Methaemoglobinaemia from Vagisil creme in a 50-year-old woman

2021 ◽  
Vol 14 (3) ◽  
pp. e239697
Author(s):  
Sarah Cheyney ◽  
Zachary Field ◽  
Jacqueline Kropf ◽  
Steve Carlan
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Topical Anaesthetic ◽  
Over The Counter ◽  
Perimenopausal Woman ◽  
Threatening Condition ◽  
Life Threatening

Methaemoglobinaemia is a life-threatening condition that results from increased methaemoglobin production. As methaemoglobin is unable to reversibly bind to oxygen potentially lethal hypoxia and functional anaemia can occur. Benzocaine can be used as a topical anaesthetic and can be found in many nonprescription preparations marketed for self-application. It is known to cause methaemoglobinaemia in rare cases but most reports describe the complication occurring during endoscopy procedures. Methaemoglobinaemia occurring after topical benzocaine use on the perineum of a perimenopausal woman is exceedingly rare. A 50-year-old woman with methaemoglobinaemia secondary to the perineal application of over-the counter Vagisil (benzocaine 20% and resorcinol 3%- an antiseptic and disinfectant, respectively) presented to the emergency department. She had been using Vagisil for severe, chronic vaginal itching. While methaemoglobinaemia secondary to excessive use of over-the-counter medications such as Vagisil creme is exceedingly rare, it should be included in the differential diagnosis.

scholarly journals T-wave inversion in the precordial leads: сardiac and non-cardiac causes

Kardiologiia ◽  
2020 ◽  
Vol 60 (5) ◽  
pp. 136-145
Author(s):  
I. R. Tsoy ◽  
I. P. Kolos
Keyword(s):  
Pulmonary Embolism ◽  
Differential Diagnosis ◽  
Anterior Wall ◽  
Left Ventricular ◽  
Arrhythmogenic Cardiomyopathy ◽  
Cardiac Memory ◽  
T Wave ◽  
Wave Inversion ◽  
Threatening Condition ◽  
Life Threatening

The T-wave inversion (TWI) is a common electrocardiographic finding. Causes for TWI are numerous and sometimes TWI may appear in life-threatening conditions. The aim of this review was to provide an up-to-date analysis of TWI, including i) definition and prevalence; ii) causes, and iii) differential diagnosis in benign TWI, reversible myocardial ischemia of the left ventricular anterior wall; takotsubo cardiomyopathy; subarachnoid hemorrhage; pulmonary embolism; right ventricular arrhythmogenic cardiomyopathy; and “cardiac memory”. The review presents practical electrophysiological criteria, which allow suspecting in time a life-threatening condition to choose an up-to-date treatment.

scholarly journals Spontaneous Heterotopic Pregnancy: Case Report and Literature Review

Medicina ◽  
2020 ◽  
Vol 56 (8) ◽  
pp. 365 ◽  
Author(s):  
Miglė Černiauskaitė ◽  
Brigita Vaigauskaitė ◽  
Diana Ramašauskaitė ◽  
Mindaugas Šilkūnas
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Laboratory Tests ◽  
Heterotopic Pregnancy ◽  
Fallopian Tubes ◽  
Lower Abdomen ◽  
Healthy Baby ◽  
Extrauterine Pregnancy ◽  
Threatening Condition ◽  
Life Threatening

Heterotopic pregnancy is defined as a condition when intrauterine and extrauterine pregnancy occur simultaneously. It is a life-threatening condition that requires immediate and accurate diagnostics and treatment. We present a case of a 28-year-old primigravida female who conceived spontaneously and at her seventh week of gestation and was presented to the emergency department with weakness and acute pain in lower abdomen. Laboratory tests and transvaginal ultrasonography revealed the diagnosis of heterotopic pregnancy. Urgent laparoscopic salpingotomy was chosen as a treatment option. The ectopic pregnancy was successfully removed with the preservation of the intrauterine embryo and fallopian tubes. The course of pregnancy after the surgery was without complications, and a healthy baby was delivered at the 39th week of gestation. When treated properly and on time, a heterotopic pregnancy can result in live childbirth with favorable outcomes for both the child and the mother.

scholarly journals Atraumatic hemopericardium in a patient receiving warfarin therapy for a pulmonary embolus

CJEM ◽  
2005 ◽  
Vol 7 (03) ◽  
pp. 168-170
Author(s):  
Peter G. Katis
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Cardiac Tamponade ◽  
Pulmonary Embolus ◽  
Warfarin Therapy ◽  
Pericardial Tamponade ◽  
Thromboembolic Disease ◽  
Threatening Condition ◽  
Life Threatening ◽  
Echocardiographic Evidence

ABSTRACT Acute pericardial tamponade is a potentially life-threatening condition that requires immediate treatment. This report describes a patient who presented to the emergency department with an acute hemopericardium and echocardiographic evidence of cardiac tamponade following the initiation of warfarin therapy for a recently diagnosed pulmonary embolism. The association between cardiac tamponade, oral anticoagulation and pulmonary thromboembolic disease is briefly discussed.

