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Case Reports in Emergency Medicine

Ashley Griswold, Briana Tully, Kenneth Katz, Gillian Beauchamp, Matthew Cook, Robert Cannon
Lamotrigine is a new generation antiepileptic which blocks sodium channels and can cause significant toxicity in overdose. A case of a three-year-old child who suffered a seizure and required endotracheal intubation after accidental lamotrigine ingestion is presented. The lamotrigine concentration measured 23.2 mcg/mL which is the highest reported after accidental pediatric exposure. A review of the literature regarding pediatric lamotrigine poisoning is also included.
2019: Case Reports in Emergency Medicine
Quevedo-Florez Leonardo Alexander, Montenegro-Apraez Alvaro Andrés, Aguiar-Martinez Leonar Giovanni, Hernández Juan Carlos, Cortés-Tascón Juan David
Pneumothorax is the entry of air into the virtual space between the visceral and the parietal pleurae, which can occur spontaneously or to a greater extent in a traumatic way. In daily clinical practice it is frequent to find injuries that generate traumatic pneumothorax that is ipsilateral to the lesion. However, there are case reports of contralateral pneumothorax that occurred in procedures such as insertion of pacemakers, or in cases of pneumonectomy. The following is the case report of a 37-year-old man who was admitted with a sharp wound to the right paravertebral region who developed a left haemopneumothorax due to a tangential course of the injuring agent...
2018: Case Reports in Emergency Medicine
Elisabeth Petit, Karen Schoonheydt, Philippe Meert, Marie Van Laer
Ergotamine toxicity has become a rare condition which can be caused by, among others, drug-drug interaction. In this work we report a case with vasospastic ischemia induced by the wrongful combination of ergotamine with recently started Antiretroviral Therapy. Clinicians were not aware that patient was self-medicating for years with medication containing ergotamine and caffeine for migraines. This diagnosis was established after evaluating the evolving 'and spreading' ischemia and CT scans and thoroughly interviewing patient's family...
2018: Case Reports in Emergency Medicine
Farrukh N Jafri, Jodi Shulman, José C Gómez-Márquez, Matthew Lazarus, David M Ginsburg
Lemierre's syndrome is an acute oropharyngeal infection with a secondary septic thrombophlebitis of the internal jugular vein (IVJ) that was first reported in literature in 1936. It involves the progression of disease from a focal suppurative peritonsillar infection to a local septic thrombophlebitis with hematogenous progression to and distant septic emboli. It is a rare and potentially fatal syndrome requiring prompt diagnosis and management. We present the case progression of an 18-year-old male who presented to our hospital with resolved sore throat, fever, and chest discomfort who experienced a sharp clinical decline...
2018: Case Reports in Emergency Medicine
Yuki Otsuka, Tetsuya Yumoto, Hiromi Ihoriya, Namiko Matsumoto, Kota Sato, Koji Abe, Hiromichi Naito, Atsunori Nakao
Managing acutely agitated or violent patients in the emergency department (ED) represents a significant challenge. Acute agitation as an initial manifestation of neuro-Behcet's disease (NBD) is an extremely rare clinical entity. A 44-year-old male, who had been complaining about a severe headache and fever for several days, was admitted to our ED due to acutely presented incontinence and agitation. On admission, physical restraint and sedation with sevoflurane and propofol were required for his combative and violent behavior...
2018: Case Reports in Emergency Medicine
Sameera Ganti, Pothiawala Sohil
Flank pain with hematuria is a common presentation in the emergency department. The commonest differential diagnosis of these patients is renal/ureteric calculus or pyelonephritis. These patients are usually treated with analgesia, antibiotics in case of pyelonephritis, and are discharged with an outpatient referral to a urologist. This case report describes a 51 year old male who presented to the ED for recurrent flank pain and hematuria. Bedside ultrasonography in the ED demonstrated a cystic lesion in the renal area...
