JEM reports最新文献_第7页

An atypical case of infective endocarditis initially diagnosed as myopericarditis 一例不典型的感染性心内膜炎，最初诊断为心包炎

JEM reports

Pub Date : 2025-01-27 DOI: 10.1016/j.jemrpt.2025.100145

Negin Ceraolo , Rachel Dietz , Spencer Prete , Erin L Simon

Background

Acute myopericarditis is inflammation of the pericardium, or the membrane surrounding the heart, and the myocardium, or the muscular myocardial layer of the heart. Infective endocarditis is an infection of the cardiac endothelium. Diagnosis relies on clinical evaluation, blood cultures to identify the causative organism, and echocardiography to visualize vegetations on heart valves. In the emergency department (ED), distinguishing between myopericarditis and infective endocarditis is crucial to avoid misdiagnosis.

Case report

We present the case of a 36-year-old male who was initially hospitalized for myocarditis and discharged on medications with cardiology follow-up planned. Twelve days later, the patient was readmitted with recurring chest pain. A bedside cardiac ultrasound showed mild mitral regurgitation. The patient was found to have bacteremia with Streptococcus anginosus which was concerning for endocarditis. The patient was transferred to a quaternary care hospital, where he underwent successful mitral valve repair.

Why should an emergency physician be aware of this?

In the ED setting, it is crucial to broaden differential diagnoses. Myopericarditis can sometimes result from endocarditis, which can present in various ways. Therefore, endocarditis should be ruled out in acute presentations of chest pain. To avoid missing cases of endocarditis, obtaining blood cultures from patients with myopericarditis symptoms is essential. Additionally, expediting a transesophageal echocardiogram (TEE) can lead to a faster and more accurate diagnosis. Promptly conducting these tests can reduce the number of missed endocarditis cases and prevent patients from returning to the emergency department.

背景：急性心肌炎是心包（即包围心脏的膜）和心肌（即心脏的心肌肌层）的炎症。感染性心内膜炎是一种心脏内皮的感染。诊断依赖于临床评估，血培养来确定致病生物，超声心动图来观察心脏瓣膜上的植被。在急诊科（ED），区分心包炎和感染性心内膜炎是避免误诊的关键。病例报告我们报告一位36岁男性患者，他最初因心肌炎住院，出院后接受药物治疗，并计划进行心脏病学随访。12天后，患者再次因胸痛复发入院。床边心脏超声显示轻度二尖瓣返流。患者被发现有血管链球菌菌血症，可能引起心内膜炎。患者被转移到一家第四护理医院，在那里他接受了成功的二尖瓣修复。急诊医生为什么要意识到这一点？在急诊科，扩大鉴别诊断是至关重要的。心包炎有时可由心内膜炎引起，其表现形式多种多样。因此，急性胸痛时应排除心内膜炎。为避免遗漏心内膜炎病例，有心肌炎症状的患者进行血培养是必要的。此外，加快经食管超声心动图（TEE）可以导致更快，更准确的诊断。及时进行这些检查可以减少心内膜炎漏诊病例的数量，并防止患者返回急诊室。

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引用次数: 0

Angiotensin converting enzyme inhibitor-induced penile angioedema: A case report 血管紧张素转换酶抑制剂诱导阴茎血管性水肿1例

JEM reports

Pub Date : 2025-01-27 DOI: 10.1016/j.jemrpt.2025.100143

Anthony Acosta , Enas Alamreia , Nimra Afreen , Zane Elfessi

Background

Angioedema is local swelling in the subcutaneous or submucosal layers resulting from bradykinin-mediated capillary leakage allowing fluid to accumulating in the interstitial space. It is estimated to affect up to 1 in 10,000 individuals each year worldwide.

Case report

Angioedema typically affects areas such as the face, lips, mouth, and throat, larynx, uvula, and GI tract, but rarely affects the genitals. Causes of angioedema include allergic reactions, drug-induced, hereditary factors, acquired factors, and idiopathic. We report a rare case of penile angioedema due to the angiotensin-converting enzyme (ACE) inhibitor lisinopril.

Why should an EM Physician be aware of this?

