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American Journal of Emergency Medicine

Siu Fai Li, Lindsey Edwards, Vincent Nguyen
A 27-year-old man presented with an intentional overdose of concentrated caffeine powder that he bought over the internet. The patient received benzodiazepines and ondansetron for symptomatic treatment when he arrived in the Emergency Department (ED). Subsequently, he developed recurrent supraventricular tachycardia in the ED. The SVT was successfully treated with metoprolol. The patient's caffeine level was >90 mg/L. This is the first known report of treatment of caffeine-induced supraventricular tachycardia with metoprolol...
November 26, 2018: American Journal of Emergency Medicine
Ali Sakhnini, Naiel Bisharat
No abstract text is available yet for this article.
November 26, 2018: American Journal of Emergency Medicine
Buğra İlhan, Halil Doğan, Emine Ayça Şahin, Neşe Karslıoğlu, Özge Koçak
Flakka, as the newest member of the synthetic cathinone group, is a substance with serious cardiovascular, neurological, psychiatric, infectious effects and addictive potential. There are only a few case reports and laboratory studies in the literature and there is no dermatological side effects reported yet. We present the first Stevens-Johnson syndrome/Toxic epidermal necrolysis (SJS/TEN) overlap case after Flakka use.
November 24, 2018: American Journal of Emergency Medicine
Takaaki Mori, Osamu Nomura, Takateru Ihara
Although ultrasound-guided peripheral nerve block (UGPNB) has recently been introduced into pediatric emergency departments (EDs), knowledge of its use is still limited among pediatric emergency physicians. Ultrasound-guided ulnar nerve block (UGUNB) is a form of peripheral nerve block available for controlling the pain caused by phalangeal injuries, but studies of its use in pediatric patients are still scarce. The aim of this case series was to describe the experience of UGUNB use for pediatric phalangeal fractures in a pediatric ED setting...
November 24, 2018: American Journal of Emergency Medicine
Michael Ullo, Andreia Alexander, Gregory Sugalski
No abstract text is available yet for this article.
November 24, 2018: American Journal of Emergency Medicine
Elise Springer, S Barron Frazier, Donald H Arnold, Adam A Vukovic
BACKGROUND: Computed tomography (CT) is frequently used to identify intra-abdominal injuries in children with blunt abdominal trauma (BAT). The Pediatric Emergency Care Applied Research Network (PECARN) proposed a prediction rule to identify children with BAT who are at very low risk for clinically-important intra-abdominal injuries (CIIAI) in whom CT can be avoided. OBJECTIVE: To determine the sensitivity of this prediction rule in identifying patients at very low risk for CIIAI in our pediatric trauma registry...
November 23, 2018: American Journal of Emergency Medicine
Francisco Martín-Rodríguez, Raúl López-Izquierdo, Miguel A Castro Villamor, Iratxe Moro Mangas, Pablo Del Brío Ibáñez, Juan F Delgado Benito, José L Martín Conty, Jesús Álvarez Manzanares, Agustín Mayo-Iscar, Carlos Del Pozo Vegas
BACKGROUND: Prehospital Emergency Medical Services must attend to patients with complex physiopathological situations with little data and in the shortest possible time. The objective of this work was to study lactic acid values and their usefulness in the prehospital setting to help in clinical decision-making. STUDY DESIGN: We conducted a longitudinal prospective, observational study on patients over 18 years of age who, after being evaluated by the Advanced Life Support Unit, were taken to the hospital between April and June 2018...
November 19, 2018: American Journal of Emergency Medicine
Quentin Daffos, Erwin Hansconrad, Patrick Plaisance, Dominique Pateron, Youri Yordanov, Anthony Chauvin
INTRODUCTION: Interest in ultrasonography in emergency medicine has increased in recent years, as reflected by a marked increase in publications on the topic. The aim of this study was to 1) describe and evaluate methodological characteristics of randomized controlled trials (RCTs) evaluating an ultrasound intervention in emergency department and 2) estimate whether the reports adequately described the intervention to allow replication. METHODS: We searched MEDLINE via PubMed for RCTs published in 2015 assessing an ultrasound intervention, regardless of type, that were performed in an emergency department or evaluated in an emergency situation...
November 17, 2018: American Journal of Emergency Medicine
Joseph R Pare, Samara E Pollock, James H Liu, Megan M Leo, Kerrie P Nelson
OBJECTIVES: Ultrasound guided peripheral intravenous catheters (USPIV) are frequently utilized in the Emergency Department (ED) and lead to reduced central venous catheter (CVC) placements. USPIVs, however, are reported to have high failure rates. Our primary objective was to determine the proportion of patients that required CVC after USPIV. Our secondary objective was to determine if classic risk factors for difficult vascular access were predictive of future CVC placement. METHODS: We performed a retrospective review for patients treated at a large academic hospital...
November 17, 2018: American Journal of Emergency Medicine
Ingrid Llovera, Kirsten Loscalzo, Jia Gao, Timmy Li, Martina Brave, Lance Becker, Isabel Barata
OBJECTIVE: We studied the impact four new urgent care centers (UCCs) had on a hospital emergency department (ED) in terms of overall census and proportion of low acuity diagnoses from 2009 to 2016. We hypothesized that low acuity medical problems frequently seen in UCCs would decrease in the ED population. Since Medicaid was not accepted at these UCCs, we also studied the Medicaid vs non-Medicaid discharged populations to see if there were some differences related to access to urgent care...
