Hyperkalemia is a commonly encountered electrolyte abnormality that can significantly alter normal cardiac conduction. Potentially lethal dysrhythmias associated with hyperkalemia include complete heart block and Mobitz Type II second-degree AV block. We report a unique case of Mobitz Type 1 second-degree atrioventricular (AV) block, known commonly as Wenckebach, due to hyperkalemia. The patient's symptoms and electrocardiogram (ECG) evidence of Wenckebach block resolved with lowering of serum potassium levels, with subsequent ECG showing first-degree AV block. This paper highlights an infrequently reported dysrhythmia associated with hyperkalemia that emergency physicians should be familiar with.

Aparajita Sohoni

Berenice Perez

Amandeep Singh

Wenckebach Block due to Hyperkalemia: A Case Report

Ambulance crashes are a significant risk to prehospital care providers, the patients they are carrying, persons in other vehicles, and pedestrians. No uniform national transportation or medical database captures all ambulance crashes in the United States. A website captures many significant ambulance crashes by collecting reports in the popular media (the website is mentioned in the introduction). This report summaries findings from ambulance crashes for the time period of May 1, 2007 to April 30, 2009. Of the 466 crashes examined, 358 resulted in injuries to prehospital personnel, other vehicle occupants, patients being transported in the ambulance, or pedestrians. A total of 982 persons were injured as a result of ambulance crashes during the time period. Prehospital personnel were the most likely to be injured. Provider safety can and should be improved by ambulance vehicle redesign and the development of improved occupant safety restraints. Seventy-nine (79) crashes resulted in fatalities to some member of the same groups listed above. A total of 99 persons were killed in ambulance crashes during the time period. Persons in other vehicles involved in collisions with ambulances were the most likely to die as a result of crashes. In the urban environment, intersections are a particularly dangerous place for ambulances.

Teri L. Sanddal

Nels D. Sanddal

Nicolas Ward

Laura Stanley

Ambulance Crash Characteristics in the US Defined by the Popular Press: A Retrospective Analysis

Background. Strategies combining pretest clinical assessment and D-dimers measurement efficiently and safely rule out venous thromboembolism events (VTE) in low- and intermediate-risk patients. Objectives. As process of ageing is associated with altered concentrations of coagulation markers including an increase in D-dimers levels, we investigated whether D-dimers could reliably rule out VTE across age categories. Method. We prospectively assessed the test performance in 1,004 patients visiting the emergency department during the 6-month period with low or intermediate risk of VTE who also received additional diagnostic procedures. Results. 67 patients had VTE with D-dimers levels above the threshold, and 3 patients displayed D-dimers levels below the threshold. We observed that specificity of D-dimers test decreased in an age-dependent manner. However, sensitivity and negative predictive value remained at very high level in each age category including older patients. Conclusion. We conclude that, even though D-dimers level could provide numerous false positive results in elderly patients, its high sensitivity could reliably help physicians to exclude the diagnosis of VTE in every low- and intermediate-risk patient.

G. Der Sahakian

Y. E. Claessens

J. C. Allo

J. Kansao

G. Kierzek

J. L. Pourriat

Accuracy of D-Dimers to Rule Out Venous Thromboembolism Events across Age Categories

We report a case of prehospital &#x0201C;cannot intubate&#x0201D; and &#x0201C;cannot ventilate&#x0201D; scenarios successfully managed by strictly following a difficult airway management algorithm. Five airway devices were used: the Macintosh laryngoscope, the gum elastic Eschmann bougie, the LMA Fastrach, the Melker cricothyrotomy cannula, and the flexible fiberscope. Although several airway devices were used, overall airway management duration was relatively short, at 20&#x02009;min, because for each scenario, failed primary and secondary backup devices were quickly abandoned after 2 failed attempts, each attempt of no more than 2&#x02009;min in duration, in favor of the tertiary rescue device. Equally, all three of these rescue devices failed, an uncuffed cricothyroidotomy cannula was inserted to restore optimal arterial oxygenation until a definitive airway was secured in the ICU using a flexible fiberscope. Our case reinforces the need to strictly follow a difficult airway management algorithm that employs a limited number of effective devices and techniques, and highlights the imperative for early activation of successive preplanned steps of the algorithm.

J&#233;r&#244;me Sudrial

Caroline Birlouez

Anne-Laurette Guillerm

Jean-Luc Sebbah

Roland Amathieu

Gilles Dhonneur

Difficult Airway Management Algorithm in Emergency Medicine: Do Not Struggle against the Patient, Just Skip to Next Step

We report a case of a splenic artery aneurysm rupture presenting with shock which required timely embolization therapy. This case demonstrates how the rapid use of bedside ultrasound by emergency department (ED) physicians can help identify the cause of shock and, therefore, initiate appropriate treatment quickly even if the cause is rare, as in this case.

Masayuki Iyanaga

Susan Watts

Takeshi Kasai

A Patient with Splenic Artery Aneurysm Rupture and  the Importance of Rapid Sonography in the ED

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Emergency Medicine International publishes original research articles and&nbsp;review articles&nbsp;related to prehospital care, disaster preparedness and response, acute medical and paediatric emergencies, critical care and wound care

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Emergency Medicine International - Table of contents 2010

Emergency Medicine International | Hindawi

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Emergency Medicine International publishes original research articles and review articles related to prehospital care, disaster preparedness and response, acute medical and paediatric emergencies, critical care and wound care

Emergency Medicine International