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Source: The American Journal of Emergency Medicine
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Total 261 results found since Jan 2013.
Throwing it in reverse: An update on reversal of oral factor Xa inhibitors
In recent years, the use of oral Factor Xa (FXa) inhibitors such as rivaroxaban and apixaban, have seen more extensive utilization for stroke prevention in non-valvular atrial fibrillation and the prevention/treatment of venous thromboembolisms [1,2]. Some studies have shown a similar bleed risk between FXa inhibitors and warfarin while other studies demonstrated a decreased risk for a bleed with FXa inhibitors. Despite a possible decreased risk, the paucity of data available for treating an acute major bleed due to FXa inhibitors has led some clinicians to shy away from their use.
Source: The American Journal of Emergency Medicine - April 7, 2019 Category: Emergency Medicine Authors: Brian W. Gilbert, Jacob A. Reeder, Mohammed A. Alkhalifah, David A. Moran, Michael A. Corvino Source Type: research
Comparing Pleth variability index (PVI) variation induced by passive leg raising and Trendelenburg position in healthy volunteers
Hypovolemia, which is the main cause of circulatory failure in emergency medical settings, can often be managed by volume expansion [1]. However, the fluid responsiveness (FR) varies between the patients, and volume status of the patient can be evaluated by some predictors. Studies have demonstrated that static hemodynamic measurements (e.g., central venous pressure, mean arterial pressure) were of little value in discriminating between the patients who will or will not respond to volume expansion, and dynamic indices (e.g., arterial pressure wave form, stroke volume) were more accurate in evaluating volume status [1].
Source: The American Journal of Emergency Medicine - May 6, 2019 Category: Emergency Medicine Authors: Osman L ütfi Demirci, Gülşah Çıkrıkçı Işık, Şeref Kerem Çorbacıoğlu, Yunsur Çevik Source Type: research
Tranexamic acid for treatment of pulmonary hemorrhage after tissue plasminogen activator administration for intubated patient
The risk of tPA in the treatment of stroke, is that approximately 5% of patients may have significant intracranial bleeding, increasing mortality to 45%. Use of tPA can also cause other forms of life-threatening bleeding, most commonly gastrointestinal bleeding. In this case review, we discuss the presentation and management of a patient with post-tPA pulmonary hemorrhage and the use of tranexamic acid (TXA) for the cessation of bleeding.
Source: The American Journal of Emergency Medicine - May 13, 2019 Category: Emergency Medicine Authors: Snaha Sanghvi, Anna Van Tuyl, Josh Greenstein, Barry Hahn Source Type: research
A change of heart: Transformation of the electrocardiogram in a patient with apical hypertrophic cardiomyopathy
An asymptomatic 83-year-old man with a history of hypertension, prior stroke with no residual deficits, and bilateral carotid artery stenosis, presented for evaluation prior to cataract surgery. His transthoracic echocardiogram was typical for apical hypertrophic cardiomyopathy (AHCM), and his electrocardiograms (ECG) showed large precordial R-waves and inverted T-waves, previously associated with AHCM, while his ECG 7 years earlier was normal. Mechanistic explanations for the developed ECG abnormalities, and their importance for the detection and monitoring of patients with AHCM are provided.
Source: The American Journal of Emergency Medicine - March 4, 2020 Category: Emergency Medicine Authors: Benjamin Gold, John Madias Source Type: research
Is caval index an appropriate tool for predicting hypovolemia in stroke
We have read with interest the recent article, “Challenge of Intravascular Volume Assessment in Acute Ischemic Stroke” by Miller J.B. et al. [1].
Source: The American Journal of Emergency Medicine - March 11, 2020 Category: Emergency Medicine Authors: Engin Ozakin, Kadir Ugur Mert Source Type: research
COVID-19 infection with extensive thrombosis: A case of phlegmasia cerulea dolens
Reports have been published from multiple countries regarding increased thrombus formation in COVID-19 patients, especially critically ill patients. These include DVT formation as well as pulmonary embolism and stroke. Currently, the exact mechanism as to why COVID-19 patients are at higher risk for thrombotic complications has not been determined. It has been thought to be due to endothelial injury, blood stasis or a hypercoagulable state [1]. To our knowledge this is the first reported case of phlegmasia cerulea dolens in a patient diagnosed with COVID-19.
Source: The American Journal of Emergency Medicine - May 14, 2020 Category: Emergency Medicine Authors: Michael H. Morales, Candace L. Leigh, Erin L. Simon Source Type: research
Priapism in a patient with coronavirus disease 2019 (COVID-19): A case report
Thromboembolic complications related to SARS-CoV-2 have been extensively reported. They include deep vein thrombosis, pulmonary embolism, ischemic stroke, and acute coronary syndrome. Penile thrombosis has not been reported as a thrombotic complication of SARS-CoV-2 infection with hypercoagulability.Here we describe a case of priapism as a thromboembolic complication in a patient with COVID-19 who recovered from acute respiratory distress syndrome (ARDS). We discuss the underlying pathophysiological mechanisms mainly related to an hypercoagulability state.
Source: The American Journal of Emergency Medicine - June 16, 2020 Category: Emergency Medicine Authors: Myriam Lamamri, Ala Chebbi, Jordan Mamane, Sofia Abbad, Milena Munuzzolini, Florence Sarfati, St éphane Legriel Source Type: research
A rare case of thyrotoxicosis and bilateral internal carotid artery dissections
Cervical artery dissection is a rare but important diagnosis to consider in young patients presenting with stroke. Multiple etiologies of cervical artery dissections have been previously reported, but the association with thyrotoxicosis is extremely rare. A previously healthy 43-year-old female presented to the emergency department with new symptoms related to thyrotoxicosis and bilateral internal carotid artery dissections. Her atrial fibrillation and hypertension resolved by treating the underlying hyperthyroidism with methimazole and propranolol.
