This month in Scientific American™ Emergency Medicine:

  • Laboratory Evaluation of Acute Mesenteric Ischemia
  • Hypoglycemia in the Otherwise Healthy Pediatric Patient
  • Defense Centers of Excellence TBI Severity Scoring


ischemicbowel

CT of an ischemic bowl due to thrombosis of the superior mesenteric vein. Note the dilated bowel with a thickened bowel wall. By James Heilman, MD (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons

MESENTERIC ISCHEMIA

Laboratory Evaluation of Acute Mesenteric Ischemia

UGO A. Ezenkwele
MD, MPH, Chief, Emergency Department, Mount Sinai Queens,
Associate Professor, Department of Emergency Medicine,
Icahn Mount Sinai School of Medicine, New York, NY

Although elevated lactate or acidosis on a venous blood sample may suggest acute mesenteric ischemia, as of yet, there are no laboratory tests readily available in the emergency department that possess enough diagnostic accuracy to establish mesenteric ischemia definitively. Different plasma biomarkers, such as D-lactate, urinary and plasma fatty acid-binding proteins (FaBPs), α-glutathione S-transferase, and D-dimer have been tested in humans. The most promising plasma markers according to a recent review were intestinal-type FaBP, α-glutathione S-transferase, and D-lactate. Novel inflammatory biomarkers such as the neutrophil/lymphocyte ratio and platelet/lymphocyte ratio have been studied; however, more research is needed.

 


PEDIATRIC DIABETIC KETOACIDOSIS AND HYPOGLYCEMIA

Hypoglycemia in the Otherwise Healthy Pediatric Patient

RACHEL J. WILLIAMS, MD
Department of Emergency Medicine, Maine Medical Center, Portland, ME
SAMANTHA L. WOOD, MD, FAAEM, FACEP
Tufts University School of Medicine, Department of Emergency Medicine, Department of Pediatrics, Pediatric Critical Care, Maine Medical Center, Portland, ME

When hypoglycemia is detected in the otherwise healthy pediatric patient, ingestion of a toxin should be thoroughly considered as an etiology. Ingestion may be accidental (i.e., a 2-year-old taking a family member’s antihyperglycemic medication) or deliberate (i.e., a teenager making an attempt at self-harm). Excessive alcohol intake may also be a factor. The local poison control center should be contacted for guidance if a child is suspected of having hypoglycemia due to an ingestion, and toxic alcohols in addition to ethanol should be considered. Toxicologic testing may be required.

 


PEDIATRIC MINOR HEAD INJURY AND CONCUSSION

Defense Centers of Excellence TBI Severity Scoring

CHAD SCARBORO, MD
Department of Emergency Medicine/Pediatric Emergency Medicine, Carolinas Medical Center, Charlotte, NC
SIMONE LAWSON, MD
Department of Emergency Medicine/Pediatric Emergency Medicine, Carolinas Medical Center, Charlotte, NC

Traditionally, the severity of a traumatic brain injury (TBI) has been based on the patient’s Glasgow Coma Scale (GCS) score. However, the Defense Centers of Excellence includes several factors in addition to the GCS score when classifying the severity of TBI in the case of nonpenetrating head injuries, because a favorable GCS score may mask a serious injury. The Defense Centers of Excellence score is based on structural imaging (normal/abnormal); Glasgow Coma Scale score (best available score in first 24 hr); and length of time associated with loss of consciousness, alteration of consciousness/mental state, and posttraumatic amnesia.