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1.
BACKGROUND:
Acute chest pain represents a common presentation at emergency department. Aortic dissection in young patients, however, is fortunately rare.METHODS:
We report a case of giant ascending aortic aneurysm with Stanford type A aortic dissection in an otherwise well 22-year-old male patient. Operative aortic valve and root replacement was undertaken with favourable outcome.RESULTS:
Histopathologic examination of the resected aorta revealed acute on chronic inflammatory change with Langerhans type giant cells consistent with a diagnosis of giant cell aortitis.CONCLUSION:
While uncommon, emergencies of the aorta may present in young patients. Predisposing conditions are discussed.KEY WORDS: Aorta, Aneurysm, Tamponade, Dissection 相似文献2.
Background
A timely diagnosis of aortic dissection is associated with lower mortality. The use of emergent bedside ultrasound has been described to diagnose aortic dissection. However, there is limited literature regarding the use of bedside ultrasound to identify superior mesenteric artery dissection, a known high-risk feature of aortic dissection.Objective
Our aim was to present a case of superior mesenteric artery dissection identified by bedside ultrasound and review the utility of bedside ultrasound in the diagnosis of aortic emergencies.Case Report
We report a case of superior mesenteric artery dissection found on emergent bedside ultrasound in a 46-year-old male complaining of abdominal pain with a history of cocaine abuse and prior aortic dissection. Bedside ultrasound in the emergency department revealed an intimal flap in the descending aorta with extension into the superior mesenteric artery prompting early surgical consultation before computed tomography because of concern for acute mesenteric ischemia.Conclusion
Superior mesenteric artery dissection is a high-risk feature of aortic dissection and can be identified with emergent bedside ultrasound. 相似文献3.
BACKGROUND:
The diagnosis of aortitis is often delayed as symptoms are largely non-specific. We report a case of Staphylococcal thoracic aortitis in a 73-year-old Chinese woman complicated by aortic dissection.METHODS:
The patient presented with pyrexia of unknown origin, and a contrast enhanced computed tomography aortogram revealed a large thrombus at the anterior aspect of the ascending aorta with two large ulcerations as a result of a chronic type A aortic dissection. A hemiarch replacement with a 28 mm Gleweave Vascutek graft was performed with resuspension of aortic valve commisures. Aortic thrombus cultures were positive for coagulase negative Staphylococcus aureaus, and histology showed chronic dissection of the aorta.RESULTS:
The patient was treated with intravenous cefazolin for a 6-week duration and made good progress.CONCLUSIONS:
This case highlights Staphylococcal infective aortitis complicated by dissection presenting as fever of unknown origin. Timely diagnosis is essential as progression to catastrophic rupture may occur.KEY WORDS: Aneurysm, Aortic diseases, Endovascular stent, Infected/microbiology, Staphalococcus aureus 相似文献4.
Marc Beirer Ingo J. Banke Daniela Münzel Heiko Wendorff Nawid Khaladj Chlodwig Kirchhoff Stefan Huber-Wagner Peter Biberthaler 《The Journal of emergency medicine》2014
Background
Acute aortic dissection during pregnancy is an uncommon but important emergency due to its lethal risk to both mother and child. The dissection usually involves the ascending aorta or the aortic arch. Although additional affection of the descending aorta up to bifurcation is possible, further increasing the risk of organ malperfusion, full-length aortic dissection (DeBakey I) is known to be very rare. Dissection during pregnancy has been reported predominantly in combination with Marfan syndrome. Acute aortic dissection Stanford type A (AADA) DeBakey I during pregnancy without signs of Marfan syndrome as a warning signal is very uncommon in the current literature.Objectives
The etiology, diagnosis, differential diagnosis, and management of this rare disease are discussed in relation to the current literature.Case Report
We report the case of an athletic 34-year-old woman in the third trimester of pregnancy, without history of previous diseases, who presented to our Emergency Department after collapsing. In the resuscitation department, an emergency cesarean section was performed due to the start of circulation failure in the mother. Computed tomography scan revealed a severe aortic dissection starting from 1 cm distal the aortic valve over the full length up to the iliac arteries, involving the brachiocephalic and carotid arteries up to the level of the larynx. Emergency replacement of the ascending aorta and the aortic arch was performed. Both the mother and baby survived and were doing well 1 year postoperatively.Conclusion
This alarming result of AADA (DeBakey I) in late pregnancy without obvious warnings such as Marfan syndrome illustrates the importance of performing early imaging in similar cases. 相似文献5.
