Consultation with the Specialist

1993 ◽  
Vol 14 (6) ◽  
pp. 237-238
Author(s):  
James Seidel
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Physical Examination ◽  
Local Community ◽  
Community Hospital ◽  
Vital Signs ◽  
Neurologic Examination ◽  
The Right ◽  
Spine Radiographs ◽  
Large Hematoma

Case Report Bobbi, a 5-year-old, was playing "catch" on the lawn of his surburban home. When he went to fetch the ball that had rolled into the street, he was struck by an automobile traveling about 25 miles per hour. Witnesses reported that Bobbi's body was lifted up by the car and thrown about 12 feet onto the pavement. A neighbor responded immediately and noted that Bobbi was responsive to verbal commands and had a large bump on the front of his head and a swollen right thigh. The Emergency Medical Services System was activated, and within 10 minutes he was transported to the emergency department at the local community hospital. Bobbi was in obvious pain but was awake and responded to questions. He knew his sister's and teachers' names, but did not remember being struck by the car. His vital signs were: respirations 35/min; pulse, 100/min; blood pressure, 98/68 mm Hg; and temperature, 36.5°C. Physical examination was remarkable for a large hematoma on the right frontal and parietal areas of the skull and a swollen tender right thigh. Bobbi's spine was normal upon physical examination, and the neurologic examination was normal except for some retrograde amnesia. There was no spinal swelling or tenderness, and cervical spine radiographs were normal

INDEX OF SUSPICION

1996 ◽  
Vol 17 (2) ◽  
pp. 65-68
Author(s):  
Martha Toledo-Valido ◽  
M. Joyce Neal ◽  
John T. Duelge ◽  
Meena Kalyanaraman ◽  
Maria Patterson
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Early Diagnosis ◽  
Physical Examination ◽  
Respiratory Distress ◽  
Shortness Of Breath ◽  
Breath Sounds ◽  
History Of ◽  
Case Presentations ◽  
The Right

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation A 3-year-old girl is brought to the emergency department because of 24 hours of fever, nonproductive cough, and shortness of breath that has worsened progressively. She has no history of significant illness. She has been taking amoxicillin for 1 week to treat otitis media and pharyngitis. On physical examination, the child appears in obvious respiratory distress. She has a temperature of 101°F (38.3°C), pulse of 150 beats/min, respiratory rate of 46 breaths/min, and blood pressure of 137/72 mm Hg. She is breathing with subcostal and intercostal retractions and nasal flaring. Her breath sounds are diminished in the area of the right upper lobe, and generalized inspiratory and expiratory wheezing is heard. Both tympanic membranes are red and distorted.

Appendicitis: a rare adverse event in colonoscopy

2021 ◽  
Vol 14 (7) ◽  
pp. e242523
Author(s):  
Samer Al-Dury ◽  
Mohammad Khalil ◽  
Riadh Sadik ◽  
Per Hedenström
Keyword(s):  
Emergency Department ◽  
Adverse Event ◽  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Physical Examination ◽  
De Novo ◽  
Perforated Appendicitis ◽  
Lower Quadrant ◽  
The Right ◽  
Right Lower Quadrant

We present a case of a 41-year-old woman who visited the emergency department (ED) with acute abdomen. She was diagnosed with perforated appendicitis and abscess formation on CT. She was treated conservatively with antibiotics and discharged. On control CT 3 months later, the appendix had healed, but signs of thickening of the terminal ileum were noticed and colonoscopy was performed, which was uneventful and showed no signs of inflammation. Twelve hours later, she developed pain in the right lower quadrant, followed by fever, and visited the ED. Physical examination and blood work showed signs consistent with acute appendicitis, and appendectomy was performed laparoscopically 6 hours later. The patient recovered remarkably shortly afterwards. Whether colonoscopy resulted in de novo appendicitis or exacerbated an already existing inflammation remains unknown. However, endoscopists should be aware of this rare, yet serious complication and consider it in the workup of post-colonoscopy abdominal pain.

scholarly journals Pneumoscrotum as Complication of Blunt Thoracic Trauma: A Case Report

