scholarly journals Thyroid Storm, Rhabdomyolysis, and Pulmonary Embolism: An Unusual Triad Case Report

2020 ◽  
Vol 4 (4) ◽  
pp. 540-543
Author(s):  
Montane Silverman ◽  
Jesse Wray ◽  
Rachel Bridwell ◽  
Amber Cibrario
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Case Report ◽  
Male Patient ◽  
Medical Emergency ◽  
Thyroid Storm ◽  
Diagnosis And Management ◽  
Difficult Diagnosis ◽  
Life Threatening ◽  
Significant Mortality

Introduction: Thyroid storm is a medical emergency associated with significant mortality. Hyperthyroid states have been associated with hypercoagulability as well as rhabdomyolysis. However, the pathophysiology of this association remains under investigation. Case Report: A 62-year-old male patient presented to the emergency department with weakness and was found to have thyroid storm with concurrent submassive pulmonary embolisms and rhabdomyolysis. To our knowledge, this is the first reported presentation of this triad. Conclusion: This case highlights the potentially difficult diagnosis and management of thyroid storm, as well as associated life-threatening complications, including venous thromboemboli and rhabdomyolysis.

Catastrophic Antiphospholipid Syndrome Following Lower Extremity Arterial Bypass Surgery: Case Report and Evidence Review

2021 ◽  
pp. 153857442110462
Author(s):  
Ahmed A. Sorour ◽  
Levester Kirksey ◽  
Sarah Keller ◽  
Michael S. O’Connor ◽  
Sean P. Lyden
Keyword(s):  
Case Report ◽  
Lower Extremity ◽  
Antiphospholipid Syndrome ◽  
Current Literature ◽  
Bypass Surgery ◽  
Multidisciplinary Approach ◽  
Catastrophic Antiphospholipid Syndrome ◽  
Diagnosis And Management ◽  
Life Threatening ◽  
Evidence Review

Catastrophic antiphospholipid syndrome (CAPS) is a rare life threatening presentation of antiphospholipid syndrome. Surgery has been proposed as one of the triggering factors for this life threatening entity. There are no detailed published reports in the current literature describing CAPS as a complication after surgery. We report a case of a 21 year old that developed CAPS postoperatively and discuss the multidisciplinary approach for diagnosis and management.

scholarly journals Life–threatening Pulmonary Oedema Secondary to Tracheal Compression

2002 ◽  
Vol 30 (6) ◽  
pp. 804-806 ◽  
Author(s):  
H. Butterell ◽  
R. H. Riley
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Airway Obstruction ◽  
Pulmonary Oedema ◽  
Negative Pressure ◽  
Upper Airway ◽  
Tracheal Compression ◽  
Negative Pressure Pulmonary Oedema ◽  
Life Threatening ◽  
Thyroid Goitre

We present a case of negative pressure pulmonary oedema due to an overlooked cause. A 45-year-old female patient presented to the emergency department unconscious with severe pulmonary oedema. Subsequent investigations revealed a thyroid goitre causing significant tracheal compression. This case report highlights an extremely rare but potentially dangerous sequela of upper airway obstruction.

scholarly journals Flushing of an intravenous catheter

2019 ◽  
Vol 29 (3) ◽  
pp. 614-618
Author(s):  
Rutger C.C. Hengeveld ◽  
Bianca E. Olofsen ◽  
Edmée C. van Dongen-Lases ◽  
Peter A. Leenhouts ◽  
Victor F.H.A. Hakkenberg van Gaasbeek ◽  
...  
Keyword(s):  
Emergency Department ◽  
Renal Function ◽  
Case Report ◽  
Sodium Chloride ◽  
Continuous Infusion ◽  
Intravenous Catheter ◽  
Blood Samples ◽  
Close Proximity ◽  
Laboratory Results ◽  
Life Threatening