Headache and Facial Pain

2020 ◽  
Author(s):  
Elizabeth W. Loder
Keyword(s):  
Differential Diagnosis ◽  
Cerebrovascular Disorders ◽  
Preventive Treatment ◽  
The United States ◽  
Headache Patient ◽  
Over The Counter ◽  
Secondary Headaches ◽  
Preventive Medication ◽  
Life Threatening ◽  
Women And Children

Headaches are a near-universal experience, with a 1-year prevalence of 90% and a lifetime prevalence of 99%. Headaches and pain to the head account for roughly 3% of visits to US emergency departments annually, making them the fourth most common reason for seeking emergency care. There are numerous types of headaches, and although the majority are benign, types exist that may result from serious and potentially life-threatening causes. As such, it is important for the physician to consider a broad differential diagnosis for every headache patient. This review discusses the classification of headaches, identifies pain-sensitive structures in the head, discusses the history and examination in patients with headache, and describes many of the primary and secondary headaches. Figures show the areas of the brain sensitive to pain; 1-year prevalence of migraine in men, women, and children; frequency of attacks in migraineurs; prevalence of headaches by age group and in patients with cerebrovascular disorders; and symptoms of idiopathic intracranial hypertension. Tables list the major categories of headache disorders, key elements of the headache history, helpful questions to ask, features of selected primary and secondary headaches, reasons to consider neuroimaging, efficacy of selected over-the-counter medications, triptans available in the United States, medication options for urgent or emergency treatment of migraine, selected preventive medications for migraine, generally accepted indications for preventive treatment, general principles for the use of preventive medications, titration schedules for preventive medication, interval or short-term preventive treatment of menstrual migraine, strategies for managing increase in migraines in patients starting estrogen replacement therapy, transition medications for rapid, temporary suppression of headaches, medications possibly effective for cluster and hypnic headaches, differential diagnosis of the acute, severe, new-onset headache, and etiologies of papilledema and headache. This review contains 6 highly rendered figures, 23 tables, and 115 references.

Sigmoid volvulus in children

2021 ◽  
Vol 14 (5) ◽  
pp. e241869
Author(s):  
Merete Berthu Damkjaer ◽  
Waqas Farooqui ◽  
Inge Ifaoui ◽  
Luit Penninga
Keyword(s):  
Differential Diagnosis ◽  
Ct Scan ◽  
Sigmoid Volvulus ◽  
Abdominal Discomfort ◽  
Paediatric Patients ◽  
Threatening Condition ◽  
Life Threatening ◽  
Abdominal Distress ◽  
Emergency Resection

Sigmoid volvulus in paediatric patients is a rare but potentially life-threatening condition. Since 1940, only 100 cases have been reported. There are no consensual guidelines for juvenile sigmoid volvulus unlike in adults, where the condition and the treatment is well described. We report a case of a 12-year-old patient, who presented with uncharacteristic symptoms of mild abdominal discomfort and lack of passage of stool. A CT-scan showed a sigmoid volvulus and emergency resection was performed with placement of a colostomy. With this case, we want to emphasise juvenile sigmoid volvulus as a probable differential diagnosis when symptoms of abdominal distress and constipation occur.

scholarly journals Acute abdomen due to an infarction of wandering spleen: case report

2020 ◽  
Vol 2020 (2) ◽  
Author(s):  
Ragheb Assaf ◽  
Baraa Shebli ◽  
Ayham Alzahran ◽  
Ahmad Rami Rahmeh ◽  
Ali Mansour ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chronic Pain ◽  
Acute Abdomen ◽  
Rare Condition ◽  
Wandering Spleen ◽  
Ectopic Spleen ◽  
Threatening Condition ◽  
Life Threatening ◽  
Displaced Spleen

