Vertebral Artery Dissection Mimicking Migraine: A Case Report

Vertebral artery dissection (VAD) is caused by an intimal tear that leads to bleeding into the vascular wall, which may cause vascular occlusion by thrombus formation and subsequent distal emboli (leading to ischemic stroke), aneurysm formation and subarachnoid hemorrhage. Cervical artery dissections (either carotid or vertebral artery dissection) are an important cause of stroke in patients under 50-years of age. Headache with or without neck pain is a common symptom. Usually, it occurs with focal neurological signs but sometimes it may occur without any neurological deficits and may mimic migraine. Often it occurs spontaneously without trauma but sometimes there is history of minor traumas, sudden neck movements or chiropractic manipulation. Imaging modalities include magnetic resonance imaging (MRI) brain, magnetic resonance angiography (MRA), and computed tomography angiography (CTA). Treatment involves anticoagulation or antiplatelet agents.

Legalities in All Wound Care Negligence of Care

Wound care costs in the United States exceeds 10 times more than that of other countries.1 Legal suites are increasingly paid out by clinicians, not the hospitals or the healthcare system.2 Many clinicians are facing lawsuits for malpractice or professional neglect. When taken to court and found guilty, the judgment will result in a large settlement then include the loss of the clinician’s license.1 Since malpractice has a limited judgement, many lawyers are seeking damages as a result of elder abuse. In using elder abuse, the judgements do not have a limitation and often result in very large settlements.2 Clinicians need to learn how to protect him/herself from lawsuits and present the best defense. Areas of negligences in care are: 1) Failure to follow the provider’s orders. 2) Failure to properly monitor and observe the patient and the progress of the wound, 3) Failure to report changes in the patient’s condition. 4) Failure to properly document wound assessment properly and with true description.2

Prolonged Cardiac Arrest in Severe Bupropion Intoxication: Everything You Should Know About Anti-Arrhytmics, Transesophageal Echocardiography Guided Resuscitation and Extracorporeal Membrane Oxygenation

A 30-year-old woman was admitted to the emergency department one and half hours after severe bupropion extended-release intoxication, estimated to be between 18 and 36 g. She initially presented with seizures and later developed signs of cardiotoxicity with persisting sustained ventricular tachycardia. Despite multiple defibrillation attempts and the administration of sodium bicarbonate, calcium gluconate and magnesium, restoration of sinus rhythm was found unsuccessful. In another attempt to treat this refractory ventricular tachycardia lidocaine was given followed by deterioration to asystole. During cardiopulmonary resuscitation (CPR), the quality of chest compression was assessed and optimised using transoesophageal echocardiography. Eventually venoarterial extracorporeal membrane oxygenation (VA-ECMO) was needed to achieve hemodynamic stability. In this case report we discuss the successful use of VA-ECMO after bupropion intoxication, which has only been reported in 3 other cases but should be considered as one of the treatment options in severe overdose cases. Also, the rare complication of asystole after lidocaine administration and the value of transoesophageal echocardiography during CPR will be discussed.

Ultra-Early Cord Decompression in the Emergency Setting and its Impact on Outcome

Background Traumatic cervical are injuries are very common due to high motility of cervical spine and its vulnerability to traumatic injuries. Optimal time for stabilizing the patients with traumatic spinal fractures remains controversial. It is almost due to different outcomes in various studies and the lack of consensus about it. Here we explain an ultra–early cord decompression that led to complete recovery of a patient with severe cervical cord injury. Case Presentation The patient was a 27-year-old gymnast woman with a recent history of spinal cord injury caused by high jumping with head back and neck hyperextension presented within 2-hours of trauma. As a critical case and lack of advanced radiologic equipment, only cervical spinal radiographs were used for decision-making within the first 3 hours of injury to save the patient’s cord function by surgical decompression. Conclusion Many studies have proposed different intervention times for achieving the optimal result; however, we present an ultra-early surgery (within 3-hours of injury), conducted in a context of limited medical facilities. This case revealed an excellent result after 12-months follow-up.

