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Journal of Emergency Medicine

William C Puddy, Lisa A Blankinship, Joshua Bernstein, Basil H Aboul-Enein
Conscientious objectors are typically defined only by their unwillingness to serve in the armed forces. Desmond Doss participated in World War II as a combat medic and a conscientious objector by providing emergency medicine on active battlefields while refusing to handle a weapon or harm another human being. Born and raised with humility, Doss developed spiritually as a Seventh Day Adventist. Although fixated on the Ten Commandments and "Thou shall not kill," Doss felt a call to serve and voluntarily enlisted in the U...
November 12, 2018: Journal of Emergency Medicine
Kun-Yu Lee, Yi-Liang Wu, Sai-Wai Ho
BACKGROUND: The Heimlich maneuver is a simple and universal resuscitative procedure that is performed to relieve foreign-body airway obstruction. We present a case of silent Stanford type A aortic dissection, a rarely reported complication of the Heimlich maneuver. CASE REPORT: A 67-year-old male presented to the emergency department with left-sided hemiplegia shortly after receiving a Heimlich maneuver. Acute ischemic stroke was suspected, and the thrombolytic protocol was initiated...
November 9, 2018: Journal of Emergency Medicine
Tanya Mokhateb-Rafii, Martin Bialer, Shaun Rodgers, Christine Moore, Todd Sweberg
BACKGROUND: RIPPLY2-associated spondylocostal dysostosis is a rare disorder that leads to segmentation defects of the vertebrae. These vertebral defects can result in severe instability of the cervical spine, leading to cardiac arrest after only minor whiplash injury. CASE REPORT: We present the case of a healthy 7-year-old child who experienced an out-of-hospital cardiac arrest. He was reported to have profound respiratory distress and collapsed after going down a slide, without trauma...
November 9, 2018: Journal of Emergency Medicine
Erin E Bennett, Kevin Hummel, Andrew G Smith, Nicola Longo
BACKGROUND: Inborn errors of metabolism (IEM) commonly present in infancy and, less commonly, later in life. CASE REPORT: This case describes an IEM, specifically, ornithine transcarbamylase deficiency, in a previously healthy 7-year-old boy who presented to an emergency department with vomiting for approximately 24 h prior to admission. The child became progressively encephalopathic while in the emergency department, but an ammonia level was not obtained until several hours after admission...
November 9, 2018: Journal of Emergency Medicine
Robert A Trommeter, Clifford L Freeman, Karan S Shah, Jeffry P McKinzie, Austin T Smith
No abstract text is available yet for this article.
November 9, 2018: Journal of Emergency Medicine
Shweta Iyer, Ee Tay, Sofya Maslyanskaya
No abstract text is available yet for this article.
November 9, 2018: Journal of Emergency Medicine
Heidi H Kimberly, Christopher J Nash
No abstract text is available yet for this article.
November 9, 2018: Journal of Emergency Medicine
Katherine R Forrester, Scott M Thomas, Nita K Gupta, Manasa Karumuri, James M Gerard
BACKGROUND: Patients undergoing procedural sedation with intravenous ketamine often receive repeat doses to maintain dissociation; however, data between doses are lacking. OBJECTIVES: The purpose of this study was to characterize the frequency, time interval, and dosages of ketamine received by children undergoing procedural sedation and to explore the effects of age and body mass index on these parameters. METHODS: This was a retrospective study of patients 1 to 18 years of age undergoing procedural sedation with intravenous ketamine in a pediatric emergency department between October 2016 and June 2017...
November 8, 2018: Journal of Emergency Medicine
Victoria L Zhou, Frances S Shofer, Nikita G Desai, Ilona S Lorincz, Nikhil K Mull, David H Adler, John C Greenwood
BACKGROUND: The resuscitation and critical care unit is a novel emergency department-intensive care unit designed to provide early critical care to emergency department patients for ≤24 h. OBJECTIVES: This study sought to identify clinical variables associated with short intensive care unit (ICU) stays in patients with diabetic ketoacidosis (DKA), who commonly require ICU-level care. METHODS: We conducted a retrospective, single-center, cross-sectional study of DKA patients ≥18 years of age who presented to an academic, urban hospital emergency department over 16 months...
November 3, 2018: Journal of Emergency Medicine
Marina N Boushra, Susan N Miller, Alex Koyfman, Brit Long
BACKGROUND: Evaluation and treatment of the acutely ill patient is typically complicated by multiple comorbidities and incomplete medical histories. This is exemplified by patients with sepsis, whose care is complicated by variable presentations, shifting definitions, and a variety of potential sources. Many practitioners fail to consider and recognize less-common sources of infection in a timely manner. Additionally, multiple noninfectious conditions can present with the fever and tachycardia typical of the septic patient...
November 2, 2018: Journal of Emergency Medicine
Sina Mashayekhi, Mojtaba Ziaee, Alireza Garjani, Parvin Sarbakhsh, Samad Ghaffari
No abstract text is available yet for this article.
