International Journal of Emergency Medicine最新文献

Background: Piperacillin-tazobactam (PT), a broad-spectrum β-lactam/β-lactamase inhibitor combination, is clinically used to treat infections caused by Gram-positive and Gram-negative aerobic and anaerobic bacteria. While gastrointestinal adverse effects, skin reactions, and fever have been previously reported during PT therapy, its association with periodic fever, leukopenia, and hypokalemia specifically in post-trauma surgical patients has not been documented.

Case presentation: We report the case of a 55-year-old male trauma patient who received PT for 17 days pre-operatively for suspected infection. He then underwent surgical procedures including rib fracture open reduction and internal fixation, along with thoracic closed drainage. Post-operatively, on day 2, the patient developed periodic fever, occurring specifically between 20:00 and 23:00 hours each night, with normal daytime temperatures. Concurrently, during PT administration, the patient exhibited leukopenia and hypokalemia. Notably, cessation of PT led to an immediate resolution of the periodic fever, gradual normalization of leukocyte counts, and restoration of potassium levels. Although PT can cause fever, diagnosis can be challenging in the post-operative setting due to the potential for confounding factors.

Conclusions: This case suggests that in surgical patients presenting with periodic fever, particularly when accompanied by leukopenia and hypokalemia after exposure to PT, the drug should be considered a potential causative agent, even if other post-operative complications are being investigated.

Background: Carbon monoxide (CO) intoxication due to suicide attempts or accidental exposure is a critical problem in Korea. Patients with CO intoxication can experience various neurologic and systemic symptoms. Although some of these symptoms may result in severe sequelae, the pathophysiological mechanisms remain unclear. Hyperbaric oxygen (HBO) therapy is the most important treatment for CO poisoning. However, standardized protocols remain unclear, and most related studies focus on the association of HBO therapy with the development of sequelae. Therefore, we intended to conduct studies focusing on the early features of CO intoxication.

Methods: A retrospective descriptive cross-sectional study was conducted based on an analysis of medical records for patients with CO intoxication treated with hyperbaric oxygenation from January 2020 to March 2023. We excluded patients with a misdiagnosis, duplicate registration, or refusal of treatment. Patients were divided into two groups on the basis of their mental status at the time of presentation, and their demographic, physiological, and environmental characteristics were compared. Chi-square tests and t tests were performed, and 95% confidence intervals were calculated.

Results: Out of 525 patients identified with CO exposure, 288 patients were included in this study. A total of 186 (64.6%) patients were male, and most were in their mid-forties. Alert patients appeared to visit the hospital earlier compared with other patients (431.82 ± 975.20 vs. 151.78 ± 229.96, p value < 0.001). The proportion of suicide attempts was greater in the nonalert group (94 (56%) vs. 101 (84.2%), p value < 0.001). The frequencies of myocardial damage, shock, and ventilator treatment were 51 (42.5%), 6 (5%), and 13 (10.8%), respectively, and were greater in the unconscious group. Most symptoms usually improved almost completely at the early stage of the HBO therapy protocol.

Conclusions: In general, patients who are not alert at the time of presentation receive more intensive HBO therapy. According to our study, most intoxication symptoms improve during the early phase of HBO therapy, and delayed neuropsychiatric sequalae can occur in the future, even in initially alert patients. Therefore, physicians should be more careful with patients with neurological symptoms, evidence of myocardial damage, or severely elevated creatine phosphokinase levels, and these patients should be fully administered HBO therapy.

Platelet gene resistance may result in acute thrombosis, although clinical reports are scarce.This article presents a classic case of acute in-stent thrombosis and discusses its diagnostic and therapeutic strategies.The patient, a 57-year-old male, was admitted due to chest pain that lasted for one hour. After a thorough examination, he was diagnosed with acute ST-segment elevation myocardial infarction. Acute thrombosis rapidly occurred within 30 minutes following emergency coronary stent implantation.

Background: Snakebites caused by Bitis nasicornis and Bitis gabonica are rare but can lead to severe systemic and local complications, including acute compartment syndrome (ACS). The role of surgical intervention in snakebite management remains controversial, with limited data available for snakebite envenomation.

Case presentation: Two cases of upper limb envenomation by Bitis nasicornis and Bitis gabonica were managed at the General University Hospital in Prague in year 2024. Both developed acute compartment syndrome requiring prompt antivenom therapy, fasciotomy, and intensive care. In the first case, antivenom (EchiTab-Plus-ICP) was given within 1 h, 10 vials in total, and fasciotomy at 10 h; the patient was discharged on day 16 with preserved limb function. In the second, antivenom (SAIMR) was administered within 3 h, 4 vials in total (the maximum available in Europe at that time), and fasciotomy at 8 h; recovery was complete by day 7. Diagnosis of ACS was based on clinical signs without intracompartmental pressure measurement.

Conclusion: These cases highlight that timely surgical intervention, combined with intensive care and antivenin may play a critical role in preventing irreversible tissue damage following viperid envenomation. However, universal guidelines are lacking. Incorporating intracompartmental pressure monitoring into treatment protocols may further improve diagnostic accuracy and patient outcomes.

Background: ST-elevation myocardial infarction is a life-threatening condition and the electrocardiogram is an essential tool for its prompt diagnosis. However, ST-segment elevation migration can occur due to several factors, including lead misplacement, coronary vasospasm, thrombus migration, aortic dissection, and acute pericarditis.

Case presentation: A 47-year-old man with chest pain whose electrocardiogram revealed ST-segment elevation in different territories within one hour. The apparent ST-segment elevation migration was attributed to limb lead reversal, as confirmed by the cardiac catheterization findings, which were consistent with the second electrocardiogram.

Conclusions: The accurate identification of ST-segment elevation is important to the cardiologist in order to determine the culprit vessel. This case highlights the accidental electrocardiogram electrode misplacement can result in misdiagnosis, which can be identified by recognizing unusual P-QRS pattern, using familiar-language electrode labeling, and performing serial electrocardiogram reviews.

Background: Toxic encephalopathy, which results from exposure to neurotoxic substances, poses a considerable clinical challenge, especially for occupational groups like painters and construction workers.

Case presentation: This case report describes a 35-year-old female painter who experienced acute toxic encephalopathy, presenting with severe headache, nausea, and vomiting. Initially, her condition was misdiagnosed as cervical spondylosis. However, recognizing her occupational exposure to organic solvents was essential for arriving at the correct diagnosis. This case highlights the importance of thorough evaluations, particularly detailed occupational histories, to avoid misdiagnosis and ensure timely management of such conditions. Neuroimaging results showed bilateral symmetric white matter changes, which supported the diagnosis of organic solvent toxicity. This finding aligns with existing literature that discusses how lipid solubility can disrupt neuronal function. The patient's positive outcome following prompt treatment underscores the critical need for early recognition of toxic encephalopathy, as it can significantly improve recovery chances.

Conclusion: This case enhances our understanding of the complexities associated with diagnosing acute encephalopathy caused by organic solvents and underscores the urgent need for healthcare providers to be more aware of occupational hazards.