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Polymethylmethacrylate cement pulmonary embolism and infarct
Discussion Pulmonary cement emboli can occur in up to 23% of percutaneous vertebroplasty.1 This procedure is widely used making emergency practitioner recognition of complications important. Most complications are related to leakage of the bone cement into the venous system. Pulmonary migration...
Source: Emergency Medicine Journal - February 13, 2014 Category: Emergency Medicine Authors: Stevens, A. C. Tags: Fractures, Drugs: cardiovascular system, Pain (neurology), Stroke, Venous thromboembolism, Radiology, Pulmonary embolism, Clinical diagnostic tests, Radiology (diagnostics), Ethics, Trauma Images in emergency medicine Source Type: research

Patients with Acute Thoracic Aortic Dissection: A One-Year Case Series of Patients Presenting to an ED
Thoracic dissection is an often fatal disease. Although physicians must have a high level of suspicion for this disorder, up to 38% of patients with dissection do not have it suspected on evaluation, and up to 28% are found on autopsy not to have been correctly diagnosed. Although rare, thoracic aortic dissection is the most common lethal disease affecting the aorta and more common than abdominal aortic aneurysm (AAA) rupture. Mortality can be as high as 1–2% per hour, making quick and accurate diagnosis important. This is made more complex by the various presentations of thoracic dissection, based on area of dissection,...
Source: The Journal of Emergency Medicine - January 23, 2014 Category: Emergency Medicine Authors: D. Salo, F. Fiesseler, K. Baldino, H. Patel Source Type: research

Acute neurology in the emergency department
A 66-year-old woman presented with sudden onset tearing interscapular pain 1 h after gentle neck exercises. Over the next 3 h, she developed flaccid left arm and leg paralysis and a left Horner's syndrome. Her initial CT scan revealed no evidence of cerebral ischaemia or aortic/carotid dissection but did reveal what was thought to be a calcified arteriovenous malformation in the right frontal lobe. Thrombolysis for a presumed acute stroke was considered but not initiated. By 5 h, the patient had lost light touch sensation and proprioception of her left side, and additionally she developed grade 3/5 right-sid...
Source: Emergency Medicine Journal - December 22, 2013 Category: Emergency Medicine Authors: Mertes, S. C. Tags: Eye Diseases, Spinal cord injury, Pain (neurology), Spinal cord, Stroke, Radiology, Clinical diagnostic tests, Radiology (diagnostics), Ethics, Trauma Images in emergency medicine Source Type: research

A patient with altered mental status and possible seizure reveals an atypical aortic dissection upon workup
In this report, we present the case of a 57-year-old woman who was transported to the emergency department with an acute episode of altered mental status, presenting as a possible stroke with possible seizures. The patient's only complaint was mild low back pain. Physical examination revealed disorientation to time with no other neurologic deficits or abnormal findings. Results from initial noncontrast head computed tomography, chest radiograph, and laboratory studies were all normal, except for an elevated d-dimer and serum creatinine. Chest computed tomography with contrast demonstrated a type A aortic dissection. The pa...
Source: The American Journal of Emergency Medicine - November 18, 2013 Category: Emergency Medicine Authors: Olufolahan J. Lawal, Harinder S. Dhindsa, Joshua W. Loyd Tags: Case Reports Source Type: research

Heart rate and systolic blood pressure in patients with minor to moderate, non-haemorrhagic injury versus normal controls
Discussion Median HR remained approximately 10 bpm higher in the TARN (injury) set compared to the HSE (non-injury, control) set, irrespective of age. Understanding that HR reacts in this way for mild to moderately injured patients is important as it will affect clinical interpretation during the initial assessment.
Source: Emergency Medicine Journal - October 18, 2013 Category: Emergency Medicine Authors: Bruijns, S. R., Guly, H. R., Bouamra, O., Lecky, F., Wallis, L. A. Tags: Pain (neurology), Stroke, Hypertension Original article Source Type: research

Clinical research priorities in emergency medicine
ConclusionThe findings provide guidance and support for research areas amenable to collaborative multicentre clinical research within emergency medicine. Discussion rounds are planned to translate these perceived research priorities to actual priorities.
Source: Emergency Medicine Australasia - October 9, 2013 Category: Emergency Medicine Authors: Gerben Keijzers, Ogilvie Thom, David Taylor, Jonathan Knott, Tags: Original Research Source Type: research

