Leprosy case series in the emergency room: A warning sign for a challenging diagnosis

Purpose To determine the nature and types of domestic eye injuries. Methods The authors prospectively analyzed data of 100 consecutive patients with domestic eye injury (104 eyes) referred to the emergency room of Farabi Hospital during October 2003. Standardized international classification of ocular trauma (Birmingham Eye Trauma Terminology) was used for eye injury classification. Results Domestic ocular trauma represented 4.85% of all ocular emergencies (2061 patients) referred to the emergency room during that period. Male to female ratio was 1.13 and mean age of patients was 26±18 years (range, 1–73). Cornea was involved in 50.0% and sclera, lens, and retina each was involved in 4.8%. There was severe visual loss (best-corrected distance visual acuity <20/200 due to trauma) in 4% of the patients. The most frequent domestic ocular injury was globe injury (93.7%) including mechanical (72.1% closed and 4.8% open), chemical (14.4%), and thermal (1.9%) injuries. Conclusions Closed mechanical injuries were the most common type of domestic ocular injury in our series. Considering the high rate of domestic eye trauma among ocular emergency cases, more preventive measures should be taken at home.

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Evaluation of acute compartment syndrome of extremities in emergency room: a case series of 32 children

Internet Journal of Medical Update - EJOURNAL ◽

10.4314/ijmu.v10i2.6 ◽

2015 ◽

Vol 10 (2) ◽

pp. 37

Author(s):

A Singh ◽

S Ali ◽

RN Srivastava

Keyword(s):

Emergency Room ◽

Compartment Syndrome ◽

Case Series ◽

Acute Compartment Syndrome

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The importance of simulation education for the management of traumatic cardiac injuries: a case series

Surgical Case Reports ◽

10.1186/s40792-019-0762-y ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Takashi Nagata ◽

Tomohiko Akahoshi ◽

Michiko Sugino ◽

Wataru Ishii ◽

Ryoji Iizuka ◽

...

Keyword(s):

Emergency Room ◽

Cardiac Tamponade ◽

Operating Room ◽

Motor Vehicle ◽

Prior Experience ◽

Median Sternotomy ◽

Case Series ◽

Cardiac Trauma ◽

Stab Wounds ◽

Blunt Cardiac Trauma

Abstract Background The management of cardiac trauma requires rapid intervention in the emergency room, facilitated by a surgeon with prior experience to have good outcomes. Many surgeons have little experience in the requisite procedures. We report here 4 patients who suffered cardiac trauma, and all 4 patients survived with good neurologic outcomes. Case presentations Patient 1 suffered blunt cardiac trauma from a motor vehicle accident and presented in shock. Cardiac tamponade was diagnosed and a cardiac rupture repaired with staples through a median sternotomy after rapid transport to the operating room. Patient 2 suffered blunt cardiac trauma and presented in shock with cardiac tamponade. Operating room median sternotomy allowed extraction of pericardial clot with recovery of physiologic stability. Patient 3 presented with self-inflicted stab wounds to the chest and was unstable. She was brought to the operating room and thoracotomy allowed identification of a left ventricle wound which was repaired with a suture. Patient 4 presented in cardiac arrest with multiple self-inflicted stab wounds to the chest. Emergency room thoracotomy allowed repair of a right ventricle laceration with recovery of vital signs. Conclusions The management of all 4 patients was according to the principles taught in the ATOM course. Three of the 4 surgeons had no prior experience with management of cardiac trauma and credited the good outcomes to taking the ATOM course. These are uncommon injuries and formal training in their management is beneficial to patients.

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The Diagnostic Yield and Cost of Radiologic Imaging for Urgent and Emergent Ocular Conditions in an Eye Emergency Room

Journal of Academic Ophthalmology ◽

10.1055/s-0040-1715570 ◽

2020 ◽

Vol 12 (02) ◽

pp. e115-e123

Author(s):

Jordan D. Deaner ◽

Austin R. Meeker ◽

Daniel J. Ozzello ◽

Vishal Swaminathan ◽

Dilru C. Amarasekera ◽

...

Keyword(s):

Emergency Room ◽

Diagnostic Yield ◽

Case Series ◽

Economic Cost ◽

Chief Complaint ◽

Binary Outcomes ◽

Examination Finding ◽

Imaging Results ◽

Radiologic Imaging ◽

Patient Reported

Abstract Objective The aim of this study is to assess the diagnostic yield and economic cost of radiologic imaging for urgent and emergent ophthalmic conditions in an emergency room (ER) setting Design Retrospective, consecutive case series. Methods Charts of all patients who underwent radiologic imaging in a dedicated eye ER over a single year were reviewed. Data collected included age, patient reported chief complaint, visual acuity, principal examination finding, indication for imaging, imaging modalities performed, and the current procedural terminology (CPT) codes billed for the imaging performed. Imaging results were classified into three groups with binary outcomes: normal or abnormal; significant if it led to a change in patient management, and relevant if the imaging findings were related to the chief complaint or principal examination finding. Imaging costs were calculated using the billed CPT codes. Results A total of 14,961 patients were evaluated during the 1-year study and 1,371 (9.2%) patients underwent imaging. Of these, 521 patients (38.0%) had significant findings. A majority of this group had significant and relevant findings (469, 34.2% of total). Subgroup analysis was performed based upon patient chief complaint, principal examination finding, and indication for imaging. Overall, the total cost of imaging was $656,078.34 with an average cost of $478.54 per patient. Conclusion Imaging for urgent and emergent ophthalmic conditions in an eye ER resulted in significant management changes in 38.0% of patients. Radiographic imaging contributes to healthcare expenditures; however, these costs must be weighed against the substantial costs of delayed and misdiagnoses, especially when patients present with acute ophthalmological symptoms.

