The American Journal of Emergency Medicine via MedWorm.com

Information for Authors

The American Journal of Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

(Source: The American Journal of Emergency Medicine)

The American Journal of Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

(Source: The American Journal of Emergency Medicine)

Editorial Board

The American Journal of Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

(Source: The American Journal of Emergency Medicine)

Masthead

The American Journal of Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

(Source: The American Journal of Emergency Medicine)

Bilateral obstructing renal stones: an uncommon cause of acute renal failure

The American Journal of Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

Bilateral renal calculi are an uncommon cause of acute renal failure (ARF). The causes of ARF include prerenal, obstructive (or postrenal), and intrinsic . Postrenal causes account for 5% to 15% of cases of ARF . This case report will present a case of acute renal failure secondary to bilateral obstructing ureteral calculi. (Source: The American Journal of Emergency Medicine)

Beneficial response to mild therapeutic hypothermia for comatose survivors of near-hanging

The American Journal of Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

We report a retrospective series of 2 patients who received mild therapeutic hypothermia for their comatose state after a near-hanging injury. The exclusionary criteria and protocols that we use for comatose survivors of cardiac arrest were used. After at least 24 hours of mild therapeutic hypothermia, both patients had a complete return of neurological function, with Glasgow Coma Scale scores of 15 at the time of discharge from the hospital. These data, taken with other case series, suggest that therapeutic hypothermia may be beneficial for comatose survivors of near-hanging. (Source: The American Journal of Emergency Medicine)

Pancreatic cholangiocarcinoma as an ST-elevation myocardial infarction with thrombolytic therapy

The American Journal of Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

We report the case of a 46-year-old patient who presented a chest pain with ST-segment elevation in precordial leads V1 (2 mm), V2 (4 mm), and V3 (3 mm). Thrombolytic therapy was initiated with the combination tenecteplase tissue plasminogene activator, aspirin, and heparin. Further electrocardiogram and cardiac enzymes measured every 2 hours during the first 24 hours remained normal, and after a computed tomography of the abdomen, the patient was taken to surgery for an exploratory abdominal operation that revealed pancreatic cholangiocarcinoma. No adverse effects were attributed to the initial thrombolytic therapy. Finally, myocardial ischemia was excluded because the electrocardiogram, cardiac enzymes, and a 1-month later cardiac stress test remained normal and because no coronary event...

Severe metabolic acidosis secondary to coadministration of creatine and metformin, a case report

The American Journal of Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

We present the case of a patient who developed acute renal failure and lactic acidosis while using creatine and metformin simultaneously. (Source: The American Journal of Emergency Medicine)

Computed tomography–guided pericardiocentesis: utility in the management of malignant pericardial effusion

The American Journal of Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

We present a case in which a CT-guided approach was used to successfully drain a malignant pericardial effusion in the emergent setting. Clinicians should be aware of the potential role of CT in this setting. (Source: The American Journal of Emergency Medicine)

First case of stress cardiomyopathy as a result of methadone withdrawal secondary to drug-drug interaction

The American Journal of Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

We describe the first case of stress cardiomyopathy secondary to a drug-drug interaction. A 44-year-old man was admitted for acute agitation, hallucinations, tachycardia, and fever within 2 hours of ingestion of naltrexone prescribed to stop alcohol consumption. He had been receiving methadone (120 mg/d) for several months for a history of heroin use; thus, acute opiate withdrawal syndrome secondary to naltrexone treatment was diagnosed. Because electrocardiography showed diffuse ST-segment elevation, a transthoracic echocardiography was performed. It revealed apical akinesia of the left ventricle with a reduction in systolic function. The echocardiogram showed an ejection fraction of 35%, apical and midventricular wall motion abnormalities of the left ventricle, and a cardiac output of 4 ...

FAST scan in the diagnosis of acute diaphragmatic rupture

The American Journal of Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

Focused assessment with sonography in trauma (FAST) scan can be used by emergency physicians in the diagnosis of diaphragmatic rupture in blunt abdominal trauma. We introduce a new feature ‘Rip’s absent organ sign’ on FAST scan in the diagnosis of acute diaphragmatic rupture. (Source: The American Journal of Emergency Medicine)

Reversible Leukoencephalopathy Syndrome

The American Journal of Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

We present a case demonstrating such prolific changes throughout the brain stressing on the need for early appropriate use of radiodiagnostics. (Source: The American Journal of Emergency Medicine)

Novel method for detecting brain abnormality in a patient with epidural hematoma: a case report

The American Journal of Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

We report a novel method of identifying brain abnormality in a patient with a normal neurological examination result using a bedside handheld automated electroencephalogram device. (Source: The American Journal of Emergency Medicine)

Fatal posterior sternoclavicular joint dislocation due to occult trauma

The American Journal of Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

We present an unprecedented case of a 16-year-old boy without any initial history or signs of trauma who died of a brachiocephalic vein laceration secondary to an occult PSCJD. The pathophysiology, treatment, and diagnosis of PSCJD are discussed. (Source: The American Journal of Emergency Medicine)

Prehospital physician management of pericardial tamponade due to penetrating trauma

The American Journal of Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

Dr Barthélémy and colleagues' interesting case report demonstrates the importance of the identification of pericardial tamponade, the utility of ultrasound, and the possibility of excellent outcome in patients with tamponade due to a right ventricular stab wound who receive timely surgical intervention . (Source: The American Journal of Emergency Medicine)

Pitfalls in salicylate toxicity

The American Journal of Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

We read with great interest the report by Drs Herres, Ryan, and Salzman entitled “Delayed Salicylate Toxicity With Undetectable Initial Levels After Large-dose Aspirin Ingestion” . The authors have uncovered many of the pitfalls that have plagued treatment of aspirin-poisoned patients and make it such a difficult ingestion to treat appropriately. It also brings home the point that salicylate intoxication, like acetaminophen, may seem relatively innocuous in the face of worsening toxicity. (Source: The American Journal of Emergency Medicine)

