Case Reports in Emergency Medicine最新文献

Background: Over several decades, standard management of blunt spleen injury (BSI) has been changed from operative intervention to the selective operative and nonoperative management (NOM). However, some patient needs laparotomy first. This article describes a case of a BSI patient who failed nonoperative management after angioembolization (AE). Case Presentation. A 58-year-old man fell from his motorcycle and was brought to our hospital. His vital sign was stable after extracellular fluid bolus. A contrast-enhanced computed tomography scan of the abdomen showed AAST grade V spleen injury. AE was performed for the splenic artery, but his systolic blood pressure suddenly dropped under 60 mmHg. The resuscitative endovascular balloon occlusion of the aorta was inserted, and immediate laparotomy was performed. A pancreatic tail injury was detected, and the splenic artery and vein were burst at the pancreatic tail and controlled by hemostatic suture. After splenectomy, a drain was placed at the pancreatic tail and the abdomen was temporally closed. The postoperative course was not remarkable except for abdominal abscess treated with antibiotics, and he was discharged on foot.

Conclusion: Although NOM is becoming one of the choices for severe BSI, there will still be a patient who requires surgery. Surgeons should be aware of the mechanism of injury and the limitation of AE as an adjunct to NOM. Patient selection for initial NOM and timing to convert to laparotomy are important.

Introduction: Acidosis with traumatic brain injury is a common and serious cause of consciousness disorders in emergency medicine. Extreme acidosis is significantly associated with high mortality (more than 67% if pH levels are under 7). Case Presentation. We describe the case of a 23-year-old man with unknown medical history who was found near the entrance of the emergency department sweat with a tachypnea (55 per minute), a lot of blood around him, and confused. The initial hypothesis was a hemorrhagic shock after a fight, but he did not have any hemodynamic trouble. The initial venous gazometry showed a major lactic acidosis (pH less than 6,8, HCO3 incalculable and lactate up to 20 mmol/L). A Focused Assessment with Sonography in Trauma-echography (FAST-echo) and secondly a body-tomodensitometry were conducted and did not reveal any anomaly. The team was now thinking that the patient situation was caused by an epileptic seizure (association of lactic acidosis and confusion), and the bleed was a consequence of the head trauma. The patient was treated only by NaCl 0,9%. One hour after his admission, the tachypnea began to decrease and he could speak and explain what was happen. He had to run as fast as possible to escape to a fight. The last gazometry, realized 2 hours after his admission, finds a normal pH at 7,35, HCO3 24,5 mmol/L and lactate 2,6 mmol/L. He was authorized to going home.

Conclusion: We report here a rare case of major lactic acidosis in emergency medicine caused by a supramaximal effort.

An 80-year-old man with flu symptoms collapsed at his house and had a backache worsened over time. His family called for an ambulance. On arrival, chest X-ray showed reduced permeability of the right lung field, and truncal computed tomography (CT) suggested right multilobular empyema and right iliopsoas abscess. A blood test showed an acute inflammatory response. The patient underwent right small thoracotomy for empyema and ultrasonic-guided drainage for the right iliopsoas abscess and started the administration of antibiotics. We started the administration of doripenem by intravenous drip and then deescalated to ampicillin based on the culture results. Streptococcus intermedius was cultured from all sites. Following these treatments for three months, his general condition improved. We herein report a unique case of complicated empyema and iliopsoas abscess in which a favorable outcome was obtained by an appropriate diagnosis and treatment. Reports of multiple abscesses have been increasing recently because of the growing geriatric population and aging-related complications. It is important to search the whole body to detect multiple abscesses in cases where an abscess is detected at a single site.

Intoxication and drug overdose as suicidal attempt are rare in pregnancy. We report here the case of aluminum phosphide poisoning in a pregnant lady through oral and intravaginal administration which was managed with aggressive supportive measures without resorting to extracorporeal life support.

A 45-year-old man was admitted to the Emergency Department with fatigue and muscular weakness. Soon after hospital admission, he developed "torsades de pointe" and was successfully resuscitated. The admission laboratory investigations had revealed a profound hypokalemia (1.65 mmol/L). The patient had a long-term use of alcohol-free "pastis" in an attempt to reduce his chronic ethanol consumption. As the beverage likely contained a significant amount of liquorice, the diagnosis of glycyrrhizin chronic intoxication was suspected. The diagnosis of liquorice-related pseudohyperaldosteronism was assessed by normal plasma aldosterone levels and low plasma renin activity. Intravenous and oral supplementation of potassium was required for 5 days, and the patient had an uneventful follow-up.

