Uğur Aksu, Kamuran Kalkan, Oktay Gulcu, Selim Topcu, Ibrahim Halil Tanboga
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.029
Published online: September 19 2015
xBrugada syndrome is an inherited heart disease without structural abnormalities that is thought to arise as a result of accelerated inactivation of Na channels and predominance of transient outward K current to generate a voltage gradient in the right ventricular layers. Brugada syndrome occurs in patients with structurally normal heart and predisposes patients to malignant ventricular arrhythmias. Acute pulmonary embolism has been associated with a variety of electrocardiograms, and rarely, it may mimic electrocardiographic pattern of Brugada syndrome and this condition was defined as Brugada phenocopy [1-4].
Sho Nachi, Hideshi Okada, Hisaaki Kato, Kodai Suzuki, Shiho Nakano, Takahiro Yoshida, Shozo Yoshida, Hiroaki Ushikoshi, Izumi Toyoda, Shinji Ogura
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.028
Published online: September 19 2015
xPatients with simple pneumopericardium due to blunt thoracic trauma occasionally progressed to tension pneumopericardium, although pneumopericardium is believed to be benign in general. A 65-year-old man had both arms caught in a grinding machine and his face struck hard at work. He was diagnosed with bilateral degloving injuries of both arms and mediastinal emphysema on computed tomography. He required transfer to an advanced emergency medical service center for treatment. Although he was hemodynamically stable then, the patient's condition deteriorated during transportation.
An-Yi Wang, Chien-Hua Huang, Wei-Tien Chang, Wen-Jone Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.025
Published online: September 19 2015
xBispectral index (BIS) is a simple, noninvasive, and continuous electroencephalographic monitor that could reflect the level of consciousness. Initially, BIS was developed to measure the anesthetic depth during operation; now, BIS could be used as a predictor of neurologic outcome in postresuscitative care. We report a case that had out-of cardiac arrest due to subarachnoid hemorrhage, and we used BIS to monitor the patient's consciousness level. During observation, another episode of cardiac arrest occurred due to delayed cerebral ischemia–related cardiac depression.
Erin L. Simon, Mitch Kovacs, Leslie Gair
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.024
Published online: September 20 2015
xSeptic arthritis is a rare infection usually involving the knee or hip but can infrequently affect less obvious joints such as the pubic symphysis. Risk factors for septic arthritis include joint repair or replacement surgery, systemic infection, intravenous recreational drug use, and alcoholism. We present the case of a 48-year-old man with a final diagnosis of septic arthritis of the pubic symphysis who had no risk factors besides alcoholism. The presentation was unusual in that the patient was afebrile, and the infection seemed to be spontaneous.
Basem F. Khishfe, Anna Sankovsky, Isam Nasr
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.022
Published online: September 20 2015
xOvarian vein thrombosis (OVT) is a rare but potentially serious condition that affects mostly postpartum women. It has also been associated with other conditions, such as pelvic inflammatory disease, malignancy, sepsis, inflammatory bowel disease, and recent pelvic or abdominal surgery. It is critical to recognize and treat this condition as early as possible to avoid the potential complications of the thrombosis and adverse sequelae such as infection and sepsis. We report a case of idiopathic OVT in a previously healthy premenopausal woman presenting with sudden onset groin pain.
Atıf Bayramoğlu, Murat Saritemur, Sener Tasdemir, Mevlana Omeroglu, Haktan Bagis Erdem, Ibrahim Sahin
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.020
Published online: September 19 2015
xKeutel syndrome is a rare autosomal recessive cartilage tissue disorder, occurs as a result of matrix γ-carboxyglutamate protein (MGP) mutations. Peripheral pulmonary stenosis, brachytelephalangia, inner ear deafness, and abnormal ossification or calcification of the cartilage (ears, nose, larynx and the tracheobronchial tree) are most common features of this syndrome. We report a case of Keutel syndrome who presented emergency service with acute shortness of breath. Abnormal tracheobronchial calcification, ossification of the cartilage in the external ears and alae nasi, and short terminal phalanges are imaged in radiologic examinations and in molecular analysis a rare variant of MGP mutation (IVS1 + 1G > A) (c.61 + 1G > A) was detected in our patient.