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Eftychios Lostoridis ◽  
Konstantinos Gkagkalidis ◽  
Nikolaos Varsamis ◽  
Nikolaos Salveridis ◽  
Georgios Karageorgiou ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blunt Chest Trauma ◽  
Thoracic Trauma ◽  
Chest Trauma ◽  
Vital Signs ◽  
Rare Clinical Entity ◽  
Blunt Thoracic Trauma ◽  
Thoracic Cage ◽  
Case Presentation ◽  
The Right

Introduction. Pneumoscrotum is a rare clinical entity. It presents with swollen scrotal sac and sometimes with palpable crepitus. It has many etiologies. One of them is due to blunt trauma of the thoracic cage, causing pneumothorax and/or pneumomediastinum.Case Presentation. We report the case of an 82-year-old male who was transferred to the Emergency Department with signs of respiratory distress after a blunt chest trauma. A CT scan was obtained, and bilateral pneumothoraces with four broken ribs were disclosed. Subcutaneous emphysema expanding from the eyelids to the scrotum was observed, and a chest tube was inserted on the right side with immediate improvement of the vital signs of the patient.Discussion. Pneumoscrotum has three major etiologies: (a) local introduction of air or infection from gas-producing bacteria, (b) pneumoperitoneum, and (c) air accumulation from lungs, mediastinum, or retroperitoneum. These sources account for most of the cases described in the literature. Treatment should be individualized, and surgical consultation should be obtained in all cases.Conclusion. Although pneumoscrotum itself is a benign entity, the process by which air accumulates in the scrotum must be clarified, and treatment must target the primary cause.

A case of Fournier’s gangrene diagnosed with POCUS

POCUS Journal ◽  
2019 ◽  
Vol 4 (1) ◽  
pp. 3
Author(s):  
Marco Badinella Martini, MD ◽  
Antonello Iacobucci, MD
Keyword(s):  
Type 2 Diabetes ◽  
Emergency Department ◽  
Alzheimer Disease ◽  
Physical Examination ◽  
Subcutaneous Emphysema ◽  
Vital Signs ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
History Of

An 87-year-old man with a history of type 2 diabetes and severe Alzheimer disease was admitted to the emergency department with a lesion of the perineum for two days. The patient appeared agitated and not collaborating on the visit. His vital signs were normal. Physical examination revealed an edematous, suppurative, and foul-smelling perineal-scrotal lesion, with possible subcutaneous emphysema.

scholarly journals Could We Use Vital Signs and Lactate Levels Together to Predict the Prognosis in Abdominal Pain?

Acta Medica ◽  
2021 ◽  
pp. 1-6
Author(s):  
Filiz Froohari Damarsoy ◽  
Nalan Metin Aksu ◽  
Elif Öztürk ◽  
Meltem Akkaş
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Abdominal Pain ◽  
Systolic Blood Pressure ◽  
Pulse Rate ◽  
Venous Blood ◽  
Vital Signs ◽  
Common Diagnosis ◽  
Intracystic Hemorrhage ◽  
Lactate Levels

Objectives: Abdominal pain occupies most of the emergency department admissions. This entity leads to research various markers for the early detection of causes in patients presenting with abdominal pain. There is limited data about collaborations between lactate levels and vital signs at admission in abdominal pain. Materials and Methods: Patients aged 18 years and older, who had presented with abdominal pain to the Emergency Department, in total 102 patients, were included to the study. The patients’ demographics, vital signs, abdominal physical examination findings, diagnosis and outcomes of patients were recorded. The 1 ml venous blood samples were collected by blood gase injectors from the patients and lactate levels were analyzed. Results: Female patients’ percentile was 68,6% and mean age was 39 years old. The systolic blood pressure levels were normal in 45 patients, low in 26% patients and high in 29% patients. The seventy-six of the patients had normal pulse rate and 26 of them were tachycardic. Most common diagnosis was non-specific abdominal pain (37,25%) and the least common was ovarian torsion/intracystic hemorrhage (0,98%) and obstruction due to hernia (0,98%). There was no statistically significant relation between lactate level and pulse rate (p=0,637), systolic blood pressure (p=0,052), diastolic blood pressure (p=0,095), respiratory rate (p=0,527), body temperature (p=0,040) and oxygen saturation (p=0,905). Similarly, no significant association occurred between lactate levels and diagnosis and outcomes. Conclusion: Further studies including more patients groups have to be done in order to attain more reliable data about this topic.

