scholarly journals Hampton’s Hump: A Notable Radiographic Finding in a Patient with Infectious Endocarditis

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Matthew Earle ◽  
James Bailey ◽  
Ross P. Berkeley
Keyword(s):  
Emergency Department ◽  
Weight Loss ◽  
Radiographic Finding ◽  
Infectious Endocarditis ◽  
Critically Ill Patient ◽  
Lower Extremity Edema ◽  
Stable Patient ◽  
Diagnostic Investigation ◽  
Progressive Dyspnea ◽  
Clinical Scenarios

Infectious endocarditis is a relatively uncommon entity that may present with a variety of clinical scenarios, ranging from a stable patient with nonspecific symptoms to a critically ill patient suffering from embolic disease. We report a case of an otherwise healthy 35-year-old female who presented to the Emergency Department with gradually progressive dyspnea, weight loss, and lower extremity edema. As part of her initial evaluation, a chest radiograph was performed and demonstrated Hampton’s Hump, a peripheral wedge-shaped opacity consistent with a possible pulmonary infarct. Further diagnostic investigation in the Emergency Department led to an unanticipated diagnosis of infectious endocarditis. This case serves as an important reminder that nonspecific diagnostic findings need to be appropriately considered in context and is a rare demonstration of Hampton’s Hump associated with infectious endocarditis.

Chronic mesenteric ischaemia presenting as possible large bowl malignancy: an easily overlooked differential diagnosis

2021 ◽  
Vol 14 (3) ◽  
pp. e240202
Author(s):  
Benjamin McDonald
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Weight Loss ◽  
Differential Diagnosis ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Mesenteric Ischaemia ◽  
Abdominal Symptoms ◽  
Chronic Mesenteric Ischaemia ◽  
Descending Colon

An 80-year-old woman presented to a regional emergency department with postprandial pain, weight loss and diarrhoea for 2 months and a Computed Tomography (CT) report suggestive of descending colon malignancy. Subsequent investigations revealed the patient to have chronic mesenteric ischaemia (CMI) with associated bowel changes. She developed an acute-on-chronic ischaemia that required emergency transfer, damage control surgery and revascularisation. While the patient survived, this case highlights the importance of considering CMI in elderly patients with vague abdominal symptoms and early intervention to avoid potentially catastrophic outcomes.

A difficult airway made worse by apprehension: an obese young male with COVID 19

2021 ◽  
Vol 11 (5) ◽  
pp. 129-134
Author(s):  
Ishan N Perera
Keyword(s):  
Emergency Department ◽  
Difficult Airway ◽  
Night Shift ◽  
Young Male ◽  
Critically Ill Patient ◽  
Third Wave ◽  
Personal Safety ◽  
Comorbid Conditions ◽  
Successful Completion ◽  
Patient Factors

Intubation of a critically ill patient in the emergency department is always considered a difficult airway. Timing, patient factors which are not optimized, and intubation done by infrequent intubators. Add to this the complications and demands of Covid 19 pandemic which make crash intubations a thing feared for personal safety as well as successful completion of intubation without complications. If the patient has intrinsic comorbid conditions contributing to a difficult airway, worse the procedure would be. Furthermore, Covid pneumonia presents its own challenges in preoxygenation, timing of the intubation, ventilation of the patient and transport as well. This is a patient I came across during the third wave of covid19 pandemic in Sri Lanka, working in the Emergency department night shift. He came in acute respiratory distress and required intubation and ventilation.

Sleep-Related Breathing Disorders

2016 ◽  
pp. 773-774
Author(s):  
Mithri R. Junna
Keyword(s):  
Systolic Pressure ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Lower Extremity Edema ◽  
Right Ventricular Systolic Pressure ◽  
Sleep Related Breathing Disorders ◽  
Transthoracic Doppler Echocardiography ◽  
Ventricular Systolic Pressure ◽  
Progressive Dyspnea ◽  
The Many

Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure of at least 25 mm Hg at rest, as measured during right heart catheterization (RHC). The many causes of PH are classified into 5 groups. The clinical presentation of patients with PH is nonspecific: progressive dyspnea, chest pain, lower extremity edema, and fatigue. Typically, a diagnosis of PH is suggested by an increased right ventricular systolic pressure on transthoracic Doppler echocardiography and is confirmed with RHC.