Hong Lak Choi, Jin Hong Min, Jun Ho Kang, Hoon Kim, Jung Soo Park
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.018
Published online: September 20 2015
xA 32-year-old man was presented at our hospital with paroxysmal dyspnea and unconsciousness. At presentation, he was in a coma and showed central cyanosis. We tried endotracheal intubation to ensure appropriate ventilation, but we were unable to intubate owing to swelling in the supraglottic area. We then immediately performed cricothyroidotomy. During the procedure, when the cricothyroid membrane was punctured, a pinkish bubble developed at the puncture site. After securing the patient’s airway, we changed our approach from cricothyroidotomy to tracheostomy.
James L. Homme, Jason M. Block
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.030
Published online: September 22 2015
xAcute hemorrhagic edema of infancy (AHEI) is a rare acute benign cutaneous leukocytoclastic vasculitis affecting children younger than 24 months of age. Its presentation can be confused with those of urticaria, erythema multiforme, Henoch-Schönlein purpura, idiopathic thrombocytopenia, meningococcemia, Kawasaki disease, and drug rash. We present 2 cases of acute hemorrhagic edema of infancy, discuss the characteristics of AHEI, and compare and contrast AHEI with similar dermatologic presentations.
Shumpei Onishi, Toshihisa Ichiba, Takeshi Nagata, Hiroshi Naito
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.019
Published online: September 23 2015
xInitial manifestations of systemic lupus erythematosus (SLE) in young women are commonly arthritis, rash and fever. This case had an unusual initial presentation of SLE presenting fever and flank pain with renal vein thrombosis (RVT).
Jiang-you Wang, Han Chen, Xi Su, Zhi-ping Zhang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.043
Published online: October 2 2015
xA 22-year-old smoker man with hyperlipidemia presented to the emergency department with intermittent, exertional chest pain of 3 days' duration. Electrocardiography performed on arrival revealed anterior T-wave inversions with biphasic lateral T waves, which raised concern about Wellens' syndrome. The initial troponin I concentration was 0.05 ng/mL (reference range, 0-0.04 ng/mL); it rose to 0.69 ng/mL at 6 hours and peaked at 1.28 ng/mL before intervention. Coronary angiography performed 12 hours after presentation showed stenosis of 95% of the middle segments of left anterior descending artery, which was successfully treated with a drug-eluting stent.
Ali Duman, Kenan Ahmet Turkdogan, Ayhan Akoz, Mucahit Avcil, Bekir Dagli, Selcuk Eren Canakci
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.046
Published online: October 2 2015
xAlthough the clinical findings of scorpion stings are often mild, they may lead to multiorgan failure and even cardiogenic shock. The toxin has both local and systemic effects. Local effects include edema, bruising (ecchymosis), and burning pain, whereas systemic effects include nausea, vomiting, hypotension or hypertension, cardiovascular toxicity, renal failure, and hemorrhage at different areas. The toxins have been implicated in a number of cardiac arrhythmias, including torsade de pointes, long QT syndrome, and atrial fibrillation.
Rachel Berkowitz, James Mangan, Jacqueline Mahal, Sebastian D. Siadecki, Gabriel Rose, Ramona Sunderwirth, Kyle Cramer, Brian K. Meyers, Carlos Oliveira, Turandot Saul
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.042
Published online: October 3 2015
xA 62-year-old woman presented to the hospital in Beira, Mozambique, complaining of shortness of breath, productive cough, and chest discomfort for 1 month. The symptoms had been worsening over the past week. She had a history of tuberculosis 2 years previously, for which she was treated with an unknown regimen for 6 months. HIV status was unknown. She endorsed no other medical history. Physical examination was notable for a cachectic female with mild dyspnea but in no distress. She was afebrile with normal vital signs and had moist mucous membranes.
Michelle Barlow, Richard Lynch
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.041
Published online: October 2 2015
xA rare case of sequential bilateral anterior shoulder dislocation in an older adult after trauma is presented. The shoulders were dislocated sequentially in 2 separate falls. To the best of our knowledge, this is the second case of sequential or nonsimultaneous bilateral anterior shoulder dislocation reported to date.
Kyoung Hoon Lim, Jinyoung Park
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.040
Published online: October 2 2015
xThrombotic thrombocytopenic purpura (TTP) is a fatal clinical syndrome characterized by thrombocytopenia, microangiopathic hemolytic anemia, renal failure, neurologic manifestation, and fever. Although rare, TTP can occur after vascular, gynecological, orthopedic, or abdominal surgery. To our knowledge, however, TTP after a traumatic abdominal injury has never been reported. This report describes a 23-year-old man who experienced TTP after a traumatic liver injury and was treated successfully with plasmapheresis.
