Pub Date : 2023-07-01DOI: 10.1016/j.jemrpt.2023.100049
Zahra Al Haloob, G. Braitberg, Anthony Tu Tran, J. Rotella, Anselm Wong
{"title":"Re-presentations to the emergency department post COVID-19 admission in Australia","authors":"Zahra Al Haloob, G. Braitberg, Anthony Tu Tran, J. Rotella, Anselm Wong","doi":"10.1016/j.jemrpt.2023.100049","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100049","url":null,"abstract":"","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54779879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Indwelling urethral catheters can sometimes be accidently inserted into the ureter, which impedes urine flow.
Case report
We report a 74-year-old Japanese woman with neurogenic bladder who visited to our hospital due to fever. She was diagnosed as pyelonephritis based on her symptoms and laboratory findings, including pyuria. Abdominal computed tomographic scan showed an indwelling urethral catheter accidently malpositioned into a right ureter, caused ureteral dilatation, and hydronephrosis. Her urethral catheter was replaced, and she was successfully treated with piperacillin-tazobactam and cefotiam.
Why should an emergency physician be aware of this?
Urethral catheter malpositioning into the ureter may be asymptomatic and overlooked in patients with neurogenic bladder, which can result in obstructive pyelonephritis. Prompt urethral catheter replacement is essential in treating such conditions.
{"title":"Obstructive pyelonephritis caused by the accidental malpositioning of a urethral catheter into the ureter: A case report","authors":"Hiroshi Ito, Toshiya Nakashima, Jura Oshida, Taisuke Kodama, Sayato Fukui, Daiki Kobayashi","doi":"10.1016/j.jemrpt.2023.100041","DOIUrl":"10.1016/j.jemrpt.2023.100041","url":null,"abstract":"<div><h3>Background</h3><p>Indwelling urethral catheters can sometimes be accidently inserted into the ureter, which impedes urine flow.</p></div><div><h3>Case report</h3><p>We report a 74-year-old Japanese woman with neurogenic bladder who visited to our hospital due to fever. She was diagnosed as pyelonephritis based on her symptoms and laboratory findings, including pyuria. Abdominal computed tomographic scan showed an indwelling urethral catheter accidently malpositioned into a right ureter, caused ureteral dilatation, and hydronephrosis. Her urethral catheter was replaced, and she was successfully treated with piperacillin-tazobactam and cefotiam.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>Urethral catheter malpositioning into the ureter may be asymptomatic and overlooked in patients with neurogenic bladder, which can result in obstructive pyelonephritis. Prompt urethral catheter replacement is essential in treating such conditions.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44532380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1016/j.jemrpt.2023.100019
Henry Zou , Bethany Beard MD
Background
Ulnar artery thrombosis (UAT) refers to occlusion of the ulnar artery due to a blood clot and is a subcategory of hypothenar hammer syndrome (HHS). We present a case of right ulnar artery thrombosis that was pharmacologically managed in the Emergency Department (ED) and inpatient ward.
Case report
A 52-year-old male with a history of anemia and elevated ferritin presented to the ED with a 5-day history of skin discoloration, numbness, and tingling of his right 5th finger. CT angiogram showed a focal 1.5 cm-long thrombotic ulnar artery occlusion at the palmar bifurcation and embolic occlusion of the 5th digital arteries in the finger. Following consultation with vascular surgery, he was given intravenous heparin, transitioned to apixaban for lifelong anticoagulation therapy, and discharged following the placement of a ZioⓇ patch.
Why should an emergency physician be aware of this?
The patient's career involving manual labor, elevated ferritin, and smoking history may have been risk factors for UAT development. Our case illustrates the value of interdisciplinary collaboration and conservative management in low-acuity cases of UAT.
