scholarly journals Case Report: Delayed Post-partum Preeclampsia in rural Ecuador

2017 ◽  
Vol 2 (2) ◽  
Author(s):  
Miguel Obregón ◽  
Carolina Betancourt ◽  
David Gaus
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Magnesium Sulfate ◽  
Post Partum ◽  
Hypertensive Urgency ◽  
Case Presentation ◽  
Delay In Diagnosis ◽  
Peripartum Period ◽  
High Index Of Suspicion ◽  
Time Of Presentation

Background: Delayed, Post-partum preeclampsia is an unusual presentation of preeclampsia.  Delay in diagnosis at the time of presentation could result in progression to eclampsia.  Consideration should be given to routine post-partum checkup at 3-4 weeks rather than 6 weeks in countries where home birthing is still common. Case Presentation: We report a case of delayed, post-partum preeclampsia in a mother 4 weeks post-partum who presented to our emergency department with headache and abdominal pain. Hypertensive urgency was diagnosed.  Subsequently, a 24 hour urine indicated significant proteinuria, and delayed postpartum preeclampsia was established.  Her blood pressure normalized and adequate diuresis was maintained.  Magnesium Sulfate was not initiated. Conclusion: A high index of suspicion for preeclampsia is required in hypertension in the peripartum period.  This is also true up to one month post partum.  When should magnesium sulfate be discontinued in these patients who have adequate diuresis and normal blood presssures, the signs normally used in the immediate post-partum period that the preeclampsia has resolved?

scholarly journals Case Report: Delayed Post-partum Preeclampsia in rural Ecuador

2017 ◽  
Author(s):  
David Gaus ◽  
Miguel Obregón ◽  
Carolina Betncourt
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Abdominal Pain ◽  
Case Report ◽  
Magnesium Sulfate ◽  
Post Partum ◽  
Hypertensive Urgency ◽  
Case Presentation

<p><strong>Case Presentation</strong>: We report a case of delayed, post-partum preeclampsia in a mother 4 weeks post-partum who presented to our emergency department with headache and abdominal pain. Hypertensive urgency was diagnosed.  Subsequently, a 24 hour urine indicated significant proteinuria, and delayed postpartum preeclampsia was established.  Her blood pressure normalized and adequate diuresis was maintained.  Magnesium Sulfate was not initiated.</p>

An Emergency Department Approach to Drug Treatment of Hypertensive Urgency and Emergency

2005 ◽  
Vol 18 (5) ◽  
pp. 363-376 ◽  
Author(s):  
Kevin O. Rynn ◽  
Frank L. Hughes ◽  
Brian Faley
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Treatment Options ◽  
Severity Of Illness ◽  
Joint National Committee ◽  
Patient Specific ◽  
National Committee ◽  
Hypertensive Urgency ◽  
Specific Patient ◽  
Hypertensive Urgencies

Patients who present with hypertensive urgency or emergency require immediate attention to assess the severity of illness. Guidelines from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure are available but do little to address the management of acute elevations in blood pressure. Various treatment options, both old and new, exist to manage these patients in the emergency department. Decisions on therapy are patient specific and depend on the underlying cause of elevated blood pressure. This article sets out to describe specific patient presentations and reviews current available options in the management of hypertensive urgencies and emergencies.

Severe Headache

2018 ◽  
pp. 107-112
Author(s):  
Aman Shah
Keyword(s):  
Computed Tomography ◽  
Blood Pressure ◽  
Emergency Department ◽  
Pressure Control ◽  
Acute Onset ◽  
Severe Headache ◽  
High Morbidity ◽  
Common Cause ◽  
Aneurysmal Rupture ◽  
High Index Of Suspicion

This case highlights the clinical presentation and diagnostic workup of a subarachnoid hemorrhage (SAH) in an emergency department setting. Given the high morbidity and mortality associated with this diagnosis, clinicians must have a high index of suspicion when patients present with an acute onset, severe headache. While computed tomography of the head is the best initial diagnostic test, lumbar puncture should be performed if the imaging is equivocal or negative and the clinical concern for SAH persists. After SAH is diagnosed, prompt consultation and co-management with neurosurgery should occur, in addition to strict blood pressure control and efforts to reduce intracranial pressure. Trauma is the most common cause of SAH while aneurysmal rupture is the leading cause of atraumatic SAH.

