scholarly journals Not-so-typical typical atrioventricular nodal re-entrant tachycardia in an adolescent

2021 ◽  
Vol 2021 (3) ◽  
Author(s):  
Ang JS
Keyword(s):  
Emergency Department ◽  
Heart Rate ◽  
Case Report ◽  
The Elderly ◽  
Slow Pathway ◽  
Atypical Presentation ◽  
Emergency Physicians ◽  
P Waves ◽  
Slow Heart Rate ◽  
Narrow Complex Tachycardia

Dysrhythmias are commonly encountered in the Emergency Department (ED). Timely management and recognition of dysrhythmia in the ED is essential and crucial. Physicians working in the ED should be familiar with atypical presentation of common dysrhythmias. This case report illustrates atrioventricular nodal re-entrant tachycardia (AVNRT) with an unusually slow heart rate in an adolescent. A 16-year-old male presented to the ED twice for palpitations. His electrocardiograms showed narrow complex tachycardia with absent P waves. Electrophysiology studies confirmed typical slow-fast AVNRT which was treated successfully with radiofrequency ablation of the slow pathway. Diagnosing rare dysrhythmias or common dysrhythmias which manifest atypically can be challenging for non-cardiologists. Although AVNRT generally occurs with a heart rate of >130 bpm, emergency physicians should be aware that AVNRT can take place with a relatively slower rate in both the elderly and young.

scholarly journals Atypical Presentation of Aseptic Meningitis Due to Varicella Zoster: A Case Report

2021 ◽  
Vol 5 (4) ◽  
pp. 440-442
Author(s):  
Sharon Jia ◽  
Thuyvi Luong
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Varicella Zoster Virus ◽  
Aseptic Meningitis ◽  
Atypical Presentation ◽  
Emergency Physicians ◽  
Varicella Zoster ◽  
Intravenous Acyclovir ◽  
Immunocompetent Patients

Introduction: Varicella zoster virus (VZV) meningitis is primarily an infection of the immuno-compromised. However, it can also affect immunocompetent individuals. Reactivation of VZV typically presents with a distinct dermatomal rash suggestive of varicella zoster, but there have also been reports of VZV meningitis presenting without a rash. Case Report: We describe a case of VZV meningitis in a healthy, 30-year-old male presenting to the emergency department shortly after receiving his first coronavirus disease 2019 vaccination. He was treated with intravenous acyclovir and then discharged home on oral valacyclovir. Conclusion: Emergency physicians should consider aseptic meningitis in immunocompetent patients presenting with atypical headaches in this population.

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 Sepsis-induced Autoimmune Hemolytic Anemia: A Case Report

2020 ◽  
Vol 4 (4) ◽  
pp. 668-670
Author(s):  
Zach Edwards ◽  
Stephen DeMeo
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Case Report ◽  
Hemolytic Anemia ◽  
Patient Outcomes ◽  
Autoimmune Hemolytic Anemia ◽  
Rare Complication ◽  
Signs And Symptoms ◽  
Emergency Physicians ◽  
Colonic Diverticula

Introduction: Sepsis commonly brings patients to the emergency department (ED). Patient outcomes can vary widely. In some cases, rare complications of sepsis such as autoimmune hemolytic anemia can occur. Case Report: A 68-year-old female presented with sepsis secondary to infected nephrolithiasis. The patient had signs and symptoms consistent with hemolysis upon arrival to the ED. Her hemolysis progressively worsened over a two-day period leading to a diagnosis of warm autoimmune hemolytic anemia. She responded well to treatment; however, her condition began to worsen due to a new infection caused by perforated colonic diverticula. The patient ultimately expired from complications of her perforated colonic diverticula. Conclusion: It is crucial that emergency physicians understand the risk factors, symptoms, pathophysiology, and treatment of this rare complication of sepsis so that favorable patient outcomes can be achieved.

scholarly journals Massive levothyroxine ingestion in a pediatric patient: case report and discussion