Introduction: Phlebotomy is an error-prone process in which mistakes are difficult to reveal. This case report describes the effect on laboratory results originating from a blood sample collected in close proximity to an intravenous catheter. Materials and methods: A 69-year-old male patient was referred to the Emergency department where pneumonia was suspected. Phlebotomy was performed to collect blood samples to assess electrolytes, renal function, liver function, infection and haematological parameters. Results: The laboratory analysis showed reduced potassium and calcium concentrations. To prevent life-threatening cardiac failure the clinician decided to correct those electrolytes. Remarkably, the electrocardiogram showed no abnormalities corresponding to hypokalaemia and hypocalcaemia. This observation, in combination with an overall increase in laboratory parameters with the exception of sodium and chloride, led to the suspicion of a preanalytical error. Retrospectively, an intravenous catheter was inserted in close proximity of the puncture place but no continuous infusion was started prior to phlebotomy. However, the intravenous catheter was flushed with sodium chloride. Since potential other causes were excluded, the flushing of the intravenous catheter with sodium chloride prior to phlebotomy was the most probable cause for the deviating laboratory results and subsequently for the unnecessary potassium and calcium suppletion. Conclusion: This case underlines the importance of caution in the interpretation of laboratory results obtained from specimens that are collected in the proximity of an intravenous catheter, even in the absence of continuous infusion.

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 An Unusual Presentation of Postpartum Spontaneous Coronary Artery Dissection

2019 ◽  
Vol 3 (3) ◽  
pp. 228-232
Author(s):  
Jonathan Alterie ◽  
Francis Villanueva ◽  
Mohamed Arekat ◽  
April Brill
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Coronary Artery ◽  
Cardiac Biomarkers ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Chest Discomfort ◽  
Coronary Artery Dissection ◽  
Life Threatening ◽  
Multiparous Female

The postpartum population is one with a unique physiologic profile that predisposes these patients to rare and often life-threatening conditions. Herein, we discuss a case of a 37-year-old, multiparous female who presented to the emergency department with vague chest discomfort 14 days after delivering her sixth child via vaginal delivery. The patient was found to have elevated cardiac biomarkers and was ultimately diagnosed with pregnancy-related spontaneous coronary artery dissection (P-SCAD). This case report discusses the evaluation, pathophysiology, workup, and management of P-SCAD.

An unusual cause of vomiting in a palliative care setting

2011 ◽  
Vol 9 (3) ◽  
pp. 327-330
Author(s):  
Linda Railsback
Keyword(s):  
Palliative Care ◽  
Case Report ◽  
Male Patient ◽  
Care Setting ◽  
Nausea And Vomiting ◽  
Middle Aged ◽  
Diagnosis And Management ◽  
Palliative Care Setting ◽  
Abdominal Malignancy ◽  
Therapeutic Considerations

AbstractControl of symptoms, including nausea and vomiting, is central to palliative care. Self-induced vomiting in a middle-aged male patient with a life-limiting abdominal malignancy provided a challenge in diagnosis and management. This case report discusses diagnostic and therapeutic considerations.

scholarly journals Pulmonary Artery Aneurysm as a Cause of Massive Hemoptysis: Diagnosis and Management

2011 ◽  
Vol 2011 ◽  
pp. 1-2 ◽  
Author(s):  
Peter Corr
Keyword(s):  
Pulmonary Tuberculosis ◽  
Pulmonary Artery ◽  
Artery Aneurysm ◽  
Medical Emergency ◽  
Endovascular Coiling ◽  
Massive Hemoptysis ◽  
Pulmonary Artery Aneurysm ◽  
Active Pulmonary Tuberculosis ◽  
Diagnosis And Management ◽  
Life Threatening

Massive hemoptysis is a life-threatening medical emergency. Prompt radiological diagnosis and management are essential. I present a case of an inflammatory pulmonary aneurysm (Rasmussen aneurysm) from active pulmonary tuberculosis. This is an uncommon cause for massive hemoptysis which was successfully treated by endovascular coiling.

scholarly journals Methamphetamine Use With Subsequent Thyrotoxicosis/Thyroid Storm, Agranulocytosis, and Modified Total Thyroidectomy: A Case Report

2017 ◽  
Vol 10 ◽  
pp. 117955061774129 ◽  
Author(s):  
Omar Viswanath ◽  
Deanna C Menapace ◽  
Don B Headley
Keyword(s):  
Emergency Department ◽  
Total Thyroidectomy ◽  
Feedback Loop ◽  
Blood Stream ◽  
Vascular Supply ◽  
Thyroid Storm ◽  
Shortness Of Breath ◽  
Past Medical History ◽  
Methamphetamine Use ◽  
Significant Mortality

