Charlotte Derr, Jessica Maloney Drake
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.036
Published online: March 2 2012
xA 69-year-old man presented to the emergency department with hematemesis, hypotension, tachycardia, and hypothermia. The emergency physician performed a bedside ultrasound of the chest, heart, and abdomen. The heart was unable to be visualized in the parasternal, apical, or subxiphoid windows, and free fluid and particulate matter were visualized in the chest and abdomen. The inability to visualize the heart in the normal cardiac windows suggested a diagnosis of pneumopericardium. Based upon the patient's presenting symptoms and ultrasound findings, an esophageal perforation was suspected.
Hesham R. Omar, Devanand Mangar, Rachel Karlnoski, Hany D. Abdelmalak, Enrico M. Camporesi
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.037
Published online: March 2 2012
xST-segment elevation myocardial infarction is usually caused by plaque rupture and subsequent thrombosis of a single culprit vessel. In rare occasions, simultaneous thrombosis of 2 coronary arteries occurs, which is usually associated with a worse prognosis. Although surgery provokes hemodynamic stress, leading in some instances to myocardial ischemia due to supply/demand mismatch, other factors may also contribute to postoperative myocardial infarction. We present a case of postoperative simultaneous left anterior descending and right coronary stent thrombosis that followed cessation of long-term aspirin therapy in a patient with stable coronary artery disease.
Jaime L. Jones, Amy A. Ernst
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.041
Published online: March 2 2012
xNeck pain is a common cause for presentation to an emergency department. Most causes are benign and often secondary to arthritis or injuries. We present a case of septic cervical facet arthritis, a very rare cause of neck pain. The clinical presentation of septic cervical facet arthritis includes fever, neck pain that is often unilateral that is worse with movement, nerve root symptoms, and radiation of pain to the shoulder. Consequences may be severe and include joint destruction and infection progression.
Yongmei Deng, Weiwei Zheng, Jihong Zhu
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.003
Published online: March 2 2012
xWe describe a case of thyroid crisis with hypoglycemia, lactic acidosis, multiple organ failure, and disseminated intravascular coagulation—rare but severe complications of thyroid crisis. The patient was a 59-year-old Chinese woman who presented with evidence of heart failure and atrial fibrillation. Analysis of a blood sample yielded astonishing results: her blood glucose was 1.7 mmol/L, and lactate greater than 15 mmol/L with the arterial pH as 6.94. Liver enzymes (alanine aminotransferase, 1846 U/L; aspartate aminotransferase, 6242 U/L) and bilirubin elevated rapidly and dramatically.
Benjamin R. Close, Colin J. Banks
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.005
Published online: March 2 2012
xA 23-month-old boy was brought to the emergency department of an adult and pediatric tertiary care center 1 hour after an inadvertent “double dose” of 120 mg flecainide (9.2 mg/kg). His electrocardiogram revealed sinus rhythm with a terminal R wave in aVR greater than 7 mm, a bifascicular block, and prolonged QRS and QTc intervals. A dramatic improvement in the bifascicular block and terminal R wave occurred after the administration of sodium bicarbonate. He was discharged after 36 hours with no complications.
Polat Durukan, Omer Salt, Seda Ozkan, Banu Durukan, Cemil Kavalci
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.006
Published online: February 10 2012
xCervicofacial subcutaneous emphysema is defined as the abnormal introduction of air in the subcutaneous tissues of the head and neck. It is mainly caused by trauma, head and neck surgery, general anesthesia, and coughing or habitual performance of Valsalva maneuver. The occurrence of subcutaneous emphysema after dental treatment is rare, and diffusion of gas into the mediastinum is much rarer, especially when the procedure is a nonsurgical treatment. The most common dental cause of pneumomediastinum is the introduction of air via the air turbine handpiece during surgical extraction of an impacted tooth.
Tao Zhu, Daoyang Zhou, Qiang Shu
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.007
Published online: March 2 2012
xA 44-year-old male patient was admitted to our emergency department (ED) with an episode of severe anaphylaxis displaying generalized urticaria and dyspnea 1 hour after consuming a kiwifruit. Initially, the patient reported discrete itching of his abdominal skin and was in moderate respiratory distress. The patient's wheal response and itch were attenuated 30 minutes after emergency treatment with intravenous antianaphylaxis drugs. However, he had symptoms of the chest distress, dizzy, and dysphoria.
Shitij Arora, Hemant Goyal, Prachi Aggarwal, Frantz Duffoo, Thara Basavaiah, Jigar Patel, Afzal Hossain
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.012
Published online: March 19 2012
xEpiploic appendagitis is a rare, self-limiting inflammation of the epiploic appendices or omental appendices. It presents as abdominal pain often misdiagnosed as appendicitis, cholecystitis, or diverticulitis. Epiploic appendagitis can be treated conservatively with anti-inflammatory and pain medications. It is important to diagnose this etiology of abdominal pain in order to avoid long-term hospital stay and other medical expenses including surgery. In this case report we present a rare case of epiploic appendagitis that presents in a 75 year old female patient.
