Bilateral pneumothoraces and pneumomediastinum complicating a generalized tonic-clonic seizure

ABSTRACTPatients often present to the emergency department following a generalized tonic-clonic seizure, particularly of new onset. Complications associated with seizures usually arise from injuries sustained from loss of consciousness or during convulsive activity. This report describes a patient with an idiopathic seizure who developed postictal alveolar edema and delayed bilateral pneumothoraces and pneumomediastinum. A literature search revealed only 1 other case of this potentially life-threatening pulmonary complication from seizures.

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Management of transient loss of consciousness of suspected syncopal cause, after the initial evaluation in the Emergency Department

Emergency Care Journal ◽

10.4081/ecj.2016.6046 ◽

2016 ◽

Vol 1 (1) ◽

Author(s):

Ivo Casagranda ◽

Michele Brignole ◽

Simone Cencetti ◽

Gianfranco Cervellin ◽

Giorgio Costantino ◽

...

Keyword(s):

Emergency Department ◽

Initial Evaluation ◽

Loss Of Consciousness ◽

Transient Loss Of Consciousness ◽

Risk Levels ◽

Risk Patients ◽

Life Threatening ◽

Transient Loss ◽

Multidisciplinary Group ◽

Diagnostic Investigations

The recommendations enclosed in the present document have been developed by a group of experts appointed by the <em>Gruppo Multidisciplinare per lo Studio della Sincope</em> (Multidisciplinary Group for the Study of Syncope; GIMSI) and Academy of Emergency Medicine and Care (AcEMC). The aim is to define the diagnostic pathway and the management of patients referred to the Emergency Department (ED) for transient loss of consciousness of suspected syncopal cause, which is still unexplained after the initial evaluation. The risk stratification enables the physician to admit, discharge or monitor shortly the patient in the intensive short-stay Syncope Observation Unit (SOU). There are three risk levels of life-threatening events or serious complications (low, moderate, high). Low risk patients can be discharged, while high risk ones should be monitored and treated properly in case of worsening. Moderate risk patients should undergo clinical and instrumental monitoring in SOU, inside the ED. In all these three cases, patients can be subsequently referred to the Syncope Unit for further diagnostic investigations.

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Clinical Issues in Acute Childhood Seizure Management in the Emergency Department

Journal of Child Neurology ◽

10.1177/0883073898013001031 ◽

1998 ◽

Vol 13 (1_suppl) ◽

pp. S7-S10 ◽

Cited By ~ 6

Author(s):

Thomas E. Temdrup

Keyword(s):

Emergency Department ◽

Seizure Activity ◽

Clonic Seizure ◽

Anticonvulsant Therapy ◽

Emergency Medical Service Personnel ◽

Diagnostic Measures ◽

Seizure Disorders ◽

Generalized Seizures ◽

Emergency Department Management ◽

Life Threatening

Generalized tonic-clonic seizure activity in infants and children frequently leads to an emergency department visit, often after emergency medical service personnel, such as paramedics, provide initial evaluation and treatment. Important subsets of patients who present to the emergency department include those with non-seizure-mediated movements, those with nongeneralized seizure activity, those with complications of anticonvulsant therapy, and those with status epilepticus. Recognizing, diagnosing, and treating these conditions and minimizing complications are key issues to be considered in the refinement of emergency department practice. Of the children with seizures who are seen in the emergency department, those with febrile convulsions or exacerbations of underlying seizure disorders predominate, while those with new-onset epilepsy or other seizure disorders account for a smaller proportion. Current issues in the emergency department management of seizures in children include: (1) modifying interventions to stabilize patients and simultaneously minimize the physiologic deterioration accompanying generalized seizures; (2) selection, initiation, administration, and refinement of anticonvulsant therapy; (3) minimizing complications of prolonged seizures and their treatment; (4) rapid recognition and treatment of life-threatening illnesses that underlie seizure presentations; (5) selection of appropriate diagnostic measures; and (6) use of electroencephalography in selected patients. (J Child Neurol 1998;13(Suppl 1):S7-S10).

