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Case Reports in Emergency Medicine

Sha Yan, Laryssa Patti
Intravenous drug use (IVDU) can lead to numerous complications from skin abscesses to bacteremia to endocarditis. Here, we present a rare case of acute suppurative thyroiditis as a complication of IVDU, in which a 26-year-old female with a past medical history of IVDU presented to the emergency department for evaluation of a large right sided neck mass. On exam, she had signs of sepsis and thyrotoxicosis. Fine needle aspiration confirmed suppurative thyroiditis. Blood cultures and culture from fine needle aspiration grew Staphylococcus aureus ...
2017: Case Reports in Emergency Medicine
Caleb H Creswell, Tony L Kille, Matthew R Hoffman, Tabassum Kennedy, Seth H Dailey
Foreign body ingestion occurs in not only children but also adults, particularly those with history of neurologic disease, alcohol use, or psychiatric disease. We present the case of a 40-year-old male with schizophrenia who presented to the emergency room with a long history of pharyngeal foreign body sensation which had recently progressed to include trismus, odynophagia, and dyspnea. Flexible laryngoscopy demonstrated fullness of the right posterior pharyngeal wall and computed tomography (CT) showed a linear opaque foreign body extending from the level of the oropharynx to the thyroid ala...
2017: Case Reports in Emergency Medicine
Brittany Pelsue, Jonathan G Rogg
This report describes a case of transient hyperammonemia following tonic-clonic status epilepticus with an initial ammonia level of 537 Umol/L. This appears to be the highest transient ammonia level reported in the literature in this clinical scenario. This is an affirmation that an initial elevated ammonia level in the absence of hepatic dysfunction should be interpreted with caution when associated with status epilepticus. Repeat levels should be drawn to identify transient hyperammonemia and determine the need for treatment if levels do not decrease...
2017: Case Reports in Emergency Medicine
David Hakimian, Orr Tomer, Nurith Hiller, Samuel N Heyman, Sarah Israel
Worldwide use of synthetic cannabinoids (SCs) is rapidly increasing, in part due to the generation of numerous new compounds, sidestepping legal restrictions. Their detection using standard toxicology panels is difficult, due to their vast heterogeneity and lack of structural resemblance to cannabinoids. Sympathetic overactivity and arterial spasm play a role in some of the life-threatening reactions to SCs, such as coronary or cerebral vasoconstriction. Here we report a patient with repeated consumption of SCs that led to mesenteric ischemia and death...
2017: Case Reports in Emergency Medicine
James E Tsang, June Sun, Gaik C Ooi, Kenneth W Tsang
Airway foreign bodies are a leading cause of death among children and require urgent recognition by medical personnel. While most cases are diagnosed readily from a clinical history of acute respiratory distress, some cases remain more indolent and present later. We report the case of a 7-year-old boy who aspirated a "LEGO" toy and presented with a week history of increasing respiratory distress compatible with known asthma. Despite a normal chest X-ray, a low-dose computed tomography showed the presence of a foreign body in the left main bronchus, which was subsequently removed by fiberoptic bronchoscopy...
2017: Case Reports in Emergency Medicine
Thirunavukarasu Kumanan, Mahesan Guruparan, Ratnasamy Vithiya, Indika Gawarammana
It is known that a number of toxic substances produce myocardial injury by several mechanisms involving interruption of coronary blood flow due to stimulation of clotting mechanism and coronary vasospasm. Number of toxic substances may cause direct myocardial toxicity independent of coronary blood flow. Acute myocardial injury due to stings and bites is a rare entity and not well understood. Here we illustrate a case of myocardial injury due to Russell's viper envenomation.
