scholarly journals Pediatric tizanidine toxicity reversed with naloxone: a case report

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Doaa Bader ◽  
Ahmed Adam ◽  
Mohamed Shaban ◽  
Bader Alyahya
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Case Reports ◽  
Accidental Ingestion ◽  
Case Presentation ◽  
Heart Rates ◽  
Receptor Agonists ◽  
Epidemiologic Data ◽  
Adrenoceptor Agonist ◽  
Level Of Consciousness

Abstract Background Tizanidine, an α-2 adrenoceptor agonist, is widely prescribed for the management of spasticity in adults. Case reports on pediatric tizanidine overdose are limited. Here, we report a case of pediatric tizanidine toxicity that was reversed with naloxone. Case presentation A 3-year-old male presented to the emergency department with lethargy, bradycardia, and bradypnea after accidental ingestion of multiple tizanidine tablets. Improvements in the level of consciousness and respiratory and heart rates were observed after two intravenous administrations of naloxone at a dose of 0.05 and 0.1 mg/kg, respectively. Conclusions This case report provides further evidence regarding the use of naloxone as a viable antidote for centrally acting α-2 receptor agonists and presents additional epidemiologic data on childhood tizanidine poisoning.

scholarly journals Pediatric Tizanidine Toxicity Reversed with Naloxone a case report

2021 ◽  
Author(s):  
doaa emad emad ◽  
ahmad adam ◽  
mohamed shaban ◽  
bader alyahya
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Case Reports ◽  
Accidental Ingestion ◽  
Heart Rates ◽  
Naloxone Administration ◽  
Receptor Agonists ◽  
Epidemiologic Data ◽  
Level Of Consciousness

Abstract BackgroundTizanidine, an α-2 adrenoreceptor agonist, is widely prescribed for the management of spasticity in adults. Case reports for pediatric tizanidine overdose are limited. Here, we report a case of pediatric tizanidine toxicity that was reversed with naloxone.Case presentationA three year-old male presented to the emergency department with lethargy, bradycardia, and bradypnea after accidental ingestion of multiple tizanidine tablets. Improvements in the level of consciousness, respiratory and heart rates were observed post intravenous naloxone administration of 0.05 and 0.1 mg/kg respectively.ConclusionsThis case report provides additional epidemiologic data on childhood tizanidine poisoning and further documentation on the use of naloxone as a viable antidote for centrally acting α-2 receptor agonists.

scholarly journals Chilaiditi Syndrome: A Case Report Highlighting the Intermittent Nature of the Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Esha M. Kapania ◽  
Christina Link ◽  
Joshua M. Eberhardt
Keyword(s):  
Case Report ◽  
Complete Resolution ◽  
Clinical Symptoms ◽  
Case Reports ◽  
Delayed Diagnosis ◽  
Spontaneous Resolution ◽  
Radiographic Evidence ◽  
Case Presentation ◽  
Chilaiditi Syndrome

Background. Chilaiditi syndrome is a phenomenon where there is an interposition of the colon between the liver and the abdominal wall leading to clinical symptoms. This is distinct from Chilaiditi sign for which there is radiographic evidence of the interposition, but is asymptomatic. Case Presentation. Here, we present the case of a patient who, despite having clinical symptoms for a decade, had a delayed diagnosis presumably due to the interposition being intermittent and episodic. Conclusions. This case highlights the fact that Chilaiditi syndrome may be intermittent and episodic in nature. This raises an interesting question of whether previous case reports, which describe complete resolution of the syndrome after nonsurgical intervention, are perhaps just capturing periods of resolution that may have occurred spontaneously. Because the syndrome may be intermittent with spontaneous resolution and then recurrence, patients should have episodic follow-up after nonsurgical intervention.