scholarly journals Are Further Interventions Needed to Prevent and Manage Hospital-Acquired Hyponatraemia? A Nationwide Cross-Sectional Survey of IV Fluid Prescribing Practices

2020 ◽  
Vol 9 (9) ◽  
pp. 2790
Author(s):  
Per Sindahl ◽  
Christian Overgaard-Steensen ◽  
Helle Wallach-Kildemoes ◽  
Marie Louise De Bruin ◽  
Hubert GM Leufkens ◽  
...  
Keyword(s):  
Emergency Department ◽  
Inappropriate Prescribing ◽  
Plasma Sodium ◽  
Prescribing Practices ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Clinical Scenarios ◽  
Hypotonic Fluids ◽  
Hospital Acquired ◽  
The Impact

Background: Hyponatraemia is associated with increased morbidity, increased mortality and is frequently hospital-acquired due to inappropriate administration of hypotonic fluids. Despite several attempts to minimise the risk, knowledge is lacking as to whether inappropriate prescribing practice continues to be a concern. Methods: A cross-sectional survey was performed in Danish emergency department physicians in spring 2019. Prescribing practices were assessed by means of four clinical scenarios commonly encountered in the emergency department. Thirteen multiple-choice questions were used to measure knowledge. Results: 201 physicians responded corresponding to 55.4% of the total population of physicians working at emergency departments in Denmark. About a quarter reported that they would use hypotonic fluids in patients with increased intracranial pressure and 29.4% would use hypotonic maintenance fluids in children, both of which are against guideline recommendations. Also, 29.4% selected the correct fluid, a 3% hypertonic saline solution, for a patient with hyponatraemia and severe neurological symptoms, which is a medical emergency. Most physicians were unaware of the impact of hypotonic fluids on plasma sodium in acutely ill patients. Conclusion: Inappropriate prescribing practices and limited knowledge of a large number of physicians calls for further interventions to minimise the risk of hospital-acquired hyponatraemia.

scholarly journals Rare case of triple mutant (KRAS + NRAS + BRAF) metastatic colon adenocarcinoma

2019 ◽  
Vol 12 (9) ◽  
pp. e221816
Author(s):  
Anusha Vittal ◽  
Disha Sharma ◽  
Ipsita Samanta ◽  
Anup Kasi
Keyword(s):  
Colorectal Cancer ◽  
Emergency Department ◽  
Weight Loss ◽  
Rare Case ◽  
Treatment Strategies ◽  
Colon Adenocarcinoma ◽  
Smoking History ◽  
Braf Mutations ◽  
Triple Mutant ◽  
Dismal Prognosis

KRAS is detected in 30%–50% of colorectal cancer (CRC) and BRAF mutations are found in 10% of CRC. A 62-year-old man with the long-standing smoking history presented to the emergency department with abdominal pain, weight loss and constipation. CT scan of abdomen/pelvis showed obstructive mass which was found to be colon adenocarcinoma which on further molecular analysis tested positive for KRAS, NRAS and BRAF mutations. His tumour progressed despite chemotherapy and surgery and he died within a year of diagnosis. Concomitant KRAS, NRAS and BRAF mutations are rare enough to be considered mutually exclusive but coexistent mutations appear to be a distinct molecular and clinical subset which needs new and effective treatment strategies in a setting of dismal prognosis.

scholarly journals LO48: Pediatric cannabinoid hyperemesis syndrome in the emergency department: a 5-year retrospective review

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S24-S24
Author(s):  
D. Foster ◽  
K. Van Aarsen ◽  
J. Yan ◽  
J. Teefy ◽  
T. Lynch
Keyword(s):  
Emergency Department ◽  
Weight Loss ◽  
Abdominal Pain ◽  
Pediatric Patients ◽  
Venous Blood ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Cannabis Use ◽  
Discharge Diagnosis ◽  
Cannabinoid Hyperemesis Syndrome