Penile angioedema is an extremely rare complication of ACE inhibitor use and should be included in the differential diagnosis for genital swelling. In the absence of complications from angioedema, such as paraphimosis, patients can be discharged from the emergency department without the need for pharmacotherapy as the swelling is self-resolving after discontinuation of the offending agent.

背景：水肿是由缓激肽介导的毛细血管渗漏引起的皮下或粘膜下层的局部肿胀，使液体积聚在间隙中。据估计，全世界每年每1万人中就有1人受到影响。血管性水肿通常影响面部、嘴唇、口腔、咽喉、喉、小舌和胃肠道等部位，但很少影响生殖器。血管性水肿的病因包括过敏反应、药物诱导、遗传因素、获得性因素和特发性因素。我们报告一例罕见的阴茎血管性水肿由于血管紧张素转换酶（ACE）抑制剂赖诺普利。为什么急诊医师应该意识到这一点？阴茎血管性水肿是一种极为罕见的并发症的ACE抑制剂的使用，应包括在鉴别诊断生殖器肿胀。在没有血管性水肿并发症的情况下，如寄生虫病，患者可以从急诊科出院，而不需要药物治疗，因为在停止使用药物后，肿胀会自行消退。

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引用次数: 0

Bilateral true vocal fold avulsion following trampoline accident: A case report 蹦床事故致双侧真声带撕脱1例

JEM reports

Pub Date : 2025-01-27 DOI: 10.1016/j.jemrpt.2025.100146

Allison Epstein , Alexandra Welschmeyer , Temitope Adeyeni , Jamil Hayden , Matthew Gropler , Jay Shah , Nelson Scott Howard

Background

Vocal cord avulsion is a rare and potentially devastating injury which may result from blunt laryngotracheal trauma. While there are cases of unilateral vocal cord avulsion, we present a pediatric patient with bilateral vocal cord avulsion from blunt trauma to the anterior neck following a trampoline accident.

Case report

This 10-year-old female presented with dysphonia and dysphagia and was found to have bilateral vocal cord avulsion effecting the superior vocal fold with a noticeable height mismatch and exposed cartilage seen only on diagnostic direct laryngoscopy, corresponding to a Schaeffer Grade 3 laryngeal injury. Distal chip laryngoscopy was not as useful in providing a comprehensive examination of the patient due to muscle tension with arytenoid prolapse. Primary endoscopic repair was performed with subsequent improved vocal cord position, voice quality, and tolerance of oral intake.

Why should an emergency physician be aware of this?

Laryngeal trauma in children is rare, and early detection is critical to optimize long term outcomes. To date, no universal protocol for diagnosis and management of these injuries in the pediatric population exists. A low index of suspicion of endolaryngeal injury must be maintained for children with these injuries given their smaller airway diameter and increased propensity to develop acute airway compromise in the absence of obvious warning signs or symptoms. We highlight our endoscopic repair technique and excellent postoperative course with improvements in voice, swallow, and overall quality of life.

背景：声带撕脱伤是一种罕见且具有潜在破坏性的损伤，它可能是由钝性喉气管外伤引起的。虽然有单侧声带撕脱的病例，我们提出一个儿童患者的双侧声带撕脱从钝性创伤到颈部前蹦床事故后。病例报告：这名10岁的女性表现为发音困难和吞咽困难，发现双侧声带撕脱伤，影响上声带，高度明显不匹配，软骨暴露，仅在直接喉镜诊断中可见，对应于Schaeffer 3级喉损伤。远端芯片喉镜在提供一个全面的检查，由于肌肉紧张和杓状脱垂的病人是没有用的。初步内镜修复后，声带位置、语音质量和口腔摄入耐受性均得到改善。急诊医生为什么要意识到这一点？喉外伤在儿童中是罕见的，早期发现是优化长期结果的关键。迄今为止，在儿科人群中没有诊断和管理这些损伤的通用方案。对于这些损伤的儿童，必须保持低怀疑指数，因为他们的气道直径较小，在没有明显的警告迹象或症状的情况下，更容易发生急性气道损害。我们强调我们的内窥镜修复技术和良好的术后过程，改善了声音，吞咽和整体生活质量。