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.

scholarly journals Hypertensive Crisis in Acute Cerebrovascular Diseases Presenting at the Emergency Department: A Narrative Review

2021 ◽  
Vol 11 (1) ◽  
pp. 70
Author(s):  
Mariagiovanna Cantone ◽  
Giuseppe Lanza ◽  
Valentina Puglisi ◽  
Luisa Vinciguerra ◽  
Jaime Mandelli ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Hypertensive Crisis ◽  
Intravenous Thrombolysis ◽  
Strong Relationship ◽  
Organ Damage ◽  
Cerebrovascular Diseases ◽  
Narrative Review ◽  
Cerebrovascular Event ◽  
Hypertensive Urgency

Hypertensive crisis, defined as an increase in systolic blood pressure >179 mmHg or diastolic blood pressure >109 mmHg, typically causes end-organ damage; the brain is an elective and early target, among others. The strong relationship between arterial hypertension and cerebrovascular diseases is supported by extensive evidence, with hypertension being the main modifiable risk factor for both ischemic and hemorrhagic stroke, especially when it is uncontrolled or rapidly increasing. However, despite the large amount of data on the preventive strategies and therapeutic measures that can be adopted, the management of high BP in patients with acute cerebrovascular diseases presenting at the emergency department is still an area of debate. Overall, the outcome of stroke patients with high blood pressure values basically depends on the occurrence of hypertensive emergency or hypertensive urgency, the treatment regimen adopted, the drug dosages and their timing, and certain stroke features. In this narrative review, we provide a timely update on the current treatment, debated issues, and future directions related to hypertensive crisis in patients referred to the emergency department because of an acute cerebrovascular event. This will also focus greater attention on the management of certain stroke-related, time-dependent interventions, such as intravenous thrombolysis and mechanic thrombectomy.

scholarly journals Pediatric Cecal Volvulus: A Case Report

2020 ◽  
pp. 1-3
Author(s):  
Chukwubuike Emeka ◽  
Chukwubuike Emeka
Keyword(s):  
Intestinal Obstruction ◽  
Rare Case ◽  
Clinical Presentation ◽  
Chromosomal Abnormalities ◽  
Cecal Volvulus ◽  
Predisposing Factor ◽  
Case Presentation ◽  
Mobile Cecum ◽  
High Index Of Suspicion ◽  
Time Of Presentation

Introduction: Cecal volvulus (CV) is rare cause of intestinal obstruction especially in children. There is no established protocol for the treatment of CV due to its rarity. Case Presentation: We present a rare case of CV in a 9-year-old girl. Discussion: The spectrum of intestinal malrotation may give rise to a mobile cecum that may result to CV. Constipation could be a predisposing factor. The clinical presentation which may include abdominal pain, distension, constipation and vomiting depends on the time of presentation. There may be associations with chromosomal abnormalities. Conclusion: Although CV is a rare cause of intestinal obstruction, awareness and high index of suspicion is needed by clinician for early diagnosis and treatment.

scholarly journals Chlorhexidine – a commonly used but often neglected culprit of dialysis associated anaphylactic reactions (case report)

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Jia Neng TAN ◽  
Yi ◽  
Sabrina HAROON ◽  
Titus LAU
Keyword(s):  
Dialysis Patient ◽  
Kidney Injury ◽  
Healthcare Setting ◽  
Dialysis Treatment ◽  
Case Presentation ◽  
Fluid Removal ◽  
Life Saving ◽  
End Stage ◽  
High Index Of Suspicion ◽  
Time Of Presentation

Abstract Background Hemodialysis-associated anaphylactic reactions are rare and frequently complex in nature due to the sheer number of possible culprit agents. Unfortunately, dialysis is often unavoidable or strictly essential for life-saving solute clearance or fluid removal in patients with end stage kidney failure and those with severe acute kidney injury. It is of utmost importance that the culprit agent is identified and avoided to allow continuation of dialysis treatment as needed. Case presentation We present 2 cases of hemodialysis-associated anaphylactic reactions. These patients developed anaphylactic reactions peri-dialysis and were initially suspected to have dialyser reactions. They were investigated in a controlled healthcare setting and possible culprit agents were systemically identified and eliminated. They both underwent allergy testing and were diagnosed with chlorhexidine allergy. Of note, Case 1 was an incident dialysis patient at the time of presentation and Case 2 was a prevalent dialysis patient. This suggests that the time from initial sensitization to reaction may not always be helpful in determining if a particular agent is the culprit of an anaphylactic reaction. In both cases, the patients were dialysed through a tunnelled dialysis catheter. We postulate that the presence of an exit site, which represents a compromise to the integrity of the skin’s epidermal barrier, may have a significant role in the development of these reactions. As chlorhexidine is a widely used disinfectant in hemodialysis, it is imperative that we consider it as a possible culprit agent when these reactions arise. To our knowledge, there are no other reported cases of anaphylaxis secondary to chlorhexidine use in dialysis patients other than a previous report in 2017. Our report also highlights the possibility of these reactions occurring more frequently in patients with damaged epidermal barriers and in patients exposed to higher environmental concentrations of chlorhexidine. These are novel concepts that can be explored with further research. Conclusion Chlorhexidine associated anaphylactic reactions can occur in the peri-dialysis setting and a high index of suspicion is paramount to diagnosis.