2017: Case Reports in Emergency Medicine
Yuzeng Shen, Mark Kwok Fai Leong
Abdominal pain is one of the most common presenting complaints at the Emergency Department (ED). Given the myriad of possible differential diagnoses for abdominal pain, it becomes more important to diagnose conditions requiring emergent surgical intervention early. We present a case of an elderly male patient with abdominal pain secondary to perforated hollow viscus, subtle evidence of pneumoretroperitoneum on the initial supine abdominal X-ray, and review the signs of pneumoperitoneum and pneumoretroperitoneum on plain abdominal X-rays...
2017: Case Reports in Emergency Medicine
Laryssa Patti, William Haussner, Grant Wei
Robotic assisted laparoscopic surgery is becoming more widely available, but despite its multiple benefits, it is not without risk. This case is of a 62-year-old female who presented to the emergency department for dyspnea two days after robotic assisted laparoscopic hysterectomy. Physical exam revealed diffuse facial, neck, upper extremity, torso, and lower extremity crepitus, which was diagnosed as diffuse subcutaneous air on computed tomography (CT). Imaging also revealed right apical pneumothorax and pneumomediastinum...
2017: Case Reports in Emergency Medicine
Julie Estrada, David Meurer, Kevin De Boer, Karl Huesgen
A 46-year-old male presented to our tertiary care emergency department (ED) with shortness of breath and chest pain following an uneventful four-hour SCUBA dive at 100 feet. His prehospital emergency medical services (EMS) assessment revealed transient hypotension and hypoxia. He later developed progressive skin mottling. Serology was significant for acute kidney injury, transaminitis, hemoconcentration, and hypoxia on an arterial blood gas. Computed tomography (CT) angiography demonstrated intravascular gas throughout the mesenteric and pulmonary arteries as well as the portal venous system...
2017: Case Reports in Emergency Medicine
James Espinosa, Rahul Sharma, Alan Lucerna, Doug Stranges
We report a case of a 71-year-old female who presented with right lower quadrant (RLQ) abdominal pain and was diagnosed on CT scan with right-sided diverticulitis with perforation. She was admitted under the surgical service after consultation and received intravenous fluids, intravenous antibiotics, and pain medications as needed. The patient was discharged 2 days after admission in stable condition with follow-up with gastroenterology. The differential diagnosis of right lower quadrant abdominal pain is vast...
2017: Case Reports in Emergency Medicine
Brian C Traub, Mark K Lane, Jeff A Traub
We present a rare case of acute exercise-induced bilateral upper-arm compartment syndrome in a patient who, after a year-long hiatus from exercise, subjected his upper-extremities to the stress of over 100 pushups. The patient presented with severe pain of the bilateral biceps and triceps and complaints of dark urine. Decompressive fasciotomy was performed followed by an intensive care unit (ICU) stay for associated myoglobinuria secondary to rhabdomyolysis. The patient suffered no long-term sequelae as a result of his conditions and recovered full function of the bilateral upper-extremities...
2017: Case Reports in Emergency Medicine
Tam Dang, Cham Nguyen, Phu N Tran
Despite the risk of cyanide toxicity and lack of efficacy, amygdalin is still used as alternative cancer treatment. Due to the highly lethal nature of cyanide toxicity, many patients die before getting medical care. Herein, we describe the case of a 73-year-old female with metastatic pancreatic cancer who developed cyanide toxicity from taking amygdalin. Detailed history and physical examination prompted rapid clinical recognition and treatment with hydroxocobalamin, leading to resolution of her cyanide toxicity...
2017: Case Reports in Emergency Medicine
Kylen Swartzberg, Ahmed Adam, Feroza Motara, Abdullah E Laher
INTRODUCTION: Acute urinary retention is a rare occurrence in women necessitating further investigation. Potential underlying causes may be broadly classified into obstructive, neurological, pharmacological, and psychogenic categories. CASE: A 36-year-old nulliparous female presented to the Emergency Department with a two-day history of acute urinary retention. Point-of-care ultrasonography and CT scan imaging confirmed the presence of a large uterine mass causing compression of the bladder...