Short answer question case series: a dangerous cause of dyspnoea
Case vignette A 52-year-old man with hepatitis C and a remote history of recreational drug abuse presents with several days of shortness of breath, cough and malaise. He was seen at an outside hospital and diagnosed with pneumonia given his cough and shortness of breath. Subsequently, he was seen again and found to have a small abscess of his arm that was drained. On review of systems, he endorses nausea and generalised weakness but denies abdominal pain, chest pain, numbness, fever, headache or dizziness. On physical exam, he is afebrile but tachypnoeic, has decreased breath sounds at the bases, and has an appropriately h...
Source: Emergency Medicine Journal - July 19, 2013 Category: Emergency Medicine Authors: Woodfield, A., Runde, D., Jang, T. Tags: Poisoning/Injestion, Foodborne infections, Hepatitis and other GI infections, Pneumonia (infectious disease), TB and other respiratory infections, Cranial nerves, Headache (including migraine), Pain (neurology), Stroke, Drugs misuse (including addiction), Source Type: research

Functional outcomes and quality of life of young adults who survive out-of-hospital cardiac arrest
Conclusions The majority of survivors have good functional and quality of life outcomes. Telephone follow-up is feasible in the young adult survivors of cardiac arrest; loss to follow-up is common.
Source: Emergency Medicine Journal - June 13, 2013 Category: Emergency Medicine Authors: Deasy, C., Bray, J., Smith, K., Harriss, L., Bernard, S., Cameron, P., on behalf of the VACAR Steering Committee Tags: Editor's choice, Drugs: cardiovascular system, Stroke Original article Source Type: research

The locked-in syndrome: posterior stroke in the ED
We present this report and brief review as it is unusual to watch locked-in syndrome evolve in the ED. Providers should be aware of the presenting symptoms and the differential diagnosis for bulbar muscle weakness as well as the management of posterior stroke.
Source: The American Journal of Emergency Medicine - May 22, 2013 Category: Emergency Medicine Authors: Corey Goldberg, Stephen Topp, Christopher Hopkins Tags: Case Reports Source Type: research

Painless aortic dissection: thrombolytic and antithrombotic vigilance
We thank Huang et al for their interesting article on identification of painless aortic dissection (AD) before thrombolytic treatment for acute ischemic stroke. We would like to emphasize the importance of being vigilant to AD before initiating any contraindicated therapy. We recently had an 84-year-old man with history of atrial fibrillation and transient ischemic attack who presented to the emergency department with acute shortness of breath without chest pain. The symptom contributed to atrial fibrillation with rapid ventricular response. Chest x-ray showed increased soft tissue prominence of the aortic arch suspicious ...
Source: The American Journal of Emergency Medicine - May 20, 2013 Category: Emergency Medicine Authors: Promporn Suksaranjit, Kunatum Prasidthrathsint, Wonngarm Kittanamongkolchai, Supawat Ratanapo, Narat Srivali, Daych Chongnarungsin Tags: Correspondence Source Type: research

Documentation of neurovascular status in supracondylar fractures and the development of an assessment proforma
Conclusions Preoperative documentation of neurovascular status in children with displaced supracondylar fractures was poor. Documentation of AIN examination was particularly poor. The introduction of a proforma (Liverpool upper limb fracture assessment) is proposed to increase documentation of neurovascular assessment and optimise emergency department evaluation of children presenting with upper limb injuries.
Source: Emergency Medicine Journal - May 13, 2013 Category: Emergency Medicine Authors: Mayne, A. I. W., Perry, D. C., Stables, G., Dhotare, S., Bruce, C. E. Tags: Pain (neurology), Stroke Original article Source Type: research

Benedictine hand of 'central' origin
A 67-year-old man was admitted to emergency room to investigate a left hand weakness started on awakening. Anamnesis revealed only a mild hypertension currently treated with ACE-inhibitors. Antigravitary tests in upper limbs showed a ‘benedictine’ hand (figure 1A,B). Sensory examination was unremarkable although the patient complained of nocturnal paraesthesias in left hand. Brain CT scan was negative. Initial diagnosis was ischaemic stroke even if a proximal median nerve injury was mimicked. Nerve conduction study and electromyographic examination of left arm, performed the day after, showed only a ‘mild...
Source: Emergency Medicine Journal - January 24, 2013 Category: Emergency Medicine Authors: Luigetti, M., Ranieri, F., Profice, P., Pilato, F., Capone, F., Di Lazzaro, V. Tags: Workplace injury, Pain (neurology), Stroke, Hypertension, Radiology, Clinical diagnostic tests, Radiology (diagnostics), Ethics, Trauma Images in emergency medicine Source Type: research

Acute Aortic Emergencies—Part 2 Aortic Dissections
Patients with aortic disease are some of the highest acuity patients that emergency clinicians encounter. Dissection is the most common aortic catastrophe and involves separation of the aortic layers in a longitudinal fashion leading to diminished perfusion and systemic ischemia. Characteristics of pain, branch vessel involvement, and incidence lead to an understanding of patient presentation, morbidity, and mortality. Diagnosis, selection of diagnostic studies, the degree of preoperative ischemia, and risk of operative mortality can be accomplished using validated clinical decision tools. Emergency interventions are guide...
Source: Advanced Emergency Nursing Journal - January 1, 2013 Category: Emergency Medicine Tags: Cases of Note Source Type: research

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