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Case Reports in Emergency Medicine

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https://www.readbyqxmd.com/read/27895945/congenital-renal-fusion-and-ectopia-in-the-trauma-patient
#1
Andrew A Rosenthal, Jordan J Ditchek, Seong K Lee, Rafael Sanchez, Chauniqua Kiffin, Dafney L Davare, Eddy H Carrillo
We present two separate cases of young male patients with congenital kidney anomalies (horseshoe and crossed fused renal ectopia) identified following blunt abdominal trauma. Despite being rare, ectopic and fusion anomalies of the kidneys are occasionally noted in a trauma patient during imaging or upon exploration of the abdomen. Incidental renal findings may influence the management of traumatic injuries to preserve and protect the patient's renal function. Renal anomalies may be asymptomatic or present with hematuria, flank or abdominal pain, hypotension, or shock, even following minor blunt trauma or low velocity impact...
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27822396/acute-paraplegia-as-a-presentation-of-aortic-saddle-embolism
#2
Lisandro Irizarry, Anton Wray, Kim Guishard
Background. Acute onset paraplegia has a myriad of causes most often of a nonvascular origin. Vascular etiologies are infrequent causes and most often associated with postsurgical complications. Objective. To describe the occurrence and possible mechanism for aortic saddle embolism as a rare cause of acute paraplegia. Case Report. Described is a case of a 46-year-old female who presented with the sudden onset of nontraumatic low back pain with rapidly progressive paraplegia which was subsequently determined to be of vascular origin...
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27807487/tibiofibula-transposition-in-high-energy-fractures
#3
Peter R Loughenbury, Rebecca A Gledhill, Nick Evans
We report two cases of failed attempts at closed reduction of high-energy tibial fractures with an associated fibula fracture. The first case was a 39-year-old male involved in high-speed motorbike collision, while the second was a 14-year-old male who injured his leg following a fall of three metres. Emergency medical services at the scenes of the accidents reported a 90-degree valgus deformity of the injured limb and both limbs were realigned on scene and stabilized. Adequate alignment of the tibia could not be achieved by manipulation under sedation or anaesthesia...
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27761272/clinical-heterogeneity-of-guillain-barr%C3%A3-syndrome-in-the-emergency-department-impact-on-clinical-outcome
#4
Athanasios Papathanasiou, Ioannis Markakis
Guillain-Barré syndrome (GBS) is mainly classified into acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN). Although diagnosis of GBS requires progressive weakness and universal areflexia or hyporeflexia, cases of GBS with preserved or increased deep tendon reflexes (DTRs) have been increasingly recognized. We report three cases of GBS, presenting at a single unit in six months. Our first case presented with pure sensory symptoms. The second case had nonspecific generalized weakness, while the third presented with typical ascending weakness...
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27703817/conservative-treatment-of-carpometacarpal-dislocation-of-the-three-last-fingers
#5
Hélène Jumeau, Philippe Lechien, Florence Dupriez
Posterior carpometacarpal (CMC) dislocation is a rare condition. Treatment is usually surgical though no strict consensus can be found upon literature review. If diagnosed early and no associated fractures are found, CMC dislocation could benefit from conservative treatment comprising closed reduction and splint immobilisation. We report the case of a 26-year-old man diagnosed with a posterior dislocation of the third, fourth, and fifth CMC joints after a fall of 1.5 meters, treated by external reduction under procedural sedation and immobilisation with a cast for 6 weeks...
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27668101/a-ruptured-ectopic-pregnancy-presenting-with-a-negative-urine-pregnancy-test
#6
Johnathan Michael Sheele, Rachel Bernstein, Francis L Counselman
A negative urine pregnancy test in the emergency department traditionally excludes the diagnosis of pregnancy. We report a rare case of ruptured ectopic pregnancy in a patient with a negative urine pregnancy test but with a serum beta-human chorionic gonadotropin (β-hCG) of 10 mIU/mL. The patient developed hemoperitoneum and required laparoscopy by Obstetrics and Gynecology (OB/Gyn). This case highlights the fallibility of the urine pregnancy test in diagnosing early pregnancy.
