American Journal of Emergency Medicine最新文献

Background: Abdominal pain remains a top chief complaint for patients presenting to the emergency department (ED). Benign or emergent etiologies can present similarly. A thorough history and physical examination are critical for emergency physicians, especially for post-operative patients with concerns for a possible bowel perforation. Hysteroscopies with myomectomies are a minimally invasive surgical technique to remove fibroids. Gynecologic procedures historically have a low incidence of bowel perforation, however, in patients with post-operative pain presenting to the ED, distinguishing between a normal post-operative course and a post-operative complication can be challenging.

Case: A 33-year-old female with a history of obesity, colitis, type II diabetes, and hypertension presented to the freestanding ED with complaints of severe lower abdominal following a hysteroscopy with myomectomy earlier that day. The initial differential diagnosis had concern for a surgical complication, although her computed tomography of the abdomen and pelvis revealed mildly dilated loops of small bowel, suggestive of a low-grade small bowel obstruction (SBO) or enteritis. On reassessment, she noted pre-operative diarrhea after taking antibiotics. After admission, a transvaginal ultrasound revealed a collection of fluid in her pelvis prompting a diagnostic laparoscopy. Two enterotomies in her ileum with two uterine defects were successfully repaired, and she recovered several days later with minimal complications.

Discussion: This patient initially presented with abdominal pain associated with nausea and vomiting following a hysteroscopy with myomectomy, where initial testing led to a possible diagnosis of enteritis. Due to her continued abdominal pain, the ED physician admitted the patient, and it was found that she had two ileum perforations from suspected uterine perforations.

Background: Unintentional plant ingestions and poisoning are common. Generally, these ingestions are asymptomatic or minimally symptomatic. Increased toxicity is often associated with the foraging for plants incorrectly identified as edible plants. We present a case series of seven family members poisoned by suspected Death Camas, also known as Meadow Death Camas, (Toxicoscordion venenosum), when the plant was misidentified as edible while foraging for Wild Onion (Allium canadense).

Case series: Five children and two adults presented to the emergency department after eating bulbs of suspected Death Camas (Toxicoscordion venenosum). Symptoms began within 30 to 60 min including nausea, vomiting, and abdominal pain. This was followed by bradycardia and hypotension consistent with Death Camas poisoning from alpha blockade, sodium channel activation, and increased vagal activity from the toxins. All of the patients required admission to the intensive care unit. Six patients were treated with supportive care alone and two patients required vasopressor support. An 89-year-old female developed a wide complex tachycardia and was treated with amiodarone. All patients had resolution of toxicity within 24 h and were discharged to home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Foodborne illness is a common presentation highlighted by signs and symptoms manifesting in multiple people eating the same meal. The misidentification of toxic plants as edible is associated with acute onset of signs and symptoms of toxicity. The toxins associated with Death Camas (Toxicoscordion venenosum), commonly thought to be edible Wild Onion (Allium canadense), are unique as these can cause gastrointestinal effects (e.g., nausea, vomiting, diarrhea), and cardiovascular effects (e.g., bradycardia, hypotension), which are often refractory to supportive therapy alone (e.g., crystalloid fluids), and can require atropine and vasopressors.