The loading dose of clopidogrel in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty

The American Journal of Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

Dangas et al reported that in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) with contemporary anticoagulation regimens, a 600-mg loading dose of clopidogrel may safely reduce 30-day ischemic adverse event rates compared with a 300-mg loading dose. Although the higher dose demonstrated better 30-day clinical outcomes in multivariable and propensity score analysis, the emphasis should be put on whether the statistic advantages were mainly present in higher risk groups in this setting. (Source: The American Journal of Emergency Medicine)

Stroke registry: hemorrhagic vs ischemic strokes

The American Journal of Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

Conclusion: There were a much greater percentage of hemorrhagic strokes in this population than would have been predicted from previous studies. This finding may be due to improvement of CT scan availability and implementation unmasking a previous underestimation of the actual percentage or to an increase in therapeutic use of antiplatelet agents and warfarin causing an increase in the incidence of hemorrhage. (Source: The American Journal of Emergency Medicine)

Practice variation in the management for nontraumatic pediatric patients in the ED

The American Journal of Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

Conclusion: Emergency physicians spent more time and medical resources and admitted patients at a higher rate. Emergency physicians and pediatricians managed critical patients similarly. (Source: The American Journal of Emergency Medicine)

Iatrogenic water intoxication after pelvic ultrasonography imaging

The American Journal of Emergency Medicine — Mon, 08 Feb 2010 00:00:00 +0100

This report describes water poisoning in 3 patients with no hepatic, cardiac, or renal disease. Both patients had a history of excessive fluid intake. (Source: The American Journal of Emergency Medicine)

Electrocardiographic differential diagnosis of narrow QRS complex tachycardia: an ED-oriented algorithmic approach

The American Journal of Emergency Medicine — Mon, 08 Feb 2010 00:00:00 +0100

Abstract: The differentiation of narrow complex tachycardias is a common diagnostic conundrum encountered by emergency physicians. Although a number of published algorithms are available to assist the clinician in evaluating features of the 12-lead electrocardiogram (ECG), many of these are too cumbersome, requiring multiple decisions and introducing treatment suggestions within the diagnostic framework. To optimize the diagnosis of the narrow complex tachycardia, we propose 3 separate algorithms tailored to address varying levels of available clinical information. The static algorithm depends only on the 12-lead ECG without the benefit of historical data or diagnostic interventions. The comparative algorithm requires a baseline ECG to which the presenting ECG is compared. The dynamic algo...

Electrocardiographic manifestations of cardiac infectious-inflammatory disorders

The American Journal of Emergency Medicine — Mon, 08 Feb 2010 00:00:00 +0100

Abstract: Inflammatory disorders of the heart, although uncommon in the general population, often present initially to the emergency department. Symptoms and clinical manifestations are shared with other more common cardiopulmonary diseases, particularly acute coronary syndrome and congestive heart failure, making prompt diagnosis challenging. This review will highlight some of the clinical and electrocardiographic features that will help early diagnosis and differentiation of inflammatory cardiac disorders from other more common conditions. (Source: The American Journal of Emergency Medicine)

Intravenous tissue plasminogen activator and stroke in the elderly

The American Journal of Emergency Medicine — Mon, 08 Feb 2010 00:00:00 +0100

Conclusions: These data highlight the need to clarify the risk-benefit profile of IV tPA in ischemic stroke victims who are older than 80 years. (Source: The American Journal of Emergency Medicine)

Prospective comparison of emergency physician–performed venous ultrasound and CT venography for deep venous thrombosis

The American Journal of Emergency Medicine — Mon, 08 Feb 2010 00:00:00 +0100

Conclusions: Emergency physician–performed ultrasound produces results consistent with CTV in the diagnosis of femoropopliteal DVT. More proximal clots are not evaluated with EPPU and thus may result in a false negative. (Source: The American Journal of Emergency Medicine)

Aspirin administration in ED patients who presented with undifferentiated chest pain: age, race, and sex effects

The American Journal of Emergency Medicine — Mon, 08 Feb 2010 00:00:00 +0100

Conclusion: For patients with undifferentiated chest pain, overall race, sex, and age differences were explained by higher rates of aspirin administered to older men with non-ACS chest pain. (Source: The American Journal of Emergency Medicine)

Factors associated with sustained return of spontaneous circulation in children after out-of-hospital cardiac arrest of noncardiac origin

The American Journal of Emergency Medicine — Mon, 08 Feb 2010 00:00:00 +0100

Conclusions: Few children with noncardiac OHCA present with shockable cardiac rhythms. Furthermore, long-term ROSC is difficult to maintain in children who receive in-hospital CPR for more than 20 minutes. (Source: The American Journal of Emergency Medicine)

ED overcrowding is associated with an increased frequency of medication errors

The American Journal of Emergency Medicine — Mon, 08 Feb 2010 00:00:00 +0100

Conclusions: We identified an increased frequency of medication errors in our ED with increased crowding as measured with a real-time modified EDWIN score. (Source: The American Journal of Emergency Medicine)

Guide for Authors

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

(Source: The American Journal of Emergency Medicine)

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

(Source: The American Journal of Emergency Medicine)

Editorial Board

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

(Source: The American Journal of Emergency Medicine)

Child presenting to the ED with prolonged autonomic symptoms followed by generalized seizure activity

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

A 5-year-old girl presented to the emergency department (ED) with a parental complaint of vomiting and seizure-like activity. The patient had been in her normal state of health before the onset of this activity and had had no recent illnesses. Shortly after the child had gone to bed, she awoke complaining of feeling sick to her stomach. Over several minutes the child became less responsive to questioning, followed by rightward eye and head deviation and vomiting. Following this, the child's eyes remained fixed in a rightward gaze and she was no longer responsive to questioning despite appearing awake. On the way to the hospital the child became flaccid, which was shortly followed by further vomiting and right upper extremity jerking and finally full upper extremity convulsive activity. In ...

