Pneumomediastinum: A rare presentation in Emergency Department following blunt trauma to neck during a football match

Blunt trauma abdomen leading to gallbladder perforation is a rare event usually recognized on evaluation and treatment of other visceral injuries during laparotomy. The gallbladder is relatively a well-protected organ. Isolated gallbladder perforation is extremely rare. The clinical presentation is variable, early diagnosis and treatment is of extreme importance to reduce morbidity and mortality associated with gallbladder perforation. We report a case of a patient who sustained isolated gallbladder injury following blunt trauma abdomen to emergency department in Safdarjung Hospital, New Delhi.

Download Full-text

Groin Abscess: Assessing The Diagnostic Accuracy Of Emergency Department Clinicians And Imaging Modalities

Emergency Medicine Trauma & Surgical Care ◽

10.24966/ets-8798/100050 ◽

2020 ◽

Vol 7 (2) ◽

pp. 1-4

Author(s):

Victor Ameh ◽

Keyword(s):

Emergency Department ◽

Diagnostic Accuracy ◽

Correct Diagnosis ◽

Retrospective Chart Review ◽

District General Hospital ◽

Adult Patients ◽

Provisional Diagnosis ◽

Rare Presentation ◽

The Right ◽

Groin Abscess

Objective: To determine the clinical and imaging diagnostic accuracy in adult patients presenting to the Emergency Department with groin abscess. Method: Retrospective chart review of all adult patients presenting to a district general hospital with a provisional diagnosis of groin abscess was undertaken from January 2019 to December 2019. A proforma was used to capture data such as the age, sex, co-morbidities, grade of assessing clinician and imaging profile. Results: 39 patients with a provisional diagnosis of groin abscess were identified; representing approximately 1% of all ED attendances. There were 21 males and 18 females. The age range was from 23 to 73 years (mean age 42). The abscess was located on the left side in 19 patients (49%), 18 (46%) on the right and 2 (5%) were bilateral. The overall rate of correct diagnosis of the ED clinicians compared to CT diagnosis is indicated by a sensitivity of 82%, positive predictive value of 90% and an accuracy of 75%. 22 patients had CT scan which confirmed an abscess in 18 (83%). Conclusion: Groin abscess is a rare presentation to the Emergency department. Most patients were seen by clinicians below the consultant grade. Diagnostic accuracy was highest amongst physicians.

Download Full-text

Subcutanaeous emphysema: An extremely rare manifestation of supraglottic squamous cell carcinoma

Annals of Geriatric Education and Medical Sciences ◽

10.18231/j.agems.2021.015 ◽

2021 ◽

Vol 8 (2) ◽

pp. 64-67

Author(s):

Abhishek Subhash Chande ◽

Shilpa Bawankule ◽

Pallavi Yelne ◽

Vinay Verma ◽

Sujal Patel

Keyword(s):

Emergency Department ◽

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Rare Presentation ◽

Mass Growth ◽

Local Extension ◽

Supraglottic Squamous Cell Carcinoma ◽

Rare Manifestation ◽

Common Causes

We present the case report of a 60 years old man who presented to the emergency department with complaints of breathlessness for 2 weeks. After all common causes were ruled out, the patient was subjected to CT scan of neck in which he showed laryngeal mass growth which was perforating through the cartilage. There were a few surrounding lymph nodes and after an FNAC, it was found to be squamous cell carcinoma. The patient was referred for chemotherapy and radiotherapy at higher centre. To our knowledge, this is a very rare presentation of local extension of tumour. The patient presenting with carcinoma at a very late stage, succumbed to it 2 months later.

Download Full-text

Utility of Plain Film Pelvic Radiographs in Blunt Trauma Patients in the Emergency Department

The American Surgeon ◽

10.1177/000313480607201025 ◽

2006 ◽

Vol 72 (10) ◽

pp. 951-954 ◽

Cited By ~ 13

Author(s):

Amal Kamil Obaid ◽

Andrew Barleben ◽

Diana Porral ◽

Stephanie Lush ◽

Marianne Cinat

Keyword(s):

Emergency Department ◽

Ct Scan ◽

Blunt Trauma ◽

Injury Severity ◽

Plain Film ◽

Pelvic Fractures ◽

Trauma Patients ◽

Pelvic Radiographs ◽

Highly Sensitive ◽

Pelvic Embolization

The objective of this study was to evaluate the utility and sensitivity of routine pelvic radiographs (PXR) in the initial evaluation of blunt trauma patients. A retrospective review was performed. One hundred seventy-four patients with a pelvic fracture who had computed tomography (CT) and PXR were included (average age, 36.1; average Injury Severity Score, 16.3). Nine (5%) patients died. Five hundred twenty-one fractures were identified on CT. One hundred sixteen (22%) of these fractures were missed by PXR. Eighty-eight (51%) patients were underdiagnosed by PXR alone. The most common fractures missed by PXR were sacral and iliac fractures. Eight patients required angiograms, with four undergoing therapeutic pelvic embolization. Forty-seven (27%) patients were hypotensive or required a transfusion in the emergency department. These patients were more likely to require an angiogram (17% vs 0%, P < 0.0001) and were more likely to require embolization (9% vs 0%, P < 0.001). This study demonstrates that CT scan is highly sensitive in identifying and classifying pelvic fractures. PXR has a sensitivity of only 78 per cent for identification of pelvic fractures in the acute trauma patient. In hemodynamically stable patients who are going to undergo diagnostic CT scan, PXR is of little value. The greatest use of PXR may be as a screening tool in hemodynamically unstable patients and/or those that require transfusion to allow for early notification of the interventional radiology team.

