scholarly journals A Patient with speechlessness and rhabdomyolysis: a rare presentation of severe hypocalcaemia

2020 ◽  
Vol 13 (12) ◽  
pp. e238072
Author(s):  
Florine Helene Jiwa ◽  
Kim van den Hoek ◽  
Clementine Jaantje Joanna van Zeijl ◽  
Albertus Jozef Kooter
Keyword(s):  
Emergency Department ◽  
Cold Water ◽  
Case Reports ◽  
Atypical Presentation ◽  
Rare Presentation ◽  
Calcium Supplements ◽  
Blood Tests ◽  
Prompt Treatment ◽  
Life Threatening ◽  
Severe Hypocalcaemia

A 29-year-old man with no medical history presented to our emergency department with episodes of sudden speechlessness, hoarseness, vomiting after drinking cold water and spasms of his hands. Chvostek’s and Trousseau’s signs were both seen at presentation. Blood tests revealed severe hypocalcaemia (1.03 mmol/L) and rhabdomyolysis (creatine kinase (CK) of 2962 IU/L). The patient was treated immediately with calcium intravenously with an almost immediate improvement of his voice and quick normalisation of his CK. Additional investigation showed primary hypoparathyroidism in the presence of a vitamin D deficiency, requiring lifelong treatment with calcium supplements and alphacalcidol. Severe hypocalcaemia can be life threatening and prompt treatment is essential. This case reports the unusual first presentation of hypocalcaemia via speechlessness and vomiting together with rhabdomyolysis. Identifying an atypical presentation of hypocalcaemia is critical, for it can be lifesaving.

scholarly journals Adult Onset Henoch-Schonlein Purpura and Intussusception: A Rare Presentation

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Mridula Krishnan ◽  
Joseph Nahas
Keyword(s):  
Unusual Case ◽  
Surgical Intervention ◽  
Gastrointestinal Symptoms ◽  
Adult Onset ◽  
Henoch Schonlein Purpura ◽  
Rare Presentation ◽  
Prompt Treatment ◽  
Life Threatening ◽  
Schonlein Purpura ◽  
Henoch Schönlein Purpura

We present an unusual case of a young 26-year-old male who was diagnosed with Henoch-Schonlein Purpura (HSP). Initial presentation was primarily mild gastrointestinal symptoms, which progressed to a life threatening intussusception and subsequently resolved with prompt glucocorticoid use rather than typical surgical intervention. Of importance, the patient’s initial gastrointestinal symptoms without associated skin manifestations made the diagnosis difficult. In conclusion, it is important to recognize uncommon presentations of HSP as it may lead to life threatening complications and surgical intervention may be avoided with prompt treatment.

scholarly journals Recognition of a disulfiram ethanol reaction in the emergency department is not always straightforward

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243222
Author(s):  
Kristof Segher ◽  
Liesbeth Huys ◽  
Tania Desmet ◽  
Evi Steen ◽  
Stefanie Chys ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Case Reports ◽  
Alcohol Use Disorders ◽  
Interrater Agreement ◽  
History Taking ◽  
Key Words Ethanol ◽  
Life Threatening ◽  
Ethanol Reactions ◽  
Ethanol Interaction

Objectives Disulfiram is an adjunct in the treatment of alcohol use disorders, but case reports indicate that disulfiram ethanol reactions are not always recognized in the emergency department. Our first aim is to remind of this risk with two case reports of life-threatening reactions not immediately considered by the emergency physician. The second aim is to estimate the probability that a disulfiram reaction goes unrecognized with the use of a retrospective study of patients admitted to the emergency department. Methods Clinical files of patients admitted between October 1, 2010 and September 30, 2014 to the emergency department were retrospectively screened for the key words “ethanol use” and “disulfiram”. Their diagnoses were then scored by a panel regarding the probability of an interaction. Results Seventy-nine patients were included, and a disulfiram-ethanol reaction was scored as either ‘highly likely’, ‘likely’ or ‘possible’ in 54.4% and as ‘doubtful’ or ‘certainly not present’ in 45.6% of the patients. The interrater agreement was 0.71 (95% CI: 0.64–0.79). The diagnosis was not considered or only after a delay in 44.2% of the patients with a ‘possible’ to ‘highly likely’ disulfiram interaction. One patient with a disulfiram overdose died and was considered as a ‘possible’ interaction. Discussion and conclusions A disulfiram ethanol interaction can be life threatening and failure to consider the diagnosis in the emergency department seems frequent. Prospective studies with documentation of the intake of disulfiram and evaluation of the value of acetaldehyde as a biomarker are needed to determine the precise incidence. Improving knowledge of disulfiram interactions and adequate history taking of disulfiram intake may improve the care for patients.