Postpartum appendicitis manifesting as umbilical purulence

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

We describe an unusual case of postpartum appendicitis complicated by appendiceal rupture, abscess formation, and enterocutaneous umbilical drainage. (Source: The American Journal of Emergency Medicine)

Case report and review: Potts disease and epididymal tuberculosis presenting as back pain and scrotal mass

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

We present the case of a man who presented to the emergency department with a history of acute on chronic back pain and an incidental scrotal mass. He was subsequently diagnosed with tuberculosis spondylitis (Potts disease) and epididymal tuberculosis. The epidemiology, clinical presentation, diagnosis, and treatment of tuberculosis spondylitis are discussed. (Source: The American Journal of Emergency Medicine)

Queer consequence of cough: atrial myxoma embolization with acute occlusion of the abdominal aorta

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

We introduce a rare case of sudden paraplegia preceded by vigorous coughing. This case demonstrates that detachment of a myxoma fragment can possibly be triggered by an abrupt increase in intrathoracic pressure. It is a potential complication that has never been reported in the literature. This case illustrates that clinicians should consider cardiac myxoma in a patient with an embolic event of ambiguous etiology, especially when the event is preceded by a forceful, valsalva maneuver-like action. (Source: The American Journal of Emergency Medicine)

Necrotizing fasciitis causing severe myocardial dysfunction with ST-segment elevation in a young man

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

We report on a 30-year-old-man with history of intramuscular injection resulted in gluteal abscess that progressed to necrotizing fasciitis. On admission, the patient developed circulatory collapse, severe left ventricular dysfunction, and ST-segment elevation in the inferior leads. Wound and blood cultures indicated staphylococcal infection. The clinical, laboratory, echocardiographic, and electrocardiographic features are discussed. (Source: The American Journal of Emergency Medicine)

Management of a severe carbamazepine overdose with continuous venovenous hemodiafiltration

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

Carbamazepine (CBZ) is a commonly used antiepileptic agent. Common toxic effects include neurological abnormalities; ataxia, seizures, coma, cardiorespiratory problems; dysrhythmias; conduction disorders; respiratory depression; and eye abnormalities, such as nystagmus and ophthalmoplegia. Carbamazepine is highly protein bound. There is no antidote for the medication. Carbamazepine is not removed effectively through conventional hemodialysis. Supportive measures and charcoal hemoperfusion have been regarded as efficient treatment methods. We herein report a 17-year-old girl to whom continuous venovenous hemodiafiltration lacking the albumin-enhance after suicidal overdose of CBZ was performed. We suggest continuous venovenous hemodiafiltration lacking the albumin-enhance as an alternative ...

Spontaneous diaphragmatic rupture complicated with perforation of the stomach during Pilates

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

We report the case of a 29-year-old woman who presented to the emergency department (ED) with pain in the epigastric area that started 1 day before visiting the ED during deep breathing in Pilates. The radiography and computed tomography of her chest demonstrated a left diaphragmatic rupture complicated with the perforation of viscera. She immediately underwent left thoracotomy. In addition, primary repair of the diaphragm and stomach was performed. On the basis of our findings, we conclude that spontaneous DR may be caused by a static sport activity, such as Pilates, causing a serious life-threatening condition. (Source: The American Journal of Emergency Medicine)

Atropine aggravates signs and symptoms of Takotsubo cardiomyopathy

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

We present a novel case of Takotsubo cardiomyopathy, associated with worsening chest pain and T-wave inversions on electrocardiogram after atropine use. Our patient was an 82-year-old woman who complained of substernal chest discomfort of 5 hours duration. Atropine 0.5 mg was administered intravenously by the emergency medical service for symptomatic bradycardia. The patient subsequently complained of worsening chest pain and developed new T-wave inversions on the electrocardiogram. Cardiac catheterization was diagnostic and revealed normal coronary arteries but akinesis of the apical segment. Although the pathogenesis of Takotsubo cardiomyopathy is not completely understood, catecholamine-mediated myocardial stunning due to enhanced sympathetic activity is the most widely accepted underly...

Prolonged and profound therapeutic hypothermia for the treatment of “brain death” after a suicidal intoxication. Challenging conventional wisdoms

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

Therapeutic hypothermia has been reported to improve the neurologic outcome of comatose survivors of out-of-hospital cardiac arrest. The use of therapeutic hypothermia in patients who have had an acute ischemic-hypoxic brain injury after a suicidal intoxication has not been previously reported. (Source: The American Journal of Emergency Medicine)

Prinzmetal-variant angina in a patient using zolmitriptan and citalopram

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

We report a case of 48-year-old woman presenting with chest pain and diffuse ST-segment elevation on electrocardiography during an episode of angina, while she was taking zolmitriptan 5 mg/d and citalopram 20 mg/d for migraine and depression, respectively. Coronary angiography (performed because of prolonged angina and presence of diffuse ST-segment elevation on electrocardiography) revealed that diffuse narrowing of left anterior descending coronary artery alleviated after intracoronary nitrate therapy. The most likely cause of myocardial infarction was coronary artery spasm because of the possible increased serotonergic activity secondary to concomitant use of zolmitriptan and citalopram. (Source: The American Journal of Emergency Medicine)

Hyaluronidase for the management of dextrose extravasation

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

Abstract: Intravenous catheter malfunction causing extravasation is a common occurrence in the emergency department (ED). A 17-year-old girl who had a syncopal episode was given an ampule of dextrose 50% water into her antecubital region by emergency medical services. During her evaluation at the ED, she developed erythema and swelling in the antecubital region where the dextrose was given and extravasation was suspected. Most extravasations have relatively minor sequelae, but once an extravasation has occurred, damage can continue for months and involve nerves, tendons, and joints. If treatment is delayed, surgical debridement, skin grafting, and even amputation have been reported in literature. Hyaluronidase is a parenteral protein enzyme traditionally derived from bovine testicular tiss...