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Intraoperative monitoring of visual evoked potentials in patients undergoing transsphenoidal surgery for pituitary adenoma: a systematic review

BMC Neurology ◽

10.1186/s12883-021-02315-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Farizeh Jashek-Ahmed ◽

Ivan Cabrilo ◽

Jarnail Bal ◽

Brett Sanders ◽

Joan Grieve ◽

...

Keyword(s):

Pituitary Adenoma ◽

Evoked Potentials ◽

Visual Evoked Potentials ◽

Visual Function ◽

Transsphenoidal Surgery ◽

Intraoperative Monitoring ◽

Case Series ◽

Warning Sign ◽

Published Evidence ◽

Visual Evoked

Abstract Background Transsphenoidal surgery is the gold standard for pituitary adenoma resection. Although rare, a serious complication of surgery is worsened vision post-operatively. Objective To determine whether, in patients undergoing transsphenoidal surgery for pituitary adenoma, intraoperative monitoring of visual evoked potentials (VEP) is a safe, reproducible, and effective technological adjunct in predicting postoperative visual function. Methods The PubMed and OVID platforms were searched between January 1993 and December 2020 to identify publications that (1) featured patients undergoing transsphenoidal surgery for pituitary adenoma, (2) used intraoperative optic nerve monitoring with VEP and (3) reported on safety or effectiveness. Reference lists were cross-checked and expert opinion sought to identify further publications. Results Eleven studies were included comprising ten case series and one prospective cohort study. All employed techniques to improve reliability. No safety issues were reported. The only comparative study included described a statistically significant improvement in post-operative visual field testing when VEP monitoring was used. The remaining case-series varied in conclusion. In nine studies, surgical manipulation was halted in the event of a VEP amplitude decrease suggesting a widespread consensus that this is a warning sign of injury to the anterior optic apparatus. Conclusions Despite limited and low-quality published evidence regarding intra-operative VEP monitoring, our review suggests that it is a safe, reproducible, and increasingly effective technique of predicting postoperative visual deficits. Further studies specific to transsphenoidal surgery are required to determine its utility in protecting visual function in the resection of complex pituitary tumours.

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Acute chorea: case series from the emergency room of a Brazilian tertiary-level center

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x-anp-2020-0124 ◽

2021 ◽

Vol 79 (3) ◽

pp. 233-237

Author(s):

Guilherme Diogo SILVA ◽

Jacy Bezerra PARMERA ◽

Monica Santoro HADDAD

Keyword(s):

Emergency Room ◽

Case Series ◽

Clinical Findings ◽

Clinical Aspects ◽

Tertiary Level ◽

Glucose Levels ◽

Sydenham Chorea ◽

Neuroimaging Data ◽

Normal Glucose ◽

Common Etiology

ABSTRACT Background: Chorea is a movement disorder characterized by random, brief and migratory involuntary muscle contractions. It is defined as acute when present within hours to days. Three main causes for this scenario have emerged as most likely: vascular, toxic-metabolic and inflammatory. Objectives: To identify the prevalence of the main etiologies and major clinical findings of acute chorea in the emergency room of a tertiary-level referral center; and to suggest an approach for guiding the diagnostic workup and clinical management. Methods: We retrospectively reviewed the clinical aspects and neuroimaging data of 10 patients presenting with acute chorea at the neurological emergency room of our hospital from 2015 to 2019. Results: Stroke was the most common etiology (50% of the cases). All of them were ischemic. It was noteworthy that only one case demonstrated the classical ischemic topographic lesion at the contralateral subthalamic nuclei. Regarding nonvascular etiologies, nonketotic hyperglycemia was the major cause, followed by drug-related chorea. One patient showed inflammatory etiology, which was probably Sydenham chorea reactivation. Conclusion: Acute chorea is an uncommon and challenging problem at the emergency room, often associated with potentially treatable causes. We suggest that use of the acronym DANCE (Diagnosis of chorea, Acute stroke protocol, Normal glucose levels, Check neuroimaging, Exposure to drugs) could form a potential initial approach in the evaluation, in order to emphasize causes that require prompt proper management (e.g. thrombolysis).