Download Full-text

More Than Just A Gastroenteritis - Bottle gourd (Lagenaria Siceraria) Toxicity Diagnosed in the Emergency Department

10.21203/rs.3.rs-1139827/v1 ◽

2021 ◽

Author(s):

Wey Ting Lee ◽

Guoyi Geoffrey Ng ◽

Dong Haur Phua

Keyword(s):

Emergency Department ◽

Traditional Medicine ◽

Complementary Medicine ◽

Early Recognition ◽

Public Awareness ◽

General Medicine ◽

Bottle Gourd ◽

Local Context ◽

Lagenaria Siceraria ◽

Rare Presentation

Abstract BackgroundBottle gourd (Lagenaria siceraria) is sometimes used in complementary medicine practice for the treatment of chronic ailments. It belongs to the Cucurbitaceae family. However, there have been reports of toxicity due to consumption of bottle gourd juice leading to severe abdominal upset and upper gastrointestinal bleeding. As emergency physicians we need to be aware of such complementary medicine induced haemorrhagic gastroenteritis as possible etiology of gastrointestinal haemorrhage. Case presentationWe present a case of a 41-year-old gentleman who presented to the emergency department (ED) with multiple episodes of vomiting, hematemesis and diarrhoea after consuming bottle gourd juice. The patient was resuscitated and stabilized with fluids, proton pump inhibitors and antiemetics. He was subsequently admitted to General Medicine ward for further management. He continued to receive symptomatic treatment in the ward and underwent esophagogastroduodenoscopy (OGD) during his hospitalization stay. His symptoms improved and he was discharged stable five days later. ConclusionEarly recognition of this rare presentation of bottle gourd toxicity is important in our local context especially where traditional medicine is widely prevalent nowadays. Treatment is supportive. Public awareness of dangerous effects from the consumption of bitter bottle gourd juice and complementary medicine without proper consultation with practitioner plays a crucial role to prevent further cases. Physicians need to advise patients on the use of traditional medicine and their potential side effects.

Download Full-text

Closed Emergency Department Reduction of a Superior Patellar Dislocation After Blunt Trauma

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2018.06.020 ◽

2018 ◽

Vol 55 (4) ◽

pp. 567-569

Author(s):

Parisa P. Javedani ◽

Lisa C. Goldberg ◽

Ashish R. Panchal

Keyword(s):

Emergency Department ◽

Blunt Trauma ◽

Patellar Dislocation

Download Full-text

Absence of 5 clinical criteria ruled out cervical spine injury in blunt trauma in the emergency department

Evidence-Based Medicine ◽

10.1136/ebm.6.2.63 ◽

2001 ◽

Vol 6 (2) ◽

pp. 63-63

Author(s):

R. Bloch

Keyword(s):

Emergency Department ◽

Cervical Spine ◽

Blunt Trauma ◽

Cervical Spine Injury ◽

Spine Injury ◽

Clinical Criteria

Download Full-text

An unusual presentation of small bowel intussusception

CJEM ◽

10.1017/cem.2014.42 ◽

2015 ◽

Vol 17 (3) ◽

pp. 318-321 ◽

Cited By ~ 2

Author(s):

Samantha Dankoff ◽

Pramod Puligandla ◽

Alana Beres ◽

Farhan Bhanji

Keyword(s):

Emergency Department ◽

Small Bowel ◽

Abdominal Ultrasound ◽

Endogenous Opioid ◽

Neurologically Impaired ◽

Rare Presentation ◽

Diagnostic Dilemma ◽

Early Management ◽

Small Bowel Intussusception ◽

Level Of Consciousness

AbstractA previously healthy 2-year-old boy presented to the emergency department with a decreased level of consciousness. A physical examination was unremarkable except for miosis and atypical limb movements. The patient underwent an extensive workup, including the search for metabolic, infectious, neurologic, and toxicologic etiologies. An abdominal ultrasound was performed because the child continued to remain neurologically impaired with no cause identified on other investigations. The ultrasound revealed a persistent uncomplicated ileoileal intussusception. The patient was taken to the operating room for surgical reduction. The child recovered fully postoperatively. This case illustrates the rare presentation of intussusception encephalopathy, which can be a diagnostic dilemma, especially when none of the symptoms of intussusception are present. Endogenous opioid poisoning is hypothesized to be the cause of the miosis and may hint at the diagnosis and aid in early management.

Download Full-text