is critical for effective cardiopulmonary resuscitation. Pediatric resuscitation guidelines recommend that CC be at least one-third of the anterior-posterior (AP) chest diameter or approximately 4 cm in infants and 5 cm in children. We aimed to find a better indicator of CC depth that maximizes CC depth while also minimizing injury.
Ju Yeon Heo, Ki Jeong Hong, Sang Do Shin, Kyoung Jun Song, Young Sun Ro
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.019
Published online: August 13 2015
xRapid access to reperfusion is important in ST-segment elevation myocardial infarction (STEMI). The goal of this study is to assess the association of the educational level of patients with STEMI and prehospital and inhospital delay before reperfusion.
Catherine A. Marco, Scarlett Michael, Jamie Bleyer, Alina Post
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.026
Published online: August 17 2015
xDo-not-resuscitate (DNR) orders are an important means to communicate end-of-life wishes. Previous studies have demonstrated variable prevalence of DNR orders among hospitalized trauma patients.
Jae Hyuk Lee, Kyuseok Kim, You Hwan Jo, Min Ji Lee, Ji Eun Hwang, Min A. Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.036
Published online: August 21 2015
xValproic acid (VPA) has been reported to have survival and neuroprotective effects in a cardiac arrest rat model. This study was designed to investigate the effect of VPA combined with therapeutic hypothermia (HT) in an asphyxial cardiac arrest rat model.
John P. Haran, Gregory Wu, Vanni Bucci, Andrew Fischer, Edward W. Boyer, Patricia L. Hibberd
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.035
Published online: August 21 2015
xThe Infectious Disease Society of America (IDSA) publishes evidence-based guidelines for the treatment of skin and soft tissue infections. How closely physicians follow these guidelines is unknown, particularly in the emergency department observation unit (EDOU) where increasing numbers of patients are treatment for these infections. Our objectives were to describe (1) the antibiotic treatment patterns EDOU patients, (2) physicians' adherence to the IDSA guidelines, and (3) factors that influence physician's prescribing practices.
Richard S. Klasco, Richard E. Wolfe, Matthew Wong, Jonathan Edlow, David Chiu, Phillip D. Anderson, Shamai A. Grossman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.042
Published online: August 26 2015
xThe incidence of errors and adverse events in emergency medicine is poorly characterized.
Kathryn R. Crowder, Tristan D. Jones, Eddy S. Lang, Dongmei M. Wang, Steven M. Clark, Grant D. Innes, James D. McMeekin, Michelle M. Graham, Andrew D. McRae
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.041
Published online: August 26 2015
xHigh-sensitivity troponin T (hs-TnT) assays detect myocardial injury sooner, possibly improving throughput times for emergency department (ED) assessment of suspected acute myocardial infarction (AMI). This study evaluates the influence of hs-TnT implementation on ED length of stay (LOS), consultations and admissions, as well as ED revisits with cardiology admissions for patients undergoing testing for suspected AMI.
Justin C. Stone, James H. Moak
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.067
Published online: July 6 2015
xUltrasound-guided paracentesis is commonly performed in the emergency department (ED) setting. Injury to the inferior epigastric artery (IEA) is an uncommon but potentially life-threatening complication of paracentesis. Use of anatomic landmarks has been recommended to avoid this structure. If feasible, sonographic localization of the IEA before ultrasound-guided paracentesis may provide the operator with anatomic mapping of this vascular structure.
Frederick Fiesseler, Renee Riggs, David Salo, Richard Klemm, Ashley Flannery, Richard Shih
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.038
Published online: August 25 2015
xPatients with drug-seeking behavior can be both labor and resource intensive to the emergency department (ED).
Stefano Franchini, Teodoro Marcianò, Cristina Sorlini, Corrado Campochiaro, Moreno Tresoldi, Maria Grazia Sabbadini, Lorenzo Dagna
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.047
Published online: August 29 2015
xWe evaluated serum levels of CXCL12 in patients with severe sepsis/septic shock and controls.
Jared A. Schaefer, Tamara J. Mlekoday
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.050
Published online: September 7 2015
xPrompt and effective analgesia is a mainstay of emergency department (ED) medicine; however, it is often delayed in times of overcrowding and by the need to establish intravenous (IV) access. Thus, noninvasive analgesic administration by means of the intranasal route could potentially reduce time to analgesic administration by eliminating IV line insertion.