scholarly journals Clinical Characteristics and Predictors of All-Cause Mortality in Patients with Hypertensive Urgency at an Emergency Department

2021 ◽  
Vol 10 (19) ◽  
pp. 4314
Author(s):  
Jeong-Hun Shin ◽  
Byung Sik Kim ◽  
Minhyung Lyu ◽  
Hyun-Jin Kim ◽  
Jun Hyeok Lee ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Emergency Department ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Target Organ ◽  
Hypertensive Urgency ◽  
All Cause Mortality ◽  
History Of ◽  
Male Sex

Hypertensive urgency is characterized by an acute increase in blood pressure without acute target organ damage, which is considered to be managed with close outpatient follow-up. However, limited data are available on the prognosis of these cases in emergency departments. We investigated the characteristics and predictors of all-cause mortality in Korean emergency patients with hypertensive urgency. This cross-sectional study included patients aged ≥ 18 years who visited an emergency tertiary referral center between January 2016 and December 2019 for hypertensive urgency, which was defined as a systolic blood pressure of ≥ 180 mmHg and a diastolic blood pressure of ≥ 110 mmHg, or both, without acute target organ damage. The 1 and 3 year all-cause mortality rates were 6.8% and 12.1%, respectively. The incidence of emergency department revisits and readmission after 3 months and 1 year was significantly higher in non-survivors than in survivors. In a multivariate analysis, age ≥ 60 years (hazard ratio (HR), 16.66; 95% CI, 6.20–44.80; p < 0.001), male sex (HR, 1.54; 95% CI, 1.22–1.94; p < 0.001), history of chronic kidney disease (HR, 2.18; 95% CI, 1.53–3.09; p < 0.001), and proteinuria (HR, 1.94; 95% CI, 1.53–2.48; p < 0.001) were independent predictors of 3 year all-cause mortality. The all-cause mortality rate of hypertensive urgency remains high despite the increased utilization of antihypertensive medications. Old age, male sex, history of chronic kidney disease, and proteinuria were poor prognostic factors for all-cause mortality in patients with hypertensive urgency.

Aspergillus Spondylodiscitis After Spinal Stenosis Surgery: A Case Report

2020 ◽  
Vol 5 (3 And 4) ◽  
pp. 155-160
Author(s):  
Mohsen Aghapoor ◽  
◽  
Babak Alijani Alijani ◽  
Mahsa Pakseresht-Mogharab ◽  
◽  
...  
Keyword(s):  
Antifungal Drugs ◽  
The Body ◽  
Lower Limbs ◽  
Lumbar Pain ◽  
Case Presentation ◽  
Delay In Diagnosis ◽  
Death Case ◽  
Therapeutic Results ◽  
History Of ◽  
Probable Diagnosis

Background and Importance: Spondylodiscitis is an inflammatory disease of the body of one or more vertebrae and intervertebral disc. The fungal etiology of this disease is rare, particularly in patients without immunodeficiency. Delay in diagnosis and treatment of this disease can lead to complications and even death. Case Presentation: A 63-year-old diabetic female patient, who had a history of spinal surgery and complaining radicular lumbar pain in both lower limbs with a probable diagnosis of spondylodiscitis, underwent partial L2 and complete L3 and L4 corpectomy and fusion. As a result of pathology from tissue biopsy specimen, Aspergillus fungi were observed. There was no evidence of immunodeficiency in the patient. The patient was treated with Itraconazole 100 mg twice a day for two months. Pain, neurological symptom, and laboratory tests improved. Conclusion: The debridement surgery coupled with antifungal drugs can lead to the best therapeutic results.

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