Articles

Buprenorphine for High-dose Tramadol Dependence: A Case Report of Successful Outpatient Treatment

Author Affiliation Leslie Mukau, MD University of California San Diego, Department of Emergency Medicine, San Diego, California; El Centro Regional Medical Center, Department of Emergency Medicine, El Centro, California Kadia Wormley, MD Highland Hospital-Alameda Health System, Department of Emergency Medicine, Oakland, California Christian Tomaszewski, MD, MS, MBA University of California San Diego, Department of Emergency […]

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Caution Regarding Self-reported Tramadol Dependence

Author Affiliation James Dunford, MD University of California San Diego, School of Medicine, San Diego, California; McAlister Institute for Treatment and Education, El Cajon, California Aaron Schneir, MD University of California San Diego Health System, Department of Emergency Medicine, Division of Medical Toxicology, San Diego, California   We are writing in regard to the following […]

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Man Presenting After Hydrochloric Acid Ingestion

Emma R. Furlano, MD

We describe a case of a man who developed severe caustic injury of his upper gastrointestinal tract after ingestion of a commercially available 9.5% hydrochloric acidic cleaning solution. He rapidly deteriorated and required endotracheal intubation. He underwent several imaging modalities demonstrating his injuries and ultimately succumbed to his injuries.

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Insidious Manifestations of Cutaneous T-cell Lymphoma

Alexis L. Cates, DO

A 66-year-old gentleman presented with several months of a generalized pruritic skin eruption along his face, thorax, and extremities. Although he had been seen previously, no diagnosis was made until he presented to the emergency department (ED) with worsening lesions. The patient was ultimately diagnosed with cutaneous T-cell lymphoma.

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A Case of Perforating Folliculitis in a Peritoneal Dialysis Patient

Glenn Goodwin, DO, EMT-P

A 30-year-old male with a past medical history of hypertension and renal failure on peritoneal dialysis presented to the emergency department with a chief complaint of a rash on his anterior trunk for the prior three weeks. Dermatological examination revealed multiple, discrete folliculocentric, erythematous, and hyperpigmented papules, with scattered adjacent angulated erosions.

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Ultrasound-Guided, Mid-Forearm Median Nerve Block for Relief of Carpal Tunnel Syndrome Pain in the Emergency Department: A Case Report

Daniel L. Puebla, MD, MS

Carpal tunnel syndrome (CTS) is a common complaint in the emergency department (ED) and accounts for approximately 90% of all peripheral neuropathies.
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Pain control from injection with corticosteroids into the carpal tunnel space is associated with multiple possible complications including atrophy, iatrogenic median nerve injury, and skin changes. Ultrasound (US)-guided mid-forearm median nerve block is an ED procedure that can be used to avoid direct injection into the carpal tunnel space. Here we present a case report proposing the use of US-guided mid-forearm block as a safe and effective adjunct to the management of acute pain caused by CTS.

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Spontaneously Conceived Ruptured Heterotopic Pregnancy Presenting with Chest Pain and Dyspnea: A Case Report

Farrah Nasrollahi, MD

Heterotopic pregnancy, defined as simultaneous intrauterine and ectopic pregnancy, is a rare and potentially life-threatening condition. The incidence of heterotopic pregnancy has significantly increased in the modern era, primarily due to use of assisted reproductive technology. Heterotopic pregnancy in the absence of risk factors is uncommon. The symptoms of heterotopic pregnancy are similar to those of ectopic pregnancy, primarily abdominal pain and vaginal bleeding.

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Septic Arthritis of the Sternoclavicular Joint

George V. Koshy, DO, MPH

Sternoclavicular joint (SCJ) septic arthritis is a rare but rapidly fatal joint infection. Without proper medical or surgical management, it can progress to osteomyelitis, chest wall abscess, mediastinitis, or myositis.

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Cerebral Air Embolism After Endoscopy: A Case Report

James Whall, MD

Cerebral air embolisms are a rare but potentially devastating event where air enters the vascular system. Although commonly associated with intravascular catheters, they can arise from a variety of mechanisms including endoscopic procedures.

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Vitamin C and D Deficiency in Urban America: A Case Report

Alyssa A. Lombardi, MD, PhD

Scurvy is caused by vitamin C deficiency and manifests with a variety of symptoms including generalized fatigue, apathy, anemia, myalgias, easy bruising, and poor wound healing. It is generally thought of as a disease of the past, especially in developed countries. However, vitamin C deficiency still occurs, especially in patients with lack of access to fruits and vegetables. Other micronutrient deficiencies, including vitamin D deficiency, are also prevalent and can cause a multitude of signs and symptoms including osteomalacia, muscle weakness, and increased risk of many chronic illnesses.