Cardiogenic shock associated with reversible dilated cardiomyopathy during therapy with regular doses of venlafaxine

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

We report a cardiac complication in a patient treated with regular doses of venlafaxine. A 49-year-old man with prior normal cardiac function and stable chronic hepatitis C was treated for a major depressive disorder with usual doses of venlafaxine during an 8-month period until the occurrence of a cardiogenic shock in a context of dilated cardiomyopathy. Three months after withdrawal of the drug, the left ventricular ejection fraction returned to normal values. Cardiomyopathy is a rare complication with high doses of venlafaxine that was not previously reported in patients free of prior cardiac disease and cardiomyopathy and treated with usual doses (initially 150 mg daily; after 3 months, 75 mg daily). An objective assessment revealed that venlafaxine was probably implied in the subseque...

Ultrasound identification of traumatic pneumobilia

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

A 65-year-old woman presented to the emergency department with low back pain after being hit by a truck at low speed. Although her abdominal examination showed benign results, an extended Focused Assessment With Sonography in Trauma ultrasound examination was performed and incidentally demonstrated evidence of pneumobilia. There were no additional intra-abdominal injuries noted. Subsequent computed tomography and magnetic resonance cholangiopancreatography confirmed these findings. The etiology of traumatic pneumobilia is discussed with a brief review of the literature on the subject. (Source: The American Journal of Emergency Medicine)

Acute multiple organ failure with imidacloprid and alcohol ingestion

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

Imidacloprid [1-(6-chloro-3-pyridylmethyl)-N-nitroimidazolidin-2-ylideneamine] belongs to a relatively new class of insecticidal chemistry, the chloronicotinyl neonicotinoid compounds. Animal studies indicate relatively low toxicity to mammals due to nicotinic receptor resistance. Human poisoning is usually mild, and reports are quite limited. Here, we report a case of ingestion of alcohol with an insecticide containing imidacloprid. Clinical manifestation included mild disorientation, followed by bradycardia, ventricular arrhythmia, and cardiopulmonary arrest. Acute multiple organ failure, including oliguric kidney injury, acute lung injury, hypotension, and metabolic acidosis developed within hours of ingestion. Renal replacement therapy, including intermittent hemodialysis and continuou...

Acute deep vein thrombus due to May-Thurner syndrome

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

A 63-year-old white woman with a history of hypertension, hyperlipidemia, hypothyroidism, and transient ischemic attack, on Premarin, presented with a 2-week history of worsening edema and pain on the left side of the lower extremity associated with purplish discoloration and decreased temperature after a prolonged car travel. Physical examination revealed 2+ edema from the midthigh to the toes associated with purpuric discoloration. All arterial pulses were 4+. Ultrasound examination demonstrated an acute deep vein thrombus extending from the external iliac veins down throughout the visualized veins of the left calf. The patient was started on intravenous heparin and underwent venogram with subsequent thrombolysis. After 48 hours of alteplase infusion, balloon angioplasty was performed an...

Penetrating neck trauma causing tracheal rupture, spinal cord injury, and massive pneumocephalus

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

We describe a case in which tracheal, esophageal, and spinal cord injuries associated with massive pneumocephalus were caused by a flying chainsaw segment. To our knowledge, this is the first such case reported in the medical literature. The management challenges inherent in this exceedingly rare combination of injuries are discussed, and a novel theory explaining the possible pathophysiological mechanism that led to pneumocephalus in our patient is put forth. (Source: The American Journal of Emergency Medicine)

Special considerations apply when Streptococcus bovis is the culprit pathogen

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

The subsequent management of splenic abscess that has fully resolved on antibiotic treatment depends on the identity of the culprit pathogen. Due to the association of Streptococcus bovis with colorectal neoplasm , when this organism is the culprit pathogen either in splenic or in hepatic abscess , this observation mandates a subsequent search for underlying colorectal neoplasm, the latter requiring surgical treatment in its own right even if the abscess, be it in spleen or liver , has fully resolved. In the context of hepatic abscess, vigilance for underlying colorectal cancer is required even when other microbial agents are identified as culprit pathogens because of the association of silent underlying colon cancer and hepatic abscess attributable to a wide variety of pathogens . Diagnos...

Caveats in preexcitation-related atrial fibrillation

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

Although ventricular rates of the order of 190 beats/min or more are highly specific for atrial fibrillation (AF) attributable to Wolff-Parkinson-White (WPW) syndrome, the caveat is that ventricular rates of 160 to 190 beats/min can also occur in WPW-related AF , and at the lower end of this range, WPW-related AF has to be distinguished from AF occurring in patients with preexisting bundle branch block, given the fact that AF, in its own right, can generate ventricular rates of the order of 159 beats/min (SD, 16), sometimes blurring the distinction between irregularity and regularity of the ventricular rate . The consequence of the latter phenomenon may be a misclassification of AF as reentrant supraventricular tachycardia, and this is true not only of AF patients with narrow-complex QRS c...

In response to ….