2017: Case Reports in Emergency Medicine
Ali J Electricwala, Jaffer T Electricwala
We report a rare case of dislocation of second to fourth carpometacarpal (CMC) joints of the right hand with combined dorsal and ulnarward displacement of the second to fourth digits and fracture of the shaft of the first metacarpal associated with degloving injury. These injuries were diagnosed early and treated successfully with closed reduction and internal fixation using Kirschner wires. The functional outcome was good at follow-up at 5 years. A high index of suspicion is required to successfully diagnose and treat this condition...
2017: Case Reports in Emergency Medicine
Ciel Harris, Lauren Stemboroski, Asim Shuja
The majority of foreign bodies ingested pass uneventfully through the gastrointestinal tract without endoscopic intervention. Nevertheless, certain ingested objects pose a greater risk for complications and are more challenging to remove than others. This case report describes a 49-year-old male who swallowed a cigarette lighter causing a gastric ulcer. The lighter was successfully removed by flexible endoscopy using a polypectomy snare. Urgent removal is required due to the shape of the object and its hazardous contents...
2017: Case Reports in Emergency Medicine
Rachel F Schult, Nicole M Acquisto, Crystal K Stair, Timothy J Wiegand
Lionfish envenomation can cause erythema, edema, necrosis, and severe pain at the exposed site. Treatment often includes supportive wound care, pain management, and hot water immersion. We report a case of lionfish exposure presenting to an inland emergency department treated successfully with these measures.
2017: Case Reports in Emergency Medicine
Ramezani Awal Riabi Hamed, Ramezani Awal Riabi Hamid, Naghizade Hamid
We have described a new case of accidental intestinal myiasis that had occurred due to Eristalis tenax in Iran. A 4-year-old girl living in rural area near Bajestan city located in the south of Khorasan Razavi province visited the hospital lab with complaints of one live larva in feces and did not have other symptoms, except anal itching. This case had a history of consuming subterranean village water and did not have a history of traveling outside the city or contact with other patients. Conclusion. Based on the morphology characteristic, the larva was identified as "rat-tailed maggot" or larvae fly E...
2017: Case Reports in Emergency Medicine
Glenn Harnett
Resistance to macrolides is rising in the USA and warrants careful consideration when confronted with a patient with suspected pneumonia in the urgent care clinic. This case study exemplifies the potentially serious consequences of treatment failure following prescription of a macrolide for community-acquired bacterial pneumonia. Furthermore, the consequential treatment dilemmas currently faced by physicians are briefly discussed.
2017: Case Reports in Emergency Medicine
Michael R Minckler, Ellie Conser, Javier J Figueroa, Aaron J Scott, Joshua Gaither, Richard Amini
Priapism is defined as an erection that persists beyond four hours, lasting beyond or unrelated to sexual stimulation (Salonia et al., 2014). Because the risk of ischemic damage and impotence is high with priapism (35%), management guidelines are directed towards rapid treatment of this condition (Salonia et al., 2014). This report describes the rare case of an 18-year-old male who presented to the Emergency Department (ED) three times with recurrent and worsening episodes of sustained penile erections. On the patient's third visit, he presented with priapism of greater than six-hour duration that was found to be the result of chronic myeloid leukemia...
2017: Case Reports in Emergency Medicine
Ming-Ta Tsai, Shi-Yu Huang, Shih-Yu Cheng
Lead poisoning (LP) is less commonly encountered in emergency departments (ED). However, lead exposure still occurs, and new sources of poisoning have emerged. LP often goes unrecognized due to a low index of suspicion and nonspecific symptoms. We present a case of a 48-year-old man who had recurring abdominal pain with anemia that was misdiagnosed. His condition was initially diagnosed as nonspecific abdominal pain and acute porphyria. Acute porphyria-like symptoms with a positive urine porphyrin test result led to the misdiagnosis; testing for heme precursors in urine is the key to the differential diagnosis between LP and acute porphyria...
2017: Case Reports in Emergency Medicine
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