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引用次数: 0

Unveiling Wunderlich syndrome: Diagnosis and management of a rare spontaneous renal hematoma 揭示Wunderlich综合征：罕见自发性肾血肿的诊断和治疗

JEM reports

Pub Date : 2025-01-27 DOI: 10.1016/j.jemrpt.2025.100144

Rebecca Merrill , Pete Jordanides , Jessica Krizo , Erin L. Simon

Background

Wunderlich syndrome (WS) is a rare condition that is described as an atraumatic, spontaneous renal hemorrhage in the perirenal space. Symptoms typically present as nondescript flank pain, but a flank mass and hypovolemic shock are also possible. Computed tomography (CT) imaging with intravenous contrast should be the modality of choice to diagnose WS, with recent studies highlighting the efficacy of transcatheter arterial embolization (TAE) as the preferred treatment over surgery. WS is often secondary to conditions such as renal neoplasms, vascular diseases, and infections, necessitating adequate follow up to determine the etiology.

Case report

We present the case of a 79-year-old woman presenting to the emergency department (ED) with left flank pain. Computed tomography with angiography revealed a large left renal subcapsular hematoma with perinephric and retroperitoneal extension with active extravasation, characteristic of Wunderlich syndrome. The patient was treated emergently with transcatheter arterial embolization of the lower polar branch of her left renal artery. In the ED, WS can present with a variety of non-specific symptoms, making the diagnosis challenging for emergency physicians.

Why should an emergency physician be aware of this?

Wunderlich syndrome is a rare, sudden, and life-threatening emergency that requires prompt diagnosis, as the hematoma can spread to the perinephric space leading to massive internal hemorrhage. Causes and presenting symptoms are variable, with flank pain being a common symptom. CT or MRI imaging is necessary for diagnosis, and embolization is often the treatment of choice to avoid further complications.

背景：wunderlich综合征（WS）是一种罕见的疾病，被描述为肾周间隙的非创伤性自发性肾出血。症状通常表现为难辨的腹部疼痛，但也可能出现腹部肿块和低血容量性休克。计算机断层扫描（CT）和静脉造影剂应该是诊断WS的首选方式，最近的研究强调了经导管动脉栓塞（TAE）作为比手术更好的治疗方法的有效性。WS通常继发于肾肿瘤、血管疾病和感染等疾病，需要充分的随访以确定病因。病例报告我们提出的情况下，79岁的妇女提出的急诊科（ED）左侧疼痛。计算机断层扫描与血管造影显示一个大的左肾包膜下血肿伴肾周和腹膜后延伸并活动性外渗，Wunderlich综合征的特征。病人紧急接受左肾动脉下极支经导管栓塞治疗。在急诊科，WS可以表现出多种非特异性症状，这使得急诊医生的诊断具有挑战性。急诊医生为什么要意识到这一点？Wunderlich综合征是一种罕见的、突发的、危及生命的紧急情况，需要及时诊断，因为血肿可以扩散到肾周间隙，导致大量内出血。病因和表现症状各不相同，腹部疼痛是常见症状。CT或MRI成像对诊断是必要的，栓塞通常是避免进一步并发症的治疗选择。

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引用次数: 0

Hypoglycaemia and monitoring practices following insulin-dextrose therapy for hyperkalaemia 胰岛素-葡萄糖治疗高钾血症后的低血糖和监测实践

JEM reports

Pub Date : 2025-01-25 DOI: 10.1016/j.jemrpt.2025.100142

Samuel Ford , Julian Williams , Ian Coombes , Adam La Caze

Background

Hypoglycaemia is commonly encountered following insulin-dextrose therapy (IDT) for hyperkalaemia. This retrospective study aimed to assess the local incidence of hypoglycaemia following IDT for hyperkalaemia in the Emergency Department (ED).

Objectives

Describe the local incidence of hypoglycaemia and BGL monitoring practices following IDT for hyperkalaemia in the ED.

Methods

Adult patients with hyperkalaemia (>5.5 mmol/L) who received IDT in a large metropolitan ED were included. The primary outcome was the incidence of hypoglycaemia, defined as a BGL less than 70 mg/dL (3.9 mmol/L), within 5 h post-administration. Secondary outcomes included hypoglycaemia severity, time to hypoglycaemia, risk factors for hypoglycaemia, blood glucose and potassium monitoring. Data collection spanned January 1, 2019 to May 1, 2020.