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27651958/spider-bite-a-rare-case-of-acute-necrotic-arachnidism-with-rapid-and-fatal-evolution
#7
Mario Pezzi, Anna Maria Giglio, Annamaria Scozzafava, Orazio Filippelli, Giuseppe Serafino, Mario Verre
The spider bites are quite frequent and often resolve quickly without leaving outcomes; only some species are capable of causing necrotic and systematic lesions in humans. Among them, we should mention the genus Loxosceles. The venom released from the spider bite of Loxosceles species is composed of proteins, enzymes, and nonenzymatic polypeptides. The phospholipase D family was identified as the active component of the venom. This family of enzymes is responsible for the local and systemic effects observed in loxoscelism...
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27642528/pulmonary-embolism-presenting-as-abdominal-pain-an-atypical-presentation-of-a-common-diagnosis
#8
Hasan Rehman, Elizabeth John, Payal Parikh
Pulmonary embolism (PE) is a frequent diagnosis made in the emergency department and can present in many different ways. Abdominal pain is an unusual presenting symptom for PE. It is essential to maintain a high degree of suspicion in these patients, as a delay in diagnosis can be devastating for the patient and confers a high risk of mortality if left untreated. Here, we report the case of a 53-year-old male who presented to the emergency department with worsening right upper quadrant abdominal pain with fevers...
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27635267/lyme-disease-presenting-with-multiple-cranial-nerve-deficits-report-of-a-case
#9
Abhishek Chaturvedi, Keith Baker, Donald Jeanmonod, Rebecca Jeanmonod
Lyme disease is a tick-transmitted multisystem inflammatory disease caused by the spirochete Borrelia burgdorferi. With more than 25,000 CDC reported cases annually, it has become the most common vector-borne disease in the United States. We report a case of 38-year-old man with Lyme disease presenting with simultaneous palsy of 3rd, 5th, 7th, 9th, and 10th cranial nerves.
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27579187/necrotizing-fasciitis-presenting-as-an-itchy-thigh
#10
Thor Shiva Stead, V Shushrutha Hedna
We present a case of necrotizing fasciitis diagnosed in the emergency department. The clinical presentation and diagnostic findings of necrotizing fasciitis are discussed.
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27563472/severe-methemoglobinemia-due-to-sodium-nitrite-poisoning
#11
Kenichi Katabami, Mineji Hayakawa, Satoshi Gando
Case. We report a case of severe methemoglobinemia due to sodium nitrite poisoning. A 28-year-old man was brought to our emergency department because of transient loss of consciousness and cyanosis. He was immediately intubated and ventilated with 100% oxygen. A blood test revealed a methemoglobin level of 92.5%. Outcome. We treated the patient with gastric lavage, activated charcoal, and methylene blue (2 mg/kg) administered intravenously. Soon after receiving methylene blue, his cyanosis resolved and the methemoglobin level began to decrease...
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27555971/ultrasound-guided-forearm-nerve-blocks-a-novel-application-for-pain-control-in-adult-patients-with-digit-injuries
#12
Richard Amini, Parisa Patricia Javedani, Albert Amini, Srikar Adhikari
Phalanx fractures and interphalangeal joint dislocations commonly present to the emergency department. Although these orthopedic injuries are not complex, the four-point digital block used for anesthesia during the reduction can be painful. Additionally, cases requiring prolonged manipulation or consultation for adequate reduction may require repeat blockade. This case series reports four patients presenting after mechanical injuries resulting in phalanx fracture or interphalangeal joint dislocations. These patients received an ultrasound-guided peripheral nerve block of the forearm with successful subsequent reduction...
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27547477/posttraumatic-haematuria-with-pseudorenal-failure-a-diagnostic-lead-for-intraperitoneal-bladder-rupture
#13
Ketan Vagholkar, Suvarna Vagholkar
Bladder rupture is a very morbid injury following blunt or penetrating lower abdominal trauma. Prompt diagnosis is crucial to initiate optimal treatment. Intraperitoneal bladder rupture is associated with haematuria and biochemical features of renal failure. Cystogram is diagnostic. Immediate open surgical repair is the main stay of treatment. A case of intraperitoneal rupture diagnosed preoperatively by the presence of haematuria and pseudorenal failure is presented to highlight the association of posttraumatic haematuria and pseudorenal failure in such injuries...