Survival of multiple nail gun injuries to the head, lung, and heart: A case report

2020 ◽  
Author(s):  
Suo-Hsien Wang ◽  
Mao-Yu Chen ◽  
Tzu-Yen Huang ◽  
Che-Chia Chang ◽  
Chih-Ying Chien
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Suicide Attempt ◽  
Surgical Planning ◽  
Surgical Intervention ◽  
Treatment Strategies ◽  
Emergency Physicians ◽  
Significant Morbidity ◽  
Case Presentation ◽  
The Brain

Abstract Background: Most nail gun injuries occur at the extremities due to working accidents. Injuries to the brain or thorax are relatively rare, and cases with both injuries are even rarer. Initial evaluation, resuscitation and surgical planning can be challenging. Case presentation: Here, we present a case with nail gun injuries to the brain, lung, and heart by suicide attempt. The patient presented to the emergency department under shock. After resuscitation and surgical intervention, he was discharged without significant morbidity. Conclusions: Multiple nail gun injuries, especially those to vital organs such as the brain, lung, and heart, can be challenging to emergency physicians and surgeons. Imaging tools, treatment strategies, and possible complications are discussed in this article to provide optimized outcomes in such situations.

scholarly journals A prickly situation: an attempted Caterpillar ingestion - case report

2020 ◽  
Vol 49 (1) ◽  
Author(s):  
Amar K. Bhardwaj ◽  
Naif Fnais ◽  
Christopher J. Chin
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Foreign Body ◽  
Oral Cavity ◽  
Direct Laryngoscopy ◽  
Effective Technique ◽  
Efficient Manner ◽  
Case Presentation ◽  
Tussock Moth ◽  
Initial Method

Abstract Background Foreign body ingestion is a common problem in pediatrics. Each foreign body can present its’ own unique challenges during removal, and we present the management of an ingested Spotted Tussock Moth (Lophocampa maculata), more commonly known as a caterpillar. Case presentation An 18-month-old boy presented to the emergency department with difficulty handling secretions and odynophagia. It was reported he had placed a caterpillar in his mouth and then spat it out. On examination, hundreds of miniscule filaments (setae) were seen embedded in his lips and tongue. Our service was consulted out of concern for airway involvement. The patient was taken to the operating room where a direct laryngoscopy under general anesthesia with spontaneous ventilation was performed to confirm the setae were confined to the anterior tongue and lips. Once we were satisfied the airway was stable, the airway was secured, and we then began to remove the setae. The initial method used was to use Adson-Brown forceps to remove the setae, however this proved difficult and time-consuming given the volume of setae and how thin the setae were. Ultimately, a more effective technique was developed: a 4 × 4 AMD-RITMES® gauze was applied to the mucosa in order to dry up any secretions and then a piece of pink, waterproof BSN medical® tape was applied to the mucosa. After 3 s of contact it was removed. This technique was then repeated and was used to remove the vast majority of the setae. Conclusion To our knowledge, we have described the first technique to remove the caterpillar setae from the oral cavity mucosa in a fast, safe and efficient manner.

scholarly journals Buprenorphine therapy in the setting of induced opioid withdrawal from oral naltrexone: a case report

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Laura M. Szczesniak ◽  
Vincent J. Calleo ◽  
Ross W. Sullivan
Keyword(s):  
Emergency Department ◽  
Acute Treatment ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Opioid Use ◽  
Accidental Ingestion ◽  
Heroin Use ◽  
Case Presentation ◽  
Acute Withdrawal ◽  
Oral Naltrexone

Abstract Background Patients with opioid use disorder (OUD) frequently present to the emergency department for acute treatment of overdose and withdrawal. Case presentation A 29-year-old male presented to the emergency room after intravenous heroin use followed by accidental ingestion of naltrexone. He was treated with buprenorphine with significant improvement in his Clinical Opioid Withdrawal Score, from moderately severe to mild withdrawal symptoms within a few hours. Conclusion Buprenorphine and minimal supportive care can be used to treat acute withdrawal precipitated by oral naltrexone in patients with OUD.

scholarly journals Left Renal Vein Thrombus and Pulmonary Thromboembolism Caused by Nutcracker Syndrome: a Case Report