6.
Haldun Akoglu Omer Faruk Celik Ali Celik Rabia Ergelen Ozge Onur Arzu Denizbasi 《The American journal of emergency medicine》2018,36(6):1014-1017
Introduction
The diagnostic accuracy of the FAST exam performed by EM residents were shown to be similar to radiology residents. However, in the last 2 decades, an extended-FAST (E-FAST) protocol including thoracic examination to exclude pneumo- and hemothorax was introduced. The accuracy of emergency physicians (EPs) while performing E-FAST is a less studied area, especially in Europe. The aim of this study was to compare the diagnostic accuracy of the E-FAST exam performed by EM residents with the results of CT scan as a gold standard.Methods
This was a prospective, observational, diagnostic accuracy study conducted at the ED of a Level 1 Trauma Center. All consecutive adult multiple trauma patients were eligible, and any patient in whom thoraco-abdominal CT was ordered were recruited. Unstable and unavailable patients were excluded. E-FAST examination was performed by EPs as the index test, and CT examinations reported by a blinded academic radiology faculty was the gold standard.Results
A total of 140 patients were recruited from eligible 144 patients. The final study population was 132 for abdominal and 130 for thorax examinations. In this study, AUC of E-FAST was 0.71 for abdominal free fluid, 0.87 for pneumothorax and 1.00 for pleural effusion. The sensitivity was 42.9% and specificity was 98.4%. The + LR for abdominal free fluid was 26.8 and ? LR was 0.58.Conclusion
E-FAST examination has an excellent specificity. However, the sensitivity of the test is not high enough to rule-out thoraco-abdominal injuries in trauma patients when performed by EPs. 相似文献7.
Qing-yi Zhu Shi Tai Liang Tang Wen Peng Sheng-hua Zhou Zhen-guo Liu Xin-qun Hu 《The American journal of emergency medicine》2017,35(11):1713-1717
Background
Stanford type A aortic dissection (TAAD) may lead to coronary artery occlusion and malfunction. However, TAAD manifesting as acute ST-segment elevation myocardial infarction (STEMI) has not been studied. In the present study, we reported 8 TAAD cases with STEMI as the primary presentation, and analyzed their clinical characteristics and outcome.Methods
The records were reviewed for patients admitted to the large comprehensive university hospital for PCI due to STEMI from January 1, 2002 to January 1, 2017.Results
The incidence of STEMI secondary to TAAD in our center was 0.51% (8/1,576). A total of 5 patients underwent urgent coronary angiography (CAG) without awareness of TAAD. Compression at the ostium of right coronary artery (RCA) was found in 2 patients, dissected flap of RCA in 1 patient, and heterogeneous filling and false lumen in RCA in 1 patient. Three of these 5 patients received surgery and survived. One patient accepted urgent RCA stenting because of cardiogenic shock and died after refusal of surgical therapy and failure of medical treatment. Another 2 patients received thrombolytic therapy died prior to CAG. Thus, the total in-hospital mortality was 37.5% (3/8).Conclusions
TAAD presenting as STEMI was a rare condition that predominantly involved RCA. A quick and correct clinical diagnosis of STEMI caused by TAAD prior to invasive procedure would be important. Urgent CAG without awareness of TAAD could provide important information for a timely diagnosis. High level of suspicion and awareness is the key to establishing the diagnosis and achieving optimal clinical outcome. 相似文献8.