Extra-Pulmonary Manifestations of Coronavirus Disease 2019: A Multi System Disease

Introduction The outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV- 2), has been recently declared a pandemic by the World Health Organization. Apart from acute respiratory manifestations, SARS-CoV-2 may also adversely affect other organ systems. To date, however, there is a very limited understanding of the manifestations and management of COVID-19 related conditions outside of the pulmonary system. This study provides an overview of the current literature about the extra pulmonary manifestations of COVID-19 that may affect the renal, cardiovascular, gastrointestinal, hematological, hematopoietic, neurological, or reproductive systems. This study also describes the current understanding of the extra pulmonary manifestations caused by COVID-19 to improve the management and prognosis of patients with COVID-19. Materials and Methods A total number of 200 hospitalized patients with COVID-19 disease were retrospectively evaluated for extra-pulmonary manifestations findings or complications. These patients had undergone various imaging studies, blood examinations during the course of hospital stay. The data reviewed using the institutional PACS, database system over a period of four months (August to November 2020). Results Among the 200 patients (males and females), 175 of them had extra-pulmonary complications. Various extra-pulmonary findings such as acute kidney injury, renal failure, cytokinase strome, acute myocardial injury, congestive cardiac failure, pulmonary thromboembolism, gastrointestinal, neurological complications were observed. Inclusion and Exclusion Criteria All retrospective clinical studies, case series, and case reports with data on extra-pulmonary manifestations in COVID-19 that were published from the end of December 2019 till the end of February 2021 were included. Studies that did not mention extrapulmonary manifestations were excluded. Literature Search The review was based on publications available on PubMed and data collected by the World Health Organization (WHO). Search terms used were ‘novel coronavirus 2019 (2019-nCoV)’, ‘SARS- CoV-2’, or ‘COVID-19’ combined with ‘asymptomatic’, ‘gastrointestinal’, ‘cardiac’, ‘neurological’, ‘hepatic’, ‘hematological’, ‘renal’, ‘psychiatric’, ‘hematological’, and ‘atypical’.

Nebulized Tranexamic Acid for Hemoptysis

The synthetic antifibrinolytic drug, tranexamic acid, is widely used intravenously, orally and topically to treat various bleeding complications. In recent years, there has been increasing evidence of its use as inhalation drug for hemoptysis. In this review, the available literature about aerosolized tranexamic acid is listed.

Macroscopic White Blood Cell Casts: An Extremely Rare Presentation of Klebsiella Pyelonephritis

In this case report, we present a patient with severe pyelonephritis who presented complaining of passing worm-like tissue from his penis. This patient was passing macroscopic ureteral white blood cell casts resulting from a severe pyelonephritis caused by Klebsiella pneumoniae.

Electrical Injury and Prolonged Cardiac Arrest: A Case Report of Complete Neurological Recovery

Introduction Sudden cardiac arrest continues to have a high mortality rate. Out of hospital cardiac arrest (OHCA) has a poor outcome compared to those occurring in a healthcare setup due to lack of awareness and appropriate resources. The most common rhythm abnormality in OHCA is ventricular fibrillation which requires early defibrillation, ideally on the location. Case Report A 19-years male was witnessed by lay bystanders to have become unresponsive following contact with an electric lighting pole on the road median in Chandigarh. A passer-by medical resident detected no pulse and initiated chest compression. Since there was no immediate return of spontaneous circulation and aetiology suggested a defibrillate rhythm. The patient was taken in the car and rushed to a tertiary care centre, 10-minutes away. Cardiopulmonary resuscitation (CPR) was interrupted during transport for lack of adequate personnel. Ventricular fibrillation was noted and shock was delivered along with inotropes. Around 26-minutes into the resuscitation, the patient had the return of spontaneous circulation. After post-cardiac arrest care in intensive care unit (ICU), he was extubated and discharged home in 1-week with full neurological recovery. Discussion Recovery of full neurologic function could be explained by the alternating presence of stable and unstable cardiac rhythms and in part at least brought about by immediate attempts at resuscitation. The report seeks to review these aspects of emergency care besides highlighting the need for both immediate and accurate emergency medical services such as lay responder training, public access defibrillation and responsive transport systems for such patients.