2021 ◽  
Author(s):  
Kanta Hori ◽  
Shota Yamamoto ◽  
Maki Kosukegawa ◽  
Noboru Yamashita ◽  
Yuichiro Shinno
Keyword(s):  
Case Report ◽  
Renal Vein ◽  
Pulmonary Thromboembolism ◽  
Case Reports ◽  
Left Renal Vein ◽  
Clinical Manifestations ◽  
Venous Hypertension ◽  
Nutcracker Syndrome ◽  
Case Presentation ◽  
Renal Venous Hypertension

Abstract Background: Nutcracker syndrome (NCS) refers to compression of the left renal vein (LRV) between the aorta and superior mesenteric artery (SMA), which results in renal venous hypertension and its resultant clinical manifestations. Left renal vein thrombus (LRVT) complicating NCS is relatively rare. To the best of our knowledge, there are only four case reports of LRVT complicating NCS. Furthermore, there are no reports of pulmonary thromboembolism (PTE) caused by NCS. Herein, we describe a rare case of NCS causing LRVT and PTE and its clinical management. Case Presentation: A 40-year-old man was admitted to our hospital with acute left flank pain. Computed tomography angiography (CTA) revealed compression of the LRV between the aorta and the SMA with an LRVT. Furthermore, CTA revealed bilateral PTE. Rivaroxaban was administered as an anticoagulant. Twenty days after initiation, CTA revealed complete resolution of PTE and LRVT, and repeat CTA at 3 and 6 months showed no recurrence. Conclusions: This case report demonstrates that NSC may be a possible cause of LRVT and PTE. We review the reported cases of NCS complicated by LRVT and discuss the imaging modalities for NCS.

scholarly journals Dantrolene for the treatment of MDMA toxicity

CJEM ◽  
2010 ◽  
Vol 12 (05) ◽  
pp. 457-459 ◽  
Author(s):  
Brian E. Grunau ◽  
Matthew O. Wiens ◽  
Marc Greidanus
Keyword(s):  
Emergency Department ◽  
Mechanical Ventilation ◽  
Renal Failure ◽  
Creatine Kinase ◽  
Acute Renal Failure ◽  
Case Report ◽  
Acute Illness ◽  
Primary Role ◽  
Appetite Suppressant ◽  
Level Of Consciousness

ABSTRACTMDMA (3,4-methylenedioxymethamphetamine), popularly known as “Ecstasy,” was first introduced and patented by Merck & Co., Inc., in 1914 as an appetite suppressant. Currently, its primary role is as an illegal stimulant used to produce a euphoric effect during parties. This case report describes a 31-year-old man who, after taking 3 tablets of Ecstasy, presented to an emergency department with a decreased level of consciousness and became progressively hyperthermic and rigid. During the course of his acute illness, his temperature reached 42.2°C rectally. He was given mechanical ventilation. He was aggressively cooled and dantrolene was initiated. Soon after the administration of dantrolene his temperature decreased and his rigidity began to resolve. The only complication was rhabdomyolysis with a creatine kinase level increasing to over 150 μkat/L. This did not progress to acute renal failure. The patient made a full recovery and was discharged to psychiatry for assessment.

scholarly journals Perforation of a Retrocecal Appendix Resulting in Retroperitoneal Air: A Case Report

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Behrang Litkouhi ◽  
Alicia S. Huang ◽  
David J. Lundy ◽  
Maria Solis
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Case Report ◽  
Acute Appendicitis ◽  
Clinical Symptoms ◽  
Case Reports ◽  
Abscess Formation ◽  
Retroperitoneal Abscess ◽  
Retroperitoneal Perforation ◽  
Retroperitoneal Air