Gavin Budhram, Jennifer Cronsell, Michele Schroeder, Jeremy Sautner, Elizabeth Schoenfeld, Tala Elia, Jennifer Friderici
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.017
Published online: September 19 2015
xUltrasonography is often used in the evaluation of patients with ocular concerns; however, several pathologic conditions and even some age-related changes can have similar sonographic appearances. One approach that clinicians use is to assume that unilateral findings visible at normal gain are acute, whereas bilateral findings requiring high gain are chronic, especially in the elderly population. To date, no studies have systematically evaluated this assumption.
Łukasz Bogdański, Zenon Truszewski, Andrzej Kurowski, Łukasz Czyżewski, Piotr Zaśko, Piotr Adamczyk, Łukasz Szarpak
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.005
Published online: September 19 2015
xTracheal intubation during cardiopulmonary resuscitation is a high-risk procedure. The aim of this study was to compare efficacy of intubation with the Pentax AWS, Airtraq, and McCoy laryngoscopes in patients with cervical spine immobilization during resuscitation in a randomized, controlled simulation trial.
Steven F. DeFroda, Joseph A. Gil, Steven Bokshan, Gregory Waryasz
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.027
Published online: September 19 2015
xPatients experiencing high-energy trauma evaluated at level I trauma centers often present with multiple injuries and varying levels of hemodynamic instability. The polytrauma patient requires immediate assessment and stabilization of their orthopedic injuries once the primary trauma survey is complete, and oftentimes, operative fixation of injuries is delayed while patients are resuscitated by general trauma services. The authors describe the application of the upper extremity “quad” splint which includes components of a sugar tong, intrinsic plus, thumb spica, and dorsal extension blocking splint and its indication for patients with multiple upper extremity fractures distal to the humerus.
Brit Long, Alex Koyfman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.037
Published online: August 25 2015
xMucormycosis is a rare presentation for patients in the emergency department (ED), primarily affecting immunocompromised patients. Multiple forms of infection are present, and with poor prognosis, ED diagnosis and treatment of this deadly condition are necessary.
Athanasios Chalkias, Artem Kuzovlev, Antonio Noto, Ernesto d’Aloja, Theodoros Xanthos
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.006
Published online: September 18 2015
xCytochrome c, an electron carrier that normally resides in the mitochondrial intermembrane space, may translocate to the cytosol under ischemic and hypoxic conditions and contribute to mitochondrial permeability transition pore opening. In addition, reperfusion of brain tissue following ischemia initiates a cell death cascade that includes cytochrome c–mediated induction of apoptosis. Further studies are needed to determine the contribution of cytochrome c in the regulation of cell death, as well as its value as an in vivo prognostic marker after cardiac arrest and resuscitation.
Hakan Sarlak, Salim Ozenc, Ibrahim Arzıman, Mustafa Tanrıseven
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.050
Published online: June 22 2015
xWe read the article “Blood pressure treatment and outcomes in hypertensive patients without acute organ damage: a retrospective cohort” written by Levy et al [1] with great interest. They concluded that there was no evidence of benefit with treatment to acutely lower blood pressure in the patients with markedly elevated blood pressure and absent signs or symptoms of acute target organ damage [1].
Phillip D. Levy, Robert D. Welch
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.051
Published online: July 7 2015
xThank you for your interest in our article. We are in agreement with you that a cautious approach to blood pressure reduction in hypertensive patients without acute organ damage is warranted and acknowledge that this has been emphasized in several other publications. However, many emergency physicians still retain a level of discomfort withholding antihypertensive therapy for patients who have markedly elevated blood pressure and the purpose of our study was to show that outcomes are equivocal with such an approach.
Shah Sweni, Subramanian Senthilkumaran, Namasivayam Balamurugan, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.003
Published online: July 6 2015
xJain et al [1] have reported reversible brain magnetic resonance imaging (MRI) changes in neuroleptic malignant syndrome (NMS). Previous reports revealed similar such changes in different parts of cerebrum and cerebellum [1,2]. Apart from mechanisms suggested by the authors [1], we would like to mention additional mechanisms for NMS such as those related to electrolyte “sodium” and another to chemical “glutamate” and the diagnostic role of functional MRI [3].
Dustin W. Anderson, Michael J. Vitto, David P. Evans
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.017
Published online: August 10 2015
xThe evolution of emergency ultrasound (EUS) in resident education began in the early 1990s with the American College of Emergency Physicians (ACEP) publishing their first position statement supporting the use of ultrasound (US) by trained physicians [1]. Soon afterwards, The Society for Academic Emergency Medicine (SAEM) endorsed this statement and recommended formal EUS training for all emergency residency programs [2]. In 1994, Mateer et al published the “Model curriculum for physician training in emergency ultrasonography” that laid the template for standardized EUS education [3].
