Case Report Archives - Page 17 of 21 - The Western Journal of Emergency Medicine

Popliteal Artery Injury Associated with Blunt Trauma to the Knee without Fracture or Dislocation

Volume 15, Issue 2, March 2014
Ahmet Imerci, MD et al.

Popliteal artery injuries are frequently seen with fractures, dislocations, or penetrating injuries. Concern about arterial injury and early recognition of the possibility of arterial injury is crucial for the salvage of the extremity. This article provides an outline of the diagnostic challenges related to these rare vascular injuries and emphasizes the necessity for a high level of suspicion, even in the absence of a significant penetrating injury, knee dislocation, fracture, or high-velocity trauma mechanism. The importance of a detailed vascular examination of a blunt trauma patient is emphasized.

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Complete Ventricular Asystole in a Patient with Altered Mental Status

Volume 15, Issue 2, March 2014
Stephen Zanoni, MD et al.

Patients who present with recurrent syncope are at risk for having underlying conduction disease, which may worsen if not promptly recognized and treated. We describe a patient who initially presented to a Mexican clinic with recurrent syncope and an electrocardiogram that showed complete heart block. After being transferred to our emergency department, he deteriorated into complete ventricular asystole with preserved atrial function and required placement of a transvenous cardiac pacemaker.

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Betrayed Mood in Public View: Taking a MySpace History

Volume XV, Issue 1, February 2014
Vinodinee L. Dissanayake, MD et al.

Social networking sites (SNS), the modern mainstay of adolescent expression, may provide vital information to physicians. The emergency department (ED) is a setting where SNS may be helpful. A reticent 19-year-old in the ED prompted a search for pertinent information on the Internet, where a profile on www.myspace.com relayed a troubled post. The patient was admitted for psychiatric evaluation due to intentional overdose. These SNS may provide a venue for physicians to learn about risky behaviors and life stressors that would help identify underlying medical issues in young adults. We provide a guideline on how to utilize SNS with privacy rights in mind.

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Diagnosis of Necrotizing Faciitis with Bedside Ultrasound: the STAFF Exam

Volume XV, Issue 1, February 2014
Erik Castleberg, MD et al.

We propose the STAFF ultrasound exam may be beneficial in the rapid evaluation of unstable patients with consideration of necrotizing fasciitis, in a similar fashion to the current use of a focused assessment with sonography for trauma exam in the setting of trauma.

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Recurrent Priapism from Therapeutic Quetiapine

Volume 15, Issue 1, February 2014
Omeed Saghafi, MD, et al.

Priapism is rarely related to use of non-erectile related medications. The objective was to educate about the multiple possible causes of priapism and to provide treatment recommendations for the different types of priapism. We present the case of a 43-year-old African American male with a history of schizoaffective disorder who presented to our emergency department multiple times over a three year period with priapism, each episode related to the ingestion of quetiapine. Following penile aspiration and intercavernosal injection of phenylephrine, this patient had resolution of his priapism. This case demonstrates an unusual case of recurrent priapism.

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Uncommon Etiology of Chest Pain: Pulmonary Sequestration

Chest pain is a common presenting symptom in the emergency department. After ruling out emergent causes, emergency physicians need to identify and manage less commonly encountered conditions. Pulmonary sequestration (PS) is a rare congenital condition involving pulmonary parenchyma. In PS, a portion of non-functional lung tissue receives systemic blood supply from an anomalous artery. While most individuals with PS present in early life with symptoms of difficulty feeding, cyanosis, and dyspnea, some present later with recurrent pneumonia, hemoptysis, or productive cough. In this report, we present a case of PS in an adult with acute onset pleuritic chest pain.

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Sedative Dosing of Propofol for Treatment of Migraine Headache in the Emergency Department: A Case Series

Migraine headaches requiring an emergency department visit due to failed outpatient rescue therapy present a significant challenge in terms of length of stay (LOS) and financial costs. Propofol therapy may be effective at pain reduction and reduce that length of stay given its pharmacokinetic properties as a short acting intravenous sedative anesthetic and pharmacodynamics on GABA mediated chloride flux.

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Ethical and Legal Issues

When a Patient Declines Curative Care: Management of a Ruptured Aortic Aneurysm

Volume 14, Issue 5, September 2013
Sangeeta Lamba, MD, et al.