{"title":"Emergent pharmacological management of ulnar artery thrombosis","authors":"Henry Zou , Bethany Beard MD","doi":"10.1016/j.jemrpt.2023.100019","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100019","url":null,"abstract":"<div><h3>Background</h3><p>Ulnar artery thrombosis (UAT) refers to occlusion of the ulnar artery due to a blood clot and is a subcategory of hypothenar hammer syndrome (HHS). We present a case of right ulnar artery thrombosis that was pharmacologically managed in the Emergency Department (ED) and inpatient ward.</p></div><div><h3>Case report</h3><p>A 52-year-old male with a history of anemia and elevated ferritin presented to the ED with a 5-day history of skin discoloration, numbness, and tingling of his right 5th finger. CT angiogram showed a focal 1.5 cm-long thrombotic ulnar artery occlusion at the palmar bifurcation and embolic occlusion of the 5th digital arteries in the finger. Following consultation with vascular surgery, he was given intravenous heparin, transitioned to apixaban for lifelong anticoagulation therapy, and discharged following the placement of a Zio<sup>Ⓡ</sup> patch.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>The patient's career involving manual labor, elevated ferritin, and smoking history may have been risk factors for UAT development. Our case illustrates the value of interdisciplinary collaboration and conservative management in low-acuity cases of UAT.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49775060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1016/j.jemrpt.2023.100036
Chizite Iheonunekwu , Calvin Jackson , Kara Weichler , Oscar N. Emihe , Erin L. Simon
Background
A bezoar is a collection of indigestible material found in the gastrointestinal (GI) tract that has become large enough not to progress through the rest of the intestinal system. Bezoars are caused by both food and non-food materials. Symptoms resemble other forms of GI obstructions with post-prandial fullness, abdominal pain, nausea, vomiting, and weight loss.
Case report
A five-year-old male presented to the emergency department (ED) complaining of abdominal pain and diarrhea. He reportedly swallowed a large quantity of chewing gum a day before his presentation. A computed tomography (CT) of the abdomen and pelvis revealed a gastric bezoar due to chewing gum. The patient was successfully treated with several passes of an esophagoduodenoscopy (EGD) to remove the chewing gum mass.
Why should an emergency physician be aware of this?
Gastric bezoars are rare and can vary in their presentations. ED physicians must consider bezoars in their differential diagnosis for pediatric patients presenting with postprandial fullness, abdominal pain, nausea, vomiting, or weight loss. Complications of bezoars include ischemia and perforation. A thorough history can help delineate the material causing the bezoar. Treatment of bezoars varies and can include treatment with carbonated beverages, endoscopy, and surgery.
{"title":"Chewing gum bezoar in a pediatric patient","authors":"Chizite Iheonunekwu , Calvin Jackson , Kara Weichler , Oscar N. Emihe , Erin L. Simon","doi":"10.1016/j.jemrpt.2023.100036","DOIUrl":"10.1016/j.jemrpt.2023.100036","url":null,"abstract":"<div><h3>Background</h3><p>A bezoar is a collection of indigestible material found in the gastrointestinal (GI) tract that has become large enough not to progress through the rest of the intestinal system. Bezoars are caused by both food and non-food materials. Symptoms resemble other forms of GI obstructions with post-prandial fullness, abdominal pain, nausea, vomiting, and weight loss.</p></div><div><h3>Case report</h3><p>A five-year-old male presented to the emergency department (ED) complaining of abdominal pain and diarrhea. He reportedly swallowed a large quantity of chewing gum a day before his presentation. A computed tomography (CT) of the abdomen and pelvis revealed a gastric bezoar due to chewing gum. The patient was successfully treated with several passes of an esophagoduodenoscopy (EGD) to remove the chewing gum mass.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>Gastric bezoars are rare and can vary in their presentations. ED physicians must consider bezoars in their differential diagnosis for pediatric patients presenting with postprandial fullness, abdominal pain, nausea, vomiting, or weight loss. Complications of bezoars include ischemia and perforation. A thorough history can help delineate the material causing the bezoar. Treatment of bezoars varies and can include treatment with carbonated beverages, endoscopy, and surgery.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46882674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1016/j.jemrpt.2023.100017
Rahul V. Nene , Mena Said , Philip A. Weissbrod , Christanne H. Coffey , Peter J. Witucki
Background
Hypopharyngeal injuries are infrequently described, and management is extrapolated from the literature on esophageal perforations. Cases may present with associated pneumomediastinum and are associated with high morbidity and mortality, particularly if there is a delay in diagnosis.
Case Report
A 52-year-old man presented with dyspnea and neck swelling after inserting a toothbrush into his throat when he thought he was developing an allergic reaction to sushi. He had extensive neck and chest crepitus, with pneumomediastinum identified on chest x-ray. Flexible laryngoscopy was used to directly identify a posterior pharyngeal perforation. The patient was hemodynamically stable without signs of sepsis, and the otolaryngology consultant deferred surgical intervention. He was successfully treated with conservative medical management and made a full recovery.
Why should an emergency physician be aware of this?
Hypopharyngeal perforation is a rare diagnosis with high morbidity and mortality. Early diagnosis, broad-spectrum antibiotics, and early surgical consultation are essential to minimize complications of this rare presentation.