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

We thank ⁎⁎⁎ for their insightful comments on our article concerning the diagnosis and management of preexcitation in the emergency department . We would like to clarify the following points: (Source: The American Journal of Emergency Medicine)

The impact of H1N1 influenza A virus pandemic on the emergency medical service in Kobe

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

Pandemic H1N1 2009 influenza virus infection has been identified as the cause of a widespread outbreak of febrile respiratory tract infection. On June 11, 2009, the World Health Organization raised its pandemic alert to the highest level, phase 6. (Source: The American Journal of Emergency Medicine)

Treatment of exertional heat injuries with portable body cooling unit in a mass endurance event

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

We report the use of a field-deployed BCU in cooling hyperthermic patients from a half marathon (21-km run). (Source: The American Journal of Emergency Medicine)

Early goal-directed therapy: on terminal life support?

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

Abstract: Early goal-directed therapy (EGDT) has become regarded as the standard of care for the management of patients with severe sepsis and septic shock. The elements of EGDT have been bundled together as the “Sepsis Bundle,” and compliance with the elements of the bundle is frequently used as an indicator of the quality of care delivered. The major elements of EGDT include fluid resuscitation to achieve a central venous pressure of 8 to 12 cm of water, followed by the transfusion of packed red cells or an inotropic agent to maintain the central venous oxygen saturation higher than 70%. Although the concept of early resuscitation is a scientifically sound concept, we believe that the major elements of the sepsis bundle are fatally flawed. (Source: The American Journal of Emergency M...

Routine testing in patients with asymptomatic elevated blood pressure in the ED

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

Abstract: Study Objective: There are no clear recommendations for the diagnostic evaluation of patients who present to the emergency department (ED) with asymptomatic elevated blood pressure. In patients presenting with asymptomatic elevated blood pressure in the ED, we measured the prevalence of abnormalities on a basic metabolic profile (BMP) that led to hospital admission as well as the prevalence of diminished renal function.Methods: This is a cross-sectional study at 2 urban teaching EDs with a largely African American population. Adult patients (≥18 years) with a triage diastolic blood pressure (BP) 100 mm Hg or higher and without symptoms suggestive of acute end-organ damage were enrolled. All patients had a BMP sent. The primary outcome measured was abnormalities on the BMP that ...

Increased rate of central venous catheterization procedures in community EDs

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

Conclusion: The overall rate of CVC increased from 2004 to 2008. However, there was a wide variation among Eds, and the CVC rate was lower in rural compared with urban EDs. The increase in CVC use in urban EDs may reflect more intensive therapy in the management of ED patients with acute illness or injury. Future efforts are needed to optimize best practices for the use of CVC in community ED practices and to characterize factors responsible for urban rural differences in the rate of CVC procedures. (Source: The American Journal of Emergency Medicine)

Outcomes from low versus high-flow cardiopulmonary resuscitation in a swine model of cardiac arrest

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

Conclusion: High-flow CPR significantly improved arrest hemodynamics, rates of ROSC, and post-ROSC indicators of myocardial status, all indicating less injury with higher flows. No evidence of organ injury from vital organ blood flow substantially above the threshold for ROSC was found. (Source: The American Journal of Emergency Medicine)

Significance of left circumflex artery-related acute myocardial infarction without ST-T changes

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

Conclusion: The relatively lower prevalence of LC-related AMI without ST-T changes in the study might be underestimated. These patients have smaller infarct size than patients with ST-T changes without differences in the short- and long-term outcomes between them. (Source: The American Journal of Emergency Medicine)

Masthead

The American Journal of Emergency Medicine — Mon, 01 Feb 2010 00:00:00 +0100

(Source: The American Journal of Emergency Medicine)

Injury patterns related to ultralight aircraft crashes

The American Journal of Emergency Medicine — Mon, 25 Jan 2010 00:00:00 +0100

This study was undertaken to catalogue the injury patterns, surgical procedures, and complications of patients involved in ultralight crashes in southwest Michigan.Basic procedures: The trauma registry at Bronson Methodist Hospital was used to retrospectively identify all ultralight crashes between 1983 and 2006. All patients who survived to the hospital were included in the study.Main findings: Seventeen patients were identified, all males with a mean age of 48.5 years. Mean injury severity score was 23, with all patients sustaining multiple injuries. Mortality was 17%. Lower extremity fractures were most common, followed by head/neck/facial injuries. Orthopedic extremity procedures were most commonly performed.Principal conclusions: Ultralight crashes result in complex high-energy injury...

Patient population and factors determining length of stay in adult ED of a Turkish University Medical Center

The American Journal of Emergency Medicine — Mon, 25 Jan 2010 00:00:00 +0100

This study is designed to analyze retrospectively patients who present to adult emergency department (ED) from January 1, 2002, to February 28, 2002. Age, sex, presentation time to ED, length of stay in emergency service, consultations, the number of patients who need to be hospitalized and also the number of hospitalized patients, diagnosis categories, and discharge instructions are analyzed. It is found that patients in most admissions are at 21 to 25 years of age. At night, the number of visits is decreased. Hospitalizations could be done to only about half of patients who in fact should be hospitalized. There is a correlation between the length of stay of patients in emergency service and the number of consultations per patient. There is also a correlation between patient complexity an...

What is the optimal dose of epinephrine during cardiopulmonary resuscitation in a rat model?