Nurit Katz-Agranov, Amir Akdam, Ruth Stalnikowicz, Omri Lernau, Mayer Brezis
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.012
Published online: August 11 2015
xThe wide availability of laboratory testing and imaging technologies overshadows the value of physical examination [1]. Detecting orthostatic hypotension and/or increase in pulse rate [2] is important for rapid recognition of emergency conditions such as hypovolemia. Physicians may rely more on ancillary testing than on orthostatic signs, despite their high sensitivity and specificity for diagnosing hypovolemia [2-4]. Orthostatic signs could be particularly valuable for diagnosing life-threatening fluid loss or massive bleeding—potentially treatable conditions if promptly diagnosed.
Nicolas Franchitto
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.045
Published online: August 28 2015
xWe have read the study of patients admitted to emergency departments (EDs) because of mental and behavioral disorders due to psychoactive substance use by Le Querrec et al [1] with great interest. The authors used the International Statistical Classification of Diseases, 10th Revision (ICD-10), codes of F10 to F19 to conduct their study and describe clinical characteristics of 20838 visits directly related to substance use disorders (SUDs). Although this is encouraging and useful, some limitations to the methodology should be considered before one comes to a conclusion.
Narat Srivali, Charat Thongprayoon, Patompong Ungprasert
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.055
Published online: September 7 2015
xWe read the article “Successful hemostasis and reversal of highly elevated PT/INR after dabigatran etexilate use in a patient with acute kidney injury” by Jones et al [1] in the American Journal of Emergency Medicine with great interest. The authors described a very interesting case of gastrointestinal hemorrhage complicated by dabigatran etexilate. The patient was successfully managed with 4-factor prothrombin complex concentrate. Delay in treatment can increase mortality rate, as physicians are less familiar with dabigatran.
Oscar M.P. Jolobe
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.054
Published online: September 7 2015
xIn the context of atrial fibrillation (AF) an increase in serum troponin could either be a marker of coronary artery disease (as suggested by the authors) [1] or a marker of coronary embolism (CE), the latter an entity associated both with paroxysmal AF [2,3] and persistent AF [2,4]. In 1 study, a retrospective analysis of 1776 consecutive patients with de novo acute myocardial infarction identified 38 patients with definite or probable CE attributable to AF [2]. Thirteen of the patients had paroxysmal AF, and the rest had chronic AF.
Ching-Hsing Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.023
Published online: September 19 2015
xIn the August issue of the American Journal of Emergency Medicine, Dr Shuaib et al. [1] reviewed the top cited articles in emergency medicine (EM) journals. There were some points in this article that may be misleading. First, there were 25 journals in the Institute of Science Information Web of Knowledge 2013 Journal Citation Reports (JCR) Science Edition subject category “emergency medicine” instead of 15 mentioned in the article [2]. The authors did not clarify the inclusion criteria of choosing 12 of 25 EM journals for investigation.
Julian T. Hertz, Richard D. Lescallette, Tyler W. Barrett, Michael J. Ward, Wesley H. Self
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.026
Published online: September 19 2015
xExcess use of urine cultures in the emergency department (ED) results in unnecessary costs and consumes limited human and laboratory resources [1-3]. In a prior single-center study, Jones et al [4] developed an ED reflex urine culture cancelation protocol based on low-risk findings for infection on urinalysis. They found that reflex cancelation of urine cultures for samples with low-risk urinalysis findings (negative for nitrites, leukocyte esterase, and bacteria and <10 leukocytes per high-power field [HPF]) would have reduced the total number of cultures performed by 39.1%, with only 1.8% of these cultures targeted for cancelation positive for a pathogen [4].
Takashi Fuse, Taka-aki Nakada, Masashi Taniguchi, Yasuaki Mizushima, Tetsuya Matsuoka
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.003
Published online: April 6 2015
xHereditary angioedema (HAE) is a rare genetic disease caused by a deficiency of functional C1 esterase inhibitor that causes swelling attacks in various body tissues. We hereby report a case of out-of-hospital cardiac arrest due to airway obstruction in HAE. Cutaneous swelling and abdominal pain attacks caused by gastrointestinal wall swelling are common symptoms in HAE, whereas laryngeal swelling is rare. Emergency physicians may have few chances to experience cases of life-threatening laryngeal edema resulting in a delay from symptom onset to the diagnosis of HAE.