Pickering syndrome: a rare presentation in emergency department

2021 ◽  
Vol 14 (2) ◽  
pp. e239421
Author(s):  
Prawal Shrimal ◽  
Ankit Kumar Sahu ◽  
Roshan Mathew ◽  
Abhinav Bansal
Keyword(s):  
Emergency Department ◽  
Renal Artery ◽  
Pulmonary Edema ◽  
Young Patient ◽  
Renal Artery Stenosis ◽  
Early Recognition ◽  
Hypertensive Emergency ◽  
Acute Pulmonary Edema ◽  
Rare Presentation ◽  
Life Threatening

Sympathetic crash acute pulmonary edema (SCAPE) is a life-threatening injury, which requires early recognition and intervention to prevent mortality. We present a case of 18-year-old woman with no previous comorbidity, presenting with SCAPE who was successfully resuscitated and eventually diagnosed with renal artery stenosis. Pickering syndrome is a rare cause of hypertensive emergency and should be considered in a young patient presenting with SCAPE in emergency department.

scholarly journals Consequences of Misdiagnosed and Mismanaged Hereditary Angioedema Laryngeal Attacks: An Overview of Cases from the Romanian Registry

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Dumitru Moldovan ◽  
Noémi Bara ◽  
Valentin Nădășan ◽  
Gabriella Gábos ◽  
Enikő Mihály
Keyword(s):  
Emergency Department ◽  
Effective Treatment ◽  
Hereditary Angioedema ◽  
Case Reports ◽  
Laryngeal Edema ◽  
Emergency Physicians ◽  
Treatment Protocols ◽  
Life Threatening

Emergency department (ED) physicians frequently encounter patients presenting with angioedema. Most of these involve histamine-mediated angioedema; however, less common forms of angioedema (bradykinin-mediated) also occur. It is vital physicians correctly recognize and treat this; particularly since bradykinin-mediated angioedema does not respond to antihistamines, corticosteroids or epinephrine and hereditary angioedema (HAE) laryngeal attacks can be fatal. Here we present four case reports illustrating how failures in recognizing, managing, and treating laryngeal edema due to HAE led to asphyxiation and death of the patient. Recognition of the specific type of angioedema is critical for rapid and effective treatment of HAE attacks. Bradykinin-mediated angioedema should be efficiently differentiated from the most common histamine-mediated form. Improved awareness of HAE and the associated risk of life-threatening laryngeal edema among emergency physicians, patients, and relatives and clear ED treatment protocols are warranted. Moreover, appropriate treatments should be readily available to reduce fatalities associated with laryngeal edema.

scholarly journals Transient binocular blindness: A rare presentation of aortic dissection

2018 ◽  
Vol 27 (4) ◽  
pp. 236-240
Author(s):  
Abdul Hafiz Shaharudin ◽  
Muhamad Hafiq Ab Hamid ◽  
Rosliza Yahaya ◽  
Nik Ahmad Shaiffudin Nik Him ◽  
Nik Arif Nik Mohamed ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Carotid Artery ◽  
Aortic Dissection ◽  
Sudden Onset ◽  
Rare Presentation ◽  
Diagnostic Dilemma ◽  
Threatening Condition ◽  
Life Threatening ◽  
High Index Of Suspicion

Introduction: Aortic dissection is a clinical chameleon that can have variable presenting features that require a careful history and physical examination. A non-specific presentation of this life-threatening condition causes a diagnostic dilemma among clinicians especially in the emergency department leading to grave consequences. Case Presentation: We present a case of aortic dissection that presented as an acute bilateral blindness that was associated with a sudden onset of loss of consciousness and central chest pain. Bedside carotid ultrasound showed a double lumen carotid artery suggesting an intraluminal flap. Computed tomography angiography revealed extensive dissection of the entire length of the aorta. Discussion: This case illustrated the need for a high index of suspicion to diagnose patients with aortic dissection especially as the patient presented with an acute binocular visual loss and chest pain. Conclusion: A bedside carotid artery ultrasound in the emergency department was found useful in screening and diagnosing a carotid artery–related pathology.