The American Journal of Emergency Medicine — Mon, 25 Jan 2010 00:00:00 +0100

Conclusion: Different doses of epinephrine produced the similar rate of ROSC, but high-dose epinephrine inhibited the recovery of spontaneous ventilation and caused relative bradycardia after CPR in an asphyxial rat model. Therefore, low and medium doses of epinephrine were more optimal for CPR in a rat asphyxial cardiac arrest model. (Source: The American Journal of Emergency Medicine)

Agreement on sedation-related events between a procedural sedation registry and computerized medical records

The American Journal of Emergency Medicine — Mon, 25 Jan 2010 00:00:00 +0100

Conclusion: When compared to the RD, the accuracy of the PSQAR was very good. However, the accuracy of the CMR, including both nursing and physician documentation, was poor and there was poor agreement between them. This has implications for chart review–based research and quality improvement. (Source: The American Journal of Emergency Medicine)

Information for Authors

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:19 +0100

(Source: The American Journal of Emergency Medicine)

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:18 +0100

(Source: The American Journal of Emergency Medicine)

Editorial Board

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:18 +0100

(Source: The American Journal of Emergency Medicine)

Leukocoria and irregular pupil

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:18 +0100

Early detection and recognition of retinoblastoma, a rare but life-threatening malignancy, are strongly correlated with increased patient survival. Therefore, it is important for the emergency physician to recognize this condition. (Source: The American Journal of Emergency Medicine)

Dimerized plasmin fragment D: a reliable biomarker for diagnosing aortic dissection?

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:18 +0100

Acute aortic dissection (AAD) is an important differential diagnosis in the early management of acute chest pain syndrome. Early recognition and treatment are crucial and will lead to a better survival. However, bedside evaluations including the symptoms, signs, or laboratory tests are all not sensitive [Arch Intern Med. 2000; 160(19):2977-2982]. Advanced diagnostic tools, such as contrast-enhanced computed tomography, transesophageal echocardiography, and magnetic resonance imaging, are usually time- and cost-consuming and not readily available in the emergency department [Arch Intern Med. 2006;166(13):1350-1356]. In recent years, the dimerized plasmin fragment D (d-dimer) test has been largely reported as a useful diagnostic biomarker with 100% sensitivity in AAD [J Am Coll Cardiol. 2004...

Soccer player whiplash maculopathy

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:18 +0100

A 17-year-old girl experienced a head-to-head collision on the soccer field and presented several hours later with central vision loss. Eye examination findings revealed macular edema consistent with whiplash maculopathy. Symptom resolution required 3 months with no intervention necessary. Whiplash maculopathy is a little-known disease pathology in which the proposed mechanism of action involves traction on the eye's vitreous base. Rapid acceleration and deceleration forces cause focal areas of detachment at the retinal pigment epithelial junction and thus result in visual loss. (Source: The American Journal of Emergency Medicine)

Assessing response to changing plasma/red cell ratios in a bleeding trauma patient

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:18 +0100

We report the case of a single patient who required massive transfusion after suffering a single gunshot wound. Initially, the patient received FFP:PRBC in 1:2 ratio, but this did not correct laboratory parameters except for INR and clotting factor VII level, which were likely normalized by treatment with recombinant activated factor VII. After receiving FFP:PRBC in a 4:5 ratio, he continued to bleed and his coagulation profile showed no appreciable improvement. In the final phase, he received FFP:PRBC in a 7:5 ratio and his laboratory parameters of coagulopathy normalized, except for factor V level which was improved. He also clinically stopped bleeding. (Source: The American Journal of Emergency Medicine)

Axillary artery transection after recurrent anterior shoulder dislocation

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:18 +0100

We present 2 such patients. The first, a 62-year-old man, presented with acute ischemia and a large hematoma in the axilla and chest wall. The second, a 63-year-old man, had a pseudoaneurysm and palpable peripheral pulses. Both underwent urgent computed tomography, which confirmed the clinical diagnosis, and the patients were taken to the operating room. In the first patient, intraoperative angiogram through both the brachial and the femoral route showed complete disruption of the axillary artery rendering an endovascular approach not possible. Proximal balloon occlusion was then undertaken through the femoral artery, controlling the bleeding and allowing easier dissection of the ruptured segment. Revascularization was performed with an interposition polytetrafluoroethylene (PTFE) bypass r...

Medial wall fracture- induced pneumo-orbita mimicking inferior rectus entrapment

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:18 +0100

Abstract: The authors report 2 patients who experienced medial wall blowout fractures. Both patients presented with significant restriction of upgaze, mild proptosis, and crepitus of the upper lid. Computed tomography revealed significant pneumo-orbita filling the superior orbit with inferior displacement of the muscle cone and subcutaneous emphysema. No floor fractures were seen in either patient, but in both cases, the medial wall was breached and was almost certainly the source of the intraorbital air. Patients were managed conservatively, and the vertical gaze deficiencies resolved after 3 to 5 days. Large amounts of intraorbital and extraorbital air in the absence of a floor fracture can imitate inferior rectus entrapment and could potentially lead to unnecessary surgical intervention...

Acute gastric volvulus: a rare but real surgical emergency

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:17 +0100

We report a case of acute gastric volvulus secondary to a paraesophageal hernia that presented with acute abdominal pain and fullness and had an unfavorable outcome. This should remind all ED physicians to maintain a high index of suspicion for this disease when treating patients with acute abdominal pain and to seek immediate surgical intervention once diagnosed. (Source: The American Journal of Emergency Medicine)

Actinomycosis osteomylelitis of the mandible

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:17 +0100

A 44-year-old man presented to the emergency department with jaw pain and swelling. He was found to have osteomyelitis of the mandible caused by Actinomyces species. Although rare, actinomycosis of the head and neck is treatable and curable and should not be forgotten on the differential diagnosis list in the typical patient population with appropriate symptoms. (Source: The American Journal of Emergency Medicine)

Rapid diagnosis of jejunojejunal intussusception by an emergency physician–performed bedside ultrasound

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:17 +0100

We report a 79-year-old man who presented to the emergency department with epigastric pain and bilious vomiting for 2 days. Shortly after his arrival, the diagnosis of jejunojejunal intussusception was made with bedside ultrasound performed by the emergency physician. The case demonstrated that early diagnosis of adult intussusceptions in the emergency department is possible by using a bedside ultrasound. (Source: The American Journal of Emergency Medicine)

Intravenous thrombolysis in a patient with known cavernous malformation: a first case report

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:17 +0100

Abstract The presence of a cerebral cavernous malformation (CM) is generally not regarded as an exclusion criterion to the use of intravenous tissue plasminogen activator (tPA). However, there is a conceivable risk of hemorrhaging with an intracerebral CM, which may dissuade clinicians from treating stroke patients with systemic tPA in the presence of a CM. The case of a 79-year-old man with acute ischemic stroke treated with systemic tPA in the setting of known CM is presented. The patient tolerated intravenous thrombolysis well and remained clinically stable throughout the observation period. This is the first reported case (to our knowledge) supporting the notion that systemic thrombolysis is safe in presence of a previously clinically silent CM. (Source: The American Journal of Emerge...