Thyroid storm is a rare, potentially lethal condition involving collapse of the hypothalamic-pituitary-thyroid feedback loop. Thyroid storm carries a significant mortality rate, thus requiring prompt identification and treatment. A 47-year-old woman presented to the emergency department complaining of palpitations, shortness of breath, and emesis for 24 hours after using methamphetamine. Past medical history was significant for untreated hyperthyroidism. Physical examination revealed a prominent, palpable thyroid. The Burch-Wartofsky-Score was 35. Management for thyroid storm included propylthiouracil (PTU), super saturated potassium iodide, intravenous hydrocortisone, and propranolol. However, a rare drug reaction to PTU on day 3 resulted in agranulocytosis. Propylthiouracil was withheld and a modified total thyroidectomy performed on day 8 without complications and the patient discharged on day 10 with levothyroxine. Undertreated hyperthyroidism may predispose patients to catecholamine-induced thyrotoxicosis due to catecholamine hypersensitivity. With known methamphetamine use, methamphetamine toxicity and a methamphetamine-exacerbated thyroid storm need to be included in the differential diagnosis in a patient presenting with signs of thyrotoxicosis. In addition, treating patients with agranulocytosis from PTU with a modified total thyroidectomy using ligation of the vascular supply as the initial surgical step limits release of thyroid hormone into the blood stream during thyroidectomy and decreases the possibility of intra operative thyroid storm.

scholarly journals Challenging Thyroid Storm in Pregnancy, Case Report

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A923-A924
Author(s):  
Zaina Abdelhalim Alamer ◽  
Mohammed Alkhatib ◽  
Emad Naem ◽  
Noor Nabeel M Suleiman ◽  
Marwa Gomaa Mokhtar ◽  
...  
Keyword(s):  
Case Report ◽  
Liver Function ◽  
Calcium Supplementation ◽  
Rare Complication ◽  
Multiorgan Failure ◽  
Medical Emergency ◽  
Thyroid Storm ◽  
Dilation And Curettage ◽  
Definitive Therapy ◽  
In Pregnancy

Abstract Background: Thyroid storm is a rare complication of hyperthyroidism. It can lead to life-threatening complications such as Arrhythmias, multiorgan failure and disseminated intravascular coagulation (DIC) (1). In pregnant patients can cause spontaneous abortions, fetal demise (2). Aggressive treatment under critical care settings is needed. Clinical Case: We report a case of 24-year-old Indian female twelve weeks pregnant; background of Graves’ disease for five years, was on carbimazole but she discontinued since she became pregnant. Presented to Hamad general hospital with nausea, vomiting and altered mental status for one day. She was afebrile, normotensive, tachypneic, tachycardiac with heart rate of 150bpm, and confused. Investigations showed supraventricular tachycardia aborted by adenosine and amiodarone, TSH was < 0.01mIU/l(0.3-4.2) and FT4> 100 pmol/L(11.6-21.9),normal baseline liver function and complete blood counts. In the emergency department, she was managed for thyroid storm with hydrocortisone, propranolol, propylthiouracil (PTU), iodine solution and cholestyramine. Then suddenly she deteriorated requiring intubation and vasopressor support under care of Medical Intensive Care Unit (MICU) progressed to multiorgan failure; acute liver injury, acute kidney injury and DIC. So, PTU was stopped and started on plasma exchange followed by total thyroidectomy and tracheostomy. US pelvis showed nonviable fetus, so dilation and curettage were done by obstetric team. Afterwards, she markedly improved except her conscious level and kidney function which required Hemodialysis. MRI brain showed small subdural hematoma treated conservatively and Wernicke encephalopathy treated with thiamine with substantial response and spontaneously breathing. Post thyroidectomy she required calcium supplementation and levothyroxine, liver function and coagulation parameters back to baseline. Conclusion: Thyroid storm in pregnancy is a medical emergency with high mortality rate, it needs high index of suspicion and early aggressive management by a multidisciplinary team. Plasmapheresis may be considered for challenging cases as a bridge for definitive therapy. Thyroidectomy may be the only option in selected cases like our case. References: 1. Karger S, Führer D. Thyreotoxische Krise--ein Update [Thyroid storm--thyrotoxic crisis: an update]. Dtsch Med Wochenschr. 2008 Mar;133(10):479-84. German. doi: 10.1055/s-2008-1046737. PMID: 18302101. 2. Ma Y, Li H, Liu J, Lin X, Liu H. Impending thyroid storm in a pregnant woman with undiagnosed hyperthyroidism: A case report and literature review. Medicine (Baltimore). 2018;97(3):e9606. doi:10.1097/MD.0000000000009606

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