Ayse Gultekingil Ozlem Teksam Hayriye Hızarcıoğlu Gulsen Burcu Berberoğlu Ates İnci Nur Saltık-Temizel Hülya Demir 《The American journal of emergency medicine》2018,36(4):665-668
Introduction
Gastrointestinal bleeding is a common problem in pediatric emergency department (PED). Some of these patients can lose significant amount of blood which may lead to shock. The aim of this study is to determine the risk factors predicting clinically significant gastrointestinal (GIS) bleeding in patients presenting to PED.Methods
This study was performed prospectively from January 1st 2013 to December 31th 2013 in patients with upper or lower GIS bleeding. Clinically significant GIS bleeding was defined as > 2 g/dL hemoglobin decrease at any time during observation in PED, need for erythrocyte transfusion or need for rapid endoscopic evaluation.Results
105 patients were enrolled, 81 of which were eligible for the study. Twenty two patients (26,8%) had clinically significant GIS bleeding. These patients have significantly more commonly have upper GI bleeding and symptoms of melena, pallor and tachycardia. Initial laboratory findings revealed lower hemoglobin, RBC and albumin levels with higher WBC and BUN levels. They need significantly more nasogastric tube placement and PPI and H2 blocker treatment. Final diagnosis included more gastritis and peptic ulcers. These patients have less hematochezia, less lower gastrointestinal bleeding and less commonly diagnosed as acute gastroenteritis or Mallory Weiss tear as a final diagnosis.Conclusions
Pediatric emergency physicians should be aware of clinical and laboratory parameters of patients with clinically significant GIS bleeding to predict which patients are under risk of life threatening blood loss. Patients who have melena, pallor, tachycardia, anemia and uremia at presentation are more prone to have significant GIS bleeding. 相似文献9.
Kyoung Min You Chiwon Lee Woon Yong Kwon Jung Chan Lee Gil Joon Suh Kyung Su Kim Min Ji Park Sungwan Kim 《The American journal of emergency medicine》2017,35(2):292-298
Purpose
We performed this study to investigate whether real-time tidal volume feedback increases optimal ventilation and decreases hyperventilation during manikin-simulated cardiopulmonary resuscitation (CPR).Basic procedures
We developed a new real-time tidal volume monitoring device (TVD) which estimated tidal volume in real time using a magnetic flowmeter. The TVD was validated with a volume-controlled mechanical ventilator with various tidal volumes. We conducted a randomized, crossover, manikin-simulation study in which 14 participants were randomly divided into a control (without tidal volume feedback, n = 7) and a TVD group (with real-time tidal volume feedback, n = 7) and underwent manikin simulation. The optimal ventilation was defined as 420-490 mL of tidal volumes for a 70-kg adult manikin. After 2 weeks of the washout period, the simulation was repeated via the participants' crossover.Main findings
In the validation study, 97.6% and 100% of the difference ratios in tidal volumes between the mechanical ventilator and TVD were within ±1.5% and ±2.5%, respectively. During manikin-simulated CPR, TVD use increased the proportion of optimal ventilation per person. Its median values (range) of the control group and the TVD group were 37.5% (0.0-65.0) and 87.5% (65.0-100.0), respectively, P < .001). TVD use also decreased hyperventilation. The proportions of hyperventilation in the control group and the TVD group were 25.0% vs 8.9%, respectively (P < .001).Principal conclusions
Real-time tidal volume feedback using the new TVD guided the rescuers to provide optimal ventilation and to avoid hyperventilation during manikin-simulated CPR. 相似文献10.