Emily Brumfield, Kenneth R.L. Bernard, Christopher Kabrhel
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.012
Published online: April 11 2015
xFlecainide is a Class Ic antiarrythmic agent associated with adverse events due to its pro-arrythmic effects. We report the case of a 33-year-old female presenting in cardiac arrest after a flecainide overdose treated with intravenous fat emulsion (IFE), sodium bicarbonate (NaHCO3), and extracorporeal membrane oxygenation (ECMO). This case reviews the pathophysiology and management of flecainide toxicity including novel strategies of IFE and ECMO.
Fumiaki Kishino, Ryota Inokuchi, Yohei Komaru, Nobuhiro Takaya, Miyuki Yamamoto, Susumu Nakajima, Naoki Yahagi
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.039
Published online: April 24 2015
xRetrograde menstruation is the backward movement of menstrual fluids. The underlying mechanisms remain unknown. The converse current itself is benign, but the result can be abdominal pain caused by peritoneal irritation and, eventually, endometriosis. The case was of a 25-year-old woman with lower abdominal pain accompanied by significant hemoperitoneum. Physical examination and inspection using abdominal ultrasonography and computed tomography failed to reveal a differential diagnosis. Detailed history taking revealed sexual activities during her menstrual period, which allowed for a diagnosis of retrograde menstruation.
Clinton C. Smithson III, Jared C. Ham, Andrew L. Juergens II
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.036
Published online: April 24 2015
xIatrogenic pneumothorax secondary to thoracentesis is relatively uncommon but does present to the emergency department (ED). Iatrogenic pneumothoraces developing tension physiology are rare. We report a case of an elderly female patient presenting to the ED with an isolated chief complaint of bilateral leg swelling, beginning the day after a thoracentesis, which was performed 3 days prior for pleural effusions secondary to lung cancer. Given that the patient was hemodynamically stable, not hypoxic, and had a history of chronic obstructive pulmonary disease and recent history of pleural effusions with diminished lung sounds throughout, this was a radiologic diagnosis.
Jonathan Orton, Emily Collette
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.086
Published online: May 6 2015
xIdiopathic spontaneous pneumomediastinum is rare but even rarer is associated unilateral periorbital subcutaneous emphysema. There is only 1 known case report noting both of these findings and was associated with endoscopic retrograde cholangiopancreatography complication [1,2]. Isolated periorbital emphysema has been associated with dental procedures [3], facial trauma, and sneezing [4]. It is has also been seen with pneumomediastinum caused by barotrauma, pneumothorax, endoscopic retrograde cholangiopancreatography, and esophageal perforation.
James F. Martin, Jessica Vidas, Ali Baday
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.070
Published online: May 1 2015
xThis is a case of a 36-year-old Spanish-speaking Hispanic man who was brought to a busy suburban New Jersey emergency department (ED) by family members for altered mental status. By report, patient was noted by family to be “not acting normal” at home, when he went into his bathroom and locked the door. A brief time thereafter, he emerged smelling of bleach and with confused speech. The family surmised that he tried to commit suicide by drinking bleach and emergently brought the patient to the ED.
M.A. Hieger, S.R. Rose, K.L. Cumpston, P.E. Stromberg, S. Miller, B.K. Wills
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.065
Published online: May 1 2015
xSignificant toxicity from amphetamine and cathinone derivatives is being increasingly reported. We describe a series of self-reported exposures to 2-(4-iodo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine (25-I-NBOME or 25-I), a novel amphetamine derivative. Ten patients with an average age of 17 years presented to local emergency departments (EDs) in our community after ingestion and/or insufflation of a drug referred to as “25-I.” Of 10 patients, 6 reported taking 25-I alone; other substances included ethanol; 2,5-dimethoxy-4-ethylphenethylamine; marijuana; and ketamine.
Nour Akil, Edward Bottei, Sameer Kamath
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.062
Published online: April 30 2015
xRanolazine is a new anti-anginal medication that was approved by the US Food and Drug Administration (FDA) in 2006 for patients with symptomatic chronic angina despite optimized therapy. This paper presents a case report of a fifteen year old male patient admitted to the pediatric intensive care unit after ranolazine overdose ingestion. He had recurrent new onset seizures that are most likely due to ranolazine overdose. Seizures have never been reported with ranolazine use or abuse.