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A rare case of varicella zoster virus encephalitis in a 16 years old unvaccinated girl

Trends in Infection and Global Health ◽

10.24815/tigh.v1i1.20362 ◽

2021 ◽

Vol 1 (1) ◽

pp. 7-11

Author(s):

Abdul Wali Khan ◽

Abad Khan ◽

Muhammad Ishaq ◽

Irfan Ullah ◽

Marhami Fahriani

Keyword(s):

Emergency Department ◽

Rare Case ◽

Altered Mental Status ◽

Clonic Seizure ◽

Tonic Clonic Seizure ◽

The Body ◽

Persistent Fever ◽

Varicella Zoster ◽

Appropriate Treatment ◽

Unvaccinated Girl

We reported a 16-year-old girl, with diffuse vesicular rashes all over the body, presented to the emergency department with altered mental status, irritability, persistent fever and one episode of a generalized tonic-clonic seizure. After thorough evaluation and investigations, the case was a varicella zoster-associated encephalitis in an unvaccinated patient. Appropriate treatment was initiated, the patient was then shifted to the critical care and subsequently discharged with no sequelae. Early diagnosis and treatment should be emphasized as they play an important role in the clinical outcome of chickenpox-associated encephalitis.

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Is There Possibility Of Withdrawal Seizure In Opioid Dependence Syndrome? A Case Report

Journal of Psychiatrists Association of Nepal ◽

10.3126/jpan.v9i2.36290 ◽

2020 ◽

Vol 9 (2) ◽

pp. 82-84

Author(s):

B Regmi ◽

S Limbu ◽

S Nepal

Keyword(s):

Case Report ◽

Opioid Dependence ◽

Clonic Seizure ◽

Opioid Withdrawal ◽

Tonic Clonic Seizure ◽

Heroin Dependence ◽

Muscle Cramps ◽

Rare Phenomenon ◽

New Onset

Opioids are commonly used and abused substance worldwide. Opioid withdrawal may manifest as severe muscle cramps, diarrhea, rhinorrhea, lacrimation, piloerection, yawning, and fever. Here, we report a 32 year old man with heroin dependence, presented with new onset generalized tonic-clonic seizure following heroin withdrawal. Seizure is a life-threating condition and rare phenomenon in opioid withdrawal therefore, reporting of this case is important. It may help clinician to be aware and consider seizure as a part of opioid withdrawal.

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Brain abscess complicating a diabetic man with Evans syndrome: a case report

BIRDEM Medical Journal ◽

10.3329/birdem.v11i2.53136 ◽

2021 ◽

Vol 11 (2) ◽

pp. 137-141

Author(s):

Dilruba Alam ◽

Rumana Habib ◽

Mahir Muhtasim ◽

Md Rezwanul Haque

Keyword(s):

Brain Abscess ◽

Fatal Outcome ◽

Diagnostic Delay ◽

Clonic Seizure ◽

Tonic Clonic Seizure ◽

Evans Syndrome ◽

Threatening Condition ◽

Life Threatening ◽

History Of ◽

Clinical Triad

Brain abscess is a relatively rare but potentially life threatening condition. The classic clinical triad of fever, headache and focal neurological sign may not be present in an immuno-compromised patient. The diagnostic delay may result in fatal outcome. A 52-year-old diabetic gentleman with history of chronic immunosuppressive therapy due to Evans syndrome presented with headache, generalized tonic- clonic seizure and right upper limb monoparesis. Clinical ground and neuroimaging was suggestive of pyogenic brain abscess. Patient was treated with antibiotic therapy for prolong period and there was complete clinical and radiological recovery. Birdem Med J 2021; 11(2): 137-141

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Life threatening abdominal compartment syndrome as an early complication of new onset ketosis prone type 2 diabetes mellitus

Diabetologie und Stoffwechsel ◽

10.1055/s-0037-1601775 ◽

2017 ◽

Vol 12 (S 01) ◽

pp. S1-S84

Author(s):

B Hartmann ◽

S Vetter ◽

B Mark ◽

A Wagner ◽

J Weidenhammer ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Compartment Syndrome ◽

Abdominal Compartment Syndrome ◽

Early Complication ◽

Life Threatening ◽

Abdominal Compartment ◽

New Onset

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Sophistry and Circumstance at the End of Life

Communication & Medicine ◽

10.1558/cam.v5i1.81 ◽

2008 ◽

Vol 5 (1) ◽

pp. 81-88

Author(s):

Philip Berry

Keyword(s):

