Articles

Active Liver Bleed Caught During FAST Exam from Spontaneous Hemangioma Rupture: A Case Report

Raul Rodriguez, DO

This case highlights the advances that have been made when skilled sonographers using point-of-care ultrasound (POCUS) are able to evaluate for more than free fluid on the focused assessment with sonography in trauma (FAST) exam. Specific solid organ injury including an active liver bleed can also be detected during FAST exam, as seen in this case of a unstable hypotensive patient.

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Case Report: Testicular Pseudoaneurysm Rupture

Caroline Baber, DO

Gastroduodenal artery embolization is an increasingly common treatment method in patients with upper gastrointestinal (GI) bleeding who fail endoscopy or as a prophylactic procedure to help prevent further episodes. However, this new technique includes new risks including GI tract ischemia and risks associated with endovascular access such as hematoma formation, pseudoaneurysm development, and arterial dissection.

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Successful Management of Pseudo-Ludwig Angina from Supratherapeutic Warfarin Use: A Case Report

Utku Ekin, MD, MPH, MS

Ludwig angina is a potentially fatal condition characterized by soft tissue infection of the submandibular, sublingual, and submental compartments. Pseudo-Ludwig angina is a rare condition characterized by sublingual swelling of non-infectious etiology, typically in the setting of supratherapeutic anticoagulation. However, other etiologies, such as angioedema and trauma, have been described.

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A Case Report of Acute-on-Chronic Methemoglobinemia

Gabriel Lathrop, DO, MS

Methemoglobinemia is a rare hematologic disorder of hemoglobin, in which iron contained within the heme moiety becomes oxidized from ferrous iron to ferric iron at a concentration greater than 1% in the blood. This biochemical change reduces binding affinity for oxygen, leading to impaired oxygen deposition in tissues and subsequent hypoxia and hypoxemia. The etiology of methemoglobinemia is often acquired from exposure to oxidizing agents, commonly antibiotics such as dapsone or local anesthetics such as benzocaine. A rare cause results from congenital deficiency of cytochrome b5 reductase, a nicotinamide adenine dinucleotide dependent enzyme within red blood cells that donates electrons to reduce ferric to ferrous iron.

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“I’m Seeing Dead People”: A Case Report on Salicylate Poisoning in a Patient with Hallucinations

Jessica Meyers, MD

Salicylate poisoning remains one of the most common global accidental overdoses and poses a considerable health threat. Typical presentations for salicylate overdoses include nausea, vomiting, and abdominal pain as well as tinnitus, tachypnea, fever, and dehydration resulting in a concomitant metabolic acidosis and respiratory alkalosis. This may progress to a predominance of neurological symptoms such as mental status changes, confusion, delirium, and hallucinations.

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Polyarticular Septic Arthritis Caused by Haemophilus Influenzae in an Asplenic Patient: A Case Report

Roberto Desarden, MD

Prevalence of serious infections from Haemophilus influenzae has diminished over the last few decades because of immunizations against the most virulent serotype. However, over the last few years a handful of septic arthritis cases secondary to H influenzae have been documented. Most of the cases documented are in the pediatric and unimmunized population. This is a case of polyarticular septic arthritis in a 69-year-old male who presented with syncope and ankle pain.

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Interfacility Transfer for VA-ECMO in Beta Blocker and Calcium Channel Blocker Overdoses: A Report of Two Cases

Richard Fisher, MD

Calcium channel blocker (CCB) and beta blocker (BB) overdoses are life-threatening conditions that can lead to vasoplegic and cardiogenic shock. Treatment involves a combination of vasopressors, calcium, glucagon, and/or high-dose insulin euglycemia therapy. The most severe overdoses may require venoarterial extracorporeal membrane oxygenation (VA-ECMO), which often results in interfacility transfers. This report describes two successful VA-ECMO transfers for refractory CCB/BB overdose.

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Bigeminy with Prolonged QT Interval as an Ominous Sign for Impending Torsades de Pointes: A Case Report

Thuc Vu, DO

Ventricular ectopic beats and corrected QT interval (QTc) prolongation are both relatively common entities that are typically benign. It is difficult to predict subsequent dysrhythmias from either electrocardiogram (ECG) feature. The combination of both features may better predict the risk of torsades de pointes. We highlight a case of torsades preceded by a bizarre bigeminal rhythm with QTc prolongation likely caused by memantine use and hypokalemia.

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Gastroduodenal Obstruction Secondary to Pica-associated Bezoar: A Case Report

Mariam Attia, DO

While mild or moderate iron-deficiency anemia may not cause any symptoms, more severe deficiencies may present clinically as fatigue, shortness of breath, exertional dyspnea, lightheadedness, tachycardia, and presyncope or syncope, and, in rare instances, pica. Pica is defined as the developmentally inappropriate ingestion of non-nutritive, non-food substances for more than one month. We present the case of a duodenal obstruction secondary to a pica-associated bezoar in a patient with iron-deficiency anemia who presented to the emergency department (ED) with abdominal pain.