The management of major vascular emergencies in the emergency department (ED) involves rapid, aggressive resuscitation followed by emergent definitive surgery. However, for some patients this traditional approach may not be consistent with their goals and values. We explore the appropriate way to determine best treatment practices when patients elect to forego curative care in the ED, while reviewing such a case.

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Ultrasound-guided Intraarticular Hip Injection for Osteoarthritis Pain in the Emergency Department

Author Affiliation Erik S. Anderson, MD Alameda County Medical Center, Highland Hospital, Department of Emergency Medicine, Oakland, California Andrew A. Herring, MD Alameda County Medical Center, Highland Hospital, Department of Emergency Medicine, Oakland, California Caitlin Bailey, MD Alameda County Medical Center, Highland Hospital, Department of Emergency Medicine, Oakland, California Daniel Mantuani, MD Alameda County Medical […]

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Uterine Rupture Due to Invasive Metastatic Gestational Trophoblastic Neoplasm

Author Affiliation David I. Bruner, MD Naval Medical Center Portsmouth, Emergency Medicine Program, Portsmouth, Virginia Amy M. Pritchard, DO Naval Medical Hospital Camp Pendleton, Oceanside, California Jonathan Clarke, MD Naval Medical Center Jacksonville, Jacksonville, Florida Introduction Case report Discussion Conclusion ABSTRACT While complete molar pregnancies are rare, they are wrought with a host of potential […]

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Vaginal Foreign Bodies and Child Sexual Abuse: An Important Consideration

Author Affiliation Forrest T. Closson, MD University of Maryland School of Medicine, Department of Pediatrics, Division of Pediatric Emergency Medicine, Baltimore, Maryland Richard Lichenstein, MD University of Maryland School of Medicine, Department of Pediatrics, Division of Pediatric Emergency Medicine, Baltimore, Maryland Introduction Case reports Discussion Recommendations ABSTRACT Vaginal foreign bodies are a complaint occasionally encountered […]

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Parenteral Hydrocarbon Injection and Associated Toxicities: Two Case Reports

Author Affiliation Michael E. Nelson, MD, MS John H. Stroger Hospital of Cook County, Chicago, Illinois Toxikon Consortium, Illinois Poison Control Center, Chicago, Illinois Isam Nasr, MD John H. Stroger Hospital of Cook County, Chicago, Illinois Westlake Hospital, Melrose Park, Illinois Introduction Case reports Discussion Conclusion INTRODUCTION Many cases of hydrocarbon toxicity occur annually due […]

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Pylephlebitis in a Previously Healthy Emergency Department Patient with Appendicitis

Author Affiliation Christopher J. Coyne, MD Los Angeles County + University of Southern California Health Network, Department of Emergency Medicine, Los Angeles, California Ashokokkumar Jain, MD, MPH Los Angeles County + University of Southern California Health Network, Department of Emergency Medicine, Los Angeles, California Case report Discussion ABSTRACT Pylephlebitis is a septic thrombophlebitis of the […]

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“I Can’t Walk!” Acute Thrombosis of Descending Aorta Causing Paraplegia

Author Affiliation Matthew L. Mitchell, MD Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan Elif Yucebey, MD Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan Mitchell R. Weaver, MD Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan A. Kathrin Jaehne, MD Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan Emanuel P. […]

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Early Presentation of Buried Bumper Syndrome

Author Affiliation Walter Geer, DO St. Luke’s University Hospital, Bethlehem, Pennsylvania Rebecca Jeanmonod, MD St. Luke’s University Hospital, Bethlehem, Pennsylvania Case Discussion Conclusion ABSTRACT Percutaneous endoscopic gastrostomy (PEG) is a relatively safe and effective method of providing nutrition to patients with neurologic deficits or proximal gastrointestinal pathology. Complications that follow this common procedure include dislodgement, […]

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Cephalohematoma in a Patient with Ehlers-Danlos Syndrome

Author Affiliation Brent M. Felton, DO McLaren Greater Lansing Hospital, Department of Emergency Medicine, Lansing, Michigan Michigan State University, Department of Emergency Medicine, East Lansing, Michigan Josh M. White, MD McLaren Greater Lansing Hospital, Department of Emergency Medicine, Lansing, Michigan Michigan State University, Department of Emergency Medicine, East Lansing, Michigan Ryan A. Jones, MD McLaren […]