YeonHo You, Won Jun Jung, Mi Jin Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2011.06.042
Published online: March 19 2012
xIntravenous fat emulsion (IFE) therapy is an adjunct therapy administered to hemodynamically compromised patients with glyphosate-surfactant intoxication when they respond poorly to conventional therapies such as fluid resuscitation or vasopressors [1,2]. However, the use of IFE as an adjunct therapy in collapsed patients with glyphosate intoxication has not been reported previously. Here, we describe the case of a patient with glyphosate-surfactant–induced cardiovascular collapse who responded to IFE.
Emre Yurdakul, Ömer Salt, Erdal Uzun, Fatih Doğar, Ahmet Güney, Polat Durukan
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.013
Published in issue: November 2012
xWe report a case of traumatic floating clavicula in a man aged 21 years. He was admitted to our emergency department with polytrauma sustained in a motor car accident, successfully treated 21 days after the accident with bipolar open reduction and wire stabilization.
Shungo Katoh, Yoichi Yamada, Rikiya Shinohe, Kenji Aoki, Masahiko Abe
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.021
Published online: March 19 2012
xClassic takotsubo cardiomyopathy (TCM) is characterized by transient dysfunction of the apical portion of the left ventricle with hyperkinesis of the other parts of the heart wall. Recently, wall motion abnormalities in parts other than in the apical portion of the heart have been reported. Inverted TCM is one form of these anomalies. In this form, the basal segments rather than the apical part of the heart are akinetic/dyskinetic, and the apex is hyperdynamic. Emotional or physical stress is known to trigger TCM, leading some authors to call TCM stress-induced cardiomyopathy (SC).
Je Sung You, Seunghwan Kim, Incheol Park, Seungho Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.031
Published online: May 25 2012
xA 46-year-old man was transferred to the emergency department and suspected of having a deep vein thrombosis. The patient reported swelling and pain in both lower legs for 16 hours. His medical history included liver cirrhosis secondary to alcohol. A detailed history revealed raw fish consumption 1 day before admission. Within 2 hours of arrival, several hemorrhagic bullae developed in the color-changed lesions of both lower legs. The patient's level of consciousness deteriorated to a stupor. He was admitted to the intensive care unit.
Mehmet Fatih Yetkin, Omer Salt, Polat Durukan, Fusun Ferda Erdogan, Seda Ozkan
DOI: http://dx.doi.org/10.1016/j.ajem.2012.02.003
Published online: May 4 2012
xPosterior reversible encephalopathy syndrome is a cliniconeuroradiologic entity with typical symptoms and symmetric high-signal intensity lesions in the bilateral parietooccipital lobes on T2-weighted or fluid-attenuated inversion recovery magnetic resonance imaging. In this presentation, we report a case of posterior reversible encephalopathy syndrome who was admitted to our emergency department because of seizure and deterioration of consciousness. The aim of this presentation is to alert the emergency physicians about one of the hypertensive emergencies with neurologic symptoms associated with hypertension.
Daniel Mantuani, Arun Nagdev
DOI: http://dx.doi.org/10.1016/j.ajem.2012.02.004
Published online: March 30 2012
xThe ultrasound-guided interscalene brachial plexus is becoming increasingly popular for anesthesia in the management of upper-extremity injuries by emergency physicians. Traditional high-volume injections of local anesthesia will also affect the phrenic nerve, leading to temporary paralysis of the ipsilateral hemidiaphragm. With direct ultrasound guidance, more precise needle placement allows for lower-volume injections that reduce inadvertent spread of local anesthetic to the phrenic nerve without decreasing the efficacy of onset of time and quality of the block.
Jamie S. Johnson, Joseph G. Kotora, Brett F. Bechtel
DOI: http://dx.doi.org/10.1016/j.ajem.2012.02.006
Published online: March 30 2012
xPatients are often referred to the emergency department for further evaluation, yet the astute physician will maintain a broad differential to avoid anchoring on prior diagnoses. In this case, a 56-year-old man was referred to our emergency department from the radiology suite secondary to concerns for an “allergic reaction” to prior magnetic resonance imaging contrast. Upon presentation, he was noted to have facial swelling with ruddy appearance and vascular congestion extending to the midchest region; no airway compromise or dyspnea was noted.
