Case Reports in Emergency Medicine最新文献

Background: Aortic dissection (AD) is a rare but serious medical emergency where the aorta's inner layer tears. Females are less likely to develop it than males, and AD cases with unusual symptoms can be hard to diagnose. Diagnosing AD can be further complicated as its symptoms and electrocardiogram (ECG) changes can mimic acute coronary syndrome, and it is challenging to distinguish it without risk factors. Case Report. This case report describes a 60-year-old female patient who presented with unusual symptoms, including pain in her chest, neck, left arm, and lower extremities. An electrocardiogram (ECG) revealed ST elevation in leads aVR and V1, as well as severe ST depression and T wave inversion in the inferior and lateral leads, which can mimic acute coronary syndrome. Despite initial treatment with nitroglycerin, the patient's pain worsened, and a CT angiography revealed type A aortic dissection extending from the aortic root to the right external iliac artery. Immediate surgery was recommended, which significantly improved the patient's condition.

Conclusions: Be aware of aortic dissection and its symptoms, even if there are no risk factors or recognizable symptoms. Consider aortic dissection as a potential diagnosis if ECG changes are present. Ongoing education can help decrease mortality and increase awareness.

Background: The most frequent atrioventricular tachycardia in the emergency room is atrioventricular nodal reentrant tachycardia (AVNRT). The first treatment option for ending stable narrow QRS complex SVTs is vagal maneuvers and adenosine. When adenosine or vagal maneuvers fail to change a patient's rhythm to normal sinus rhythm, long-acting AV nodal-blocking medications, including nondihydropyridine calcium channel blockers (verapamil and diltiazem), flecainide, or beta-blockers, are employed. Electricity (synchronized cardioversion) is the preferred form of treatment for unstable patients. Case Presentation. A 40-year-old male patient presented to the Emergency Department of Dubti General Hospital, the Afar regional state in Ethiopia, with a complaint of shortness of breath, palpitation, extreme fatigue, and chest pain of a day's duration. His blood pressure was 80/50 mmHg, he had cold extremities and a weak radial pulse, and his apical heart rate was fast, making it difficult to count. His electrocardiogram (ECG) showed paroxysmal supraventricular tachycardia (PSVT) with a heart rate of 200. He was a candidate for electrical cardioversion due to unstable PSVT, but he and his family members refused to give consent. Even though he is not indicated for pharmacologic therapy, none of the commonly used drugs were available at the hospital. We managed him with digoxin, and the outcome was positive.

Conclusion: Even though we could not find a clear recommendation regarding the use of digoxin for patients with unstable PSVT (AVNRT), by taking into consideration its negative chronotropic effect and its action to suppress the AV nodal conduction velocity, it may reduce the heart rate, and it can be used as an alternative in such difficult scenarios and a resource-limited setting. But this should be further investigated.

Introduction: We describe the case of a 47-year-old female who presented to an academic tertiary emergency department with two to three days of worsening fever, headache, malaise, and rigors. A broad infectious workup revealed a diagnosis of Human Herpesvirus 6 (HHV-6) meningoencephalitis without any additional identifiable causes. HHV-6, the virus responsible for the childhood disease roseola, is a common cause of fever, seizures, diarrhea, and a characteristic faint-pink rash in children. Symptomatic HHV-6 infection in adults is far less common. We believe this represents one of only a few reported cases of HHV-6 meningoencephalitis in an immunocompetent host. Case Report. A 47-year-old female presented to the emergency department with two to three days of fever, headache, malaise, and rigors. She had a noncontributory medical, surgical, and family history but had traveled extensively in northeast Africa six months prior. A physical exam was notable for a wide based gait, photophobia, mild nuchal rigidity, and pain with active range of motion of the neck. A broad infectious workup was pursued; however, given headache, fever, and subjective nuchal rigidity, the highest concern was for meningoencephalitis. A lumbar puncture was positive for HHV-6 without any other diagnostic findings to otherwise explain the patient's symptoms. The patient was discharged on hospital day 3 with improving symptoms.

Conclusion: HHV-6 meningoencephalitis has previously been described as a pathogen associated with individuals with immunosuppressive conditions. There have been several prior case reports of symptomatic meningoencephalitis in immune-competent individuals, and we believe this case adds to a growing body of evidence that HHV-6 meningoencephalitis can cause symptomatic infection in a broader patient population.