Nearly fatal hypokalaemia due to non-hypertensive primary hyperaldosteronism in the post partum

2021 ◽  
Vol 14 (3) ◽  
pp. e240018
Author(s):  
Juliana Marques-Sá ◽  
Mariana Barbosa ◽  
Vera Fernandes ◽  
Maria Joana Santos
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Heart Rate ◽  
Post Partum ◽  
Plasma Renin ◽  
Primary Hyperaldosteronism ◽  
Waiting Room ◽  
Abdominopelvic Ct ◽  
The Right ◽  
Electric Cardioversion

A previously healthy postpartum 33-year-old woman was admitted at the emergency department after two episodes of syncope. In the waiting room, she collapsed, ventricular fibrillation was detected, and she was reanimated by electric cardioversion. At admission, she was conscient, with blood pressure of 102/74 mm Hg and heart rate of 78 bpm. In the laboratory workup, severe hypokalaemia was found (K+ 1.77 mEq/L). Abdominopelvic CT revealed a 27 mm nodule in the right adrenal gland. High aldosterone and low plasma renin levels were detected, and the diagnosis of primary hyperaldosteronism was made, although she never had hypertension. Posteriorly, a cosecretion of aldosterone and cortisol was found. Two months after admission, the patient remained stable with normal K+ levels under spironolactone and a right adrenalectomy was performed. The cure of primary hyperaldosteronism and a partial adrenal insufficiency were confirmed. K+ levels and blood pressure remained normal without treatment and 10 months after surgery hydrocortisone was suspended.

Abstract P491: Characterizing Agreement in Level of Inter-extremity Blood-Pressure Readings of Adults in the Emergency Department (CALIBRATE Study)

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Zain A Bhutta ◽  
Isma Qureshi ◽  
Mohammad Shujauddin ◽  
Sarah Thomas ◽  
Maarij Masood ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Recruitment Strategy ◽  
Asia Pacific ◽  
Continuous Variables ◽  
Arab Population ◽  
Significant Difference ◽  
The Absolute ◽  
The Difference ◽  
The Right

Introduction: Inter-arm blood-pressure difference (IBPD) has been studied previously in multiple settings, but few reports are available from the Emergency department (ED) setting, where BP varies significantly due to acute medical conditions or stress from various factors. CALIBRATE aims to study the inter-arm blood pressure differences in the patients presenting to the ED in Qatar and to assess the IBPD distribution in this population. Methods: In sitting position, two consecutive BP measurements were obtained from the right and left arm for each participant using calibrated automated machines and appropriate cuff sizes. Considering the demographic mix of the population presenting to the ED, a 1:1 of male to female and 2:1 for GCC (Gulf Cooperation Council) to non-GCC recruitment strategy was predefined. The data were recorded using predefined data fields including patient demographics, past medical, social and family history. The continuous variables were reported as mean (SD) or median (IQR) based on the distribution of data. The data was analyzed using Stata MP 14.0 (College Station, Texas). Results: A total of 1800 patients were prospectively recruited from the ED. The mean age was 34 (10) years. The absolute systolic blood pressure (ΔSBP) difference between the right and left arm was same for the first (ΔSBP1) and the second reading (ΔSBP2), as 6 mmHg (3-10). The absolute average of ΔSBP1 and ΔSBP2 was 7 mmHg (4-10). The difference in SBP of less than 20 mmHg for IBP was seen in 95 th percentile of the population with single reading, whereas, with the average of two individual readings it was observed in 97 th percentile. No meaningful association could be detected between the significant IBPD and the study variables such as age, demographics, regions of interest and risk factors. Although, patients with diagnosed hypertension met the pre-defined criterion for significance, this difference was not clinically significant. There was no significant difference between IBPD noted for the Asia-pacific or Arab population. Conclusion: In population presenting to the ED, the IBPD of at least 20 mmHg reached at 95 th percentile validating the known significant difference. The utility of SBP difference can be improved further by taking the average of two individual readings.

scholarly journals Herbal Weight Loss Pill Overdose: Sibutramine Hidden in Pepper Pill