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Appendicitis Diagnosed by Emergency Physician Performed Point-of-Care Transvaginal Ultrasound: Case Series

Author Affiliation Robert Bramante, MD North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York Marek Radomski, DO North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York Mathew Nelson, DO North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York Christopher Raio, MD North Shore University Hospital, Department of Emergency Medicine, […]

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Uterine Arteriovenous Malformation with Sudden Heavy Vaginal Hemmorhage

Dysfunctional uterine bleeding (DUB) is a common presentation in the emergency department and has a wide differential.

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A 37-year-old Woman with Altered Mental Status and Urinary Frequency

We present a case report of a patient who initially presented with altered mental status and significant urinary frequency. Over the course of her emergency department stay, she then developed tachycardia out of proportion to a new fever along with a respiratory alkalosis. Although each objective finding has a broad differential diagnosis, thyroid storm was the only unifying diagnosis when all findings were present.

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Primary Meningococcal Arthritis Leading to Neisseria Meningitidies Purpura Fulminans

Primary meningococcal arthritis (PMA) is a rare infectious disease that occurs in as little as 1% of meningococcal infections. PMA is arthritis without meningitis, fever, rash, and hemodynamic instability. It is usually preceded by an upper respiratory infection in 50–55% of presentations, and patients may appear nontoxic, afebrile, and polyarthralgic. Despite definition they may have a rash.

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Injury Outcomes

Unique Mechanism of Chance Fracture in a Young Adult Male

Since the first description of the Chance fracture in 1948, there have been few case reports of unique mechanisms causing this classical flexion-extension injury to the spine in motor vehicle accidents, sports injury, and falls. To our knowledge, this injury has not been reported from a fall with the mechanistic forces acting laterally on the spine and with spinal support in place. We present a 21-year-old male who slid down a flight of stairs onto his side wearing a heavy mountaineering style backpack, subsequently sustaining a Chance fracture of his first lumbar vertebrae.

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Bedside Ultrasound in a Case of Blunt Scrotal Trauma

This case study describes a patient who suffered blunt force trauma to the scrotum. Use of bedside emergency ultrasound facilitated early diagnosis of a ruptured testicle and allowed for prompt urological consultation and timely surgical repair. The utility of bedside emergency ultrasound in the evaluation of testicular trauma, as well as the outcome of our case, is discussed here.

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Ultrasound Detection of a Renal Mass in a Patient with Flank Pain and Hematuria

Flank pain with hematuria is a common chief complaint in the emergency department (ED). Patients are often diagnosed with renal calculi or pyelonephritis and discharged with analgesics or antibiotics and follow-up. This case study describes a patient who presented to the ED with a 1 week history of flank pain and hematuria and was subsequently found to have a large renal mass on bedside ultrasound.

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Hepatic Abscess: Case Report And Review

Hepatic abscess is an uncommon occurrence in North America, but can be a diagnostic challenge for emergency department physicians. The clinical signs and symptoms may vary, leading to delays in diagnosis and higher morbidity. We present a case of a 35-year old male with a hepatic abscess initially misdiagnosed as pneumonia. On subsequent return to the ED for back pain complaints, a bedside ultrasound led to the appropriate diagnosis. This case report and discussion will attempt to review the literature on the etiology, diagnosis and treatment of hepatic abscess for the emergency physician.

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Visual Hallucinations: Charles Bonnet Syndrome

The following is a case of Charles Bonnet syndrome in an 86-year-old woman who presented with visual hallucinations. The differential diagnosis of visual hallucinations is broad and emergency physicians should be knowledgeable of the possible etiologies.

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Transjugular Intrahepatic Portosystemic Shunt (TIPS) Migration to the Heart Diagnosed by ED Ultrasound

A 57-year-old man presented to our emergency department with altered mental status. He had a past medical history significant for cirrhosis and previous placement of a transjugular intrahepatic portosystemic shunt (TIPS). On cardiac auscultation, a new heart murmur and an unexpected degree of cardiac ectopy were noted. On the 12-lead electrocardiogram, the patient was…

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