MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'The American Journal of Emergency Medicine' source. Wed, 08 Feb 2012 14:35:39 +0100 http://www.medworm.com/index.php?rid=5667648&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675712000101%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667648 Wed, 01 Feb 2012 05:00:00 +0100 5667648 http://www.medworm.com/index.php?rid=5667647&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675712000095%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667647 Wed, 01 Feb 2012 05:00:00 +0100 5667647 http://www.medworm.com/index.php?rid=5667646&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675712000083%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667646 Wed, 01 Feb 2012 05:00:00 +0100 5667646 http://www.medworm.com/index.php?rid=5667606&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675712000071%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667606 Wed, 01 Feb 2012 05:00:00 +0100 5667606 http://www.medworm.com/index.php?rid=5667635&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711005249%2Fabstract%3Frss%3Dyes I read with interest the case presented by Dr Jadhav et al published in your journal. They presented a patient with aluminum phosphide (ALP) poisoning who developed ventricular tachychardia (VT) unresponsive to treatment with intravenous magnesium sulfate (MgSO4), amiodarone therapy, and electrocardioversion. They concluded that, in previously reported cases of successful conversion of VT associated with ALP poisoning, all patients were hypomagnesemic, whereas serum magnesium levels were normal throughout their patient's hospital course. Interestingly, as they themselves mentioned, it has been shown that intravenous lidocaine converted 2 patients with VT associated with ALP poisoning to sinus rhythm , but it is not clear why they have not tried lidocaine as well as amiodarone when the pati... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667635 Wed, 28 Dec 2011 05:00:00 +0100 5667635 http://www.medworm.com/index.php?rid=5667632&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711005031%2Fabstract%3Frss%3Dyes I have read the interesting article by Jimmy and Foo in a recent issue of the journal and congratulate them for their observation. The article clearly exemplified that Takotsubo cardiomyopathy (TC) can present with electrocardiographic (ECG) features of pericarditis. In the presented ECG, the widespread concave upwards ST-segment elevation and PR-segment depression (except in aVR and V1) and the absence of reciprocal ST-segment depression is a clear ECG evidence of acute pericarditis. TC with ECG criteria of acute pericarditis is known in the literature and has been previously reported. demonstrates all previously published cases taking into account the sequence of events, outcome, and possible explanations provided by the authors for this association. Regarding the sequence of both pathol... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667632 Wed, 28 Dec 2011 05:00:00 +0100 5667632 http://www.medworm.com/index.php?rid=5667631&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS073567571100502X%2Fabstract%3Frss%3Dyes Urinary bladder (UB) rupture is an uncommon but serious event, mainly caused by trauma . Nontraumatic rupture of UB is called spontaneous UB rupture. Sporadic case reports have been found in the emergency medicine literature . The actual incidence of spontaneous UB rupture among the emergency department (ED) visits is still unknown. The clinical features of this condition are vague. Only small proportion of patients could be diagnosed preoperative after the initial onset of this disease . A definite diagnosis is generally made only after surgical exploration . The purposes of this study were to investigate the incidence of spontaneous UB rupture among the ED census and to assess how spontaneous UB rupture presents. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667631 Wed, 28 Dec 2011 05:00:00 +0100 5667631 http://www.medworm.com/index.php?rid=5667627&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711004207%2Fabstract%3Frss%3Dyes Bebarta et al commendably set out to determine whether patients who overdose on cyclobenzaprine are at risk for developing Tricyclic antidepressant (TCA)-like effects (ie, a widened QRS or ventricular dysrhythmia). This topic is of interest as clear evidence that cyclobenzaprine does not cause cardiotoxic effects could save the health care system considerably with regard to bed use. Unfortunately, this retrospective study fails to definitively answer this question. Moreover, misinterpretation of their findings as proof that cyclobenzaprine overdose does not cause TCA-like cardiotoxicity might place patients at risk. In addition to highlighting some of the study's flaws, we set out here to respectfully outline the methodology required to answer this important question in the future. (Source... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667627 Wed, 28 Dec 2011 05:00:00 +0100 5667627 http://www.medworm.com/index.php?rid=5667634&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711005043%2Fabstract%3Frss%3Dyes We thank Mayr et al for their article on “Hypokalemic paralysis in a professional bodybuilder.” The authors presented an excellent case presentation on hypokalemic paralysis. The authors also discussed on common causes of renal and extrarenal potassium losses. Although vomiting can cause fluid loss directly from gastrointestinal tract, potassium depletion in this setting is primarily due to increased urinary losses from the fact that concentration of potassium in gastric secretions is only 5 to 10 mEq/L. Loss of gastric acid induces metabolic alkalosis and high plasma bicarbonate level. Water and sodium bicarbonate are transported to the distal potassium secretory site. In addition, hypovolemia from vomiting induces increase in aldosterone release. These 2 effects increase renal potass... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667634 Wed, 14 Dec 2011 05:00:00 +0100 5667634 http://www.medworm.com/index.php?rid=5441577&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711004815%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5441577 Fri, 25 Nov 2011 07:32:30 +0100 5441577 http://www.medworm.com/index.php?rid=5441576&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711004803%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5441576 Fri, 25 Nov 2011 07:32:30 +0100 5441576 http://www.medworm.com/index.php?rid=5441575&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711004797%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5441575 Fri, 25 Nov 2011 07:32:30 +0100 5441575 http://www.medworm.com/index.php?rid=5441534&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711005018%2Fabstract%3Frss%3Dyes In the article “Hyperventilation and finger exercise increase venous-arterial PCO2 and pH differences” by Umeda et al (Am J Emerg Med. 2008;26(9):975-80), there was an error in Fig. 2. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5441534 Fri, 25 Nov 2011 07:32:30 +0100 5441534 http://www.medworm.com/index.php?rid=5441533&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711003408%2Fabstract%3Frss%3Dyes We thank Dr Llompart-Pou and colleagues for showing interest in our work. We are pleased to have the opportunity to reply to this constructive comments. About the comparison of durations of PI measurement, the transcranial color coded sonography examination was indeed much longer than the transcranial Doppler. The reasons are many. First, performing transcranial color coded sonography need to image the cerebral arteries before to place the sample volume at the site of the best Doppler signal. In our study, the identification of the M1 segment of the middle cerebral artery with 2-dimensional gray-scale and color imaging was often very long and difficult, all the more so in that the SonoSite TITAN did not have dedicated transcranial imaging mode. Second, we chose the manual tracing on 10 car... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5441533 Fri, 25 Nov 2011 07:32:30 +0100 5441533 http://www.medworm.com/index.php?rid=5441532&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS073567571100338X%2Fabstract%3Frss%3Dyes We read with interest the recently published article by Prunet et al regarding the role of transcranial Doppler (TCD) and a portable transcranial color coded sonography (TCCS) in the evaluation of pulsatility index (PI) and its correlation with intracranial pressure . (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5441532 Fri, 25 Nov 2011 07:32:30 +0100 5441532 http://www.medworm.com/index.php?rid=5441531&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711003342%2Fabstract%3Frss%3Dyes Recently, laryngoscope handles retrofitted with light-emitting diodes (LEDs) (Vital View II fibre optic laryngoscope handle; Vital Signs, Inc, Totowa, NJ) became commercially available for a dedicated plastic single-use blade (Vital View laryngoscope blade; Vital Signs, Ltd, West Sussex, UK). One of major features of LEDs illumination is the bluish-white color, which could have beneficial impact on the performance of intubation . This manikin study compared intubation performance using a combination of Vital View II fibre optic laryngoscope handle and a blade (VV-LED laryngoscope) with a combination of metal reusable laryngoscope blade with halogen bulb light handle (conventional laryngoscope) during cardiopulmonary resuscitation in a randomized, controlled, cross-over fashion. (Source: Th... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5441531 Fri, 25 Nov 2011 07:32:30 +0100 5441531 http://www.medworm.com/index.php?rid=5441530&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711003329%2Fabstract%3Frss%3Dyes We undertook the addition of a public access defibrillation (PAD) program at a large mid-Atlantic university. In our design of the system, we found little useful information to guide us in the development and construction our system. This letter addresses the issues and methodology of our approach to this important program. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5441530 Fri, 25 Nov 2011 07:32:30 +0100 5441530 http://www.medworm.com/index.php?rid=5441487&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711004785%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5441487 Fri, 25 Nov 2011 07:32:30 +0100 5441487 http://www.medworm.com/index.php?rid=5667633&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711005055%2Fabstract%3Frss%3Dyes We thank Stone et al for their article on “Bilateral obstructing renal stones: an uncommon cause of acute renal failure.” This was an interesting case presentation in American Journal of Emergency Medicine. The authors presented a case of recurrent calcium stones with bilateral ureteral obstruction. We found an interesting point that should be raised in this case. Approximately 5% of patients with renal stones have concurrent hyperparathyroidism . In addition, most stones in patients with hyperparathyroidism are composed of calcium oxalate . Serum calcium, phosphate, calcitriol, and parathyroid hormone level are helpful tests to make the diagnosis of this condition. Primary hyperparathyroidism should be considered in patients presenting with recurrent renal stones especially calcium st... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667633 Mon, 21 Nov 2011 05:00:00 +0100 5667633 http://www.medworm.com/index.php?rid=5667630&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711004384%2Fabstract%3Frss%3Dyes An association between stress and coronary events has been documented in many studies . Natural disasters are a major source of stress, and numerous studies have established that major earthquakes are followed by an increase in cardiovascular events. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667630 Mon, 21 Nov 2011 05:00:00 +0100 5667630 http://www.medworm.com/index.php?rid=5667629&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS073567571100430X%2Fabstract%3Frss%3Dyes We present a case series of 3 anterior glenohumeral shoulder reductions using the “Cunningham technique” and our observations of the benefits and difficulties encountered that may be of interest to the emergency medicine community. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667629 Mon, 21 Nov 2011 05:00:00 +0100 5667629 http://www.medworm.com/index.php?rid=5667628&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS073567571100427X%2Fabstract%3Frss%3Dyes In patients with chest pain, heart failure (HF), syncope, cardiac arrhythmias, and other, measurement of cardiac troponin (cTn) eases early recognition of high-risk patients. Recently, a high-sensitive troponin assay has shown to improve diagnosis of myocardial infarction or to identify patients at high risk of recurrent infarction and death . However, not infrequently, slightly elevated cTn is seen but without immediate clinical relevance. Elevated cTn is not exclusively specific for myocardial disease. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667628 Mon, 21 Nov 2011 05:00:00 +0100 5667628 http://www.medworm.com/index.php?rid=5667626&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711004190%2Fabstract%3Frss%3Dyes We thank the authors for their comments of our study. We agree that an ideal study of acute cyclobenzaprine toxicity would be prospective with blood levels, review of electrocardiograms by 2 reviewers, and prospective collection of data from hospital records. Because this type of study is both expensive and it is difficult to find centers with sufficient cases, it is rarely performed. In lieu of this ideal study, we used a retrospective data set to evaluate a large volume of short-term cases as reported to several poison centers, a source of cases used to develop clinical guidelines . (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667626 Mon, 21 Nov 2011 05:00:00 +0100 5667626 http://www.medworm.com/index.php?rid=5667618&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005899%2Fabstract%3Frss%3Dyes Conclusion: Among ED patients who lack a PCP and are given a clinic appointment from the ED, less than half keep the appointment. Moreover, clinicians are unable to predict which patients will follow up. This study highlights the difficulty in maintaining continuity of care in populations who are self-pay or have Medicaid and lack regular providers. This may have implications on discharge planning from the ED. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667618 Mon, 14 Nov 2011 05:00:00 +0100 5667618 http://www.medworm.com/index.php?rid=5401133&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711004499%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5401133 Tue, 01 Nov 2011 04:00:00 +0100 5401133 http://www.medworm.com/index.php?rid=5401132&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711004487%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5401132 Tue, 01 Nov 2011 04:00:00 +0100 5401132 http://www.medworm.com/index.php?rid=5401131&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711004475%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5401131 Tue, 01 Nov 2011 04:00:00 +0100 5401131 http://www.medworm.com/index.php?rid=5401130&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711004463%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5401130 Tue, 01 Nov 2011 04:00:00 +0100 5401130 http://www.medworm.com/index.php?rid=5401129&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS073567571100516X%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5401129 Tue, 01 Nov 2011 04:00:00 +0100 5401129 http://www.medworm.com/index.php?rid=5401128&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711005158%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5401128 Tue, 01 Nov 2011 04:00:00 +0100 5401128 http://www.medworm.com/index.php?rid=5401114&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711002701%2Fabstract%3Frss%3Dyes In the very interesting report published in the Am J Emerg Med , a young lady had anaphylaxis after a wasp sting, and despite abnormalities in coagulation cascade with markedly increased prothrombin time and activated partial thromboplastin, neither bleeding nor hepatic dysfunction was observed. The patient was discharged after treatment of anaphylaxis without administration of fresh-frozen plasma or antifibrinolytics such as tranexamic acid because the coagulation abnormalities were normalized spontaneously, and bleeding diathesis or thrombosis was absent. The authors thought that this unique case provides an interesting area of discussion. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5401114 Tue, 01 Nov 2011 04:00:00 +0100 5401114 http://www.medworm.com/index.php?rid=5401113&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711002427%2Fabstract%3Frss%3Dyes I have read with great pleasure the letters by Lina et al and Cheng about the article investigating the relationship between Killip classification and glucose levels in patients with acute myocardial infarction by Cheng and Yen . (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5401113 Tue, 01 Nov 2011 04:00:00 +0100 5401113 http://www.medworm.com/index.php?rid=5401112&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711002403%2Fabstract%3Frss%3Dyes We describe our experience on acutely ill, unprepared ICU patients requiring immediate orotracheal intubation. An 11-month prospective observational study (May 2010 to April 2011) was conducted in the ICU of “GB Morgagni-Pierantoni” Hospital, Forlì, using the AWS. We used the AWS as a rescue technique after failed DL (Cormack-Lehane grade 3 or 4) or as the first-line method in patients with known or suspected difficulty. All patients received initial bag-mask ventilation. Optimal positioning and noninvasive maneuvers such as the BURP were applied as needed. Information was recorded by the operators on a datasheet at a convenient time, after patient stabilization, in the same work suite. Data collected include identification of the operator, patient demographics, success or failure to ... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5401112 Tue, 01 Nov 2011 04:00:00 +0100 5401112 http://www.medworm.com/index.php?rid=5667625&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711004116%2Fabstract%3Frss%3Dyes We thank Wu et al for their excellent case study on Guillain-Barré syndrome (GBS). The authors presented a case of GBS with acute urinary retention from autonomic dysfunction. Dysautonomia, including urinary retention, tachycardia, and orthostatic hypotension, can occur in 70% of patients with this syndrome . However, acute urine retention in GBS can be associated with other mechanisms such as Escherichia coli infection. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667625 Fri, 28 Oct 2011 04:00:00 +0100 5667625 http://www.medworm.com/index.php?rid=5667624&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711004050%2Fabstract%3Frss%3Dyes I describe here a novel technique of inserting a 2.5-inch catheter into the internal jugular vein with ultrasound guidance using sterile technique but no barrier precautions. Patients often present to the emergency department (ED) and have difficult veins for inserting an intravenous (IV) catheter. Most commonly, this is because of previous IV drug use, morbid obesity, or previous medical illness. The options in this setting usually depend on the acuity of the patient and experience of the providers. They include ultrasound-guided peripheral vein catheter, intraosseous catheter, and central vein catheter . Based on my experience, each of these options has significant limitations. Insertion of a peripheral catheter with ultrasound guidance is technically challenging and is time consuming e... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667624 Fri, 28 Oct 2011 04:00:00 +0100 5667624 http://www.medworm.com/index.php?rid=5667623&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS073567571100372X%2Fabstract%3Frss%3Dyes We read, with interest, the article by Pozner et al stressing the importance of teaching high-quality chest compressions in cardiopulmonary resuscitation. Teaching and long-time retention of resuscitation skills are influenced by the methodology applied. After the recent publication by ILCOR of “The Universal Algorithm 2010” recommending the adoption of the compression, airway, and breathing (CAB) sequence, AHA introduced new guidelines for pediatric basic life support (PBLS) . It is of interest to evaluate if the changes affect the learning process and on the retention of knowledge. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667623 Wed, 26 Oct 2011 04:00:00 +0100 5667623 http://www.medworm.com/index.php?rid=5286248&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711003883%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5286248 Sat, 01 Oct 2011 04:00:00 +0100 5286248 http://www.medworm.com/index.php?rid=5286247&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711003871%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5286247 Sat, 01 Oct 2011 04:00:00 +0100 5286247 http://www.medworm.com/index.php?rid=5286246&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS073567571100386X%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5286246 Sat, 01 Oct 2011 04:00:00 +0100 5286246 http://www.medworm.com/index.php?rid=5286235&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711002415%2Fabstract%3Frss%3Dyes Understanding the epidemiological spread of methicillin-resistant Staphylococcus aureus (MRSA) is an important aspect in limiting the pathogen's prevalence in a community. Because emergency medical service (EMS) personnel are potential portals of infection both into and out of the hospital, knowledge of their MRSA colonization status may have implications on limiting the further spread of this organism. The prevalence of nasal MRSA colonization in EMS providers has not been documented in the current literature. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5286235 Sat, 01 Oct 2011 04:00:00 +0100 5286235 http://www.medworm.com/index.php?rid=5286212&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711003858%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5286212 Sat, 01 Oct 2011 04:00:00 +0100 5286212 http://www.medworm.com/index.php?rid=5401119&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711003214%2Fabstract%3Frss%3Dyes We read with great interest the article by Charlotte Derr and D. Eliot Goldner “Posttraumatic appendicitis: further extending the extended focused assessment with sonography in trauma examination,” which states that ultrasonography may have an unrealized potential as a diagnostic tool for traumatic appendicitis in the trauma bay . (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5401119 Mon, 12 Sep 2011 04:00:00 +0100 5401119 http://www.medworm.com/index.php?rid=5401116&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711002828%2Fabstract%3Frss%3Dyes I agree with the authors that the best imaging modalities can never replace the clinical judgment of an experienced surgeon or emergency medicine physician, but it might be “in general” comment. Another study also showed that, even in clinically evident appendicitis, computed tomography (CT) has the potential to reduce negative appendectomies . In that study, the clinically evident appendicitis was defined by emergency medicine physician. Summing up with the results of the study entitled “The accuracy of emergency medicine and surgical residents in the diagnosis of acute appendicitis,” it is not easy to say that CT is not a necessary option in patients with typical findings in history and physical examination . I would not say that CT is a mandatory in all adults with suspected app... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5401116 Mon, 12 Sep 2011 04:00:00 +0100 5401116 http://www.medworm.com/index.php?rid=5170707&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711003548%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170707 Mon, 29 Aug 2011 14:30:41 +0100 5170707 http://www.medworm.com/index.php?rid=5170706&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711003536%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170706 Mon, 29 Aug 2011 14:30:41 +0100 5170706 http://www.medworm.com/index.php?rid=5170705&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711003524%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170705 Mon, 29 Aug 2011 14:30:41 +0100 5170705 http://www.medworm.com/index.php?rid=5170696&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711003366%2Fabstract%3Frss%3Dyes In the article, “Diagnostic imaging rates for head injury in the ED and 4 states' medical malpractice tort reforms” (Am J Emerg Med. 2011 July;29(6):656-664), there was an error in the byline. The correct byline is below. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170696 Mon, 29 Aug 2011 14:30:37 +0100 5170696 http://www.medworm.com/index.php?rid=5170680&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711000994%2Fabstract%3Frss%3Dyes Thank you for the comments regarding our article. Our study was conceived because of an apparent belief by our paramedics that stainless steel blades are superior to plastic blades. We found this belief to be overwhelming among paramedics who have used both blades. We were surprised to find a difference on our 2 end points of intubation success rate and number of intubation attempts. Although multiple variables exist in intubation as is pointed out, we decided that our results were interesting enough to publish, although we could not control for some of the variables. We feel that inability to control for some variables do not diminish from the importance of these findings, especially on a study that has never been investigated in the literature. (Source: The American Journal of Emergency ... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170680 Mon, 29 Aug 2011 14:30:31 +0100 5170680 http://www.medworm.com/index.php?rid=5170678&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS073567571100012X%2Fabstract%3Frss%3Dyes We would like to thank Professor Lippi for the comments regarding our recent article and would like to respond to 5 areas of concern raised in his letter. The use of myoglobin to diagnose acute myocardial infarction (AMI) is not recommended by the ESC/ACCF/AHA/WHF Task Force or by the NACB. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170678 Mon, 29 Aug 2011 14:30:30 +0100 5170678 http://www.medworm.com/index.php?rid=5170677&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710006376%2Fabstract%3Frss%3Dyes The recent article by Fasano et al contributed to the knowledge of the mechanism of sulfonylurea-induced hypoglycemia with potential to impact clinical practice. Unfortunately, the results of the study were quite variable with regard to both insulin and C peptide concentrations in those patients who developed hypoglycemia after reported therapeutic use of sulfonylureas. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170677 Mon, 29 Aug 2011 14:30:30 +0100 5170677 http://www.medworm.com/index.php?rid=5170676&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005620%2Fabstract%3Frss%3Dyes Diarrhea and vomiting are common modes of presentation to an emergency department (ED). National Health Service guidelines recommend a stool culture be sent for patients who are systemically unwell or immunocompromised, have a recent history of travel or suspected giardiasis, have blood or pus in the stool, or had recent antibiotic usage or hospital admission. It is recommended that a stool sample be considered where there is a suspected public health hazard, such as diarrhea in food handlers, health care workers, elderly residents in care homes, or suspected outbreaks . (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170676 Mon, 29 Aug 2011 14:30:30 +0100 5170676 http://www.medworm.com/index.php?rid=5170658&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711003512%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170658 Mon, 29 Aug 2011 14:30:20 +0100 5170658 http://www.medworm.com/index.php?rid=5401117&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711003019%2Fabstract%3Frss%3Dyes We present 2 cases of prehospital TS to illustrate its interest. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5401117 Mon, 29 Aug 2011 04:00:00 +0100 5401117 http://www.medworm.com/index.php?rid=5401118&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711003159%2Fabstract%3Frss%3Dyes To the Editor, The patient who was reported as having become “hot, blind, and mad” manifested some of the clinical features of the delirium syndrome, including risk factors such as preexisting dementia in association with sensory deprivation (the latter due to blurred vision attributable to papillary dilatation) and precipitating factors such as pain (from the scalp laceration) and environmental change (the latter attributable to referral to the emergency department [ED]), all 4 components being among the ones highlighted in a recent review of this syndrome . The hidden danger is that, in the preoccupation with the management of the cognitive aspects of this syndrome, when the etiological agent is a drug that can cause pupillary dilatation (as may be the case with antihistamines) , cl... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5401118 Mon, 22 Aug 2011 04:00:00 +0100 5401118 http://www.medworm.com/index.php?rid=5401115&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711002853%2Fabstract%3Frss%3Dyes We read, with great interest, the article by Jo et al , “The accuracy of emergency medicine and surgical residents in the diagnosis of acute appendicitis,” which states that, in patients with right lower quadrant abdominal pain who have already been evaluated by an emergency medicine resident, consultation evaluation by a surgical resident does not appear to improve clinical diagnostic accuracy, and routine performance of computed tomography (CT) before surgical consultation should be considered for these patients . Although we agree with the authors that CT scanning is a useful option for detection or ruling out of acute appendicitis, in patients who have typical findings in history and physical examination, routine CT is not a necessary option, and early consultation with surgical re... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5401115 Mon, 22 Aug 2011 04:00:00 +0100 5401115 http://www.medworm.com/index.php?rid=5286234&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS073567571100235X%2Fabstract%3Frss%3Dyes We would like to thank the reader for the interest expressed in our journal article and have provided a response to the concerns conveyed in their letter. As practitioners working in both prehospital- and hospital-based settings, we have personally observed health care personnel perform the log-roll maneuver on numerous occasions and would definitely agree with the reader's assertion that there is almost certainly a lack of emphasis placed on arm placement during the performance of this task. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5286234 Fri, 12 Aug 2011 04:00:00 +0100 5286234 http://www.medworm.com/index.php?rid=5286233&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711002348%2Fabstract%3Frss%3Dyes The authors of “Are scoop stretchers suitable for use on spine-injured patients?” are to be applauded for their innovative study and basic study design . That said, the description of the methodology omitted an important detail regarding whether a specific variation of the log-roll maneuver was used in the control group, and if the log roll was standardized, which technique was used. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5286233 Fri, 12 Aug 2011 04:00:00 +0100 5286233 http://www.medworm.com/index.php?rid=5286231&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711002129%2Fabstract%3Frss%3Dyes This study examined the prevalence of pathogenic bacterial contamination on HFH ED keyboards. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5286231 Fri, 05 Aug 2011 04:00:00 +0100 5286231 http://www.medworm.com/index.php?rid=5170672&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711002269%2Fabstract%3Frss%3Dyes Conclusion: Continuous BP and HR monitoring measured by the Nexfin finger cuff device in this trial showed reasonable agreement when compared with the intermittent values obtained by automated ED equipment. However, theoretically, noninvasive and continuous monitoring of the BP and HR might better reflect underlying hemodynamics than these same measurements obtained intermittently and, thus, could be important in patient management. More study is needed to determine the optimal method of monitoring these parameters. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170672 Sun, 31 Jul 2011 23:00:00 +0100 5170672 http://www.medworm.com/index.php?rid=5170695&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711002087%2Fabstract%3Frss%3Dyes Critically ill or injured patients often cannot give informed consent to be enrolled in clinical trials. In 1996, the US government passed a rule (21 CRF 50.24) to allow research without informed consent in emergency situations. One of the requirements of the rule is “community consultation” (CC), that is, advance disclosure of the research plan with the community where the study will be conducted and solicitation of opinions regarding the acceptability of the research. However, there are no clear definitions or guidance that helps investigators and institutional review boards decide how to perform CC properly. In the past, CC has been done with advertisements in print or electronic media, random dialing surveys , and/or town hall meetings . These methodologies may be costly, time cons... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170695 Thu, 23 Jun 2011 23:00:00 +0100 5170695 http://www.medworm.com/index.php?rid=4946764&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711002531%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4946764 Mon, 20 Jun 2011 17:19:05 +0100 4946764 http://www.medworm.com/index.php?rid=4946763&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS073567571100252X%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4946763 Mon, 20 Jun 2011 17:19:05 +0100 4946763 http://www.medworm.com/index.php?rid=4946762&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711002518%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4946762 Mon, 20 Jun 2011 17:19:05 +0100 4946762 http://www.medworm.com/index.php?rid=4946761&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711002506%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4946761 Mon, 20 Jun 2011 17:19:05 +0100 4946761 http://www.medworm.com/index.php?rid=4946748&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711001318%2Fabstract%3Frss%3Dyes We read with interest the letter “Metabolic acidosis in septic shock: is the Stewart theory the magic bullet?” and we thank the authors for their thoughtful comments about our study “Defining metabolic acidosis in patients with septic shock using Stewart approach” . The author's main concern seems to be the reproducibility of biologic measurements between different analyzers. However, we would like to point out that, in our study, all samples, for both patients and volunteers, were analyzed using the same analyzers. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4946748 Mon, 20 Jun 2011 17:19:01 +0100 4946748 http://www.medworm.com/index.php?rid=5170681&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711001124%2Fabstract%3Frss%3Dyes Emergency department (ED) patients are often treated for soft-tissue infections and now demonstrate a high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) . It has been well documented that this pathogen can be transmitted by direct contact from an infected source such as a human or an inanimate object. Spread of MRSA and many other bacterial pathogens in the ED has become an infection control issue for many hospitals because of ED overcrowding, lack of adequate hand washing, and lack of universal precautions by health care providers . (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170681 Tue, 14 Jun 2011 23:00:00 +0100 5170681 http://www.medworm.com/index.php?rid=5286232&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711002142%2Fabstract%3Frss%3Dyes The prevalence of hypokalemia quoted in the recent study may not necessarily be a reflection of the state of affairs when diabetic ketoacidosis (DKA) coexists with hypervolemia attributable to heart failure. Documentation of potassium status in all body compartments is relevant to the management of these patients because unlike their hypovolemic counterparts who can tolerate the large volumes of intravenous fluids required to deliver appropriate doses of potassium replacement therapy , patients with DKA with coexisting heart failure and, hence, hypervolaemia incur the risk of worsening of heart failure with such treatment. On the other hand, if such treatment is withheld, there is a real risk of worsening of hypokalemia after the initiation of low-dose intravenous insulin infusion. Althoug... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5286232 Mon, 13 Jun 2011 04:00:00 +0100 5286232 http://www.medworm.com/index.php?rid=5170694&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711002063%2Fabstract%3Frss%3Dyes The human race has evolved over millions of years. This evolution has allowed our bodies to adapt to critical situations, which are otherwise lethal in other species. One example of such adaptation is the human blood pH. This characteristic measurement, by virtue of its compensatory mechanisms, keeps the pH in a range of 7.35 to 7.45 even under adverse circumstances. As clinicians, we have encountered patients with severe hypoxemia and hypercarbia in our emergency departments (EDs), medical and surgical wards, and the intensive care units. Moreover, many clinicians care, on a regular basis, for noncompliant patients with end-stage renal disease (ESRD) who have not undergone hemodialysis for several days at a time and that present to ED with life-threatening hyperkalemia. In these patients ... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170694 Sun, 12 Jun 2011 23:00:00 +0100 5170694 http://www.medworm.com/index.php?rid=5170693&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711002038%2Fabstract%3Frss%3Dyes Gang membership has been associated with a variety of high-risk behaviors: drug use and sales, violence both as perpetrator and as victim, and dropping out of high school . Many of these risky behaviors increase the likelihood that gang members will land in an emergency department (ED) . We do not yet know the types of health concerns that bring gang members to the ED, the ways in which their visits differ from those of nongang members, and we lack prevalence information that might lead to the development of interventions addressing gang issues or risky behaviors. In addition, the opinions of ED staff toward gang members are not well documented. Recent studies have found that health care provider biases and prejudices exist, even among physicians who claim to have none, and can have a nega... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170693 Sun, 12 Jun 2011 23:00:00 +0100 5170693 http://www.medworm.com/index.php?rid=5170691&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711002002%2Fabstract%3Frss%3Dyes We appreciate the interest of the authors regarding our recent article on the “double lung point.” We will try to answer several questions raised by the letter, giving more technical details. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170691 Sun, 12 Jun 2011 23:00:00 +0100 5170691 http://www.medworm.com/index.php?rid=5170690&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711001690%2Fabstract%3Frss%3Dyes In 2010, in the United States, about 795 000 people had a stroke, and about 80% of them are new cases; in Italy, the cases of stroke are about 195 000, with an incidence of 2.15 to 2.54 new cases-1000 inhabitants per year . Stroke is the third cause of death, after myocardial infarction and cancer, with an associated high incidence of disability and average cost of €40 000 to €50 000 per patient per year . The social impact of this disease in general population suggests the need to adequately inform the patient about the risk of developing the disease, because this could favor appropriate changes in lifestyle habits, reduction of blood pressure (BP), smoking, and the incidence of diabetes mellitus and other cardiovascular diseases. The assessment of the risk of first stroke is ... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170690 Sun, 12 Jun 2011 23:00:00 +0100 5170690 http://www.medworm.com/index.php?rid=5170689&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711001677%2Fabstract%3Frss%3Dyes We have read with great interest the article by Mert et al . The authors presented a case with atrial fibrillation that developed pulmonary edema in the setting of hypercalcemia secondary to hyperparathyroidism. However, an interesting topic that the authors did not mention about was patient's rate control medication for atrial fibrillation. Every rate control medication has different effects by hypercalcemia and eventually can cause pulmonary edema. Verapamil acts primarily at the cell membrane and inhibits transmural fluxes of calcium. The drug slows ventricular response in atrial fibrillation by inhibiting the atrioventricular conduction. This effect is abolished in the patient when serum calcium rises to abnormal levels, and slowing of the ventricular response is achieved by reducing s... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170689 Sun, 12 Jun 2011 23:00:00 +0100 5170689 http://www.medworm.com/index.php?rid=5286224&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711001185%2Fabstract%3Frss%3Dyes Conclusion: Early psychological intervention and close observation is required for patients who are female, living without a family, use antidepressants, and have a history of psychiatric treatment. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5286224 Mon, 06 Jun 2011 04:00:00 +0100 5286224 http://www.medworm.com/index.php?rid=5170692&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711002014%2Fabstract%3Frss%3Dyes The interesting case report “the double lung point: an unusual sonographic sign of juvenile spontaneous pneumothorax” by Volpicelli and Audino raises several questions. The lung point as defined by Lichtenstein et al is a dynamic sign at a specific location on the chest where lung sliding alternates with absent lung sliding during the respiratory cycle; but at any particular point in time, only one of them is present. It is not clear from the report that this sign was detected; and without it, the ultrasound diagnosis of an incomplete pneumothorax is not secure. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170692 Sun, 05 Jun 2011 23:00:00 +0100 5170692 http://www.medworm.com/index.php?rid=5170688&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711001641%2Fabstract%3Frss%3Dyes Differentiation between asymptomatic bacteriuria (AB) and symptomatic urinary tract infection (SUTI) is important for treatment guidance because antibiotic therapy for AB offers benefit to only pregnant women and patients undergoing urologic procedures . Unnecessary antibiotic prescription for AB may put patients at risk for development of antibiotic resistance and adverse reactions . As previously described by our study in regard to the increased antibiotic resistance rates among SUTI patients presenting to our emergency department (ED) , unnecessary antibiotic treatment for AB was of concern. We conducted this study to evaluate the practice of urine testing and management of AB in the ED setting. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170688 Sun, 05 Jun 2011 23:00:00 +0100 5170688 http://www.medworm.com/index.php?rid=5170687&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711001628%2Fabstract%3Frss%3Dyes Retroperitoneal hematoma (RH) is an uncommon emergency but with a high mortality rate . Clinical diagnosis is difficult because of variable presentations, from mild flank and upper abdominal discomfort to shock, depending on degree and duration of bleeding . The causes of RH are traumatic, iatrogenic, or “spontaneous.” Treatment depends on the cause and ranges from drainage of hematoma under ultrasound guidance to surgery or endovascular procedures . Ultrasonography (US) is increasingly important for initial assessment of critically ill patients . Ultrasonography enables the detection of pleural, peritoneal, and pericardial fluid, even very small amounts. In the course of US training, we learn that US is not relevant in the detection of RH, but is this always true? (Source: The America... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170687 Sun, 05 Jun 2011 23:00:00 +0100 5170687 http://www.medworm.com/index.php?rid=5170686&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711001331%2Fabstract%3Frss%3Dyes Gunshot wounds may result in abdominal or extremity injuries, which have a high rate of mortality . Multiple films may be needed to survey the injured sites and localize any residual bullet wounds. Therefore, emergency department (ED) physicians frequently face the challenge of deciding which films to take and how many films are needed because of the presence of multiple wounds and the unpredictable paths of projectiles. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170686 Sun, 05 Jun 2011 23:00:00 +0100 5170686 http://www.medworm.com/index.php?rid=5170685&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS073567571100129X%2Fabstract%3Frss%3Dyes This article will attempt to answer these questions. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170685 Sun, 05 Jun 2011 23:00:00 +0100 5170685 http://www.medworm.com/index.php?rid=5170684&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711001276%2Fabstract%3Frss%3Dyes We read, with great interest, the article published by Takahashi et al that suggested the Emergency Coma Scale (ECS) as an alternate triage tool for the assessment of patients with neurologic impairment. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170684 Sun, 05 Jun 2011 23:00:00 +0100 5170684 http://www.medworm.com/index.php?rid=5170683&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711001252%2Fabstract%3Frss%3Dyes We write to you with the results of our investigation of ondansetron as an acceptable and efficacious antiemetic for the treatment of nausea and vomiting in the rural, out-of-hospital setting. Nausea is a commonly encountered patient complaint in both the out-of-hospital and emergency department (ED) settings . Although a nonspecific symptom, nausea can result from a myriad of both benign and emergent etiologies, ranging from migraine headaches and gastroenteritis to intracranial hemorrhage and acute myocardial infarction. Nausea, when associated with vomiting, not only compromises patient comfort but, depending on the patient's presenting illness, can also significantly affect the challenging out-of-hospital patient . The adverse effects of nausea and vomiting, including airway compromise... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170683 Sun, 05 Jun 2011 23:00:00 +0100 5170683 http://www.medworm.com/index.php?rid=5170682&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711001240%2Fabstract%3Frss%3Dyes We read with great interest the letter by Dr Hasanin and Kinsara in the February 2011 issue of the American Journal of Emergency Medicine, in which they described a case of fatal multiple infarcts 1 hour after initiation of thrombolytic therapy for acute ST-elevation myocardial infarction . In their case report, echocardiography study disclosed a dilated left ventricle with severe global hypokinesis suggestive of preexisting cardiomyopathy and a disintegrated left ventricular apical thrombus pointing out to the source of the embolic complications. The authors raise the question whether echocardiography before initiating thrombolytic therapy would affect the decision of commencing thrombolytic therapy and help avoiding complications. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170682 Sun, 05 Jun 2011 23:00:00 +0100 5170682 http://www.medworm.com/index.php?rid=4946747&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS073567571100132X%2Fabstract%3Frss%3Dyes We read with a great attention the article entitled “Defining metabolic acidosis in patients with septic shock using Stewart approach” . We have some remarks about it. The authors used the Stewart approach to diagnose acid-base disturbances in patients having septic shock. Their reference for metabolic acidosis diagnosis seems to be the calculated standard base excess (SBE). It is interesting to note the lack of correlation between SBE and the strong ion gap (SIG) that represents unmeasured anions. The method used for albumin concentration measurement was different from the 2 methods that we previously compared and that have quite different results . They calculated the corrected chloride to diagnose hyperchloremic acidosis. Using our previously published data , shows the reproducibil... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4946747 Sun, 05 Jun 2011 23:00:00 +0100 4946747 http://www.medworm.com/index.php?rid=4914287&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711001835%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4914287 Tue, 31 May 2011 23:00:00 +0100 4914287 http://www.medworm.com/index.php?rid=4914286&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711001823%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4914286 Tue, 31 May 2011 23:00:00 +0100 4914286 http://www.medworm.com/index.php?rid=4914285&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711001811%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4914285 Tue, 31 May 2011 23:00:00 +0100 4914285 http://www.medworm.com/index.php?rid=4914284&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS073567571100180X%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4914284 Tue, 31 May 2011 23:00:00 +0100 4914284 http://www.medworm.com/index.php?rid=4783132&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711001392%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4783132 Sat, 30 Apr 2011 23:00:00 +0100 4783132 http://www.medworm.com/index.php?rid=4783131&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711001380%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4783131 Sat, 30 Apr 2011 23:00:00 +0100 4783131 http://www.medworm.com/index.php?rid=4783130&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711001379%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4783130 Sat, 30 Apr 2011 23:00:00 +0100 4783130 http://www.medworm.com/index.php?rid=4783129&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711001367%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4783129 Sat, 30 Apr 2011 23:00:00 +0100 4783129 http://www.medworm.com/index.php?rid=4914269&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711000477%2Fabstract%3Frss%3Dyes The recent article by Heard et al heightened awareness of the challenges faced by physicians evaluating “body stuffers.” Although serious complications after cocaine body stuffing, such as seizures, typically occur rapidly after ingestion, there is at least 1 report of delayed seizures in a crack cocaine body stuffer, occurring at 10 to 24 hours postingestion . This presents a controversy in defining an appropriate time for observation under medical supervision. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4914269 Thu, 28 Apr 2011 23:00:00 +0100 4914269 http://www.medworm.com/index.php?rid=5170679&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711000982%2Fabstract%3Frss%3Dyes In their recent article that retrospectively assessed the performance of disposable stainless steel vs plastic laryngoscope blades for emergence intubation in the prehospital setting by paramedics, Dos Santos et al reported that stainless steel disposable blade was superior to plastic disposable blade in first attempt and overall number of attempts to intubation. From this, they conclude that, before further research is done, stainless steel disposable blades should be recommended for tracheal intubations. Besides the limitations described in the discussion, however, we noted additional issues of this study, making interpretation of their results questionable. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5170679 Sun, 24 Apr 2011 23:00:00 +0100 5170679 http://www.medworm.com/index.php?rid=4914273&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS073567571100091X%2Fabstract%3Frss%3Dyes Although data indicate 3,4-Methylenedioxymethamphetamine (MDMA) and methamphetamine use in New England, little is known about recent specific MDMA and methamphetamine use in the state of Rhode Island . Therefore, given the potential increased burden of these agents in our region, we decided to undertake a study to determine the types of amphetamines used in our local trauma patients. Prior studies have implicated a potential association between amphetamine use and trauma . As such, it may also be important to determine the specific patient demographics of those using these substances in Rhode Island from both an epidemiologic and treatment perspective. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4914273 Sun, 24 Apr 2011 23:00:00 +0100 4914273 http://www.medworm.com/index.php?rid=4914270&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711000787%2Fabstract%3Frss%3Dyes The March 1, 2001, Institute of Medicine (IOM) report “Crossing the quality chasm” states: “It is in inadequate handoffs that safety often fails first” . On the tails of the Institute of Medicine observations, the Joint Commission on Accreditation of Healthcare Organizations formed a task force to address error in handoff communications. With its initial recommendations, this task force identified standardization of handoff methods to be critical for successful handoffs . (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4914270 Sun, 24 Apr 2011 23:00:00 +0100 4914270 http://www.medworm.com/index.php?rid=4914272&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711000908%2Fabstract%3Frss%3Dyes Emergency physicians in urban China, like their counterparts in the West, are facing greater pressures than before. One of the outcomes of medical reform and economic development in China has been a new reliance by patients to use the emergency department as their first choice for medical care. Moreover, an experienced emergency physician in Shanghai typically works 25 days per month, has only 5 days of vacation/holiday leave, and will see 30 to 80 (and, in unusual situations, 100 or more) patients within an 8-hour shift. As a result, most physicians leave emergency medicine in less than 10 years and seek other practice opportunities. It will be interesting to see how these work and manpower issues develop in China as its health care system takes on more aspects of Western medical systems... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4914272 Sun, 03 Apr 2011 23:00:00 +0100 4914272 http://www.medworm.com/index.php?rid=4914271&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711000891%2Fabstract%3Frss%3Dyes We report here the incidence of this AKI inside our department. We performed a retrospective screening of medical records of 1014 patients consecutively admitted in nephrology and dialysis department from January 2008 to December 2009. We detected 47 AKI that occurred in patients with diabetes treated with metformin to improve glycemia control. From the inner emergency department, the patients were referred to our ward because of severe metabolic acidosis and increased serum creatinine and potassium levels. The subjects were 55-years old (range, 42-74 years), all white, 86% women, with history of type 2 diabetes mellitus of less than 9 years. They received sulfonylurea in 60% of cases, metformin in 100%, glitazone in 18%, and subcutaneously insulin in 35%. At admission, they presented olig... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4914271 Sun, 03 Apr 2011 23:00:00 +0100 4914271 http://www.medworm.com/index.php?rid=4783120&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711000465%2Fabstract%3Frss%3Dyes We thank the authors for their interest in our recent article. The authors question our recommendation of a 6-hour observation based on the potential for delayed complications and cite 2 reports . In the Sporer study, all patients had seizures within 2 hours of observation, whereas in Pollack's series, 1 case had delayed seizures but would have been admitted and observed based on our protocol . Although we agree that some patients may have complications after the observation period, we feel that medical decisions should be based on systematic data rather than anecdote. Our work is the third study suggesting that complications in body stuffers rarely occur after 6 hours . (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4783120 Tue, 29 Mar 2011 23:00:00 +0100 4783120 http://www.medworm.com/index.php?rid=4783106&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711000660%2Fabstract%3Frss%3Dyes Conclusions: The same indicators found to be predictive of high risk for fracture in a population of pediatric patients were found to be predictive in a population including adults. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4783106 Tue, 29 Mar 2011 23:00:00 +0100 4783106 http://www.medworm.com/index.php?rid=5667622&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS073567571000584X%2Fabstract%3Frss%3Dyes Conclusions: Physicians overestimated the probability that the computed tomographic scan would yield a significant result and indicated an even greater perceived medicolegal risk if the scan was not obtained. Physician test-ordering behavior is complex, and our study queries pertinent aspects of MDCT testing. The magnification of legal risk vs the pretest probability of a significant finding is demonstrated. Physicians significantly overestimated pretest probability of a significant finding on head MDCT scans and presumed legal risk. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667622 Wed, 16 Mar 2011 04:00:00 +0100 5667622 http://www.medworm.com/index.php?rid=5667610&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005838%2Fabstract%3Frss%3Dyes Conclusion: Antidepressants and analgesics were responsible for nearly 44% of ED visits for drug-related poisoning in the United States. Interventions and future research should target prescription opioids, rural areas, children 0 to 5 years old for unintentional drug-related poisoning, and female ages 12 to 24 years for suicidal drug-related poisoning. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667610 Thu, 03 Mar 2011 05:00:00 +0100 5667610 http://www.medworm.com/index.php?rid=5667615&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005954%2Fabstract%3Frss%3Dyes Conclusion: Emergency department patients with acute painful conditions report a wide range of self-reported pain scores. Participants rated pain based on current feeling of pain or comparison to previous or hypothetical pain. Chief complaints with highest pain scores included dental pain and back pain. Factors associated with higher pain scores included younger age, Medicaid insurance, lower educational status, and higher number of previous ED visits. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667615 Wed, 02 Mar 2011 05:00:00 +0100 5667615 http://www.medworm.com/index.php?rid=4595628&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711000283%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4595628 Tue, 01 Mar 2011 00:00:00 +0100 4595628 http://www.medworm.com/index.php?rid=4595627&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711000271%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4595627 Tue, 01 Mar 2011 00:00:00 +0100 4595627 http://www.medworm.com/index.php?rid=4595626&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS073567571100026X%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4595626 Tue, 01 Mar 2011 00:00:00 +0100 4595626 http://www.medworm.com/index.php?rid=4595625&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711000258%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4595625 Tue, 01 Mar 2011 00:00:00 +0100 4595625 http://www.medworm.com/index.php?rid=5667644&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS073567571000611X%2Fabstract%3Frss%3Dyes Spontaneous rupture of the ureteropelvic junction is a rare entity with diagnostic problems. Here, we reported a case who presented with severe acute abdominal pain mimicking many abdominal problems. Physical examination and laboratory tests did not reveal any specific diagnosis, and an abdominal computed tomographic scan was performed. It showed 4-mm calculus in proximal ureter, grade 2 hydronephrosis, and perinephric fluid collection. The patient undergone to systoscopic procedure, her calculus was removed, and a double-J catheter was placed. The next day, she was discharged without any complication. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667644 Mon, 28 Feb 2011 05:00:00 +0100 5667644 http://www.medworm.com/index.php?rid=5667642&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS073567571000608X%2Fabstract%3Frss%3Dyes Dengue is one of the most common mosquito-borne infection affecting more than 50 million people worldwide annually. Most common causes for dengue-associated mortality are shock, bleeding, and respiratory failure. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667642 Mon, 28 Feb 2011 05:00:00 +0100 5667642 http://www.medworm.com/index.php?rid=5667621&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710006005%2Fabstract%3Frss%3Dyes Conclusions: The use of the SOFA score is an acceptable method for risk stratification and prognosis of patients with advanced cancer in the ED. This score can help clinicians to predict 14-day mortality and plan appropriate treatment for critically ill patients with cancer who present to the ED. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667621 Mon, 28 Feb 2011 05:00:00 +0100 5667621 http://www.medworm.com/index.php?rid=4783119&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711000155%2Fabstract%3Frss%3Dyes We read with great interest the work by Youn et al indicating that higher highly selective C-reactive protein (CRP) (hs-CRP) levels were associated with larger infarct volumes in acute ischemic stroke. Authors suggest that elevated hs-CRP levels reflect a large volume of infarct and may serve as a helpful biomarker in the evaluation of extent of acute ischemic stroke and the degree of systemic inflammation. It is worth to mention that den Hertog et al , in a large-scale evidenced study, has shown that CRP values of 7 mg/L or higher obtained within 12 hours of the onset of an acute ischemic stroke are associated with a poor outcome or death at 3 months. Previous studies concerning the relationship between CRP levels and acute ischemic stroke produced inconclusive results ; thus, we think th... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4783119 Mon, 28 Feb 2011 00:00:00 +0100 4783119 http://www.medworm.com/index.php?rid=4783118&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711000131%2Fabstract%3Frss%3Dyes We read with interest the recent article of Birkhahn et al who evaluated the use of point-of-care (POC) testing of cardiac biomarkers against standard core laboratory testing to determine the local time savings and estimate a cost-benefit ratio. It was concluded that the rapid acute cardiac evaluation pathway would have saved an overall 390 minutes (6.5 hours) in the diagnostic workup, which result from both the earlier diagnosis allowed by the POC multimarker approach (2.5 hours) and the delay in bringing the test from the laboratory to the bedside (4.0 hours). Nevertheless, this estimation is somehow questionable for several reasons. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4783118 Mon, 28 Feb 2011 00:00:00 +0100 4783118 http://www.medworm.com/index.php?rid=4783117&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711000040%2Fabstract%3Frss%3Dyes We thank Dr. Smithson for comments on our article regarding the definition of healthcare-associated (HA) urinary tract infection (UTI) used in our study. We agree with Dr. Smithson that there is no clear consensus definition of HA-UTI. However, as previously described by a number of authors , healthcare-associated infections (HAIs) are important to differentiate from community-associated infections (CAIs) because they are often due to different and more resistant organisms. Additionally, in studies of patients with UTI, healthcare exposure has been shown to be a significant risk factor for drug resistant infections . As such, we attempted to define and differentiate between CA-UTI and HA-UTI. This allowed us to assess healthcare exposure as a variable for antibiotic resistance in the multi... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4783117 Mon, 28 Feb 2011 00:00:00 +0100 4783117 http://www.medworm.com/index.php?rid=4783116&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675711000027%2Fabstract%3Frss%3Dyes I have read, with interest, the article by Khawcharoenporn et al in which the authors evaluate the antimicrobial resistance rates among uropathogens isolated from patients with urinary tract infection (UTI) who attended an emergency department. In my opinion, the most interesting aspect of this study is that the authors evaluate the causal microorganisms and the antimicrobial pattern found in patients with community-acquired (CoA) UTI and the ones found in patients with a health care–associated (HA) UTI. According to the study protocol, the authors define HA-UTI as a UTI diagnosed in patients with long-term indwelling urethral catheters, health care exposure including hospital stay for at least 48 hours, nursing home or long-term care facility, regular hemodialysis, or urological procedu... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4783116 Mon, 28 Feb 2011 00:00:00 +0100 4783116 http://www.medworm.com/index.php?rid=4783115&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710006145%2Fabstract%3Frss%3Dyes We read with great interest the article by Costantino et al and their response to the correspondence by Chartrand-Lefebvre regarding interobserver agreement in the interpretation of computed tomography (CT) pulmonary angiography (CTPA) for the diagnosis of acute pulmonary embolism (PE). The interobserver agreement among radiologists is high for the diagnosis of massive (ie, large central) PE but is diminished for the diagnosis of segmental and subsegmental PEs. A similar hierarchy of agreement has been demonstrated for conventional pulmonary angiography . The observations of Costantino et al are convincing and reflect the reality of interpreting CTPA examinations. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4783115 Mon, 28 Feb 2011 00:00:00 +0100 4783115 http://www.medworm.com/index.php?rid=4783113&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710006030%2Fabstract%3Frss%3Dyes We are very pleased that people are interested in our study . Although the 1-way analysis of variance tests showed that blood glucose levels are significantly different among Killip classes, there was no sufficient evidence to differentiate the glucose levels between each Killip class by the width of the 95% confidence interval. This resulted from a limited number of patients in our study. The proportion of diabetes in each Killip classes was the following: 31.9% for Killip class I, 33.3% for Killip class II, 34.8% for Killip class III, and 49.0% for Killip class IV. The result of χ2 revealed no significant difference among each Killip class. The odds ratios of death at 1 year between those with the glucose level above and below the 50th percentile within each Killip class were the follow... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4783113 Mon, 28 Feb 2011 00:00:00 +0100 4783113 http://www.medworm.com/index.php?rid=4783114&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710006121%2Fabstract%3Frss%3Dyes This brief report presents the first North American population data on rates of emergency department (ED) use among adults with intellectual and developmental disabilities (IDD) relative to the general population. Individuals with IDD are at greater risk for health problems compared with the general population and have higher morbidity and earlier mortality as a result. Illness in individuals with IDD can be further exacerbated in a health care system that is fragmented and inadequately resourced, particularly when medical professionals do not have the necessary expertise . These issues are magnified when, in addition to chronic and acute medical concerns, a comorbid mental health issue emerges. Consequently, individuals with coexisting IDD and psychiatric disorder have been identified as ... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4783114 Mon, 14 Feb 2011 00:00:00 +0100 4783114 http://www.medworm.com/index.php?rid=5667645&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710006133%2Fabstract%3Frss%3Dyes Tumor lysis syndrome (TLS) causes acute kidney injury (AKI) by various pathophysiologies. Herein, we report on a case of recurrent AKI in TLS induced by 2 different mechanisms and highlight the increasing magnitude of acute phosphate nephropathy after wide use of rasburicase. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667645 Mon, 07 Feb 2011 05:00:00 +0100 5667645 http://www.medworm.com/index.php?rid=5667643&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710006108%2Fabstract%3Frss%3Dyes A 53-year-old man presented to the emergency department (ED) with neck swelling, shortness of breath, and a change in the sound of his voice. Physical examination revealed an afebrile man speaking in 2- to 3-word sentences with a firm, nontender, nonerythematous mass on the right side of his neck. A bedside ultrasound demonstrated a homogenous mass with internal vascular flow. This constellation of findings was felt to be most consistent with a malignancy. Nasopharyngoscopy confirmed a near obstructing supraglottic mass, and the patient underwent an emergent tracheostomy. A lesion in the head and neck region can cause airway compromise, and, if the patient displays any evidence of respiratory decompensation, rapid evaluation is essential. Bedside ultrasonography facilitates assessment of s... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667643 Mon, 07 Feb 2011 05:00:00 +0100 5667643 http://www.medworm.com/index.php?rid=5667612&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005905%2Fabstract%3Frss%3Dyes Abstract: Introduction: Trauma activation prioritizes hospital resources for the assessment and treatment of trauma patient over all patients in the emergency department (ED). We hypothesized that length of stay (LOS) is longer for nontrauma patients during a trauma activation.Methods: A retrospective, case-control chart review was conducted in a level I trauma center. Cases consist of patients who present 1 hour before and after the presentation of the trauma activation. Controls were patients presenting to the ED during the same period exactly 1 week before and after the cases. Confounding variables measured included sex, age, arrivals, and census for the 3 areas.Results: Two hundred ninety-four trauma events occurred from January 1 until September 30, 2009. A significant difference was ... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667612 Mon, 07 Feb 2011 05:00:00 +0100 5667612 http://www.medworm.com/index.php?rid=5441507&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005401%2Fabstract%3Frss%3Dyes Conclusions: Patients with DDI had similar initial plain x-ray evaluations to patients without DDI, despite DDI patients being more severely injured. Delayed diagnosis of injury was not attributable to inadequate CT use. Most DDIs were orthopedic, highlighting the importance of a tertiary survey and a low threshold for skeletal radiographs. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5441507 Mon, 07 Feb 2011 05:00:00 +0100 5441507 http://www.medworm.com/index.php?rid=4783110&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005772%2Fabstract%3Frss%3Dyes Glyphosate surfactant (GlySH)—an agricultural chemical agent, herbicide—has been used for suicide attempts . Intoxication by GlySH may involve many organs and systems such as the lungs, the kidneys, the liver, and the cardiovascular and nervous systems and, in some cases, may be fatal . In contrast, gastrointestinal disorders associated with GlySH intoxication are considered to be moderate, usually limited to local irritation and dysphagia, mainly of the upper tract. We, therefore, wish to report a case of intoxication with a commercial herbicide agent containing GlySH, which apart from the usual multiorgan failure was also associated with extensive corrosive injuries of the large intestine. Our aim is to alert physicians for this potentially life-threatening complication. (Source: The... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4783110 Mon, 07 Feb 2011 00:00:00 +0100 4783110 http://www.medworm.com/index.php?rid=5667640&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS073567571000598X%2Fabstract%3Frss%3Dyes We report a case of bystander CPR-induced splenic laceration with hepatosplenic hematoma complicating management of a patient with cardiovascular collapse because of acute myocardial infarction. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667640 Fri, 04 Feb 2011 05:00:00 +0100 5667640 http://www.medworm.com/index.php?rid=5667639&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005978%2Fabstract%3Frss%3Dyes A 58-year-old man presented to the emergency department (ED) pulseless and with severe hypothermia. The patient received standard Advanced Cardiac Life Support (ACLS) measures and mechanical cardiopulmonary resuscitation for 57 minutes before regaining a pulse. In addition to other traditional passive and active measures, the patient was gradually rewarmed (∼1°C per hour) with an endovascular catheter in the ED with therapeutic hypothermia at 33°C maintained for 12 hours during his intensive care unit (ICU) stay. He was then rewarmed to normothermia over 15 hours and ultimately discharged at his neurologic baseline 11 days later. This case study explores the 3 issues that make this instance of cardiac arrest caused by severe hypothermia treated with an endovascular catheter unique: (1)... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667639 Fri, 04 Feb 2011 05:00:00 +0100 5667639 http://www.medworm.com/index.php?rid=5667637&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005851%2Fabstract%3Frss%3Dyes Herbal therapies are widely used in Turkey. Especially, ginger is mostly recommended to patients with symptoms of flu by their relatives. A 59-year-old woman was admitted to the emergency department (ED) because of sudden loss of consciousness. She was recommended ginger for the relief of flu symptoms. As a result of diagnostic and laboratory evaluation, the probable cause of syncope was ginger usage. This case demonstrated that sometimes herbal therapies are harmful and clinicians must be reminded of this effect. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667637 Fri, 04 Feb 2011 05:00:00 +0100 5667637 http://www.medworm.com/index.php?rid=5441574&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005802%2Fabstract%3Frss%3Dyes In this report, we describe an adolescent boy who suffered from an acute myocardial infarction by dissection of the left anterior descending coronary after a car crash. He also presented with a subdural hemorrhage and a lung contusion, injuries, which both present a substantial risk of hemorrhage. After diagnosing the therapeutical problem, we describe our decisions regarding how we approached this case. We provide an algorithm of treatment coming from our experience of these cases with the hope it can help physicians in their future decisions. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5441574 Fri, 04 Feb 2011 05:00:00 +0100 5441574 http://www.medworm.com/index.php?rid=5441572&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005784%2Fabstract%3Frss%3Dyes Inhalant abuse is the intentional inhalation of chemical vapors or volatile substance to achieve a euphoric effect. Although no statistical data are reported yet, inhalant abuse is potentially life-threatening and has resulted in a wide range of toxic effects such as central nervous system depression, seizures, aspiration, cardiac arrhythmia, asphyxiation, hypoxia, metabolic acidosis, and sudden death among others. We are reporting a 25-year-old white man who was brought to the emergency department after inhaling aerosolized computer-cleaning spray composed of difluoroethane. He was found to have marked upper and lower lip facial swelling consistent with angioedema. The patient also had a prolonged QT interval, mild inspiratory stridor, but no urticaria. In this case, we believe the difluo... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5441572 Fri, 04 Feb 2011 05:00:00 +0100 5441572 http://www.medworm.com/index.php?rid=5667638&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005863%2Fabstract%3Frss%3Dyes We present a case of a 61-year-old male smoker presenting with complaints of nonproductive cough and flulike symptoms. The chest x-ray revealed an enlarged mediastinal silhouette and no evidence of pneumonia. A computerized axial tomography scan was done, which demonstrated a very large thoracic aortic aneurysm with evidence of a hyperattenuating crescent sign, indicative of impending rupture. The patient denied chest and abdominal pain. He went to the operating room and had repair of the aneurysm. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667638 Mon, 31 Jan 2011 05:00:00 +0100 5667638 http://www.medworm.com/index.php?rid=5667620&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005942%2Fabstract%3Frss%3Dyes Conclusion: Mainstream ETCO2 measurement accurately predicts the arterial Paco2 of patients presented to ED with acute dyspnea. Further studies comparing mainstream and sidestream methods in these patients are required. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667620 Mon, 31 Jan 2011 05:00:00 +0100 5667620 http://www.medworm.com/index.php?rid=5667617&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005875%2Fabstract%3Frss%3Dyes Conclusions: Early pelvic embolization without external fixation may be useful for the initial treatment for patients with hemodynamic instability without nonpelvic hemorrhage or with extravasation of contrast in the pelvis by CT. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667617 Mon, 31 Jan 2011 05:00:00 +0100 5667617 http://www.medworm.com/index.php?rid=5667616&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005966%2Fabstract%3Frss%3Dyes Conclusions: Only one case filed against EPs over the last 2 decades was identified, it was over failure to perform US. Most frequent litigations against radiologists and obstetricians are unlikely to be duplicated in the emergency department, and future litigations may also come from EP failure to perform point-of-care US. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667616 Mon, 31 Jan 2011 05:00:00 +0100 5667616 http://www.medworm.com/index.php?rid=5667614&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005930%2Fabstract%3Frss%3Dyes Conclusions: Pulmonary CTA confirmed PE in only a minority of patients and may be overused. Clinical judgment in conjunction with d-dimer evaluation was of limited help to predict positive results but surprisingly comparable with previous results using pretest probability scoring systems. Using present and previous data, a simplified enhanced algorithm is proposed to reduce use of CTA. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667614 Mon, 31 Jan 2011 05:00:00 +0100 5667614 http://www.medworm.com/index.php?rid=5667613&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005917%2Fabstract%3Frss%3Dyes Conclusions: Chest radiography and blood tests may be inadequate in the diagnostic process of pleuritic pain. In case of silent CXR, LUS is critical for identifying patients with pleural-pulmonary radio-occult conditions at bedside and cannot be safely replaced by other conventional methods. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667613 Mon, 31 Jan 2011 05:00:00 +0100 5667613 http://www.medworm.com/index.php?rid=5667611&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005887%2Fabstract%3Frss%3Dyes Conclusions: Practice patterns vary significantly, especially antibiotic overuse, at least in this urban academic ED. Further study should be undertaken to evaluate factors that influence management strategies for SSTI. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667611 Mon, 31 Jan 2011 05:00:00 +0100 5667611 http://www.medworm.com/index.php?rid=5441573&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005796%2Fabstract%3Frss%3Dyes We present this case report to inform emergency physicians about the potential for hiccups to serve as the only presenting symptom of a myocardial infarction. The patient, a 68-year-old man with a history of diabetes mellitus, hypertension, and current tobacco use, was first seen in the emergency department after 4 days of intractable hiccups with no other complaints or symptoms. After ineffective hiccup treatment on the first visit with 2 mg Ativan and 25 intramuscular (IM) thorazine and a normal chest x-ray, he was discharged. Two days later, the patient returned to the emergency department with the same complaint of hiccups without any additional complaints or symptoms. An electrocardiogram displayed several abnormalities including Q waves in II, III, and aVF and T-wave inversions in aV... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5441573 Mon, 31 Jan 2011 05:00:00 +0100 5441573 http://www.medworm.com/index.php?rid=5441570&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005759%2Fabstract%3Frss%3Dyes We describe the case of a 48-year-old man who presented with dyspnea, confusion, and facial swelling with cyanosis. The patient developed life-threatening airway obstruction after administration of anxiolytic. The diagnosis of SVC obstruction secondary to a primary cardiac sarcoma was established based on clinical, radiologic, and post-mortem findings. This is one of very few reported cases of a primary cardiac sarcoma causing SVC obstruction. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5441570 Mon, 31 Jan 2011 05:00:00 +0100 5441570 http://www.medworm.com/index.php?rid=5667636&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005814%2Fabstract%3Frss%3Dyes We report a case of infective endocarditis in a 16-year-old girl diagnosed by focused point-of-care echocardiography in the emergency department. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667636 Thu, 27 Jan 2011 05:00:00 +0100 5667636 http://www.medworm.com/index.php?rid=5667619&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005929%2Fabstract%3Frss%3Dyes Conclusions: Prehospital case management may reduce EMS use in high-frequency EMS users and create significant cost savings to municipalities and the health care system. Additional large-scale studies are needed to validate these findings. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667619 Thu, 27 Jan 2011 05:00:00 +0100 5667619 http://www.medworm.com/index.php?rid=5441571&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005760%2Fabstract%3Frss%3Dyes A 24-year-old male patient was admitted to the coronary intensive care unit with atrial fibrillation with rapid ventricular response. He was given amiodarone (Cordarone 150 mg IV, Sanofi-Aventis) intravenous loading dose of 300 mg in 100 mL dextrose 5% in water (D5W) over 1 hour, followed by a maintenance dose of 900 mg in 500 mL D5W for infusion up to 24 hours. At the emergency department, the patient was conscious and cooperative; his pretreatment arterial blood pressure was 120/80 mm Hg, and the arrhythmic tachycardia was 145 per minute. After intravenous amiodarone loading and half an hour into maintenance infusion, extreme perspiration, hypotension (blood pressure immeasurable), and mild cyanosis developed. The patient was conscious; his auscultation and pulse were normal. He was give... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5441571 Thu, 27 Jan 2011 05:00:00 +0100 5441571 http://www.medworm.com/index.php?rid=4783112&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710006029%2Fabstract%3Frss%3Dyes We appreciate the work by Drs Cheng and Yen, which demonstrated that patients ranked in the higher Killip classes had higher glucose levels than those ranked in the lower classes . We notice that the authors used the Mantel-Haenszel χ2 for trend and 1-way analysis of variance tests to analyze their data. However, if the 95% confidence intervals of glucose levels (mg/dL) for each Killip classes are calculated, we could obtain the following results: (173-201) for Killip class I, (168-224) for Killip class II, (166-268) for Killip class III, and (203-269) for Killip class IV. Accordingly, there is no sufficient evidence to differentiate the glucose levels among each Killip class. The use of blood glucose level is not practical to stratify the severity of acute myocardial infarction at emerge... The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4783112 Thu, 27 Jan 2011 00:00:00 +0100 4783112 http://www.medworm.com/index.php?rid=4783111&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005826%2Fabstract%3Frss%3Dyes Current guidelines for treating patients with pulmonary embolism (PE) recommend both parenteral and oral anticoagulants (OAC) from the first day, at least 5 days, and until international normalized ratio 2-3 is reached in 2 consecutive days . This protocol is clear and easy to follow. Anticoagulant treatment plays a pivotal role in the management of patients with PE . The necessity for results goes with this pivotal role. However, results in PE treatment are far from satisfactory . The disappointing results should lead to prompt, critical analysis of each step in therapy. However, the validity of the current protocol for initial anticoagulants in all patients needs to be questioned. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4783111 Thu, 27 Jan 2011 00:00:00 +0100 4783111 http://www.medworm.com/index.php?rid=5667641&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005991%2Fabstract%3Frss%3Dyes A subarachnoid hemorrhage without typical presentation often poses a great challenge to an emergency physician. A 36-year-old man presented to our emergency department with symptoms mimicking extrapyramidal symptoms but was ultimately found to have a ruptured intracranial aneurysm. Emergency craniotomy and aneurysm clipping were performed. Interestingly, involuntary movements of his face, mouth, and limbs diminished soon after the operation. The patient fully regained his verbal function and completely restored his muscle power. A full neurologic examination is emphasized for timely diagnosis to prevent catastrophic deterioration, especially in patients with verbal dysfunction or with a psychiatric disorder. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667641 Mon, 24 Jan 2011 05:00:00 +0100 5667641 http://www.medworm.com/index.php?rid=4363258&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710006200%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4363258 Wed, 19 Jan 2011 15:44:09 +0100 4363258 http://www.medworm.com/index.php?rid=4363257&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710006194%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4363257 Wed, 19 Jan 2011 15:44:09 +0100 4363257 http://www.medworm.com/index.php?rid=4363256&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710006182%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4363256 Wed, 19 Jan 2011 15:44:09 +0100 4363256 http://www.medworm.com/index.php?rid=4363255&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710006170%2Fabstract%3Frss%3Dyes (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4363255 Wed, 19 Jan 2011 15:44:09 +0100 4363255 http://www.medworm.com/index.php?rid=5667609&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005747%2Fabstract%3Frss%3Dyes Conclusions: An examination of patients' patterns of care leading to a cancer diagnosis in association with an ED visit lends insight to conditions precipitating a more immediate diagnosis and their associated outcomes. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667609 Wed, 19 Jan 2011 05:00:00 +0100 5667609 http://www.medworm.com/index.php?rid=5441558&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005346%2Fabstract%3Frss%3Dyes We report a patient who presented with fever, chills, and bullae on left forearm, despite antibiotics and wound debridement; the infection extend to mid humerus with a rapid onset of skin necrosis and progressive sepsis. Aeromonas schubertii fasciitis is particularly virulent. An apparent superficial cellulitis that fails to respond to standard therapy must raise suspicion of a more extensive underlying subcutaneous infection. Aggressive surgical debridement and antibiotic coverage for gram-negative rods are the essential features of treatment. Delay caused by a mistaken diagnosis of cellulitis and subsequent inadequate debridement would likely prove fatal. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5441558 Wed, 19 Jan 2011 05:00:00 +0100 5441558 http://www.medworm.com/index.php?rid=5441513&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005619%2Fabstract%3Frss%3Dyes Conclusions: A prominently higher rate of neurologic improvement and favorable clinical outcome was observed among acute ischemic stroke patients 80 years or older treated with IV rt-PA or endovascular intervention when compared with nonthrombolytic medical treatment, supporting the use of acute thrombolytic therapies in this patient population when contraindications are not present. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5441513 Wed, 19 Jan 2011 05:00:00 +0100 5441513 http://www.medworm.com/index.php?rid=5441510&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005516%2Fabstract%3Frss%3Dyes Conclusion: Older adults who use the ED are also receiving significant amounts of care from other sources; simply providing additional access to care may not improve outcomes for these vulnerable individuals. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5441510 Mon, 10 Jan 2011 05:00:00 +0100 5441510 http://www.medworm.com/index.php?rid=5667608&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005693%2Fabstract%3Frss%3Dyes Conclusion: At a time of heightened public concern regarding flu but little disease prevalence, EDs experienced substantial increases in patient volumes. These increases were significant and comparable to the increases experienced during the subsequent epidemic of actual disease. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667608 Wed, 05 Jan 2011 05:00:00 +0100 5667608 http://www.medworm.com/index.php?rid=5667607&cid=s_34435_14_f&fid=34435&url=http%3A%2F%2Fwww.ajemjournal.com%2Farticle%2FPIIS0735675710005644%2Fabstract%3Frss%3Dyes Conclusion: Testing both H-FABP and cTnI using the Cardiac Array proved to be both a reliable diagnostic tool for the early diagnosis of myocardial infarction/acute coronary syndrome and also a valuable rule-out test for patients presenting at 3 to 6 hours after chest pain onset. (Source: The American Journal of Emergency Medicine) The American Journal of Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5667607 Wed, 05 Jan 2011 05:00:00 +0100 5667607