2018: Case Reports in Emergency Medicine
Dumitru Moldovan, Noémi Bara, Valentin Nădășan, Gabriella Gábos, Enikő Mihály
Emergency department (ED) physicians frequently encounter patients presenting with angioedema. Most of these involve histamine-mediated angioedema; however, less common forms of angioedema (bradykinin-mediated) also occur. It is vital physicians correctly recognize and treat this; particularly since bradykinin-mediated angioedema does not respond to antihistamines, corticosteroids or epinephrine and hereditary angioedema (HAE) laryngeal attacks can be fatal. Here we present four case reports illustrating how failures in recognizing, managing, and treating laryngeal edema due to HAE led to asphyxiation and death of the patient...
2018: Case Reports in Emergency Medicine
Sayuri Tokioka, Shinichiro Masuda, Masamitsu Shirokawa, Takashi Shibui
High-quality cardiopulmonary resuscitation (CPR) is crucial for survival from cardiac arrest. However, various chest compression-associated injuries have been reported. Internal mammary artery (IMA) injury is one of the rare complications after CPR, and most of cases include rib and sternum fractures. In this report, we describe a rare case of IMA injury without chest wall fractures after CPR. An 85-year-old man with a history of acute myocardial infarction 2 weeks prior visited to our hospital for sustained ventricular tachycardia (VT)...
2018: Case Reports in Emergency Medicine
Robert Hughes, Johnathan M Sheele
We report the case of a person who went into cardiac arrest after being given chlorpromazine for hiccups and was subsequently diagnosed with congenital Long QT Syndrome. Long QT Syndrome is an uncommon, congenital condition that carries a high risk of sudden cardiac death. Clinicians need to recognize the risk that chlorpromazine may prolong the QTc and prepare to manage potential complications.
2018: Case Reports in Emergency Medicine
David Kinas, Michael Dalley, Kayla Guidry, Mark A Newberry, David A Farcy
We describe a case of a young male who presents to the emergency department with severe sepsis and decompensated heart failure with underlying Methamphetamine-Associated Cardiomyopathy that was previously undiagnosed. This presentation is unique because Methamphetamine-Associated Cardiomyopathy is an uncommonly reported condition that presented in a complex clinical scenario of severe sepsis and decompensated congestive heart failure. We discuss how we used point-of-care ultrasound (POCUS) in this case to identify an unsuspected disease process and how it changed our initial resuscitation strategy and management...
2018: Case Reports in Emergency Medicine
Getaw Worku Hassen, Amaninder Dhaliwal, Catherine Ann Jenninigs, Hossein Kalantari
Background: Acute liver failure can result from acetaminophen overdose, viral infection, toxins, and other disease conditions. Liver transplant is available in limited fashion and the criteria are strict as to who should get an available liver. N- Acetyl Cysteine (NAC) has been used in non-acetaminophen induced liver failure with success. Here we report a case of acute liver failure from cocaethylene that was reversed with NAC along with other medical therapy. Case Presentation: A 50-year-old female patient presented to the Emergency Department (ED) with a two-day history of coffee ground vomiting and hematemesis...
2018: Case Reports in Emergency Medicine
Jason Goldwasser, Razwana Wahdat, James Espinosa, Alan Lucerna
This case describes a 70-year-old female who presented with right flank pain around the site where a stent had been placed in her right kidney at an outside hospital several months earlier. The patient arrived tachycardic with a leukocytosis and a lactic acidosis. Further imaging revealed a very hydronephrotic right kidney and an extremely large fluid collection in the right retroperitoneum extending into the right flank consistent with leakage of urine from the obstructed right kidney. Prompt treatment of this rare phenomenon is crucial for delay in medical care can lead to abscess, hydronephrosis, electrolyte instability, and a progressive loss of renal function...
2018: Case Reports in Emergency Medicine
Eric Lombardi, Ryan Misek, Krishna Patel
We report an unusual presentation of Guillain-Barré wherein a patient with an extensive history of psychiatric illness had a dream that his legs were crushed in an earthquake and awoke from the dream with paresthesias and rapid paralysis of bilateral lower extremities. This article discusses an atypical presentation of pathology and diagnostic evaluation for a form of Guillain-Barré called Acute Inflammatory Demyelinating Polyneuropathy (AIDP).