Results

Among 90 patients, 51 % were receiving chronic renal replacement therapies and the incidence of hypoglycaemia and severe hypoglycaemia was 30 % and 6.7 % respectively. Risk factors for hypoglycaemia were lower pre-treatment blood glucose (p=<0.001), absence of diabetes (p=<0.001) and not being prescribed insulin prior to presentation (p = 0.0026). Approximately 50 % of patients received ≤2 blood glucose measurements within 5 h post IDT. Only 44 % of patients had a potassium sample taken in the 1st hour post IDT and 24 % in hour 3.

Conclusions

This study demonstrates a higher incidence of hypoglycaemia post-IDT for hyperkalaemia than reported in the general population and estimates the incidence of severe hypoglycaemia in an Australian population. Monitoring of both blood glucose levels (BGL) and potassium was suboptimal. Strategies to improve BGL monitoring and prospective studies to define the optimal dose of insulin-glucose for hyperkalaemia are needed.

背景：低血糖是胰岛素-葡萄糖治疗高钾血症后常见的症状。本回顾性研究旨在评估急诊科（ED）高钾血症患者IDT后低血糖的局部发生率。目的探讨ED高血钾患者行IDT治疗后低血糖的局部发生率及BGL监测方法。方法纳入大城市ED接受IDT治疗的成人高血钾（5.5 mmol/L）患者。主要终点是给药后5小时内低血糖的发生率，定义为BGL低于70 mg/dL （3.9 mmol/L）。次要结局包括低血糖严重程度、低血糖发生时间、低血糖危险因素、血糖和钾监测。数据收集时间为2019年1月1日至2020年5月1日。结果90例患者中，51%的患者接受了慢性肾脏替代治疗，低血糖和严重低血糖的发生率分别为30%和6.7%。低血糖的危险因素是治疗前较低的血糖（p=<0.001）、没有糖尿病（p=<0.001）和就诊前未开胰岛素（p= 0.0026）。大约50%的患者在IDT后5小时内接受了≤2次血糖测量。只有44%的患者在IDT后1小时内取钾，24%在第3小时取钾。结论：本研究表明idt后高钾血症的低血糖发生率高于一般人群，并估计了澳大利亚人群中严重低血糖的发生率。血糖水平（BGL）和钾的监测都不理想。需要改进血糖监测的策略和前瞻性研究来确定高钾血症的最佳胰岛素-葡萄糖剂量。

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引用次数: 0

Patient acceptance of emergency department-initiated buprenorphine and reasons for declining 急诊科患者对丁丙诺啡的接受程度及其下降的原因

JEM reports

Pub Date : 2025-01-18 DOI: 10.1016/j.jemrpt.2025.100141

Lindsey K. Jennings , Allison Smith , Angela Moreland , Ralph Ward , Sarah Gainey , Suzanne Lane , Olivia Holodnik , Katherine Scarpino , Karen Hartwell , Louise Haynes , Kathleen T. Brady , Kelly Barth

Background

Medication for Opioid Use Disorder (MOUD) reduces morbidity and mortality for patients with opioid use disorder (OUD). Emergency department-initiated buprenorphine (EDIB) doubles retention in treatment at 30 days compared to outpatient referral alone. Little is known about acceptance rates of EDIB and reasons why patients decline this life-saving intervention.

Objectives

The aim of this study was to quantify the number of patients who initiate and decline buprenorphine in the ED and determine reasons for declination.

Methods

Seven SC EDs implemented EDIB programs that included ED-based peer recovery specialists (PRSs) to provide a brief intervention and assist with referral to outpatient treatment. The PRSs recorded patient interactions in a database including medical eligibility, if EDIB was provided, and the reason(s) why eligible patients declined EDIB. All eligible EDIB patients were entered in the PRS database and included in the study. Reasons for declining buprenorphine in eligible patients were analyzed with both fixed and free-text response options.