CJEM ◽  
2011 ◽  
Vol 13 (03) ◽  
pp. 165-168 ◽  
Author(s):  
Josephine Ho ◽  
Renee Jackson ◽  
David Johnson
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Heart Rate ◽  
Case Report ◽  
Hair Loss ◽  
Treatment Options ◽  
Thyroid Stimulating Hormone ◽  
Patient Case ◽  
Free Triiodothyronine ◽  
Benign Course

ABSTRACTWe describe the course of a toddler who ingested a massive amount of levothyroxine and review treatment options for such overdoses. A 2½-year-old boy presented shortly after an ingestion of up to 7.6 mg of levothyroxine (potentially as much as 700 µg/kg). He was initially asymptomatic, treated with oral charcoal 1 g/kg, and discharged home from the emergency department after a few hours. He returned approximately 24 hours later with a temperature of 38.5°C, heart rate of 163 beats per minute, respiratory rate of 30 breaths per minute, and blood pressure of 136/70 mm Hg. He had a slightly decreased appetite and no signs or symptoms of infection. He was admitted to hospital and treated with oral acetaminophen. The initial free thyroxine (T4) was > 100 pmol/L and free triiodothyronine (T3) was 35.3 pmol/L. The patient had desquamation of the palms and soles, hair loss, and irritability during the month following the ingestion. Resolution of the elevated free T4occurred by 12 days post-ingestion and normalization of the thyroid-stimulating hormone by 7 weeks post-ingestion. There were no longterm sequelae. Levothyroxine overdose can result in significant complications, including seizures and arrhythmias, both of which should be monitored for. However, as our case illustrates, massive ingestion of levothyroxine in children typically follows a benign course.

scholarly journals Optimizing Non-invasive Oxygenation for COVID-19 Patients Presenting to the Emergency Department with Acute Respiratory Distress: A Case Report

2020 ◽  
Vol 4 (3) ◽  
pp. 327-331
Author(s):  
David Zodda ◽  
Allyson Hanson ◽  
Alyssa Berns
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Respiratory Distress ◽  
The United States ◽  
Nasal Cannula ◽  
Blood Oxygenation ◽  
Severe Hypoxia ◽  
Emergency Physicians ◽  
Non Invasive ◽  
Number Of Patients

Introduction: The novel coronavirus (COVID-19) pandemic has led to an increase in the number of patients presenting to the emergency department (ED) with severe hypoxia and acute respiratory distress. With limited resources and ventilators available, emergency physicians working at a hospital within the epicenter of the United States outbreak developed a stepwise, non-invasive oxygenation strategy for treating COVID-19 patients presenting with severe hypoxia and acute respiratory distress. Case Report: A 72-year-old male suspected of having the COVID-19 virus presented to the ED with shortness of breath. He was found to be severely tachypneic, febrile, with rales in all lung fields. His initial oxygen saturation registered at SpO2 (blood oxygenation saturation) 55% on room air. Emergency physicians employed a novel non-invasive oxygenation strategy using a nasal cannula, non-rebreather, and self-proning. This approach led to a reversal of the patient’s respiratroy distress and hypoxia (SpO2 88-95%) for the following 24 hours.This non-invasive intervention allowed providers time to obtain and initiate high-flow nasal cannula and discuss end-of-life wishes with the patient and his family. Conclusion: Our case highlights a stepwise, organized approach to providing non-invasive oxygenation for COVID-19 patients presenting with severe hypoxia and acute respiratory distress. This approach primarily employs resources and equipment that are readily available to healthcare providers around the world. The intent of this strategy is to provide conventional alternatives to aid in the initial airway management of confirmed or suspected COVID-19 patients.

scholarly journals Spontaneous Isolated Celiac Artery Dissection: A Case Report

2020 ◽  
Vol 4 (3) ◽  
pp. 414-416
Author(s):  
Clifford Freeman ◽  
Aaron Lacy ◽  
Aubrey Miner ◽  
Devin Rogers ◽  
Austin Smith ◽  
...  
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Case Report ◽  
Celiac Artery ◽  
Chief Complaint ◽  
Diagnostic Tools ◽  
Artery Dissection ◽  
Emergency Physicians ◽  
Threatening Condition ◽  
Life Threatening