2018: Case Reports in Emergency Medicine
Steven Hoon Chin Lim, Shieh Mei Lai, Kelvin Cheok Keng Wong
The first-line recommended treatment for stable paroxysmal supraventricular tachycardia (PSVT) is the use of vagal maneuvers. Often the Valsalva maneuver is conducted. We describe two patients who converted to sinus rhythm without complications, using a head down deep breathing (HDDB) technique.
2018: Case Reports in Emergency Medicine
Krishan Kumar, Rick Figurasin, Swati Kumar, Muhammad Waseem
Open globe injury (OGI) is a severe form of eye trauma. It is an important cause of monocular blindness worldwide. Ruptures from blunt trauma are most common at the sites where the sclera is thinnest, at the insertions of the extraocular muscles, and at the limbus. Most often, rupture is equatorial. We present a unique case of open globe injury due to blunt ocular trauma from a thrown rock that resulted in a meridional rupture of the eye. The pertinent literature is reviewed.
2018: Case Reports in Emergency Medicine
David Noorvash, Kevin King, Meera Gebrael
We present two cases of young women with a past medical history significant for systemic lupus erythematosus (SLE), who presented to the Emergency Department with a ruptured abdominal aortic aneurysm (AAA). These cases are of particular interest because the patients did not fit the typical demographic for patients who present with a ruptured AAA. Based on these cases and a review of the relevant literature, ED providers should maintain a higher index of suspicion for AAA rupture in patients with autoimmune diseases, especially SLE...
2018: Case Reports in Emergency Medicine
Petros Ioannou, George Alexakis
Retroperitoneal bleeding is a rare and difficult to diagnose condition, defined as bleeding in the retroperitoneal space without associated trauma or iatrogenic manipulation. It has been associated with hematologic diseases and malignancies and is more common in patients receiving systemic anticoagulation. A 50-year-old man on aspirin presented with abdominal pain. Physical examination revealed abdominal tenderness and a palpable mass at the left abdominal area. An abdominal CT revealed a spontaneous retroperitoneal hematoma due to bleeding of an intraparenchymal branch of the left renal artery...
2018: Case Reports in Emergency Medicine
Martin A C Manoukian, Amode R Tembhekar, Sarah E Medeiros
A positive seatbelt sign following a motor vehicle accident is associated with an increased risk of intra-abdominal injury and hemoperitoneum. Injury to the uterus in reproductive-age women can also occur. In this report, we describe a 29-year-old nulligravida female who presented to the emergency room following a motor vehicle accident at freeway speeds. A positive seatbelt sign was noted, and a focused assessment with sonography for trauma revealed hemoperitoneum with an incidental finding of uterine leiomyomata...
2018: Case Reports in Emergency Medicine
David P Betten, Jennifer L Jaquint
The development of a retropharyngeal hematoma may lead to acute airway compromise requiring emergent airway stabilization. We describe the development of a retropharyngeal hematoma in an elderly woman who sustained a fall from standing approximately 10 hours prior to symptom onset who was taking the antiplatelet agents clopidogrel and aspirin. This delayed onset of rapid airway compromise secondary to a retropharyngeal hematoma following a fall in a patient taking clopidogrel is an unusual and potentially life threatening event...
2018: Case Reports in Emergency Medicine
Alan Lucerna, James Lee, James Espinosa, Risha Hertz, Victor Scali
The urachus is a midline tubular structure that stretches from the apex of the bladder and connects to the umbilicus. Urachal remnants result from incomplete regression of the fetal urachus in infancy. We report the case of a 21-year-old male who presented to the emergency department with purulent drainage from his umbilicus in association with a chronic intermittent "pulling sensation" in the umbilicus and suprapubic areas. An infected urachal remnant was diagnosed and was treated with an oral antibiotic and ultimately with outpatient excision of the remnant...
2018: Case Reports in Emergency Medicine
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