Results

A total of 2205 patients were eligible for EDIB. Of those, 963 (43.6 %) patients accepted buprenorphine and 1242 (56.3 %) declined. The most common reasons for declination were 1) the “patient preferring non-MOUD treatment” (53.4 %), 2) “Not ready/would like to think about it and/or check with other treatment providers or case workers” (16.7 %).

Conclusions

Over half of patients with OUD who were eligible for EDIB declined treatment, with the most common reason being preference for non-MOUD treatment. Given the success of MOUD for treatment of OUD, this topic requires further exploration.

阿片类药物使用障碍（OUD）的药物治疗降低了阿片类药物使用障碍（OUD）患者的发病率和死亡率。急诊启动丁丙诺啡（EDIB）在治疗30天的保留比单独门诊转诊加倍。EDIB的接受率和患者拒绝这种挽救生命的干预措施的原因知之甚少。目的本研究的目的是量化在急诊科使用丁丙诺啡和减少丁丙诺啡的患者数量，并确定减少的原因。方法7个社区教育中心实施了EDIB项目，其中包括以社区教育中心为基础的同伴康复专家（prs）提供简短的干预，并协助转诊到门诊治疗。prs在数据库中记录了患者的互动，包括医疗资格，是否提供了EDIB，以及符合条件的患者拒绝EDIB的原因。所有符合条件的EDIB患者均被录入PRS数据库并纳入研究。对符合条件的患者丁丙诺啡下降的原因进行了固定和自由文本反应选项的分析。结果共有2205例患者符合EDIB治疗条件。其中963例（43.6%）患者接受丁丙诺啡治疗，1242例（56.3%）患者不接受丁丙诺啡治疗。最常见的拒绝原因是1)“病人更喜欢非mod治疗”（53.4%），2)“没有准备好/不愿意考虑和/或与其他治疗提供者或个案工作者核实”（16.7%）。结论符合EDIB条件的OUD患者中有超过一半的患者拒绝了治疗，最常见的原因是偏好非mod治疗。鉴于mod治疗OUD的成功，这一课题需要进一步探索。

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引用次数: 0

Ketamine for rapid control of hyperactive delirium with severe agitation. A retrospective comparison study 氯胺酮快速控制严重躁动的多动性谵妄。回顾性比较研究

JEM reports

Pub Date : 2025-01-18 DOI: 10.1016/j.jemrpt.2025.100138

Beatrice Borreani , Annalisa Belluti , Francescopaolo D'Adamo , Luca Acquarone , Cristina Cocino , Paolo Canepa , Francesco Quaglia , Martina D'Antoni , Andrea Alienda , Alessandro Riccardi

Background

The agitated patient represents a very large clinical problem for the work of the emergency department. The therapeutic goal is rapid symptom control while ensuring maximum patient safety. Hyperactive delirium constitutes a true clinical emergency, and some sedatives carry inherent risks. Ketamine has already demonstrated remarkable safety in this setting. OBJECTIVES This study aims to indentify an effective and safe option for the rapid control of severe psychomotor agitation METHODS Our retrospective study analyzes the comparison of ketamine alone, ketamine with droperidol, and midazolam with haloperidol. RESULTS During the period of January 2022 and September 2023 we identified 66 patients with severe psychomotor agitation (13–76 years), and we demonstrated a faster and more effective response in patients treated with ketamine, and a reduction in adverse events in patients treated with ketamine and droperidol. CONCLUSIONS Our data show that patients treated with ketamine exhibit a significantly faster response, with immediate patient control, with greater safety than patients treated with midazolam. The combination with droperidol increases clinical efficacy compared with ketamine alone.

焦虑患者是急诊科工作中一个非常大的临床问题。治疗目标是快速控制症状，同时最大限度地确保患者安全。过度活跃的谵妄构成了真正的临床紧急情况，一些镇静剂具有固有的风险。氯胺酮在这种情况下已经证明了显著的安全性。目的：寻找一种有效、安全的方法快速控制重度精神运动躁动。方法：回顾性分析氯胺酮单用、氯胺酮联用氟哌啶醇、咪达唑仑联用氟哌啶醇的比较。在2022年1月至2023年9月期间，我们确定了66例严重精神运动性躁动患者（13-76岁），我们证明氯胺酮治疗患者的反应更快，更有效，氯胺酮和氟哌啶醇治疗患者的不良事件减少。结论：我们的数据显示，与咪达唑仑治疗的患者相比，氯胺酮治疗的患者反应明显更快，患者立即得到控制，安全性更高。与单独氯胺酮相比，氟哌啶醇联用可提高临床疗效。