Meghana R.K. Helder Hartzell V. Schaff Thomas A. Foley Nandan S. Anavekar David R. Deyle Alberto Pochettino Heidi M. Connolly 《Mayo Clinic proceedings. Mayo Clinic》2018,93(2):179-183
Objective
To discover whether patients with aortic root dilation and leptosomic features but without a diagnosis of Marfan syndrome (MFS) fare similarly to patients with MFS.Methods
Of 124 patients with aortic root dilation identified from August 1, 1994, through October 31, 2012, 66 had MFS and 58 had leptosomic features but did not meet the Ghent criteria. Genetic testing was performed in 35% of patients (n=43). We compared z scores and aortic root diameters for patients who presented with aortic root dilation with and without an MFS diagnosis and with and without aortic root repair.Results
No difference existed in initial aortic root diameters between groups (P=.15); however, mean ± SD z scores for patients without MFS and with MFS were 3.1±2.3 vs 4.5±3.2 (P=.005). Fourteen of 58 patients (24%) without MFS and 35 (53%) with MFS underwent aortic root operations (P<.05). For both groups who did not have surgery, aortic root diameters and z scores remained similar at follow-up (P=.20), as did 10-year survival: MFS, 100%; no MFS, 94.1% (P=.98). No significant difference was found for mean ± SD root diameter (no MFS, 38.9±7.3 mm; MFS, 35±8.6 mm; P=.06) or z score (no MFS, 2.4±2.0; MFS, 2.1±2.0; P=.53) for patients who underwent surgery. Two patients in each group had aortic root dissections.Conclusion
Similar rates of aortic dissection between the 2 groups warrant further study regarding patients with leptosomic features but no diagnosis of MFS. Aortic root dilation progressed similarly in patients who did not undergo surgery. 相似文献11.
Sun Hwa Lee Seokyong Ryu Seoung Won Choi Hye Jin Kim Tae Kyug Kang Sung Chan Oh Suk Jin Cho Jae Hoon Lee Euy Suk Chung Myoung Hwan Kim 《The Journal of emergency medicine》2017,52(4):565-568
Background
Aortic dissection in pregnancy is relatively rare, but it is often fatal. The estimated incidence of aortic dissection in the general population is 2.9 per 100,000 person-years. Early recognition and treatment of aortic dissections are crucial for survival. Whereas the majority of patients who present with aortic dissection are older than 50 years of age and have a history of hypertension, younger patients with connective tissue disease, bicuspid aortic valves, or a family history of aortic dissection are also at increased risk for developing this condition.Case Report
We report the successful diagnosis and surgical repair of an acute type A aortic dissection in a 35-year-old woman who presented to the emergency department (ED) at 37 weeks of gestation.Why Should an Emergency Physician Be Aware of This?
Emergency physicians should be alert to the possibility of aortic dissection in any pregnant woman who presents to the ED with unexplained chest, abdominal, or back pain, even those without risk factors for aortic dissection. 相似文献12.
Tolga Sinan Güvenç Hatice Betül ErerRengin Çetin MD Hakan HasdemirErkan İlhan MD Ceyhan TürkkanMehmet Eren MD FESC 《The Journal of emergency medicine》2013
Background
Aortic dissection is an important cause of acute chest pain that should be rapidly diagnosed, as mortality increases with each hour this condition is left untreated. The diagnosis can be challenging, especially if concomitant myocardial infarction is present. Echocardiography is an important tool for the differential diagnosis.Objectives
To stress the importance of recognizing aortic regurgitation for the differentiation of myocardial infarction and aortic dissection.Case Report
An 80-year-old woman was admitted to our hospital with chest pain that was diagnosed as inferior and lateral wall myocardial infarction based on electrocardiographic findings. The diagnosis was reevaluated when aortic regurgitation was detected on echocardiography. Closer inspection of the ascending aorta revealed a dissection flap as the cause of aortic regurgitation.Conclusion
Detection of aortic regurgitation in a patient with myocardial infarction and normal valves should prompt the search for a possible aortic dissection, whether or not the dissection flap can be visualized. 相似文献13.