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Gul Pamukcu Gunaydin ◽  
Nurettin Ozgur Dogan ◽  
Sevcan Levent ◽  
Gulhan Kurtoglu Celik
Keyword(s):  
Emergency Department ◽  
Weight Loss ◽  
Physical Examination ◽  
Female Patient ◽  
Active Ingredient ◽  
Vital Signs ◽  
Supportive Therapy ◽  
Pathological Findings ◽  
The World ◽  
Excessive Intake

Supposedly herbal weight loss pills are sold online and are widely used in the world. Some of these products are found to contain sibutramine by FDA and their sale is prohibited. We report a case of a female patient who presented to the emergency department after taking slimming pills. 17-year-old female patient presented to the emergency room with palpitations, dizziness, anxiety, and insomnia. She stated that she had taken 3 pills named La Jiao Shou Shen for slimming purposes during the day. Her vital signs revealed tachycardia. On her physical examination, she was restless, her oropharynx was dry, her pupils were mydriatic, and no other pathological findings were found. Sibutramine intoxication was suspected. She was given 5 mg IV diazepam for restlessness. After supportive therapy and observation in emergency department for 12 hours there were no complications and the patient was discharged home. Some herbal pills that are sold online for weight loss have sibutramine hidden as an active ingredient, and their sale is prohibited for this reason. For people who use herbal weight loss drugs, sibutramine excessive intake should be kept in mind at all times.

scholarly journals Shock Cryptic, emerging diagnostic

2021 ◽  
Vol 21 (4) ◽  
pp. 854-859
Author(s):  
Ricardo J. Ayala García ◽  
Sandra Soto Ticse ◽  
Stephany Matos Santiváñez ◽  
Allison Ortiz de Orue
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Physical Examination ◽  
Medical History ◽  
Clinical Entity ◽  
Advanced Imaging ◽  
Timely Diagnosis ◽  
Tissue Hypoperfusion ◽  
Sources Of Infection ◽  
Cryptic Shock

Cryptic shock is a poorly identified clinical entity, and it still describes a patient with signs of tissue hypoperfusion without affecting blood pressure. In the emergency department, it is important to identify signs of hypoperfusion and evaluate various hidden sources of infection by taking a complete medical history, a thorough physical examination, and, if necessary advanced imaging. It is necessary to conclude that the importance of the timely diagnosis of this clinical entity helps to improve the prognosis significantly.

Physical examination of psychiatric patients who presented at emergency department in a tertiary care hospital in Sultanate of Oman

2017 ◽  
Vol 41 (S1) ◽  
pp. S335-S335
Author(s):  
S. Alhuseini
Keyword(s):  
Emergency Department ◽  
Physical Examination ◽  
Psychiatric Patients ◽  
Demographic Data ◽  
Tertiary Care ◽  
Vital Signs ◽  
University Hospital ◽  
Psychiatric History ◽  
Care Hospital ◽  
Physical Assessment

ObjectiveTo examine the completeness of physical assessment of patients presenting with psychiatric problems to the emergency department (ED).MethodsThis was observational study based on a retrospective review of the medical records of patients who attended the ED of Sultan Qaboos university hospital and referred to the on-duty psychiatrist for assessment over a 12-month period. All patients aged 16 years and above, who presented to the ED with a psychiatric complaint were included in the study. A data collection sheet was designed to gather each patient's demographic data such as age and gender, past psychiatric history, nature of the presenting complaints, thoroughness of physical assessment, medications prescribed by the ED doctor prior to psychiatric assessment, and whether the patient was discharged, admitted to a psychiatry.ResultsA total of 202 patients met the inclusion criteria. The mean age of the patients was 34.2 years. Females represented 56% of the sample. The majority of the study group (60.4%) were patients with a documented past psychiatric history. Physical examination was conducted in the ED for 61.4% of the patients, while vital signs were recorded for 68.8% of them. Approximately, 31% of the patients required injectable psychotropic medications as tranquillizers in the ED. Patients with an isolated psychiatric complaint coupled with a documented past psychiatric history were more likely to be referred to the on-call psychiatrist without a physical examination by the ED doctors.ConclusionIn our institution, not all patients with psychiatric presentations had a complete physical examination by the ED doctors.Disclosure of interestThe author has not supplied his declaration of competing interest.

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