Abstract Wandering spleen is a rare condition characterized by the absence or underdevelopment of one or all spleen ligaments that fixate the spleen in the left upper quadrant. Many different terms refer to wandering spleen like dislocated spleen, ectopic spleen and displaced spleen. We report in this case a 13-year-old Syrian girl presented to the emergency department complaining of acute generalized abdominal pain with fever, anorexia and vomiting started 2 days prior to presentation. A splenectomy was performed, with uneventful postsurgical follow-up. Wandering spleen is prone to torsion and infarction resulting in acute abdomen and a life-threatening condition with high mortality rate reaching 50%. We advise the investigation of any recurrent episodes of chronic pain keeping up within mind this diagnosis.

scholarly journals The diagnostic accuracy of multi-organ point-of-care ultrasonography for life-threatening conditions: The case of cancer patients who visit the emergency department: retrospective observational study

2021 ◽  
Author(s):  
Yun Ang Choi ◽  
Min Sung Lee ◽  
Tae Kwon Kim ◽  
Jae Yun Jung ◽  
Ki Hong Kim ◽  
...  
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Positive Predictive Value ◽  
Cancer Patients ◽  
Predictive Value ◽  
Pulmonary Thromboembolism ◽  
Point Of Care ◽  
Threatening Condition ◽  
Life Threatening ◽  
Point Of Care Ultrasonography

Abstract Background The number of cancer patients visiting the emergency department (ED) is increasing globally, and this has highlighted the importance of diagnosing and coping with related life-threatening complications early. There may be efficacy in employing multi-organ point-of-care ultrasonography (M-PoCUS) for this purpose; however, there has been no study on the usefulness of this diagnostic tool for cancer patients only. The aim of this study was to evaluate the diagnostic accuracy of M-PoCUS for a life-threatening condition in cancer patients who visited the ED.Methods We conducted a retrospective observational study in one tertiary university hospital ED in Seoul, Republic of Korea. We selected three emergency medicine specialists to perform a protocolized M-PoCUS evaluation of cancer patients according to the requests of emergency physicians since the SARS-CoV-2 pandemic began. We enrolled 94 cancer patients in the study. The M-PoCUS diagnosis was then compared with an audit diagnosis. The primary outcomes measured were the sensitivity, specificity, positive predictive value, and negative predictive value of M-PoCUS in the above-described diagnosis.Results The M-PoCUS showed a sensitivity of 83% (95% CI, 61-95), specificity of 96% (95% CI, 88-99), positive predictive value of 86% (95% CI, 65-97), and negative predictive value of 94% (95% CI, 85-97). M-PoCUS produced 4 false negative (4.3%) pulmonary thromboembolism diagnoses and 3 false positive (3.2%) pleural effusion diagnoses. Conclusions M-PoCUS was useful in ruling out a life-threatening condition among the cancer patients. However, pulmonary thromboembolism was hard to distinguish using M-PoCUS due to pre-existing diseases scattered in cancer patients’ thorax.

scholarly journals Sudden cardiac arrest associated with myxedema coma due to undiagnosed hypothyroidism: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Asami Yoshinaka ◽  
Masayuki Akatsuka ◽  
Shuji Yamamoto ◽  
Michiaki Yamakage
Keyword(s):  
Cardiac Arrest ◽  
Differential Diagnosis ◽  
Physical Examination ◽  
Sudden Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Clinical Findings ◽  
Neurological Dysfunction ◽  
Myxedema Coma ◽  
Threatening Condition ◽  
Life Threatening

Abstract Background Myxedema coma, which occurs due to hypothyroidism, is a rare and life-threatening condition. Some patients have hemodynamic dysfunction, which consequently leads to cardiac arrest. The rarity of this condition makes it difficult to determine the cause of cardiac arrest. It is important to diagnose myxedema coma based on clinical findings, including physical examination and laboratory parameters. We present a case of undiagnosed and untreated hypothyroidism that initially caused myxedema coma and then led to cardiac arrest. Case presentation A 56-year-old woman who had no medical history was transferred to our hospital for the management of return of spontaneous circulation due to sudden cardiac arrest. Findings of laboratory tests revealed that she had hypothyroidism. On physical examination, she was found to have a puffy face, thin eyebrows, and severe systemic non-pitting edema. Therefore, the patient was clinically diagnosed with myxedema coma, which was the cause of cardiac arrest. She was treated with thyroid hormone and hydrocortisone, resulting in improvement in her general condition, except for the neurological dysfunction. Conclusions This case suggests that myxedema coma is caused by undiagnosed and untreated hypothyroidism, leading to sudden cardiac arrest. Our findings are useful in the differential diagnosis of hypothyroidism based on characteristic physical examination findings. Clinicians should be aware of the differential diagnosis of myxedema coma based on findings from physical examination and laboratory testing of thyroid function, and the treatment should be started immediately.