Acute atraumatic peri-arrest tension gastrothorax presenting to the emergency department

2021 ◽  
Vol 14 (4) ◽  
pp. e240478
Author(s):  
James Phelan ◽  
Rengarajan Subramanian ◽  
Adeep Krishnan Kutty Menon
Keyword(s):  
Emergency Department ◽  
Sudden Onset ◽  
Haemodynamic Instability ◽  
Management Options ◽  
Rare Presentation ◽  
Shopping Centre ◽  
Mediastinal Shift ◽  
Portable Chest ◽  
Life Threatening ◽  
Tension Gastrothorax

A 71-year-old woman was brought in by ambulance to the emergency department with sudden-onset difficulty in breathing whilst shopping at a large UK retail shopping centre. She had no respiratory history and portable chest X-ray revealed a huge gastrothorax, secondary pneumothorax and mediastinal shift. Clinical deterioration with haemodynamic instability required urgent decompression. Successful needle decompression followed by tube thoracostomy improved patient condition with no further complications. Surgical repair was performed but was delayed by COVID-19. This case provides a rare presentation of an acute life-threatening tension gastrothorax with difficult management considerations. A review of the management options is undertaken.

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

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.

Pharmacology Update: School Nurse Role and Emergency Medications for Treatment of Anaphylaxis

2021 ◽  
pp. 1942602X2110219
Author(s):  
Theresa A. Bingemann ◽  
Anil Nanda ◽  
Anne F. Russell
Keyword(s):  
Side Effects ◽  
School Personnel ◽  
Local Environment ◽  
School Nurses ◽  
First Line ◽  
Onset Of Action ◽  
Epinephrine Administration ◽  
Prompt Treatment ◽  
Nurse Role ◽  
Life Threatening

Anaphylaxis is a rapidly occurring allergic reaction that is potentially life threatening. Recognition of the early signs and prompt treatment of anaphylaxis is critical. School nurses are tasked with educating nonmedical school personnel on the recognition and treatment of anaphylaxis and emphasizing that epinephrine is the first line of treatment for anaphylaxis. Fortunately, there is now availability of multiple epinephrine administration devices. However, this also means that there are more devices that school nurses and nonmedical assistive personnel need to learn about to be able to administer in an emergency. Once epinephrine is administered, emergency medical services must be activated. Education regarding what to expect after the administration of epinephrine with respect to side effects and onset of action is also necessary. Though adjunctive medicines, such as antihistamines and inhalers, may also be administered after the injection of epinephrine, they should not be solely relied on in anaphylaxis. School nurses are uniquely situated for this role, as they understand the local environment in a school and can assess and reassess the needs of the faculty and staff.

Gastric antral vascular ectasia in children, rare presentation

2020 ◽  
Vol 13 (11) ◽  
pp. e236896
Author(s):  
Matthew Pizzuto ◽  
Sarah Ellul ◽  
Mohamed Shoukry
Keyword(s):  
Gastrointestinal Endoscopy ◽  
Abdominal Ultrasound ◽  
Clinical Findings ◽  
Evidence Based ◽  
Gastric Antral Vascular Ectasia ◽  
Perianal Area ◽  
Rare Presentation ◽  
Vascular Ectasia ◽  
Blood Tests ◽  
Abdominal Examination

A 14-year-old boy, a known case of perinatal hypoxic cerebral palsy, presented to paediatric emergency with acute melaena and blood staining around feeding gastrostomy site. Physical examination revealed pallor, but no signs of distress with an unremarkable abdominal examination. Routine blood tests revealed normochromic. Abdominal ultrasound scan and Meckel’s scan were unremarkable. The patient underwent examination under anaesthesia of the perianal area and joint upper and lower gastrointestinal endoscopy. Streak-like gastritis with no signs of active bleeding lesions were noted and patchy areas of colitis involving the descending and sigmoid colon and the rectum. All clinical findings and evidence-based diagnosis matched gastric antral vascular ectasia. He was successfully managed conservatively with elemental hydrolysed feeding formula.

scholarly journals Metastatic Prostate Cancer Involving the Sphenoid Sinus and Mandible

2021 ◽  
pp. 014556132110060
Author(s):  
Fadlullah Ba’th ◽  
Tanisha Hutchinson ◽  
Annie Meares ◽  
David Hamlar
Keyword(s):  
Prostate Cancer ◽  
Sphenoid Sinus ◽  
Metastatic Prostate Cancer ◽  
The United States ◽  
Endoscopic Examination ◽  
Atypical Presentation ◽  
Rare Presentation ◽  
The Third ◽  
Pathological Evaluation ◽  
Low Threshold

Prostate cancer is the third most leading cause of cancer in men in the United States. Although expected metastatic spread to bone, liver, and lymph nodes are often monitored, there are other rare presentations that can occur. This case report demonstrates a rare presentation of prostate cancer spreading to the paranasal sinuses and orbit. Not only did this case have an atypical presentation mimicking infection, the diagnosis was also only achieved through pathological evaluation after an endoscopic examination and biopsy. This case demonstrates the importance of a low threshold for endoscopic examinations in uncertain sinonasal presentations, and consistent biopsies when performing endoscopic examinations.

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