Source: The American Journal of Emergency Medicine - June 25, 2020 Category: Emergency Medicine Authors: Thomas Winter, Eyal Kraut, Kristjan Thompson Source Type: research
The significance of repetitive yawning in the emergency patient - A warning of imminent death or disability
Premortem yawning is absent from almost all major medical textbooks but has been associated for more than 2000 years with impending death from acute infections and hemorrhage and was commonly known during the Bubonic Plague pandemic [1,2]. Medical reports of premortem yawning identify multiple causes of shock including vasovagal reflex, severe hypoxia/anemia/hypoglycemia, stroke, and intracranial hyperten sion [3-5].
Source: The American Journal of Emergency Medicine - July 2, 2020 Category: Emergency Medicine Authors: Joan E. Rothenberg Tags: Correspondence Source Type: research
A unique presentation of Colovesical fistula
A colovesical fistula (CVF) is a pathological connection between the colon and the urinary bladder. Although they are uncommon, consequences can severely affect quality of life and mortality. Diverticula are the most common cause of CVF. This case details a patient's CVF diagnosis in the emergency department with unremitting gastrointestinal and urinary symptoms.A 78-year-old male patient with recent hospitalization for stroke and left carotid endarterectomy complicated by urinary retention treated with a Foley catheter presented to the Emergency Department with a chief complaint of hematuria and unremitting diarrhea.
Source: The American Journal of Emergency Medicine - August 14, 2020 Category: Emergency Medicine Authors: Michael Li, Jennifer Sadowski, Elizabeth M. Evans, Marna Greenberg Source Type: research
Mucormycosis with orbital compartment syndrome in a patient with COVID-19
AbstractDuring the current pandemic of COVID-19, a myriad of manifestations and complications has emerged and are being reported on. We are discovering patients with COVID-19 are at increased risk of acute cardiac injury, arrythmias, thromboembolic complications (pulmonary embolism and acute stroke), and secondary infection to name a few. I describe a novel case of COVID-19 in a previously healthy 33-year-old female who presented for altered mental status and proptosis. She was ultimately diagnosed with mucormycosis and orbital compartment syndrome, in addition to COVID-19.
Source: The American Journal of Emergency Medicine - September 15, 2020 Category: Emergency Medicine Authors: Amanda Werthman-Ehrenreich Source Type: research
Factors associated with hospitalization for ischemic stroke and TIA following an emergency department headache visit
Misdiagnosis of cerebrovascular disease among Emergency Department (ED) patients with headache has been reported. We hypothesized that markers of substandard diagnostic processes would be associated with subsequently ischemic cerebrovascular events among patients discharged from the ED with a headache diagnosis even after adjusting for demographic variables and medical history.
Source: The American Journal of Emergency Medicine - November 6, 2020 Category: Emergency Medicine Authors: Ava L. Liberman, Jenny Lu, Cuiling Wang, Natalie T. Cheng, Khadean Moncrieffe, Richard B. Lipton Source Type: research
Comments on “Inter-facility transfer for patients with acute large vessel occlusion stroke receiving mechanical thrombectomy.”
We read the recently-published article by Schevin et al. [1] with great interest. We commended the authors for looking into the work flow in Emergency Departments (ED) in patients with acute ischemia from large vessel occlusion (AIS-LVO) to assess where the longest delays to thrombectomy might occur. Unfortunately, this study is significantly underpowered to comment on patient outcomes. In this retrospective study of 95 patients undergoing mechanical thrombectomy (MT), the authors showed that patients' total ED length of stay and successful MT were not associated with good neurological outcome, defined as 90-day modified R...
Source: The American Journal of Emergency Medicine - November 25, 2020 Category: Emergency Medicine Authors: Quincy K. Tran, Nicholas Morris Source Type: research
Case series: Hyperdense basilar artery identified on unenhanced head CT in three cases of pediatric basilar artery occlusion
Acute basilar artery occlusion (BAO) is an easily missed, potentially devastating type of ischemic stroke. Children with BAO can present with a range of clinical symptoms, from headache, dizziness, nausea and/or vomiting [1-3] to profound alterations of consciousness, including locked-in syndrome and coma [2]. Typically in children with BAO, only an unenhanced head Computed Tomography (CT) is initially performed. When an obvious finding is not identified, such as intracranial hemorrhage, the unenhanced CT is rarely carefully further scrutinized by emergency physicians.
Source: The American Journal of Emergency Medicine - November 26, 2020 Category: Emergency Medicine Authors: Jennifer K. Potter, Jonathan D. Clemente, Andrew W. Asimos Source Type: research
Inter- ED transfer for patents with acute large vessel stroke: Efficiency vs thoroughness tradeoff
We thank the authors for their interest and agree that timely intervention for patients with large vessel occlusion (LVO) is associated with improved outcomes. Given the clear importance of timely treatment, the primary exposure we were interested in was the time spent at transferring EDs for patients who were transferred and ultimately received mechanical thrombectomy for LVO.
Source: The American Journal of Emergency Medicine - December 3, 2020 Category: Emergency Medicine Authors: MichaelJ. Ward, Michael Froehler, William L. Scheving, Kimberly Hart, Candace D. McNaughton Source Type: research