Headache and Facial Pain

2020 ◽  
Author(s):  
Elizabeth W. Loder
Keyword(s):  
Differential Diagnosis ◽  
Cerebrovascular Disorders ◽  
Preventive Treatment ◽  
The United States ◽  
Headache Patient ◽  
Over The Counter ◽  
Secondary Headaches ◽  
Preventive Medication ◽  
Life Threatening ◽  
Women And Children

Headaches are a near-universal experience, with a 1-year prevalence of 90% and a lifetime prevalence of 99%. Headaches and pain to the head account for roughly 3% of visits to US emergency departments annually, making them the fourth most common reason for seeking emergency care. There are numerous types of headaches, and although the majority are benign, types exist that may result from serious and potentially life-threatening causes. As such, it is important for the physician to consider a broad differential diagnosis for every headache patient. This review discusses the classification of headaches, identifies pain-sensitive structures in the head, discusses the history and examination in patients with headache, and describes many of the primary and secondary headaches. Figures show the areas of the brain sensitive to pain; 1-year prevalence of migraine in men, women, and children; frequency of attacks in migraineurs; prevalence of headaches by age group and in patients with cerebrovascular disorders; and symptoms of idiopathic intracranial hypertension. Tables list the major categories of headache disorders, key elements of the headache history, helpful questions to ask, features of selected primary and secondary headaches, reasons to consider neuroimaging, efficacy of selected over-the-counter medications, triptans available in the United States, medication options for urgent or emergency treatment of migraine, selected preventive medications for migraine, generally accepted indications for preventive treatment, general principles for the use of preventive medications, titration schedules for preventive medication, interval or short-term preventive treatment of menstrual migraine, strategies for managing increase in migraines in patients starting estrogen replacement therapy, transition medications for rapid, temporary suppression of headaches, medications possibly effective for cluster and hypnic headaches, differential diagnosis of the acute, severe, new-onset headache, and etiologies of papilledema and headache. This review contains 6 highly rendered figures, 23 tables, and 115 references.

scholarly journals Differential Diagnosis of HyperCKemia

2018 ◽  
Vol 02 (01) ◽  
pp. E72-E83 ◽  
Author(s):  
Rudolf Kley ◽  
Tobias Schmidt-Wilcke ◽  
Matthias Vorgerd
Keyword(s):  
Differential Diagnosis ◽  
Incidental Finding ◽  
Elevated Serum ◽  
Asymptomatic Patients ◽  
Upper Limits ◽  
Electrophysiological Studies ◽  
Threatening Condition ◽  
Life Threatening ◽  
Muscle Disorder ◽  
The Individual

AbstractElevated serum creatine kinase (CK) activity is usually an indicator of muscle damage. HyperCKemia is often an incidental finding and should be controlled after refraining from physical activity for some days, especially in asymptomatic patients. Furthermore, data from recent studies indicate that the upper limits of normal (ULN) need to be revised upward. This review includes an algorithm for the differential diagnosis of CK elevation in patients without muscular symptoms. In the field of neurology, in particular myopathies and neuropathies with affection of the lower motor neuron can cause symptomatic hyperCKemia, with CK values >1000 U/l (16,7 µkat/l) being indicative of a primary muscle disorder. Diseases with very high CK values include subtypes of muscular dystrophies, idiopathic inflammatory myopathies and metabolic myopathies. However, a normal or only slightly elevated CK value does not exclude the presence of a myopathy. The individual diagnostic procedure (e. g., muscle imaging, special laboratory studies, muscle biopsy and genetic testing) depends on the clinical phenotype and the results of electrophysiological studies. HyperCKemia can also be an adverse effect of several drugs including statins. In asymptomatic patients, statin-associated CK elevations <5 times the ULN can be tolerated. In patients with higher CK values and/or muscle symptoms, LDL-cholesterol lowering therapy should be changed. Rhabdomyolysis is a potentially life-threatening condition and is accompanied by highly elevated CK values. Acute phase treatment includes preserving renal function and restoring metabolic derangements.

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