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引用次数: 0

Acute pancreatitis and euglycemic non-diabetic ketoacidosis caused by an intentional semaglutide overdose 故意过量服用西马鲁肽引起的急性胰腺炎和血糖正常的非糖尿病酮症酸中毒

JEM reports

Pub Date : 2025-01-17 DOI: 10.1016/j.jemrpt.2025.100139

Anthony Acosta , Ashley Fanco , Hataitaya Rohan , Zane Elfessi

Background

Glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, have been approved for weight loss and have gained popularity for its efficacy and a once-weekly administration. The FDA approved max dose of 2.4 mg per week resulted in a 10 % reduction in weight over a 6-month period. GLP receptors are expressed in islet and exocrine duct cells of the pancreas. Case reports of pancreatitis and diabetic ketoacidosis have been reported in patients who have hypertriglyceridemia or carry a diagnosis of diabetes.

Case report

We report a first-of-its kind case of an intentional overdose of semaglutide leading to pancreatitis and ultimately euglycemic non-diabetic ketoacidosis (EnDKA). Overstimulation by GLP-1 agonists, like semaglutide, can lead to hyperplasia and resulting pancreatitis. Acute pancreatitis can induce a systemic inflammatory response and may be responsible for dysfunction of beta cells and subsequent insulin deficiency, resulting in diabetic ketoacidosis.

Why should an EM Physician be aware of this?

Acute pancreatitis and euglycemic non-diabetic ketoacidosis are both life threatening emergencies. As the use of weight-management drugs become increasingly popular, the incidence of these emergencies may be on the rise as well.

胰高血糖素样肽-1 （GLP-1）受体激动剂，如西马鲁肽，已被批准用于减肥，并因其疗效和每周一次给药而受到欢迎。FDA批准的最大剂量为每周2.4毫克，在6个月的时间里体重减轻了10%。GLP受体在胰腺的胰岛和外分泌管细胞中表达。病例报告胰腺炎和糖尿病酮症酸中毒已报道患者谁有高甘油三酯血症或携带诊断为糖尿病。病例报告：我们报告了首例故意过量使用西马鲁肽导致胰腺炎并最终导致血糖正常的非糖尿病酮症酸中毒（EnDKA）的病例。GLP-1激动剂（如semaglutide）的过度刺激可导致增生并导致胰腺炎。急性胰腺炎可引起全身性炎症反应，并可能导致β细胞功能障碍和随后的胰岛素缺乏，导致糖尿病酮症酸中毒。为什么急诊医师应该意识到这一点？急性胰腺炎和血糖正常的非糖尿病酮症酸中毒都是危及生命的紧急情况。随着体重管理药物的使用日益普及，这些紧急情况的发生率也可能在上升。

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引用次数: 0

Curious case of a frozen pupil – Orbital apex syndrome 奇怪的瞳孔冻结病例-眶尖综合征

JEM reports

Pub Date : 2025-01-13 DOI: 10.1016/j.jemrpt.2025.100140

Sophia Aguirre, Rahul Nene

Background

Orbital apex syndrome is a rare neurological disorder that occurs due to damage of cranial nerves at the apex of the orbit. Differentiating it from other ocular syndromes can be diagnostically challenging.

Report

We present a case of a 66-year-old female with metastatic rectal cancer who presented with worsening headache and vision loss in her right eye. She was noted to have a frozen eye and was diagnosed with orbital apex syndrome due to invasive fungal sinusitis. She was treated with debridement and antifungal therapy.

Why Should an Emergency Physician Be Aware of This?: Orbital apex syndrome is a rare condition requiring prompt diagnosis to minimize morbidity and mortality. Diagnosis relies on dedicated MRI of the orbits.

