Contrast-induced encephalopathy presenting as acute subarachnoid hemorrhage
Allergy; Contrast; Contrast-induced; coronary intervention; Emergency Medicine; Encephalitis; Encephalopathy; gadolinium; neurotoxicity; oxidative stress; rat cortical-neurons; SAH
Contrast media induced encephalopathy is a rare complication of contrast administration characterized by nonspecific neurological signs and symptoms that may present both clinically and radiolographically as subarachnoid hemorrhage. While there are few reported presentations in the neurology literature after inpatient contrast administration, similar emergency department presentations have not been documented. We describe a patient who presented with encephalopathy and expressive aphasia after outpatient evaluation of an intrathecal analgesia pump who had radiographic imaging consistent with acute subarachnoid hemorrhage. The hyperdensities seen on computed tomography scanning were subsequently identified as residual gadolinium contrast media resulting in allergic encephalopathy in this patient. (C) 2018 Elsevier Inc. All rights reserved.
Pokersnik J A; Liu L; Simon E L
American Journal of Emergency Medicine
2018
2018-06
Journal Article
<a href="http://doi.org/10.1016/j.ajem.2018.03.005" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2018.03.005</a>
DOOR-TO-BALLOON TIMES FROM FREESTANDING EMERGENCY DEPARTMENTS MEET ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION REPERFUSION GUIDELINES
care; Emergency Medicine; freestanding emergency department; global registry; hospital; infarction; interhospital transfer; mortality; percutaneous coronary intervention; perspective; primary angioplasty; randomized-trials; ST-segment elevation myocardial; system; united-states
Background: Freestanding emergency departments (FEDs) introduce a challenge to physicians who care for the patient with an ST-segment elevation myocardial infarction (STEMI) because treatment is highly time dependent. FEDs have no percutaneous coronary intervention (PCI) capabilities, which necessitates transfer to a PCI-capable facility or fibrinolysis. Study Objective: Our aim was to determine the proportion of STEMI patients who arrived to an FED and were subsequently transferred for PCI and met the door-to-balloon reperfusion guidelines of 90 min. Methods: This was a dual-center retrospective cohort review of all patients 18 years and older who were diagnosed with an STEMI and presented to the main hospital-affiliated FEDs. Electronic medical records and emergency medical services documentation were reviewed for all cases since the opening of the FEDs in July 2007 and August 2009, respectively. Key time points were abstracted and statistical evaluation was performed using Fisher's exact test. Results: A total of 47 patients met inclusion criteria. Median door-to-transport time was 34 min (inter-quartile range [IQR] 15 min). Median transport time from the FEDs to the main hospital catheterization laboratory was 21 min (IQR 5 min). Median arrival at the catheterization laboratory-to-balloon time was 25 min (IQR 13 min). Median total door-to-balloon time was 83 min (IQR 10.5 min), with 78.7% meeting the American Heart Association's recommended guidelines of <= 90 min. Conclusion: STEMI patients initially seen at two FEDs achieved door-to-balloon time goals of < 90 min. (C) 2014 Elsevier Inc.
Simon E L; Griffin P; Medepalli K; Griffin G; Williams C J; Hewit M; Lloyd T S
Journal of Emergency Medicine
2014
2014-05
Journal Article
<a href="http://doi.org/10.1016/j.jemermed.2013.08.089" target="_blank" rel="noreferrer noopener">10.1016/j.jemermed.2013.08.089</a>
Regionalization Of Emergency Care Future Directions And Research: Workforce Issues
departments; Emergency Medicine; impact; management; medicine residency; nurse-practitioners; on-call coverage; physicians; quality; shortage; surgeon
Ginde A A; Rao M; Simon E L; Edwards J M; Gardner A; Rogers J; Lopez E; Camargo C A; Piazza G; Rosenau A; Schneider S; Jouriles N
Academic Emergency Medicine
2010
2010-12
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1111/j.1553-2712.2010.00938.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2010.00938.x</a>