October 31, 2018: Journal of Emergency Medicine
Robert D Simard, Steve Socransky, Jordan Chenkin
BACKGROUND: Parapharyngeal space abscesses (PPSA) are deep-space neck infections that are associated with significant morbidity and, rarely, mortality if not promptly diagnosed and treated. The diagnosis is often difficult, as the clinical presentation can mimic peritonsillar abscesses (PTA). Transoral point-of-care ultrasound (POCUS) may be a useful tool to help distinguish PTAs from other deep-space infections such as PPSAs. CASE REPORT: A woman presented to the Emergency Department (ED) with fever, sore throat, trismus, and unilateral tonsillar swelling from a walk-in clinic with a preliminary diagnosis of PTA for drainage...
October 31, 2018: Journal of Emergency Medicine
Nathaniel M Miller, Tiffany C Alexander, Austin T Smith
No abstract text is available yet for this article.
October 31, 2018: Journal of Emergency Medicine
W Frank Peacock, Zubaid Rafique, Carol L Clark, Adam J Singer, Stewart Turner, Joseph Miller, Douglas Char, Anthony Lagina, Lane M Smith, Andra L Blomkalns, Jeffrey M Caterino, Mikhail Kosiborod
BACKGROUND: Contemporary emergency department (ED) standard-of-care treatment of hyperkalemia is poorly described. OBJECTIVE: Our aim was to determine the treatment patterns of hyperkalemia management in the ED. METHODS: This multicenter, prospective, observational study evaluated patients aged ≥ 18 years with hyperkalemia (potassium [K+ ] level ≥ 5.5 mmol/L) in the ED from October 25, 2015 to March 30, 2016. K+ -lowering therapies and K+ were documented at 0...
October 31, 2018: Journal of Emergency Medicine
Timothy Baloda, Megan L McBurnie, Theodore E Macnow
BACKGROUND: Pediatric foreign-body ingestions are common. Oral foreign bodies are rare but can be life-threatening. Management of their extraction requires knowledge and careful consideration of removal techniques, pharmacology, and potential complications. CASE REPORT: A 5-year-old boy presented to the emergency department with a wooden block retained in his mouth after a fall. The block was lodged behind the patient's primary central incisors without causing apparent oral or dental trauma...
October 31, 2018: Journal of Emergency Medicine
Erika Moors Cornell, Elizabeth C Powell
BACKGROUND: Fractures are common in children, and it can be difficult to distinguish unintentional injuries from child abuse. OBJECTIVE: We describe circumstances of injury, prevalence of suspicion for physical abuse, and use of imaging to identify additional occult fractures in young children with femur fractures. METHODS: We reviewed the medical records for children younger than 48 months old with femur fractures treated at a pediatric referral hospital (2011-2013)...
October 30, 2018: Journal of Emergency Medicine
Michael V Nguyen
BACKGROUND: The treatment of orbital compartment syndrome has a rich history rooted in surgery and emergency medicine. It is a rare but acute and vision-threatening condition that most commonly occurs secondary to facial trauma or as a postoperative complication, and was first recognized in 1950. Surgical techniques and medical management were developed and refined soon afterwards to eventually become the modern-day treatment, lateral canthotomy, and inferior cantholysis. OBJECTIVE: This article details the history of orbital compartment syndrome and the evolution of its treatment to the present day...
October 30, 2018: Journal of Emergency Medicine
Ashley T Panicker, Kenneth Nugent, Jennifer Mink, Jeffrey Glaser, Kevin Bradley, Franjo Siric, Jason T Nomura
BACKGROUND: Injuries from nail guns are a unique type of penetrating trauma seen in emergency departments (EDs), rising in prevalence in the United States. These devices can lead to life-threatening injuries that require rapid diagnosis to help guide management. CASE REPORT: An elderly man was brought to the ED having sustained a nail gun injury to the chest. After loss of pulses, brief closed chest compressions and rapid blood product administration led to a return of spontaneous circulation...
October 30, 2018: Journal of Emergency Medicine
Itai Shavit, Danielle Shavit, Oren Feldman, Nir Samuel, Anat Ilivitzki, Daniel M Cohen
BACKGROUND: Ileocolic intussusception is a major cause for intestinal obstruction in early childhood. Reduction of intussusception, in the vast majority of institutions, is performed on awake children, without sedation. OBJECTIVE: The aim of this study was to report the course of the first patients who were sedated by emergency physicians for pneumatic reduction of intussusception (PRI). METHODS: We conducted a case series analysis of prospectively collected data on patients undergoing PRI, using a sedation recording tool...
October 30, 2018: Journal of Emergency Medicine
Rachel Harper, John Ludwig, Michael Morcos, Stephen Morris
BACKGROUND: Due to an increasing prevalence of heart failure but a steady rate of heart transplantation, the number of left ventricular assist devices (LVADs) implanted is growing. These patients present to emergency departments (EDs) with a variety of complications from their implanted device as well as their baseline cardiomyopathy. One-third of patients will present with a dysrhythmia, the most common of which is ventricular tachycardia. CASE REPORT: A 77-year-old man with nonischemic cardiomyopathy and HeartMate II LVAD presented with sustained ventricular tachycardia and 43 automatic implantable cardioverter-defibrillator (AICD) discharges...
October 22, 2018: Journal of Emergency Medicine
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