{"title":"Traumatic hypopharyngeal perforation and pneumomediastinum from a toothbrush","authors":"Rahul V. Nene , Mena Said , Philip A. Weissbrod , Christanne H. Coffey , Peter J. Witucki","doi":"10.1016/j.jemrpt.2023.100017","DOIUrl":"10.1016/j.jemrpt.2023.100017","url":null,"abstract":"<div><h3>Background</h3><p>Hypopharyngeal injuries are infrequently described, and management is extrapolated from the literature on esophageal perforations. Cases may present with associated pneumomediastinum and are associated with high morbidity and mortality, particularly if there is a delay in diagnosis.</p></div><div><h3>Case Report</h3><p>A 52-year-old man presented with dyspnea and neck swelling after inserting a toothbrush into his throat when he thought he was developing an allergic reaction to sushi. He had extensive neck and chest crepitus, with pneumomediastinum identified on chest x-ray. Flexible laryngoscopy was used to directly identify a posterior pharyngeal perforation. The patient was hemodynamically stable without signs of sepsis, and the otolaryngology consultant deferred surgical intervention. He was successfully treated with conservative medical management and made a full recovery.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>Hypopharyngeal perforation is a rare diagnosis with high morbidity and mortality. Early diagnosis, broad-spectrum antibiotics, and early surgical consultation are essential to minimize complications of this rare presentation.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43140065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1016/j.jemrpt.2023.100030
Natasha Tobarran , John Huchison , Emily Kershner , Andrew Chambers , Kirk L. Cumpston , Brandon K. Wills
Background
The term “cotton fever” describes a benign, self-limited febrile response within minutes following cotton filter use with intravenous (IV) drug injection. We present a case of Pantoea species (previously Enterobacter agglomerans) bacteremia related to injection of solubilized oxycodone.
Case report
A 33-year-old male solubilized half of an oxycodone 5 mg tablet in tap water, filtered it with cotton and injected it intravenously. He immediately felt unwell. Initial vital signs included a temperature of 40.5 °C, blood pressure 150/107 mmHg, heart rate 170 bpm, respiratory rate 28 bpm, and SpO2 of 98% on room air. His physical exam was notable only for rigors. Initial laboratory studies demonstrated a serum lactate of 2.7 mmol/L without leukocytosis. He was treated with vancomycin and piperacillin/tazobactam for two days with resolution of fever. Blood cultures were positive for Pantoea species resistant to ampicillin and cefazolin. He continued piperacillin/tazobactam for three additional days then transitioned to oral levofloxacin for seven days upon discharge.
Why should an emergency physician be aware of this?
Cotton fever describes an acute, febrile response following IV injection using cotton as a filter. The initial febrile reaction could be due to pyrogens or preformed endotoxins. Bacteremia from Enterobacter agglomerans (now Pantoea species) is possible and is frequently resistant to amoxicillin and first- and second-generation cephalosporins.
{"title":"Cotton fever: A case report and review of the literature","authors":"Natasha Tobarran , John Huchison , Emily Kershner , Andrew Chambers , Kirk L. Cumpston , Brandon K. Wills","doi":"10.1016/j.jemrpt.2023.100030","DOIUrl":"10.1016/j.jemrpt.2023.100030","url":null,"abstract":"<div><h3>Background</h3><p>The term “cotton fever” describes a benign, self-limited febrile response within minutes following cotton filter use with intravenous (IV) drug injection. We present a case of <em>Pantoea</em> species (previously <em>Enterobacter agglomerans</em>) bacteremia related to injection of solubilized oxycodone.</p></div><div><h3>Case report</h3><p>A 33-year-old male solubilized half of an oxycodone 5 mg tablet in tap water, filtered it with cotton and injected it intravenously. He immediately felt unwell. Initial vital signs included a temperature of 40.5 °C, blood pressure 150/107 mmHg, heart rate 170 bpm, respiratory rate 28 bpm, and SpO2 of 98% on room air. His physical exam was notable only for rigors. Initial laboratory studies demonstrated a serum lactate of 2.7 mmol/L without leukocytosis. He was treated with vancomycin and piperacillin/tazobactam for two days with resolution of fever. Blood cultures were positive for <em>Pantoea</em> species resistant to ampicillin and cefazolin. He continued piperacillin/tazobactam for three additional days then transitioned to oral levofloxacin for seven days upon discharge.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>Cotton fever describes an acute, febrile response following IV injection using cotton as a filter. The initial febrile reaction could be due to pyrogens or preformed endotoxins. Bacteremia from <em>Enterobacter agglomerans</em> (now <em>Pantoea</em> species) is possible and is frequently resistant to amoxicillin and first- and second-generation cephalosporins.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42325167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1016/j.jemrpt.2023.100029
Andrew Loftus, Samer Abou-Arbid, David Marshall, Julian Suszanski, Christopher Clark
Background
Emergency physician use of transesophageal echocardiography (TEE) is emerging as a promising tool to aid diagnosis and treatment during resuscitation.