眶尖综合征是一种罕见的神经系统疾病，是由于眶尖处的脑神经受损而发生的。将其与其他眼部综合征区分开来在诊断上具有挑战性。报告：我们报告一例66岁的女性转移性直肠癌患者，她的右眼出现头痛加重和视力丧失。她注意到有一个冷冻的眼睛，并被诊断为眶尖综合征由于侵袭性真菌鼻窦炎。给予清创和抗真菌治疗。急诊医生为什么要意识到这一点？眶尖综合征是一种罕见的疾病，需要及时诊断以减少发病率和死亡率。诊断依赖于专用的眼眶MRI。

引用次数: 0

Hydrogen peroxide toxicity of a lower lip piercing: A case report 过氧化氢对下唇穿孔的毒性：1例报告

JEM reports

Pub Date : 2025-01-11 DOI: 10.1016/j.jemrpt.2025.100137

Monique Graf , Craig Reece Brockman II , Kara Pretzlaff

Background

Hydrogen peroxide, a well-known cleaning product, is responsible for a large number of emergency department visits each year. The current literature contains only few case reports of these exposures, and our case report provides an example of what can happen from direct hydrogen exposure and how it is managed from the emergency department.

Case report

A 26-year-old female presented to the emergency department with lower lip swelling and overlying skin changes. Vital signs were within normal limits and the remainder of her exam was within normal limits. It was elicited with further questioning that the patient had irrigated her lip piercing the night before with hydrogen peroxide. With this information, the correct diagnosis of hydrogen peroxide toxicity was made and with the help of oral and maxillofacial surgery, the patient was treated appropriately for this condition.

Why should emergency medicine physicians be aware of this

Toxic exposures, whether via direct contact, inhalation, or ingestion, are commonly seen in the emergency department and require expeditious diagnosis and treatment. Based on physical exam alone, lip swelling suggests a variety of diagnoses. In this case, as in many others, accurate history taking is crucial in making the correct diagnoses.

过氧化氢是一种众所周知的清洁产品，每年急诊就诊人数众多。目前的文献中只有很少的病例报告，而我们的病例报告提供了一个例子，说明直接氢暴露会发生什么，以及如何从急诊科处理。病例报告：一名26岁女性，因下唇肿胀及上覆皮肤改变而就诊于急诊科。生命体征在正常范围内，她的其他检查也在正常范围内。进一步的询问引出了这个病人前一天晚上用双氧水冲洗了她的唇环。根据这些信息，对过氧化氢毒性作出了正确的诊断，并在口腔颌面外科手术的帮助下，对该患者进行了适当的治疗。为什么急诊医生应该意识到，无论是通过直接接触、吸入还是摄入，毒物暴露在急诊科很常见，需要迅速诊断和治疗。仅根据身体检查，嘴唇肿胀就可以提出多种诊断。在这种情况下，就像在许多其他情况下一样，准确的病史记录对于做出正确的诊断至关重要。

{"title":"Hydrogen peroxide toxicity of a lower lip piercing: A case report","authors":"Monique Graf , Craig Reece Brockman II , Kara Pretzlaff","doi":"10.1016/j.jemrpt.2025.100137","DOIUrl":"10.1016/j.jemrpt.2025.100137","url":null,"abstract":"<div><h3>Background</h3><div>Hydrogen peroxide, a well-known cleaning product, is responsible for a large number of emergency department visits each year. The current literature contains only few case reports of these exposures, and our case report provides an example of what can happen from direct hydrogen exposure and how it is managed from the emergency department.</div></div><div><h3>Case report</h3><div>A 26-year-old female presented to the emergency department with lower lip swelling and overlying skin changes. Vital signs were within normal limits and the remainder of her exam was within normal limits. It was elicited with further questioning that the patient had irrigated her lip piercing the night before with hydrogen peroxide. With this information, the correct diagnosis of hydrogen peroxide toxicity was made and with the help of oral and maxillofacial surgery, the patient was treated appropriately for this condition.</div></div><div><h3>Why should emergency medicine physicians be aware of this</h3><div>Toxic exposures, whether via direct contact, inhalation, or ingestion, are commonly seen in the emergency department and require expeditious diagnosis and treatment. Based on physical exam alone, lip swelling suggests a variety of diagnoses. In this case, as in many others, accurate history taking is crucial in making the correct diagnoses.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100137"},"PeriodicalIF":0.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143157426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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