Gary X. Wang Sandeep S. Hedgire Thang Q. Le Jonathan D. Sonis Brian J. Yun Michael H. Lev Ali S. Raja Anand M. Prabhakar 《The American journal of emergency medicine》2017,35(4):527-530
Background
Aortic dissection is typically evaluated with computed tomography angiography (CTA). However, the feasibility of using magnetic resonance angiography (MRA) in the ED is unclear. This study examined the indications and outcomes of MRA in suspected aortic dissection evaluation in the ED.Methods
An IRB approved review identified patients who underwent MRA in the ED for acute thoracic aortic dissection from January 2010 to June 2016. Demographics, clinical assessment, CTA contraindications, outcomes, and ED disposition were analyzed.Results
50 MRAs were ordered for suspected thoracic aortic dissection. 21 (42%) for iodinated contrast allergy, 21 (42%) for renal insufficiency, 2 (4%) due to both, 2 (4%) to spare ionizing radiation, 2 (4%) for further work-up after CTA, and 2 (4%) due to prior contrast enhanced CT within 24 h. Median ED arrival to MRA completion time was 311 min. 42 studies were fully diagnostic; 7 were limited. One patient could not tolerate the examination. 49 MRAs were completed: 2 (4%) patients had acute dissection on MRA and 47 (96%) had negative exams. 17 (35%) received gadolinium. 18 (37%) patients were discharged home from the ED with a median length of stay of 643 min. 2 (4%) were admitted for acute dissection seen on MRA and 29 (59%) for further evaluation.Conclusion
MRA has a clear role in the evaluation for acute thoracic aortic dissection in the ED in patients with contraindications to CTA, and can guide management and facilitate safe discharge to home. 相似文献14.
Miguel Glatstein Gary Carbell Dennis Scolnik Ayelet Rimon Christopher Hoyte 《The American journal of emergency medicine》2018,36(6):998-1002
Background
Black widow species (Latrodectus species) envenomation can produce a syndrome characterized by painful muscle rigidity and autonomic disturbances. Symptoms tend to be more severe in young children and adults. We describe black widow spider exposures and treatment in the pediatric age group, and investigate reasons for not using antivenom in severe cases.Methods
All black widow exposures reported to the Rocky Mountain Poison Center between January 1, 2012, and December 31, 2015, were reviewed. Demographic data were recorded. Patients were divided into 2 groups. Group 1: contact through families from their place of residence, public schools and/or cases where patients were not referred to healthcare facilities. Group 2: patient contact through healthcare facilities.Results
93 patients were included. Forty (43%) calls were in Group 1 and 53 (57%) in Group 2. Symptoms were evident in all victims; 43 (46.2%) were grade 1, 16 (17.2%) grade 2 and 34 (36.5%) grade 3, but only 14 patients (41.1%) of this group received antivenom. Antivenom use was associated with improvement of symptoms within minutes, and all treated patients were discharged within hours, without an analgesic requirement or any complications. Reasons for not receiving antivenom included: skin test positive (2/20), strong history of asthma or allergies (2/20), physician preference (2/20), non-availability of the antivenom at the health care facility (14/20).Conclusion
In our study, most symptomatic black widow envenomations were minor. Relatively few patients received antivenom, but antivenom use was associated with shorter symptom duration among moderate and major outcome groups. 相似文献15.
Akira Yamashita Tetsuo Maeda Yoshihito Kita Satoru Sakagami Yasuhiro Myojo Yukihiro Wato Yutaka Yoshita Hideo Inaba 《The American journal of emergency medicine》2018,36(7):1188-1194
Background
The quality of acute aortic syndrome (AAS) assessment by emergency medical service (EMS) and the incidence and prehospital factors associated with 1-month survival remain unclear.Methods
We retrospectively analyzed the data collected for 94,468 patients with non-traumatic medical emergency excluding out-of-hospital cardiac arrest during the period of 2011–2014.Results
Of these transported by EMS, 22,075 had any of the AAS-related symptoms, and 330 had an EMS-assessed risk for AAS; of these, 195 received an in-hospital AAS diagnosis. Of the remaining 21,745 patients without EMS-assessed risk, 166 were diagnosed with AAS. Therefore, the sensitivity and specificity of our EMS-risk assessment for AAS was 54.0% (195/361) and 99.4% (21,579/21,714), respectively. EMS assessed the risk less frequently when patients were elderly and presented with dyspnea and syncope/faintness. Sign of upper extremity ischemia was rarely detected (6.9%) and absence of this sign was associated with lack of EMS-assessed risk. The calculation of modified aortic dissection detection risk score revealed that rigorous assessment based on this score may increase the EMS sensitivity for AAS. The 1-month survival rate was significantly higher in patients admitted to core hospitals with surgical teams for AAS than in those admitted to all other hospitals [87.5% (210/240) vs 69.4% (84/121); P < 0.01]. Multiple logistic regression analysis demonstrated that Stanford type A, Glasgow coma scale ≤ 14, and admission to core hospitals providing emergency cardiovascular surgery were associated with 1-month survival.Conclusions
Improvement of AAS survival is likely to be affected by rapid admission to appropriate hospitals providing cardiovascular surgery. 相似文献16.