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27547476/reversal-of-dabigatran-using-idarucizumab-in-a-septic-patient-with-impaired-kidney-function-in-real-life-practice
#14
Thomas C Sauter, Sina Blum, Michael Nagler, Fabian L Schlittler, Meret E Ricklin, Aristomenis K Exadaktylos
Background. Immediate reversal of anticoagulation is essential when facing severe bleeding or emergency surgery. Although idarucizumab is approved for the reversal of dabigatran in many countries, clinical experiences are lacking, particularly in special patient-populations such as sepsis and impaired renal function. Case Presentation. We present the case of a 67-year-old male septic patient with a multilocular facial abscess and chronic kidney disease (GFR 36.5 mL/min). Thrombin time (TT) and activated partial thromboplastin time (aPTT) 15 hours after the last intake of 150 mg dabigatran were both prolonged (>120 sec, resp...
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27493812/propofol-infusion-syndrome-in-refractory-status-epilepticus-a-case-report-and-topical-review
#15
Akil Walli, Troels Dirch Poulsen, Mette Dam, Jens Børglum
Propofol infusion syndrome (PRIS) is a fatal complication when doses of propofol administration exceed 4 mg/kg/h for more than 48 hours. Propofol overdosage is not uncommon in patients with refractory status epilepticus (RSE). We describe a case of refractory status epilepticus complicated by propofol infusion syndrome and collect from 5 databases all reports of refractory status epilepticus cases that were treated by propofol and developed the syndrome and outline whether refractory status epilepticus treatment with propofol is standardized according to international recommendations, compare it with alternative medications, and discuss how this syndrome can be treated and prevented...
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27478658/iatrogenic-radial-nerve-palsy-following-closed-reduction-of-a-simple-diaphyseal-humeral-fracture-beware-the-perfect-x-ray
#16
Morgan Jones, Hean Wu Kang, Christopher O'Neill, Paul Maginn
Radial nerve injury is a recognised complication associated with humeral shaft fracture. A case of iatrogenic radial nerve injury is presented following fracture reduction. The relevant anatomy, challenges in management of humeral fractures with associated radial nerve injury, and the importance of detailed clinical assessment and documentation are discussed.
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27418984/hemoptysis-as-the-presenting-clinical-sign-of-a-t8-t9-spine-fracture-with-diffuse-idiopathic-skeletal-hyperostosis-changes
#17
Ioannis Siasios, John Pollina, Vassilios G Dimopoulos
Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory degenerative disease that affects multiple spine levels and, in combination with osteoporosis, makes vertebrae more prone to fractures, especially in elderly people. We describe a rare case of thoracic fracture in an ankylosed spine in which hemoptysis was the only clinical sign. The patient (age in the early 80s) presented with chest pain and a cough associated with hemoptysis. The patient had no complaints of back pain and no neurological symptoms...
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27340575/avoidable-compartment-syndrome-high-index-of-suspicion-for-a-newly-presenting-haemophiliac-a-case-series
#18
A Niblock, K Donnelly, F Sayers, P Winter, G Benson
Bleeding disorders can present at any age and vary in their severity. Haemophilia, which is characterised by its x-linked recessive inheritance, can present with a spontaneous mutation and therefore no family history will be evident. Three cases of trauma induced thigh haematomas as an initial presenting feature for people with haemophilia are discussed. The cases highlight the importance of a coagulation screen if the patients bleeding phenotype does not match the injury sustained. An isolated prolonged APTT with no offending anticoagulant cause should always be investigated to look for underlying haemophilia...
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27313914/severe-cardiomyopathy-after-huffing-dust-off%C3%A2
#19
Alexis L Cates, Matthew D Cook
A 34-year-old man was found down in a parking lot after huffing fifteen cans of Dust-Off. Though lucid during the initial hospital evaluation, the patient experienced a generalized seizure followed by a torsades de pointes arrhythmia and was resuscitated. An echocardiogram revealed left and right ventricular dysfunction with an ejection fraction of 25%. This unique outcome of inhalant abuse has scarcely been reported in similar cases. The patient fully recovered and had a normal ejection fraction prior to discharge...
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27293918/intramedullary-abscess-by-staphylococcus-aureus-presenting-as-cauda-equina-syndrome-to-the-emergency-department
#20
Dimitrios Damaskos, Helene Jumeau, François-Xavier Lens, Philippe Lechien
Cauda equina syndrome (CES) is a rare entity presenting with low back pain, unilateral or bilateral sciatica, motor weakness of lower extremities, sensory disturbance in the perineal area, and urinary and/or faecal incontinence. Those symptoms are secondary to compression of the cauda equina. If not recognized, CES can lead to irreversible disabilities. We report the case of a 77-year-old lady who presented to the emergency department with a ten-day history of back pain as well as urinary incontinence.
2016: Case Reports in Emergency Medicine
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