Case report
We present a case of aVR ST-elevation myocardial infarction followed by witnessed cardiac arrest and diagnosis of aortic dissection by resuscitative TEE intra-arrest. We propose the aortic dissection caused severe aortic regurgitation, left ventricular outflow tract obstruction and coronary artery malperfusion due to intimal intussusception through the aortic valve, ultimately resulting in death.
Why should an emergency physician be aware of this?
Resuscitative TEE rapidly identified this unexpected life-threatening pathology and drastically changed patient management.
{"title":"Resuscitative transesophageal echocardiography identifies aortic dissection intussusception as the cause of aVR STEMI","authors":"Andrew Loftus, Samer Abou-Arbid, David Marshall, Julian Suszanski, Christopher Clark","doi":"10.1016/j.jemrpt.2023.100029","DOIUrl":"10.1016/j.jemrpt.2023.100029","url":null,"abstract":"<div><h3>Background</h3><p>Emergency physician use of transesophageal echocardiography (TEE) is emerging as a promising tool to aid diagnosis and treatment during resuscitation.</p></div><div><h3>Case report</h3><p>We present a case of aVR ST-elevation myocardial infarction followed by witnessed cardiac arrest and diagnosis of aortic dissection by resuscitative TEE intra-arrest. We propose the aortic dissection caused severe aortic regurgitation, left ventricular outflow tract obstruction and coronary artery malperfusion due to intimal intussusception through the aortic valve, ultimately resulting in death.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>Resuscitative TEE rapidly identified this unexpected life-threatening pathology and drastically changed patient management.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46912642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1016/j.jemrpt.2023.100038
Andrew Yousef, Olivia La Monte, Matthew Harmon, Deborah Watson
Background
The COVID-19 pandemic has made facial masks an essential part of daily life. While protective facial masks are crucial to help the spread of viral infections, they are common causes of facial skin breakdown, acne, and superficial injuries. Masks with elastic ear loops are also particularly likely to cause ear pressure injuries.
Case report
Herein, we present a case of a patient experiencing homelessness found to have significant postauricular wounds due to prolonged mask use in the context of the Covid-19 pandemic. These injuries led to bilateral erosion of the helix with partial avulsion of the ear and mask ear loops eroding into cartilage.
Why should an emergency physician be aware of this?
We describe a rare complication of mask use and highlight the difficulties the COVID pandemic has made in providing adequate care for chronic head and neck wounds amongst the homeless population. While PPE remains an important part of decreasing the risk of the spread of infections, it is important to recognize the vulnerabilities of the homeless population during the COVID pandemic and how best to care for novel auricular wounds.
{"title":"Wound healing in the vulnerable: A novel case of postauricular wounds caused by mask ties","authors":"Andrew Yousef, Olivia La Monte, Matthew Harmon, Deborah Watson","doi":"10.1016/j.jemrpt.2023.100038","DOIUrl":"10.1016/j.jemrpt.2023.100038","url":null,"abstract":"<div><h3>Background</h3><p>The COVID-19 pandemic has made facial masks an essential part of daily life. While protective facial masks are crucial to help the spread of viral infections, they are common causes of facial skin breakdown, acne, and superficial injuries. Masks with elastic ear loops are also particularly likely to cause ear pressure injuries.</p></div><div><h3>Case report</h3><p>Herein, we present a case of a patient experiencing homelessness found to have significant postauricular wounds due to prolonged mask use in the context of the Covid-19 pandemic. These injuries led to bilateral erosion of the helix with partial avulsion of the ear and mask ear loops eroding into cartilage.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>We describe a rare complication of mask use and highlight the difficulties the COVID pandemic has made in providing adequate care for chronic head and neck wounds amongst the homeless population. While PPE remains an important part of decreasing the risk of the spread of infections, it is important to recognize the vulnerabilities of the homeless population during the COVID pandemic and how best to care for novel auricular wounds.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10188374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9541192","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}
Pub Date : 2023-06-01DOI: 10.1016/S2773-2320(23)00042-1
{"title":"Aims and Scope","authors":"","doi":"10.1016/S2773-2320(23)00042-1","DOIUrl":"https://doi.org/10.1016/S2773-2320(23)00042-1","url":null,"abstract":"","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49775021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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