Introduction: Cannabinoid Hyperemesis Syndrome (CHS) in pediatric patients is poorly characterized. Literature is scarce, making identification and treatment challenging. This study's objective was to describe demographics and visit data of pediatric patients presenting to the emergency department (ED) with suspected CHS, in order to improve understanding of the disorder. Methods: A retrospective chart review was conducted of pediatric patients (12-17 years) with suspected CHS presenting to one of two tertiary-care EDs; one pediatric and one pediatric/adult (combined annual pediatric census 40,550) between April 2014-March 2019. Charts were selected based on discharge diagnosis of abdominal pain or nausea/vomiting with positive cannabis urine screen, or discharge diagnosis of cannabis use, using ICD-10 codes. Patients with confirmed or likely diagnosis of CHS were identified and data including demographics, clinical history, and ED investigations/treatments were recorded by a trained research assistant. Results: 242 patients met criteria for review. 39 were identified as having a confirmed or likely diagnosis of CHS (mean age 16.2, SD 0.85 years with 64% female). 87% were triaged as either CTAS-2 or CTAS-3. 80% of patients had cannabis use frequency/duration documented. Of these, 89% reported at least daily use, the mean consumption was 1.30g/day (SD 1.13g/day), and all reported ≥6 months of heavy use. 69% of patients had at least one psychiatric comorbidity. When presenting to the ED, all had vomiting, 81% had nausea, 81% had abdominal pain, and 30% reported weight loss. Investigations done included venous blood gas (30%), pregnancy test in females (84%), liver enzymes (57%), pelvic or abdominal ultrasound (19%), abdominal X-ray (19%), and CT head (5%). 89% of patients received treatment in the ED with 81% receiving anti-emetics, 68% receiving intravenous (IV) fluids, and 22% receiving analgesics. Normal saline was the most used IV fluid (80%) and ondansetron was the most used anti-emetic (90%). Cannabis was suspected to account for symptoms in 74%, with 31% of these given the formal diagnosis of CHS. 62% of patients had another visit to the ED within 30 days (prior to or post sentinel visit), 59% of these for similar symptoms. Conclusion: This study of pediatric CHS reveals unique findings including a preponderance of female patients, a majority that consume cannabis daily, and weight loss reported in nearly one third. Many received extensive workups and most had multiple clustered visits to the ED.

scholarly journals Intra-articular displacement of an avulsed medial (internal) epicondyle ossification centre in the paediatric elbow: a radiographic finding not to be missed

2019 ◽  
Vol 12 (11) ◽  
pp. e231635
Author(s):  
Amir Qadeer ◽  
Michael Paddock
Keyword(s):  
Emergency Department ◽  
Internal Fixation ◽  
Open Reduction ◽  
Radiographic Finding ◽  
Medial Epicondyle ◽  
Ossification Centre ◽  
Elbow Pain

We present the case of an 11-year-old girl who was presented to the Emergency Department with right elbow pain and swelling following a fall. Radiography demonstrated intra-articular displacement of an avulsed medial epicondyle ossification centre, which was not readily identified at presentation. She proceeded to an uncomplicated open reduction and internal fixation.

Bedside Thoracic Ultrasonography for the Critically Ill Patient: From the Emergency Department to the Intensive Care Unit

2020 ◽  
Vol 39 (3) ◽  
pp. 215-228
Author(s):  
María C. Arango-Granados ◽  
Luis A. Bustamante Cristancho ◽  
Virginia Zarama Córdoba
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patient

scholarly journals Cardiac Biomarkers in the Emergency Department: The Role of Soluble ST2 (sST2) in Acute Heart Failure and Acute Coronary Syndrome—There is Meat on the Bone

2019 ◽  
Vol 8 (2) ◽  
pp. 270 ◽  
Author(s):  
Aneta Aleksova ◽  
Alessia Paldino ◽  
Antonio Beltrami ◽  
Laura Padoan ◽  
Massimo Iacoviello ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Acute Heart Failure ◽  
Ventricular Remodeling ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Soluble St2 ◽  
Coronary Syndrome ◽  
Clinical Scenarios ◽  
Increased Risk

Soluble ST2 (sST2) has recently emerged as a promising biomarker in the field of acute cardiovascular diseases. Several clinical studies have demonstrated a significant link between sST2 values and patients’ outcome. Further, it has been found that higher levels of sST2 are associated with an increased risk of adverse left ventricular remodeling. Therefore, sST2 could represent a useful tool that could help the risk stratification and diagnostic and therapeutic work-up of patients admitted to an emergency department. With this review, based on recent literature, we have built sST2-assisted flowcharts applicable to three very common clinical scenarios of the emergency department: Acute heart failure, type 1, and type 2 acute myocardial infarction. In particular, we combined sST2 levels together with clinical and instrumental evaluation in order to offer a practical tool for emergency medicine physicians.

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