Introduction: Abdominal pain is a common chief complaint that can represent a wide breadth of diagnoses, ranging from benign to life-threatening. As our diagnostic tools become more sophisticated, we are able to better identify more causes of potentially life-threatening diseases. One such disease that is relatively unfamiliar to clinicians is spontaneous isolated celiac artery dissection (SICAD). Case Report: We describe a case of a 46-year-old man who presented to our emergency department with a chief complaint of abdominal pain and was found to have a SICAD and was successfully treated with anticoagulation, antihypertensives, and observation. Conclusion: It is important for emergency physicians to keep this potentially life-threatening condition in mind and to know the appropriate first steps once identified.

scholarly journals Postmortem Sperm Retrieval in the Emergency Department: A Case Report and Review of Available Guidelines

2019 ◽  
Vol 3 (4) ◽  
pp. 405-408 ◽  
Author(s):  
Andrew Zinkel ◽  
Felix Ankel ◽  
Aaron Milbank ◽  
Colleen Casey ◽  
Jeremy Sundheim
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Case Report ◽  
Emergency Physicians ◽  
Sperm Retrieval ◽  
Postmortem Sperm Retrieval

Postmortem sperm retrieval (PMSR) requests and retrievals are increasing in the emergency department (ED) setting. Few EDs have protocols in place, and many emergency physicians (EP) lack the knowledge of how to proceed when such situations arise. We report the case of a 31-year-old male cardiac-arrest victim who expired in the ED, after which his wife requested PMSR. We review the guidelines, procedures, and issues of consent that arise with PMSR. EPs must be aware of their institution’s policies and consultant availability should a request for PMSR arise.

scholarly journals Dysphagia Alone as a Unique Presentation of Wound Botulism in the Emergency Department: A Case Report

2020 ◽  
Vol 4 (4) ◽  
pp. 613-616
Author(s):  
Ryan Wyatt ◽  
Eytan Shtull-Leber ◽  
Thomas Kelly
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Cranial Nerves ◽  
Emergency Physicians ◽  
Motor Weakness ◽  
Social Challenges ◽  
Wound Botulism ◽  
Injection Drugs ◽  
History Of ◽  
Diagnostic Pitfalls

Introduction: Wound botulism is a rare and potentially fatal infectious disease, often seen in patients who abuse injection drugs. It classically presents with dysfunction of bilateral cranial nerves followed by proximal and distal motor weakness, which can progress to respiratory failure. Case Report: We report a case of a 31-year-old female who presented to the emergency department for the fifth time with an eight-day history of isolated dysphagia without any other neurologic symptoms. She reported a history of injection drug abuse via “skin popping,” was admitted to the hospital, and ultimately diagnosed with wound botulism. Conclusion: This case exemplifies the diagnostic pitfalls of rare diseases such as wound botulism and provides insight regarding the diagnosis and treatment of this entity. This case also highlights the unique medical and social challenges emergency physicians face while trying to reliably evaluate patients who abuse controlled substances.

scholarly journals On a Boat: A Case in Australia of Endophthalmitis and Pyogenic Liver, Prostatic, and Lung Abscesses in a Previously Well Patient due toKlebsiella pneumoniae

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Alecia Vandevelde ◽  
Bojana Stepanovic
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Urinary Tract ◽  
Klebsiella Pneumoniae ◽  
Case Reports ◽  
Young Male ◽  
The Elderly ◽  
Significant Morbidity ◽  
Global Spread ◽  
Tract Infections

This is a case report about a patient who arrived in our emergency department in Western Australia to the care of the urologists having just gotten off a ship with a bacterial infection that would result in a 44-day stay in hospital and have quite devastating lasting effects for the young male. His story was in fact reflective of an emerging global phenomenon. Once thought to generally be a bacterium of threat only to the elderly and alcoholics, causing pneumonia and urinary tract infections, this case report describes the potentially devastating consequences of what is now becoming recognized as a hypervirulent form ofKlebsiella pneumoniaewith the potential to spread throughout the system rapidly seeding abscesses and causing significant morbidity in nonimmunocompromised patients. Initially noticed in Asia increasingly case reports are emerging in Western countries suggesting a global spread.

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