Bahadır Caglar Suha Serin Serhat Akay Gokhan Yilmaz Alper Torun Zehra Hilal Adıbelli Ismet Parlak 《The American journal of emergency medicine》2017,35(11):1653-1656
A comparison of the sensitivity and specificity of bedside ultrasonography with conventional radiography for the evaluation of nasal fractures.
Introduction - purpose
There is increasing use of ultrasonography in the Emergency Dept (ED) and other areas. The purpose of the present study was to evaluate the sensitivity and specificity of bedside ultrasonography with conventional radiographs in the evaluation of nasal fractures in the ED.Method
Patients admitted to ED with maxillofacial trauma were evaluated in this prospective study. Ultrasonography scans of the patients were taken by the emergency physician at the bedside. The images were obtained from both laterals and parallel to the nasal dorsum. The nasal radiography scans were evaluated by an experienced radiologist blinded to the study. The ultrasonography and radiography results were compared statistically.Results
The study included 103 patients. In showing the presence of nasal fracture, the sensitivity of ultrasonography was determined to be 84.8% (95% CI 71.13%–93.66%), specificity was 93.0% (95% CI 83.00%–98.05%), positive predictive value (PPV) was 90.7% (95% CI 77.86%–97.41%), negative predictive value (NPV) was 88.3% (95% CI 77.43%–95.18%).Conclusion
Ultrasonography can be used in ED as an alternative method to conventional radiography with high rates of sensitivity and specificity in the evaluation of nasal fractures. 相似文献17.
Evaluation of activated charcoal and lipid emulsion treatment in model of acute rivaroxaban toxicity
Sinan Cem Uzunget Togay Evrin Sezen Baglan Uzunget Zamir Kemal Ertürk Egemen Akıncıoğlu Saffet Özdemir Atila Korkmaz 《The American journal of emergency medicine》2018,36(8):1346-1349
Aim
Reducing or reversing the toxicity effects of new oral anticoagulants is an important question.The purpose of the present study is to evaluate the effect of lipid emulsion (LE) and Activated Charcoal (AC) therapy on the intoxication of rivaroxaban, on mice.Methods
Adult male Balb/c mice weighing approximately 30 g were used in the study. Seven groups were assigned, with six mice in each group. Groups were defined; given only rivaroxaban, given only LE, given only AC, after the administration of rivaroxaban LE applied group in the 1st hour, after the administration of rivaroxaban LE applied group in the 3rd hour, after the administration of rivaroxaban AC applied group in the1st hour, after the administration of rivaroxaban AC applied group in the 1st hour and LE applied group in the 3rd hour. PT and Anti-Factor Xa activity were measured in all blood samples from subjects.Results
A statistically significant difference was found when all groups were compared in terms of mean PT values and Anti-FactorXa values. However, no statistically significant difference was found in the mean PT and Anti-FactorXa values when only rivaroxaban administrated group and after the administration of rivaroxaban LE and/or AC applied groups were compared one to one. No deaths occurred in groups during the observation.Conclusion
Although the administration of either AC or LE alone or in combination resulted in a decrease in the mean values of PT and anti-Factor Xa, in case of rivaroxaban toxicity, but one-to-one comparison of the groups was not statistically significant. 相似文献18.