Christopher S. Sampson, Starr-Mar’ee Bedy
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.061
Published online: April 30 2015
xIntravenous fat emulsion (IFE) therapy has been widely used in the emergency department (ED) for treating various medication overdoses. The standard recommended route to administer IFE therapy is intravenously through a peripheral or central vein. No reports of intraosseous (IO) administration in humans could be found in the literature after a brief search. We report of a patient emergently receiving IFE through the IO route. A 24-year-old woman presented to ED after a massive deliberate verapamil overdose.
Bernarda Viteri, Nicholas Koch, Heda Dapul, William Bonadio
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.057
Published online: May 1 2015
xWe report an interesting case of a child with new-onset malignant hypertension (HTN) associated with facial paralysis. A review of the medical literature on this association and discussion of diagnostic and management aspects are included.
Rushikesh Shah, Viveksandeep Thoguluva, Nidhi Bansal, Divey Manocha
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.053
Published online: April 29 2015
xEsophagitis dissecans superficialis (EDS) is a rare condition characterized by sloughing of the mucosal layer of the esophageal lining, usually triggered by an environmental/immune insult. It is associated with blistering diseases such as pemphigus vulgaris (PV), bullous pemphigoid, and epidermolysis bullosa. Oral mucosa is the most commonly (50%) affected site in PV, but esophageal involvement has only been rarely reported. The most common presentation of EDS includes dysphagia and odynophagia, but overt gastrointestinal bleeding is a distinctly uncommon.
Matthew Pirotte, Andrew Pirotte, N. Seth Trueger
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.052
Published online: April 29 2015
xManagement of the difficult airway is a relatively common problem in emergency medicine. A popular adjunct technique is the use of a tracheal introducer (sometimes called a “bougie”). Blind digital intubation is also described. There is no discussion in the literature about the use of digital assistance for endotracheal tube delivery after successful laryngoscopy.
Michael D. April, Robert E. Watts, Austin T. Folley, Michael Barakat, Lisa M. Mannina, James A. Pfaff
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.043
Published online: April 24 2015
xThe disposition for neurologically intact and alert patients complaining of persistent symptoms despite negative computed tomography (CT) imaging is controversial. Computed tomography has excellent sensitivity for osseous injuries but is insensitive for ligamentous injuries. Some advocate that these patients undergo early magnetic resonance imaging (MRI) because, although it is insensitive for osseous injury, it is highly sensitive for ligamentous and spinal cord injuries. We present the case of an alert and neurologically intact 84-year-old patient presenting with neck pain after a mechanical fall.
Ji Ning Sun, Bao Long Zhang, Hai Yan Yu, Bin Wang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.041
Published online: April 24 2015
xEmphysematous pyelonephritis is a severe necrotizing infection characterized by the presence of gas and/or fluid in the renal parenchyma, collecting system, or perirenal tissues. Emphysematous pyelonephritis with approximately 15 cm air-fluid level, diffused ureteral involvement, and the accumulation of gas in liver and peritoneal cavity is very rare. Here, we reported a severe emphysematous pyelonephritis with multiple huge air-fluid level mimicking intestinal obstruction and with the accumulation of gas in liver and ureter in computed tomography imaging.
Andrew Tabner, Graham Johnson
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.082
Published online: April 30 2015
xWe present 2 cases of acute abdominal pain secondary to oral codeine that resolved after the administration of intravenous naloxone.
Marissa Cohen, Sean Zwiebel, Rebecca Jeanmonod
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.074
Published online: April 30 2015
xIdiopathic ketotic hypoglycemia is the most common cause of hypoglycemia in toddlers. This diagnosis should be considered in any hypoglycemic toddler with no prior history of abnormal growth who is developmentally normal when toxic ingestions and sepsis are inconsistent with the clinical picture. Diagnosis is important in preventing serious long-term sequelae and is made in the setting of hypoglycemia, ketonuria, and ketonemia. Therefore, checking urine and blood ketones is an essential part of the evaluation in any hypoglycemic toddler.
Shadi Hamdeh, Anum Abbas, Jessica Fraker, J.E. Lambrecht
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.071
Published online: May 9 2015
xA 37-year-old man presented with worsening headache, vomiting, and right-sided weakness over the last few weeks. A head computed tomography showed a left hemispheric posterior medial parietal lobe lesion with surrounding edema. Further imaging with magnetic resonance imaging showed multiple enhancing mass lesions. The largest lesion measured 2.4 cm within the left occipital parietal region (Figure A and B). Laboratory data showed reactive HIV antibodies, confirmed by Western blot. An absolute CD4 count was 22 cells/μL.