November 17, 2018: American Journal of Emergency Medicine
Stephen Alerhand, Jeremy M Carter
BACKGROUND: Pericardial tamponade is neither a clinical nor an echocardiographic diagnosis alone. The echocardiogram carries diagnostic value and should be performed when there is suspicion for tamponade based on the history and physical exam. A pericardial effusion uncovered on point-of-care ultrasound (POCUS) may be mistaken for tamponade and thereby lead to inappropriate and invasive management with pericardiocentesis. OBJECTIVE: This narrative review will summarize the echocardiographic findings and associated pathophysiology that support the diagnosis of pericardial tamponade...
November 17, 2018: American Journal of Emergency Medicine
Furkan Ufuk, Muhammed Raşid Aykota
Simple bone cyst (SBC) also known as unicameral bone cyst is a benign, radiolucent bone lesion that is seen commonly in childhood. These lesions are usually found incidentally although pain and swelling can be seen. The most common complication is a pathological fracture, and this is often the cause of presentation. Here, we present a 22-year-old male with right lower quadrant pain due to SBC related pathological fracture of right iliac bone which is mimicking acute appendicitis.
November 17, 2018: American Journal of Emergency Medicine
Nurettin Özgür Doğan, Sevinç Taş Çaylak, Serkan Yılmaz
Mefenamic acid is a fenamate nonsteroidal anti-inflammatory (NSAI) drug, which is used for several years for pain management. However, it has been rarely reported that, mefenamic acid can induce central nervous system toxicity both in toxic doses and therapeutic usage. We report a case of a 27-year-old female who presented to the emergency department (ED) with altered mental status and vomiting. On admission to the ED, she was lethargic and disoriented. Her vital signs were normal and her physical examination was completely normal except dysarthric speech...
November 17, 2018: American Journal of Emergency Medicine
Ting-Yuan Ni, Fu-Yuan Siao, Chun-Wen Chiu, Hsu-Heng Yen
Refractory ventricular fibrillation with cardiac arrest caused by occlusion of the left main coronary artery may rapidly become fatal. In this report, we describe the case of a 70-year-old male who presented to emergency department with chest pain. Electrocardiogram showed ST-segment elevation in leads aVR and aVL and ST-segment depression in leads v3, v4, v5, v6, 2, 3, and aVF. Occlusion of the left main coronary artery was suspected. While waiting for percutaneous coronary intervention, the patient experienced sudden refractory ventricular fibrillation with cardiac arrest...
November 16, 2018: American Journal of Emergency Medicine
Amelia Nelson, Gregory Kelly, Richard Byyny, Catherine Dionne, Candice Preslaski, Kevin Kaucher
INTRODUCTION: Acute ischemic stroke is a leading cause of disability in the United States. Treatment is aimed at reducing impact of cerebral clot burden and life-long disability. Traditional fibrinolytic treatment with recombinant tissue plasminogen activator (tPA) has shown to be effective but at high risk of major bleeding. Multiple studies have evaluated tenecteplase as an alternative to tPA. OBJECTIVE: This review evaluates literature and utility of tenecteplase for treatment of acute ischemic stroke...
November 15, 2018: American Journal of Emergency Medicine
Tao Cheng, Jun-Zhao Liu, Sheng Ye, Zhi-Han Gu, Pan Pan, Yu Cao
No abstract text is available yet for this article.
November 15, 2018: American Journal of Emergency Medicine
Benjamin L Cooper, Jonas A Beyene
Regular, narrow complex tachycardia with a ventricular rate around 150 can be challenging. The differential includes sinus tachycardia, atrioventricular nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT), and atrial tachycardia (focal or macro re-entrant - i.e. flutter). We present a case of a 90-year-old woman presenting with shortness of breath in which the ECG was not diagnostic, but the presence of regular neck pulsations helped secure the diagnosis of AVNRT. In AVNRT, atria and ventricular contractions occur nearly simultaneously...
November 12, 2018: American Journal of Emergency Medicine
Maryam Boumezrag, Sormeh Harounzadeh, Hamza Ijaz, Angeline Johny, Lorna Richards, Yan Ma, Maxine A Le Saux, Paige Kulie, Caitlin Davis, Andrew C Meltzer
STUDY OBJECTIVES: The primary objective of this study was to compare Emergency Department patients with first-time versus recurrent acute pancreatitis. METHODS: This study was a retrospective chart review of patients with a diagnosis of acute pancreatitis who presented to a single academic urban emergency department from 2012 to 2016. Criteria for inclusion were clinical symptoms of pancreatitis, age greater than or equal to 18 years, ED diagnosis of acute pancreatitis, and an abdominal CT scan within 24 h of triage...
November 9, 2018: American Journal of Emergency Medicine
Kelvin L Moore, Shanna Dell, Miles Oliva, Yu-Hsiang Hsieh, Richard E Rothman, Renata Arrington-Sanders
No abstract text is available yet for this article.
November 9, 2018: American Journal of Emergency Medicine
Yohei Hirano, Toshikazu Abe, Hiroshi Tanaka
PURPOSE: The beneficial effect of the presence of an emergency physician in prehospital major trauma care is controversial. The aim in this study is to assess whether an emergency physician on scene can improve survival outcome of critical trauma patients. METHODS: This retrospective cohort study was conducted by using nationwide trauma registry data between 2004 and 2013 in Japan. Severe trauma patients (injury severity score (ISS) ≥ 16) who were transported directly to the hospital from the injury site were included in our analysis...
November 9, 2018: American Journal of Emergency Medicine
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