Sang Hoon Oh, Kyu Nam Park, Young Hee Park, Ji Seon Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.027
Published online: October 22 2015
xVentricular fibrillation (VF) is usually sustained, and it typically results in death unless electrical defibrillation is successfully performed within minutes. Although VF has been reported to spontaneously occur in vivo in some animal models and a few cases of self-terminating VF have been documented in clinical practice, no such case has been previously reported involving out-of-hospital emergency medical service (EMS) personnel. We report a case of self-terminating VF due to ST-segment elevation myocardial infarction that was documented by continuous electrocardiogram (ECG) strip monitoring.
Abhijai Singh, Mahesh Shrestha, Curuchi Anand
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.026
Published online: October 15 2015
xThe diagnosis of acute pancreatitis is customarily based on 2 of the 3 following criteria: (i) abdominal pain consistent with the disease (ii) serum amylase and/or lipase greater than three times the upper limit of normal. (iii) Characteristic findings from abdominal imaging: (1) Lipase has been established as a highly sensitive and specific test to assist in the diagnosis even in patients with normal amylase levels. (2) Although imaging is generally discouraged as unnecessary in making the diagnosis of pancreatitis acutely, we describe 2 patients with acute pancreatitis with normal lipase at the time of emergency department (ED) presentation and in whom a computed tomography (CT) of abdomen played a critical role in the diagnosis.
Ryota Sato, Michitaka Nasu, Ryohei Yagi, Yusuke Kitahara
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.019
Published online: October 15 2015
xPleocytosis of the cerebrospinal fluid is a key finding for the diagnosis of bacterial meningitis. Bacterial meningitis presenting in normal cerebrospinal fluid is rare in adult patients. We describe the case of a patient with pneumococcal meningitis without cerebrospinal fluid pleocytosis. This case suggests that immediate antibiotic therapy should be started when meningitis is suspected, even with normal cerebrospinal fluid findings. (See Figure.)
Toshihiko Yoshizawa, Kei Jitsuiki, Mariko Obinata, Kouhei Ishikawa, Hiromichi Ohsaka, Yasumasa Oode, Manabu Sugita, Youichi Yanagawa
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.012
Published online: October 15 2015
xA 74-year-old man noted dysarthria and right hemiparesis. His history included a gastric ulcer 2 years previously, and he had gradually lost 10 kg over a 2-year period due to appetite loss. He daily consumed 120 mg of alcohol. Upon arrival, he had clear consciousness and stable vital signs. He was malnourished. Neurologic findings included a positive finding of Barre sign in the right hand and dysarthria. A venous blood gas analysis demonstrated the following: pH 7.059; Pco2, 21.5 mm Hg; Po2, 59.1 mm Hg; HCO3−, 5.8 mmol/L; base excess, −22.7 mmol/L; lactate, 17 mmol/L; and glucose, 4 mg/dL.
Mark Basso, Scott Goldstein
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.015
Published online: October 15 2015
xWe discuss a case of a 20-year-old woman presenting with chest pain found to have a Hampton’s hump on chest x-ray and corresponding wedge infarct on computed tomographic scan. Contrary to our suspicion that this febrile and tachycardic patient had a pulmonary embolism, she was later determined to have a septic embolus secondary to endocarditis. We highlight the difficulties in diagnosing certain cases of endocarditis in the emergency department, as well as the difficulties in distinguishing septic emboli from pulmonary emboli, especially with plain radiographs.
Jamila Benmoussa, Marie Chevenon, Minesh Nandi, Thomas J. Forlenza, Jay Nfonoyim
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.044
Published online: October 26 2015
xIn this study, we describe a case of ibuprofen-induced thrombotic thrombocytopenic purpura (TTP). This patient is a 37-year-old African American man who was found unresponsive on the floor. It was later found that he ingested 30 ibuprofen pills (400 mg) with a total dose of 12 g in an attempt to commit suicide. The patient was noted to have a pale conjunctivae, scleral icterus, vitiligo, and left arm weakness. Upon Foley placement, hematuria with no clots was collected. Complete blood count revealed hemoglobin level of 6.3 mg/dL, hematocrit of 19.1%, and platelet count of 29 000/μL.
DOI: http://dx.doi.org/10.1016/S0735-6757(16)00222-9
Published in issue: May 2016
DOI: http://dx.doi.org/10.1016/S0735-6757(16)00223-0
Published in issue: May 2016
DOI: http://dx.doi.org/10.1016/S0735-6757(16)00224-2
Published in issue: May 2016