Liver Failure ◽

Medical Personnel ◽

Medical Decision ◽

Loss Of Consciousness ◽

Supportive Treatment ◽

Medical Decisions ◽

Life Threatening Illness ◽

Two Factors ◽

Life Threatening ◽

Counselling Process

When life-threatening illness robs a patient of the ability to express their desires, medical personnel must work through the issues of management and prognosis with relatives. Management decisions are guided by medical judgement and the relatives’ account of the patient’s wishes, but difficulties occur when distance grows between these two factors. In these circumstances the counselling process may turn into a doctor-led justification of the medical decision. This article presents two strands of dialogue, in which a doctor, counselling for and against continuation of supportive treatment in two patients with liver failure, demonstrates selectivity and inconsistency in constructing an argument. The specific issues of loss of consciousness (with obscuration of personal identity), statistical ‘futility’ and removal of autonomy are explored and used to bolster diametrically opposed medical decisions. By examining the doctor’s ability to interpret these issues according to circumstance, the author demonstrates how it is possible to shade medical facts depending on the desired outcome.

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Effect of Undertriage on the Outcomes of Cancer Patients with Febrile Neutropenia, Sepsis, and Septic Shock

Clinical Nursing Research ◽

10.1177/1054773821999688 ◽

2021 ◽

pp. 105477382199968

Author(s):

Anas Alsharawneh

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Length Of Stay ◽

Febrile Neutropenia ◽

Cancer Patients ◽

Emergency Setting ◽

Extended Length ◽

Life Threatening ◽

Sepsis And Septic Shock ◽

Timely Treatment

Sepsis and neutropenia are considered the primary life-threatening complications of cancer treatment and are the leading cause of hospitalization and death. The objective was to study whether patients with neutropenia, sepsis, and septic shock were identified appropriately at triage and receive timely treatment within the emergency setting. Also, we investigated the effect of undertriage on key treatment outcomes. We conducted a retrospective analysis of all accessible records of admitted adult cancer patients with febrile neutropenia, sepsis, and septic shock. Our results identified that the majority of patients were inappropriately triaged to less urgent triage categories. Patients’ undertriage significantly prolonged multiple emergency timeliness indicators and extended length of stay within the emergency department and hospital. These effects suggest that triage implementation must be objective, consistent, and accurate because of the several influences of the assigned triage scoring on treatment and health outcomes.

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303 What goes bump in the night? A literature review and noise exposure experiment in a UK paediatric emergency department

Emergency Medicine Journal ◽

10.1136/emj-2020-rcemabstracts.32 ◽

2020 ◽

Vol 37 (12) ◽

pp. 841.1-841

Author(s):

Lucy Hall ◽

Sophie Dando ◽

Anthony Hanks

Keyword(s):

Emergency Department ◽

Literature Review ◽

Literature Search ◽

Noise Exposure ◽

Cochrane Library ◽

Noise Levels ◽

Paediatric Emergency Department ◽

Paediatric Emergency ◽

Sound Levels ◽

Exposure Experiment

Aims/Objectives/BackgroundIn the Emergency department (ED), noise is a frequent and often unavoidable consequence of work undertaken and levels can often be raised during the day and night. Raised ambient noise levels have potential implications for the workforce, patients and relatives.Investigation into the problem of noise levels in the ED follows feedback from a young patient who couldn’t sleep during a prolonged stay. His complaint focused on loud, irregular banging noises such as those from closing bins that kept him awake.The team felt work should be done to see if it was a wider spread problem or just isolated to his case. A simple sound recording experiment and literature search was conducted.Methods/DesignThe literature search was conducted using electronic/online databases (Medline; Cochrane library) with a fixed date range and specific inclusion criteria.The noise exposure experiment was conducted using a verified phone app to record the sound levels. They were measured at 3 times, during a night shift, in the paediatric emergency department of UHW. All measurements were at a fixed distance and were averaged and compared with WHO recommendations.Results/ConclusionsThere are many sources of noise pollution in the ED, some are unavoidable for safety and clinical reasons.The literature review produced a small number of papers all of which found that sound levels were raised above recommended levels. Similarly, all the sounds measured in the ED also exceeded the recommendations.The most consistent finding across the papers, matched by findings from recordings, was that human behavioural modification is an easy and effective way to reduce noise levels.There are simple steps that can be taken to reduce and eliminate soundsRaising awareness regarding this problem is of great importance and focussing future work on assessing the impact in younger patients within the Emergency Department is paramount.

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