Wen-Fang Chiang, Fu-Chiang Yeh, Shih-Hua Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2012.02.007
Published online: March 30 2012
xUnilateral paralysis is rarely reported to be primary presentation of severe hypokalemia. We describe a 24-year-old woman who presented to the emergency department with sudden onset of right-sided weakness. Neurologic examination revealed diminished muscle strength and tendon reflexes over the right limbs. Computed tomography of the brain showed no organic brain lesion. However, laboratory data showed hypokalemia (K+ 2.0 mmol/L) with metabolic acidosis (HCO3− 19 mmol/L). She needed a total of 260 mmol K+ to achieve complete recovery of muscle strength at a serum K+ level of 3.2 mmol/L and was proved to have distal renal tubular acidosis.
Enbiya Aksakal, Eftal Murat Bakirci, Mucahit Emet, Mustafa Uzkeser
DOI: http://dx.doi.org/10.1016/j.ajem.2012.02.008
Published online: May 25 2012
xPregabalin, a synthetic derivate of the inhibitory neurotransmitter γ-aminobutyric acid, shows antiepileptic, analgesic, anticonvulsant, anxiolytic, and sleep-modulating activities. The major advantage of pregabalin is its relative reliability, easy use, high tolerance, and lack of negative interaction with other drugs. A 65-year-old woman with medical histories of diabetes mellitus, lumbar spondylosis, diabetic nephropathy, chronic renal failure, and anemia of chronic disease was admitted with the complaint of dizziness and syncope.
Babak Kazemi, Fariborz Akbarzadeh
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.003
Published online: May 25 2012
xWe report a rare case presenting with up to 50 episodes of syncopes per day in a 54-year-old man with the ultimate diagnosis of idiopathic glossopharyngeal neuralgia. All episodes were started with a severe pain sensation in the right side of the throat followed by asystole and then very slow ventricular escape beats. The patient was successfully treated with the combination of carbamazepine, gabapentin, and dual-chamber pacemaker implantation.
John Rowlett
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.005
Published online: May 25 2012
xIn minor cases, contrast extravasation may cause pain, swelling, and localized erythema. However, in more severe cases, extensive tissue and skin necrosis, ulceration, and compartment syndrome may occur, often necessitating a surgical consultation. Hyaluronidase has been used successfully in the management of extravasated contrast media in several reports. In addition, recombinant human hyaluronidase is approved for use as an adjunct in subcutaneous urography for improving resorption of radiopaque agents.
Damaris Brown-Vargas, John J. Cienki
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.008
Published online: May 25 2012
xCharles Bonnet syndrome describes visual field or acuity loss with complex hallucinations. This typically occurs in the elderly with preexisting visual impairment. We describe a patient who presented to the emergency department with acute hemianopsia and intermittent complex hallucinations. A 57-year-old man was referred for visual field loss and hallucinations. Chief complaint was “seeing little heads of people” and a right-sided visual loss. The patient was alert, oriented, and able to repeat and name and had fluent speech.
Daniele Torres, Gaspare Parrinello, Mauro Cardillo, Marina Pomilla, Caterina Trapanese, Bellanca Michele, Umberto Lupo, Caterina Schimmenti, Francesco Cuttitta, Rossella Pietrantoni, Danai Vogiatzis, Giuseppe Licata
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.009
Published online: May 25 2012
xHiatal hernia (HH) is a frequent entity. Rarely, it may exert a wide spectrum of clinical presentations mimicking acute cardiovascular events such as angina-like chest pain until manifestations of cardiac compression that can include postprandial syncope, exercise intolerance, respiratory function, recurrent acute heart failure, and hemodynamic collapse. A 69-year-old woman presented to the emergency department complaining of fatigue on exertion, cough, and episodes of restrosternal pain with less than 1 hour of duration.
Samuel Thomas Creavin, Claire M. Rice, Adrian Pollentine, Philip Cowburn
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.010
Published online: May 25 2012
xA woman aged 31 years presented to the emergency department after a minor head injury. She reported mild headache and a metallic taste in her mouth. Full neurologic examination was remarkable only for left-sided Horner syndrome. Left internal carotid artery dissection was confirmed on magnetic resonance imaging. She was treated with aspirin. Symptoms and signs persisted 3 months later, but there was no additional neurologic deficit.
Behçet Al, Mehmet Subası, Burçin Karsli, Pınar Yarbil, Suat Zengin
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.011
Published online: June 4 2012
xCarbon monoxide (CO) is a colorless, odorless, nonirritating, toxic gas produced by the incomplete oxidation of hydrocarbons. Common sources of CO include motor vehicles, house fires, furnaces/heaters, and wood-burning stoves. It is a serious health problem resulting in approximately 50 000 visits to the emergency department and is responsible for 3500 deaths annually in the United States. Besides accidental exposure, CO is also one of the leading causes of death by suicide. In the present study, we discuss compartment syndrome caused by CO poisoning in a 15-year-old boy.
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00517-7
Published in issue: November 2012
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00518-9
Published in issue: November 2012
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00493-7
Published in issue: November 2012
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00494-9
Published in issue: November 2012
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00495-0
Published in issue: November 2012
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00496-2
Published in issue: November 2012