Cellulitis is a potentially serious bacterial skin infection. Penile cellulitis refers to the inflammation of the penile shaft and commonly occurs in uncircumcised, sexually active young adults. We reported the case of a 25-year-old heterosexual circumcised male patient with a two-day history of swelling and pain over the penile shaft. Local examination revealed a diffusely swollen penile shaft, erythematous, warm to the touch, and tender. The penile discharge culture was suggestive of a Streptococcus species infection. Ultrasonography of the penis showed increased echogenicity of the left side of the penile shaft soft tissue with a markedly increased Doppler signal, indicating cellulitis. Based on these findings, the patient was diagnosed with cellulitis of the penis and managed with broad-spectrum antibiotics. Though history and clinical examination are sufficient to diagnose penile cellulitis, our case highlighted that ultrasound could also support the diagnosis of penile cellulitis and help rule out differentials.

Background. A large thrombus entrapped in the patent foramen ovale (PFO) is an extremely rare condition. Moreover, it is considered even rarer after temporary inferior vena cava filter (TIVCF) placement for the prevention of fatal pulmonary embolism due to venous thromboembolism (VTE). Case Report. A 58-year-old man presented with syncope following chest pain and dyspnea due to PE exacerbation during TIVCF protection, which then led to cardiogenic shock. Echocardiography revealed a large thrombus entrapped in the PFO, and computed tomography (CT) showed a bilateral pulmonary artery embolism. The patient was treated with open surgical embolectomy for a pulmonary artery thrombus and PFO thrombus with simultaneous closure of the PFO. The patient's postoperative course was uneventful. Results and Conclusion. Surgical embolectomy was useful with respect to the feasibility of resection of both intracardiac thrombus and pulmonary artery thrombus performed simultaneously, contributing to the prevention of systemic embolisms, and echocardiography plays an important role for early diagnosis.

Background: Tranexamic acid (TXA) is routinely administered intravenously (IV) and intraosseously (IO) in response to exsanguination.

Case: This report describes a patient who sustained multiple high-powered rifle gunshot wounds that received battlefield-environment intramuscular (IM) administration of TXA due to inability to obtain IV / IO access. This case represents the unlikely positive outcome in the setting of multiple remarkable obstacles, which may have been ameliorated by novel administration of TXA.

Conclusion: Cases of IM TXA administration as a primary intervention are not well represented in the current body of medical literature. This case report highlights a clinical scenario where IM TXA was utilized as part of first-line treatment that led to a positive clinical outcome. Although IM TXA is not yet endorsed by current trauma guidelines, this case suggests that IM route administration of TXA should be further investigated. If indeed IM administration of TXA proves just as efficacious as alternative routes, this would hold considerable advantageous implications for austere situations were sterility and IV / IO placement are impractical. This would also represent another avenue by which to decrease the time-to-TXA for patients, allowing sooner correction of hemorrhage and trauma-associated coagulopathy.

Acute aortic occlusion (AAO) is a rare and life-threatening condition that is rarely described in limited case series over the past several decades. The etiology and management are diverse across documented accounts, but prompt recognition facilitated by performing a thorough vascular and neurologic exam is critical to prevent delayed diagnosis and adverse outcomes. We report a patient who presented to the emergency department with the complaint of acute-onset lower extremity paralysis due to acute aortic occlusion. Her condition was rapidly diagnosed with a CT angiogram protocolized for aortic dissection and managed with anticoagulation and thrombectomy with eventual near complete recovery of her lower extremity function.

Cerebral arterial gas embolism (CAGE) is a rare but serious cause for acute neurologic deficit that occurs most often in divers who breathe compressed gas at depth or iatrogenically from a variety of invasive medical procedures. We present a rare case of CAGE caused by inhaling helium from an unregulated, high-pressure gas cylinder. Following inhalation, the patient experienced loss of consciousness, neurologic deficits, pneumomediastinum, and pneumothorax requiring transfer and treatment at a hyperbaric facility with resulting resolution of neurologic symptoms. This case highlights the importance of rapid diagnosis and hyperbaric oxygen treatment (HBO), facilitated by close coordination among community emergency departments, pediatric tertiary care centers, hyperbaric facilities, and poison control.