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Spontaneous Coronary Artery Dissection Presenting as Electrical Storm: A Case Report

Nathan Escorial, MD

Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction in patients of younger age without typical atherosclerotic risk factors and can present with ventricular arrhythmia such as ventricular tachycardia (VT) or ventricular fibrillation (VF). Electrical storm (ES) is defined as greater than or equal to 3 episodes of VT or VF occurring within 24 hours.

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Peripartum Cardiac Arrest with Terminal QRS Distortion: A Case Report

Timothy D. Kelly, MD, MPH

Peripartum cardiac arrest is increasing in incidence. While pulmonary embolism (PE) remains an important cause of peripartum morbidity and mortality, other cardiovascular emergencies such as myocardial infarction (MI) are now the leading cause of pregnancy-related death. Emergency physicians (EP) need to be well versed in subtle electrocardiographic (ECG) signs of coronary ischemia to better care for peripartum patients in cardiac arrest.

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Isolated Laryngeal Angioedema in a Patient with Long-term ACE Inhibitor Use: A Case Report

Carney Flinn,

Angiotensin converting enzyme (ACE) inhibitor-associated angioedema is the most common cause of angioedema seen in the emergency department (ED) and can be associated with a high morbidity. Most cases occur within months of initiation of an ACE inhibitor and are associated with facial and/or oropharyngeal swelling. We present a case of isolated laryngeal edema requiring intubation following 10 years of ACE inhibitor therapy.

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Delayed Onset of Symptoms After a Rattlesnake Bite in a Renal Transplant Patient: A Case Report

Thomas A. Rogers, MD

The United States is home to two major families of venomous snakes, Crotalids and Elapids. The Crotalid family, also known as pit vipers, is well known for being among the most frequent causes of snakebites reported. Crotalid envenomation can present with local findings, hematologic toxicity, and systemic toxicity. Identification of envenomated patients is key to determining who needs antivenom. Most sources recommend an observation period of six to eight hours after the snakebite to determine whether the bite was “dry” or the patient was exposed to venom.

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Isolated Laryngeal Angioedema in a Patient with Long-term ACE Inhibitor Use: A Case Report

Carney Flinn,

Angiotensin converting enzyme (ACE) inhibitor-associated angioedema is the most common cause of angioedema seen in the emergency department (ED) and can be associated with a high morbidity. Most cases occur within months of initiation of an ACE inhibitor and are associated with facial and/or oropharyngeal swelling. We present a case of isolated laryngeal edema requiring intubation following 10 years of ACE inhibitor therapy.

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Response to Clarifications on: Pectoralis Blocks Nomenclature and Applications of Regional Anesthesia Techniques

Author Affiliation Jonathan Brewer, MD Vanderbilt University Medical Center, Department of Emergency Medicine, Division of Ultrasound, Nashville, Tennessee Arun Nagdev, MD Highland Hospital, Department of Emergency Medicine, Oakland, California To the editor To The Editor We want to thank the author of the recent letter to the editor regarding our case series. Regarding the first […]

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Clarifications on: Pectoralis Blocks Nomenclature and Clinical Applications of Regional Anesthesia Techniques for Breast and Thorax

Author Affiliation Raghuraman M. Sethuraman, MD Sree Balaji Medical College & Hospital, BIHER, Department of Anesthesiology, Chennai, India To the editor To The Editor I read with great interest the recently published case series applying pectoralis blocks (Pecs blocks) for infective breast conditions.1 I greatly commend Brewer et al for employing pecs blocks in the […]

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A Woman with Abdominal Pain After Lap-belt Trauma

Chandler Davis,

A 24-year-old female presented to the emergency department with diffuse abdominal pain after involvement as a restrained driver in a motor vehicle collision (MVC). Computed tomography of the abdomen revealed a traumatic abdominal wall hernia due to rectus wall rupture with complete bowel herniation.

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ISSN: 1936-900X
e-ISSN: 1936-9018

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Emergency Medicine is a specialty which closely reflects societal challenges and consequences of public policy decisions. The emergency department specifically deals with social injustice, health and economic disparities, violence, substance abuse, and disaster preparedness and response. This journal focuses on how emergency care affects the health of the community and population, and conversely, how these societal challenges affect the composition of the patient population who seek care in the emergency department. The development of better systems to provide emergency care, including technology solutions, is critical to enhancing population health.