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Bigeminy with Prolonged QT Interval as an Ominous Sign for Impending Torsades de Pointes: A Case Report

Thuc Vu, DO

Ventricular ectopic beats and corrected QT interval (QTc) prolongation are both relatively common entities that are typically benign. It is difficult to predict subsequent dysrhythmias from either electrocardiogram (ECG) feature. The combination of both features may better predict the risk of torsades de pointes. We highlight a case of torsades preceded by a bizarre bigeminal rhythm with QTc prolongation likely caused by memantine use and hypokalemia.

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A Case Report of Obstructive Shock from an Esophageal Bolus Leading to Left Atrial Compression

Sharmin Kalam, MD

Obstructive shock results from reduced cardiac output due to physical blockage of blood flow, such as cardiac tamponade. Cardiac tamponade compresses cardiac chambers, particularly the left atrium, causing decreased end-diastolic volume and cardiac output. Rapid fluid accumulation within the pericardial sac is the usual cause. Transesophageal echocardiography provides clearer visualization of these structures than transthoracic ultrasound. This case underlines the impact of esophageal pathology on cardiac output and highlights ultrasound’s dynamic diagnostic utility alongside computed tomography.

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Challenges in Diagnosis and Management of Altered Mental Status in the Setting of Urosepsis and Hydrocephalus Secondary to an Occlusive Cyst of the Fourth Ventricle: A Case Report

Matthew Van Ligten, MS

Hydrocephalus presents a diagnostic and therapeutic challenge due to its diverse clinical manifestations and underlying causes. Symptoms can vary from feelings of unsteadiness to focal symptoms such as weakness, difficulty ambulating, or urinary incontinence. Due to the wide variety of symptoms, hydrocephalus can present a difficult diagnosis for any physician and may require different interventions depending on the underlying cause.

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Case Report of HIV and Neurosyphilis Coinfection in a Recent Migrant: Old Diseases in New Faces

Alexa Van Besien, MD

Coinfection with human immunodeficiency virus (HIV) and Treponema pallidum represents a unique challenge in management, with increased risk of neurological complications. Haiti is well-known for being disproportionately impacted by the HIV epidemic, with rates of infection ~6 times higher than in the United States (US). Rates of coinfection in Haiti are incompletely characterized but likely high. The US has seen a marked increase in migration from Haiti, with implications for public health and migrant health management.

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A Case of Status Epilepticus in a Patient Experiencing an Acute Attack of Hereditary Angioedema

Danielle Weinberg, MD

Hereditary angioedema (HAE) is a genetic disorder associated with recurrent episodes of angioedema in the absence of urticaria and pruritus. Hereditary angioedema is inherited in an autosomal dominant pattern and results in a quantitative deficiency (HAE type I) or dysfunction (HAE type II) of the C1-esterase inhibitor (C1-INH) protein. A very rare third type of HAE which is associated with normal quantitative and functional levels of C1-INH (HAE-nl-C1-INH) has been described.

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Takotsubo Syndrome Following Status Epilepticus in a Heart Transplant Recipient: A Case Report

Takeshi Shikama, MD

Takotsubo syndrome (TTS) expresses transient wall motion abnormality of the left ventricle, reportedly induced by sympathetic overstimulation. Takotsubo syndrome is unlikely to be included in the differential diagnosis of heart transplant patients with sudden cardiac dysfunction given the complete denervation occurring during the transplantation.

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Pericapsular Nerve Group Block for Prosthetic Hip Reduction in the Emergency Department: Case Report

Rebecca Thomas, DO

A pericapsular nerve group (PENG) block is unique compared to other regional anesthetic techniques (femoral nerve and fascia iliaca blocks) because it is a motor-sparing block. It also provides anesthesia to more nerves that innervate the anterior capsule of the femoroacetabular joint when compared to the femoral nerve and fascia iliaca blocks. Additionally, regional anesthesia carries fewer risks and requires less resources when compared with procedural sedation, which is the typical method for reducing a dislocated femoroacetabular joint.

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Spontaneous Evisceration, or “Burst Abdomen,” in Patient with Prior Flood Syndrome Surgical Repair

Matthias Barden, MD

We present an image and discussion of spontaneous evisceration, or “burst abdomen,” from an anterior abdominal wall hernia. A 61-year-old female with prior history of alcoholic cirrhosis and ascites presented to our emergency department with frank evisceration of multiple loops of small bowel from an open anterior abdominal wall dehiscence. Approximately one year prior to this visit she had also been seen in our department for spontaneous rupture of the skin overlying an umbilical hernia and large-volume external leakage of ascites (Flood syndrome1). She required surgery to repair the abdominal wall at that time but had subsequently developed a new ventral hernia extending from the umbilicus across a large portion of her left lower abdomen as well as several other postoperative complications. On the day of presentation, she suffered dehiscence of that one-year-old surgical site resulting in spontaneous evisceration of her small bowel. She was transferred to a facility with acute care surgical capabilities where she remained in critical condition.

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

CPC-EM
ISSN: 2474-252X

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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.