Management of foreign body in esophagus with rigid bronchoscopy

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:17 +0100

Ingestion of a sharp foreign body can lead to esophageal perforation that is related with high comorbidity. To avoid such complications, early and adequate management of these cases is essential. Currently, the most commonly used extraction technique is endoscopy. (Source: The American Journal of Emergency Medicine)

Major ST-segment elevation hiding acute severe pancreatitis

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:17 +0100

A 78-year-old woman presented with abdominal pain in a suspicion of ethanol intoxication. Baseline 12-lead electrocardiogram showed a major ST-segment elevation suggestive of an acute myocardial infarction. Troponin I was 6.6 ng/mL. Transthoracic echocardiography found normal left ventricular ejection fraction, with no wall motion abnormality or pericardial effusion. Then, amylase and lipase serum levels were 1199 and 3873 IU, respectively, and primary coronary angiography was cancelled. At 48 hours, abdominal CT scan confirmed the diagnosis of severe acute pancreatitis. At 8 days, electrocardiogram showed inverted T waves without Q wave. Delayed cardiac magnetic resonance imaging showed no signs of myocarditis or ischemic sequelae, normal segmental wall motion, and preserved left ventricu...

Primary torsion of omentum: a rare cause of acute abdomen

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:17 +0100

In this study, a rare case of primary omental torsion was reported. A 20-year-old man presented with right lower quadrant pain and nausea. Physical examination revealed abdominal tenderness in the right iliac fossa, but muscular rigidity was not found. Increased white blood cell count (23,400/mL) was noted in the whole blood count. The patient underwent laparotomy with an initial diagnosis of acute appendicitis. The abdominal exploration revealed a normal appendix and infarcted omentum secondary to torsion on the long axis. The torted and necrotic omentum was resected, and the patient was discharged uneventfully at postoperative second day. Omental tortion should be considered as a possible diagnosis especially when the appendix does not explain the patient's symptoms during the abdominal ...

Hypothermia with extracorporeal membrane oxygenation for sudden cardiac death and submersion

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:16 +0100

A case of successful recovery from cardiopulmonary arrest and submersion is reported. The victim collapsed due to ventricular fibrillation owing to acute coronary syndrome with double coronary vessel occlusion and was found nearly drowned in a hot bathtub. Although he was resuscitated, he had been hypoxic because of aspiration. Two hours after return of spontaneous circulation, he was transferred to our institution with hypoxia. No attempt of cerebral protection was done before admission. Therapeutic hypothermia was initiated with a veno-venous extracorporeal membrane oxygenation system by direct cooling of circulating blood. Not only effective oxygenation but also accurate control of the body temperature during 5 days of hypothermia were obtained. In addition, coronary bailout was success...

Ischemic stroke in trauma patients: investigating the source of embolus

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:16 +0100

We report 2 cases presenting with cerebral infarction after experiencing motor vehicle trauma, which were caused by traumatic carotid artery injuries and managed by different strategies. (Source: The American Journal of Emergency Medicine)

Adult Still disease: worsening inflammatory changes in a 26-year-old woman

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:16 +0100

We report a case of a young female whose diagnosis was delayed until the third physician visit presumably because of unfamiliarity of the disease process. (Source: The American Journal of Emergency Medicine)

Severe reaction to inadvertent intravenous administration of a large dose of norepinephrine

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:16 +0100

We report the first case ever published of norepinephrine overdose. A 43-year-old female patient admitted in the emergency department for abdominal pain inadvertently received an intravenous bolus injection of 16 mg norepinephrine instead of the scheduled antispasmodic drug phloroglucinol. She immediately experienced severe tachycardia, hypertensive crisis, peripheral vasoconstriction, and acute cardiac ischemia. Although the initial symptoms subsided within a few minutes, the patient subsequently developed hypotension, severe pulmonary edema, and right cardiac failure. Symptomatic treatment resulted in complete recovery. The clinical pattern was similar to epinephrine overdose as previously described in the literature. Indeed, although norepinephrine and epinephrine exert different agonis...

Successful treatment of traumatic coronary artery dissection with angiographic stenting

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:16 +0100

Coronary artery injury after blunt chest injury is rare, and traumatic coronary artery dissection is even rarer. A 24-year-old man, who had previously been healthy without risk factors for coronary artery disease, had a motorcycle accident resulting in mandible and left femoral shaft fractures, with only minor chest wall contusion. Operations for interdental wiring of the mandible, left femoral shaft open reduction, and internal fixation with interlocking nails were performed on the third day. Arterial desaturation was noted immediately after extubation in the operation room. The patient was reintubated and transferred to the intensive care unit for further care. An electrocardiogram showed sinus tachycardia and Q wave in precordial leads. A chest x-ray film showed bilateral lung edema, an...