Mark K. Su Jessica Hetherington Lopez Aldo Crossa Robert S. Hoffman 《The American journal of emergency medicine》2018,36(11):1951-1956
Study objective
To assess the efficacy of 10 mg intramuscular (IM) methadone in patients with opioid withdrawal syndrome (OWS).Methods
This was a prospective observational, convenience sample of patients presenting to the ED with mild to moderate OWS. Evaluations included the Clinical Opiate Withdrawal Scale (COWS), Withdrawal Symptoms Scale (WSS), Altered Mental Status Scale (AMSS) and a physician assessment of the patient's WSS (MDWSS). After enrollment, 10 mg of IM methadone was administered and patients were reassessed at 30 min post-methadone administration. The primary outcome was the change in COWS at baseline and after methadone administration. Secondary outcomes were the differences between AMSS, and WSS post-methadone.Results
Fifty-seven patients had COWS scores recorded at baseline and 30 min. Fifty-six had mild to moderate OWS. The COWS improved a mean of 7.6 after methadone administration (P < 0.001). The improvement was greater among patients presenting with moderate versus mild withdrawal (mean decrease = ?9.1 vs. ?5.5, P < 0.001). Patients were more likely to self-score themselves as having withdrawal compared to MDs (93.6% vs. 76.6% respectively, P = 0.027). Of the 62 patients with baseline and follow-up WSS by self-assessments, 69% improved post-methadone administration. In addition, the AMSS score remained the same or improved among 86% of cases with measurements at baseline and follow-up.Conclusion
A single IM dose of 10 mg methadone in the ED reduces the severity of acute mild to moderate OWS by 30 min. Larger prospective, randomized controlled, and blinded studies would be needed to confirm these results. 相似文献19.
Sylvia L. Chang Vaama Patel John Giltner Richard Lee Catherine A. Marco 《The American journal of emergency medicine》2017,35(11):1734-1737
Introduction
Eye injury is the second most common cause of visual impairment and a leading cause of monocular blindness in the United States. There are approximately 6 million ED visits related to drug use annually, including misuse or abuse of pharmaceuticals and illicit drug use. The purpose of this study was to assess the relationship between ocular trauma and substance abuse among emergency department patients and to assess that relationship with demographic factors, including age and gender.Methods
This study was a retrospective, observational study conducted at Miami Valley Hospital, an urban hospital ED, in Dayton, Ohio. Eligible participants included consecutive ocular trauma patients identified by the Trauma Registry from January 2014 through January 2016. Data were collected from the ED medical record including demographic information, mechanism of injury, visual acuity, slit lamp exam findings, ED procedures, inpatient procedures, toxicology results, ED diagnosis, ED disposition, and eye exam.Results
Among 229 patients, the mean age was 44 (range 14–93). 73% of patients were male. Most patients were White (74%), followed by African American (21%), Hispanic (2%), and other (3%). Most patients arrived by ambulance (62%), followed by helicopter (30%), and walk-ins (18%). Most patients were admitted to the hospital (79%). Mechanisms of injury included motor vehicle accidents (31%) and cases of assault (28%). Most ocular trauma involved the external eye (44%), the anterior chamber (28%), the orbit (25%) and the globe (22%). The incidence of substance abuse in this patient population was high. Of the patients tested for alcohol (N = 143), 49% tested positive. Among 98 patients who received a urine toxicologic screen, 63% tested positive for at least one illicit substance, including opiates (39%), cocaine (12%), benzodiazepines (25%), and/or THC (27%). There was no significant association between substance abuse and ED disposition.Conclusion
Mechanisms of eye injury included primarily motor vehicle accidents and assault. Most ocular trauma involved the external eye, the anterior chamber, the orbit, and the globe. The incidence of alcohol and illicit substance abuse is high among ED patients with ocular trauma. 相似文献20.
Serkan Yilmaz Onur Karakayali Ebru Kale Ahmet Akdogan 《The American journal of emergency medicine》2018,36(3):435-441