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Euthanasia requests in a Canadian psychiatric emergency room: A case series

International Journal of Law and Psychiatry ◽

10.1016/j.ijlp.2017.10.006 ◽

2017 ◽

Vol 55 ◽

pp. 37-44 ◽

Cited By ~ 2

Author(s):

David Benrimoh ◽

Antoine Perreault ◽

Frederique Van Den Eynde

Keyword(s):

Emergency Room ◽

Case Series ◽

Psychiatric Emergency ◽

Psychiatric Emergency Room

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173 It Smells Fishy: A Case Report and Discussion of Olfactory Reference Syndrome

CNS Spectrums ◽

10.1017/s1092852920000899 ◽

2020 ◽

Vol 25 (2) ◽

pp. 310-310

Author(s):

Shafi Lodhi

Keyword(s):

Emergency Room ◽

Case Series ◽

Somatoform Disorder ◽

African American Female ◽

Obsessive Compulsive ◽

Cleaning Product ◽

Compulsive Disorder ◽

Dsm 5 ◽

Patient Reported ◽

High Level

Abstract:Background: Olfactory reference syndrome (ORS) is a psychiatric condition characterized by the belief that one is emitting a foul body odor. The earliest cases of this disorder were often labeled as variants of schizophrenia. There remains significant controversy over whether this condition represents a manifestation of other psychiatric conditions or if it is a unique disorder in its own right. Through various revisions of the DSM, the disorder has been categorized at times as an atypical somatoform disorder (DSM-III), a delusional disorder (DSM-IV-TR), and an Other Specified Obsessive-Compulsive Disorder (DSM-5).Case History:We present the case of a 51 year old African American female who initially presented to an emergency room with chief complaint of vaginal odor. She stated that if the odor was not treated, she would commit suicide. Medical workup in the emergency room was unremarkable and no odor was detected. The patient was placed on a psychiatric hold and transferred to the Psychiatric Emergency Room. In the PES, the patient reported that she was afraid of eviction from her apartment due to the “horrible” smell that she was emitting. The patient had presented to multiple emergency departments over the preceding year complaining of vaginal odor. The patient persisted in her belief about this smell despite multiple medical providers informing her that they could detect no abnormal smell. Unconvinced, the patient went to great lengths to treat this odor. When normal showering did not cause the odor to cease, the patient began manually inserting pieces of deodorant into her vaginal canal. This was extracted at an outside hospital after the patient presented for treatment after developing an infection. After discharge, the patient began mixing a household cleaning product containing benzalkonium chloride with bleach and used this mixture for vaginal douching. When even this did not eliminate the perceived odor, she presented to our emergency room stating that if the odor was not treated, she would attempt suicide.Discussion:Although ORS has been described since the 1800’s, the first systematic description in the literature was a case series in 1971 by Pryse-Phillips. While ORS has been increasingly reported in the scientific literature, the DSM-5 does not consider it to be a unique clinical entity.Conclusion/Teaching Point:This case highlights the importance of clinicians being aware of clinical entities which exist outside the DSM-5. As shown in this case, ORS may lead to severe impairment and even suicidal ideation Despite this, there is a scarcity of literature on evidence based treatments for ORS. It has typically been treated with either a moderate dose SSRI or a low dose antipsychotic, with or without CBT. Given the high level of distress and disability caused by the condition, greater awareness of its existence and greater research on its treatment is certainly warranted.

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Case Series of Three Patients with Disseminated Gonococcal Infection and Endocarditis

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2021.7.53404 ◽

2021 ◽

Vol 5 (4) ◽

pp. 381-384

Author(s):

Phillip Moschella ◽

Hannah Shull ◽

Mark Pittman ◽

Alex Gleason ◽

Prerana Roth

Keyword(s):

Differential Diagnosis ◽

Sexually Transmitted Infections ◽

Case Series ◽

Warning Sign ◽

Gonococcal Infection ◽

Sexually Transmitted ◽

Resistance Patterns ◽

History Of ◽

Antibiotic Resistance Patterns ◽

Urine Testing

Introduction: The increasing incidence of Neisseria gonorrhoeae infections and emergence of cephalosporin-resistant strains means the threat of disseminated gonococcal infection and endocarditis needs to be reimagined into the differential diagnosis for patients treated in the emergency department (ED) for sexually transmitted infections and for endocarditis itself. Only 70 cases of disseminated gonococcal infection (DGI) with endocarditis had been reported through 2014.1-4 In 2019, however, an outbreak of DGI with one case of endocarditis was reported.5 This case series of three patients with DGI and endocarditis, in addition to the recent outbreak, may represent a warning sign for reemergence of this threat. Case Report: We describe three cases within a recent three-year period of gonococcal endocarditis as seen and treated at our institution. These cases show divergent presentations of this insidious disease with both classical and atypical features. One case displayed a classic migratory rash with positive urine testing and a remote history of sexually transmitted infections, while another patient developed isolated culture-confirmed endocarditis with negative cervical testing and imaging, and the final case was a male patient who presented to the ED with fulminant endocarditis as the first ED presentation of infection. Conclusion: Secondary to an overall rise in incidence and possibly due to increasing antibiotic-resistance patterns, gonococcal endocarditis should be included in the differential diagnosis of any case of endocarditis. Reciprocally, increased vigilance should surround the evaluation of any patient for sexually transmitted diseases while in the ED for both the development of DGI and endocarditis.

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