Negative pressure pulmonary hemorrhage induced by a candy

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:16 +0100

We describe a case of negative pressure pulmonary hemorrhage induced by a candy. The patient required short-term ventilation with continuous positive airway pressure (12 cm H2O) by face mask with rapid resolution of clinical and radiological findings. Negative pressure pulmonary edema may present as pulmonary hemorrhage and require positive-pressure ventilatory support for some time. The mechanism for pulmonary hemorrhage associated with negative pressure pulmonary edema is not clear, but disruption of the alveolar-capillary membrane caused by large negative pressure swings is most likely. (Source: The American Journal of Emergency Medicine)

Intraperitoneal versus retroperitoneal air signs in abdominal radiographs

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:16 +0100

We report here a patient with concurrent intraperitoneal and retroperitoneal air signs in supine KUB and emphasize the importance of the implication of retroperitoneal air sign. (Source: The American Journal of Emergency Medicine)

Issues on percutaneous feeding tube replacement

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:15 +0100

I read with interest the publication by Jacobson et al in the recent issue of the journal on confirmatory radiography post-percutaneous feeding tube (PFT) replacement. They highlighted 2 important issues on PFT replacement; the role of radiography and the importance of tract trauma. Overall, they did not show any impact of routine post replacement radiography. Like many other centers, we do not use radiography at all. In our setting, the only time radiography had been used post PFT replacement, tube misplacement was missed. This patient had a balloon-type PFT replacement done in the emergency department and injected contrast was seen entering the small bowel. The position was reported to be correct. It turned out that the balloon part had been inserted through the pylorus resulting in gast...

Response to: “If you see the contusion, there is no pneumothorax”

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:15 +0100

We would like to thank the readers for their insightful comments. We agree that a combination of several sonographic findings and techniques, such as lung sliding, comet tails, lung point, M-mode, power Doppler, and others, may be needed to confidently rule out the presence of a pneumothorax. However, evaluating these combinations was not the objective of our study. Our study was designed to specifically evaluate whether lung sliding is affected by the presence of pulmonary contusions. This question is of interest because many clinicians consider lung sliding the mainstay of the sonographic evaluation of pneumothorax. The clinical problem was briefly addressed by Blaivas and colleagues in 2005, which raised the concern that the presence of pulmonary contusions may affect lung sliding and l...

If you see the contusion, there is no pneumothorax

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:15 +0100

We evaluated with interest the data from the study of Platz et al recently published in the American Journal of Emergency Medicine. We agree with the high sensitivity attributed to chest ultrasonography in the diagnosis of pneumothorax (PNX), greater than that of chest radiography. We however disagree with the idea of a potential loss of accuracy toward diagnosis of PNX in case of pulmonary contusion. Furthermore, we consider incomplete an approach to an ultrasonographic diagnosis of PNX solely based on the presence or absence of lung sliding and that does not consider the presence of lung points (specific of PNX) or of comet tail artifacts (B-lines) . This latter sign, in particular, has the potential of being able to exclude PNX with 100% sensitivity, as B-lines actually originate from t...

McKittrick-Wheelock syndrome: is it really rare?

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:15 +0100

We report 4 cases with this rare syndrome and want to draw attention to this question: is it really rare? (Source: The American Journal of Emergency Medicine)

Pyometra: a potentially lethal differential diagnosis in older women

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:15 +0100

We report 7 cases with pyometra during a 5-year period. Four cases were diagnosed as urinary tract infection (UTI) initially, and pyometra was diagnosed by imaging studies. All had favorable outcomes, but 1 died because of delayed diagnosis. (Source: The American Journal of Emergency Medicine)

Masthead

The American Journal of Emergency Medicine — Tue, 15 Dec 2009 14:13:12 +0100

(Source: The American Journal of Emergency Medicine)

Prescription use and survival among nonagenarians presenting to the ED

The American Journal of Emergency Medicine — Mon, 23 Nov 2009 00:00:00 +0100

Abstract: To characterize prescription medication use and survival effect among nonagenarians with an emergency department (ED) visit, we performed a retrospective chart review for all nonagenarians presenting to the ED in 2002. Data were collected on medication number and category and on survival after discharge. At admission, patients were taking no medications (3.2%), 1 to 4 medications (35%), 5 to 9 medications (51.9%), or at least 10 medications (9.9%); the median number increased by 2 at discharge (P < .001). Among 565 patients dismissed, 6-month survival was 77.8% and 1-year survival was 65.6%. Patients discharged with prescriptions for opioids or other analgesics were more likely to die within 12 months than those discharged without these medications. Patients taking aspirin had a ...

Stercoral perforation of colon: a rare but important mimicker of acute appendicitis

The American Journal of Emergency Medicine — Mon, 23 Nov 2009 00:00:00 +0100

This report concerns an illustrative case of stercoral perforation of sigmoid colon that mimicked acute appendicitis, and correct diagnosis was established preoperatively by computed tomography. (Source: The American Journal of Emergency Medicine)

Celiac artery dissection presenting with abdominal and chest pain

The American Journal of Emergency Medicine — Mon, 23 Nov 2009 00:00:00 +0100

This report describes a male patient with celiac dissection presenting with left upper abdomen and chest pain, which subsided after conservative treatment with antihypertensive agents. (Source: The American Journal of Emergency Medicine)

First report of hypoglycemia secondary to dandelion (Taraxacum officinale) ingestion

The American Journal of Emergency Medicine — Mon, 23 Nov 2009 00:00:00 +0100

Consumption of herbal remedies has become prevalent throughout the world and can be found easily over the counter. Many times, these are exempt from safety controls, and the consumption may cause adverse effects and complications. In this letter, we present a case of hypoglycemia due to the ingestion of dandelion. (Source: The American Journal of Emergency Medicine)

Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures

The American Journal of Emergency Medicine — Wed, 04 Nov 2009 00:00:00 +0100

Conclusions: Ultrasound-guided femoral nerve blocks are feasible to perform in the ED. Significant and sustained decreases in pain scores were achieved with this technique. (Source: The American Journal of Emergency Medicine)

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