There have been several case reports documenting acute appendicitis complicated by perforation presenting with retroperitoneal abscess formation. To date, there are no case reports of acute appendicitis in which the only sign for retroperitoneal perforation is the presence of retroperitoneal air as detected by computed tomography (CT). In the case presented, an 18-year-old male presented to the emergency department with clinical symptoms of acute appendicitis. CT exam demonstrated an inflamed appendix with multiple collections of air in the retroperitoneum, without abscess. Laparotomy revealed perforation of a retrocecal appendix into the retroperitoneum.

scholarly journals Hypermagnesemia in a 20-month-old healthy girl caused by the use of a laxative: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Kotaro Araki ◽  
Yuhei Kawashima ◽  
Miyuki Magota ◽  
Norio Shishida
Keyword(s):  
Emergency Department ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Impaired Renal Function ◽  
Muscle Tone ◽  
Case Presentation ◽  
Cardiac Side Effects ◽  
Level Of Consciousness ◽  
Tendon Reflexes

Abstract Background Hypermagnesemia can be a fatal condition and should be diagnosed early on. Most reports of hypermagnesemia have been of adults with impaired renal function. We describe the case of a pediatric patient without renal dysfunction who developed severe hypermagnesemia. Case presentation A healthy 20-month-old Asian girl presented to our emergency department with episodes of vomiting and a reduced level of consciousness. The neurological examination showed a symmetric decrease in muscle tone, and the deep tendon reflexes were decreased. On admission, her magnesium (Mg) level was 11.0 mg/dL after receiving magnesium oxide for 4 days because of constipation. She was immediately administered calcium gluconate infusion (3.9 mEq), and then was continuously infused with it (0.23 mEq/h) as a Mg antagonist to cardiac side effects. She was kept hydrated with 0.9% sodium chloride to maintain good urine output to excrete the Mg. The level of the serum Mg decreased to 2.4 mg/dL, enabling her to regain consciousness. During 5 years of follow-up, she was neurologically well, without the recurrence of hypermagnesemia. Conclusions Even in the absence of significant renal dysfunction, the prescription of a laxative containing Mg for constipation can result in severe hypermagnesemia. In addition, the symptoms of hypermagnesemia are nonspecific, and early diagnosis is difficult unless it is actively suspected.

scholarly journals Run or Die: A Didactique Case Report of a Rare Cause of Lactic Acidosis in Emergency Medicine

2020 ◽  
Vol 2020 ◽  
pp. 1-2
Author(s):  
Jean-Baptiste Bouillon-Minois ◽  
Jeannot Schmidt ◽  
Frédéric Dutheil
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Emergency Medicine ◽  
Case Report ◽  
Brain Injury ◽  
Lactic Acidosis ◽  
Rare Case ◽  
Case Presentation ◽  
Consciousness Disorders ◽  
Initial Hypothesis

Introduction. Acidosis with traumatic brain injury is a common and serious cause of consciousness disorders in emergency medicine. Extreme acidosis is significantly associated with high mortality (more than 67% if pH levels are under 7). Case Presentation. We describe the case of a 23-year-old man with unknown medical history who was found near the entrance of the emergency department sweat with a tachypnea (55 per minute), a lot of blood around him, and confused. The initial hypothesis was a hemorrhagic shock after a fight, but he did not have any hemodynamic trouble. The initial venous gazometry showed a major lactic acidosis (pH less than 6,8, HCO3 incalculable and lactate up to 20 mmol/L). A Focused Assessment with Sonography in Trauma-echography (FAST-echo) and secondly a body-tomodensitometry were conducted and did not reveal any anomaly. The team was now thinking that the patient situation was caused by an epileptic seizure (association of lactic acidosis and confusion), and the bleed was a consequence of the head trauma. The patient was treated only by NaCl 0,9%. One hour after his admission, the tachypnea began to decrease and he could speak and explain what was happen. He had to run as fast as possible to escape to a fight. The last gazometry, realized 2 hours after his admission, finds a normal pH at 7,35, HCO3 24,5 mmol/L and lactate 2,6 mmol/L. He was authorized to going home. Conclusion. We report here a rare case of major lactic acidosis in emergency medicine caused by a supramaximal effort.

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