Hypermagnesemia is a rare disorder and commonly occurs in patients with renal dysfunction. Supportive therapy for hypermagnesemia consists of administration of high-volume fluids, calcium preparation, diuretics, and, in severe cases, hemodialysis. Few reports have described severe hypermagnesemia patients with normal renal function who improved without hemodialysis. A 56-year-old woman presented with a history of constipation in spite of taking constipation medicine, including MgO. She was brought to our emergency department due to vomiting and diffuse distension of the abdomen. Sudden vomiting, weakness, and lower level of consciousness occurred during examination. Her blood pressure dropped to 77/34 mmHg, and deep tendon reflexes of the limbs disappeared. Abdominal computed tomography showed bowel distension with wall edema, and biochemical testing showed serum Mg at 13.5 mg/dl. She was diagnosed with severe hypermagnesemia associated with intestinal obstruction and administered intravenous loop diuretics and calcium preparation in addition to high volumes of normal saline. As the serum Mg level steadily declined, her level of consciousness returned to usual. This case suggests that severe hypermagnesemia can occur in patients with normal renal function and constipation under MgO. Severe hypermagnesemia with normal renal function can improve with symptomatic treatment without hemodialysis.

Background: Exertional heat stroke is a life-threatening condition often complicated by multiorgan failure. We hereby present a case of a 25-year-old male presenting with syncope after a 10  km run in 28°C outside temperature who developed acute liver failure. Case Presentation. Initial temperature was found to be 41.1°C, and cooling measures were rapidly applied. He suffered from acute renal failure and rhabdomyolysis and proceeded to acute liver failure (ASAT 6100 U/l and ALAT 6561 U/l) due to hypoxic hepatitis on day 3. He did not meet criteria for emergency liver transplantation and recovered on supportive care.

Conclusions: Acute liver failure due to heat stroke is a life-threatening condition with often delayed onset, which nevertheless resolves on supportive care in the majority of cases; thus, a delayed referral to transplant seems to be reasonable.

Introduction. Behcet's disease is a multisystem disease. In sub-Saharan Africa, the prevalence of this disease is not known, with only one case report from Ethiopia. Case Presentation. We describe a case of a 29-year-old Ethiopian male who presented to the emergency room of Tikur Anbessa specialized hospital with 4 days history of back pain, recurrent history of oral and genital ulcers, right eye blindness, chronic cerebral vein thrombosis, gastrointestinal bleeding, aortic aneurysm with dissection, and positive pathergy test. He is retrospectively diagnosed with Behcet's disease according to both the International Criteria for Behcet's Disease (ICBD) and the International Study Group (ISG) consensus. Conclusion. Even if Behcet's disease is rare in sub-Saharan Africa, it is important to know the clinical presentation for timely diagnosis and urgent management.

ST-segment elevation in absence of acute coronary syndrome can be seen in multiple conditions, including acute pericarditis and coronary vasospasm, but it is rarely seen with severe hypercalcemia. The authors present a case of an 81-year-old female with a history of stage 4 squamous cell cancer of the lung, who presented to the emergency room with profound fatigue, weakness, anorexia, and drowsiness two weeks after her first chemotherapy cycle. Additionally, she had complaints of right-sided chest pain associated with worsening shortness of breath, as well as right arm numbness. An EKG obtained on arrival to the hospital showed diffuse ST-segment elevation (leads V3-V6, I, II, III, and aVF). Basic lab work found a calcium level of 20.4 mg/dl with elevated parathyroid hormone-related protein (PTHrP) of 135 pg/ml. Troponin I remained within normal limits. Serial EKS obtained during the patient's hospitalization demonstrated resolution of the ST elevation as calcium level normalized. This case emphasizes the importance of hypercalcemia as a differential diagnosis for ST-segment elevation and QT shortening when acute coronary syndrome is not present. Awareness of these EKG changes is critical for early diagnosis, recognition, and appropriate treatment.

Carbamazepine is an antiepileptic drug that can cause seizures in overdose. In certain patient populations, this may be misdiagnosed as a seizure disorder. We describe a case of a 20-month-old female who presented with fever and seizure-like activity who was initially thought to have complex febrile seizures. Further historical information prompted carbamazepine level to be checked, which was found to be 29 mcg/ml (therapeutic range of 4-12 mcg/ml). Her carbamazepine levels downtrended with multidose activated charcoal. Her condition improved, and she was discharged without evidence of permanent neurologic sequelae. This case illustrates that xenobiotic exposure should often be considered, even if historical clues are not present, as they can often present as other conditions leading to misdiagnosis and delayed treatment.