Clinical Cases and Reports in EM

40-year-old Female with Sudden Onset Dyspnea

Kebort, MD, et al.

A 40-year-old female presented to the emergency department (ED) after the acute onset of dyspnea. The patient was tachypneic with accessory muscle usage and diffuse wheezing on initial examination. Despite aggressive treatment, the patient deteriorated and was intubated. This case takes the reader through the differential diagnosis and systematic workup of a patient presenting to the ED with dyspnea and arrives at the unexpected cause for this patient’s presentation.

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Case Report of Thrombosis of the Distal Aorta with Occlusion of Iliac Arteries in COVID-19 Infection

LaFree, MD, et al.

We describe a patient presenting with bilateral leg pain without any respiratory symptoms or fever who ultimately was found to be COVID-19 positive and had thromboembolism of the aorta and bilateral iliac occlusion. This report reviews available evidence on the prevalence of arterial thromboembolism in COVID-19 patients and some proposed mechanisms of the pathophysiology of COVID-19-associated coagulopathy.

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A Case Report of Cerebral Venous Thrombosis as a Complication of Coronavirus Disease 2019 in a Well-appearing Patient

Logan, MD, et al.

We report a case of a previously healthy male patient who presented to the emergency department with headache and extremity paresthesia. The patient was diagnosed with cerebral venous thrombosis (CVT) and found to have a positive COVID-19 test. Inpatient anticoagulation was initiated, and symptoms had largely resolved at discharge.

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A Case Report on Distinguishing Emphysematous Pyelitis and Pyelonephritis on Point-of-care Ultrasound

Mazumder, BS, et al.

A 60-year-old female presented to the ED with normal vital signs and intermittent left-sided flank pain that radiated to her groin. She also had a history of obstructive nephrolithiasis. Within 20 minutes of arrival she became febrile (101.2°Fahrenheit), tachycardic (114 beats per minute), tachypneic (21 breaths per minute), and had a blood pressure of 114/82 millimeters mercury.

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Peer Pressure = Explosive Consequences: A Case Report of Toxic Ingestion of Cyclonite (C-4) Explosive on a Dare

Whitesides, MD, et al.

We present a case of intentional ingestion of a piece of plastic explosive in a military patient that resulted in tonic-clonic seizure and gastrointestinal illness. Although uncommon, such ingestions have been reported in military journals since the Vietnam War. Access to plastic explosives is generally limited to military personnel, and non-military medical providers may not be familiar with treatment of acute intoxication.

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Human Zinc Phosphide Exposure in Lebanon: A Case Report and Review of the Literature

Hamade, MD, et al.

We present the first documentation of a metal phosphide exposure in Lebanon. A middle-aged woman presented to the emergency department following the ingestion of an unknown rodenticide. Spectroscopy analysis of the sample brought by the patient was used and helped identify zinc phosphide. The patient developed mild gastrointestinal symptoms and was admitted to the intensive care unit for observation without further complications.

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Rare Complications of Acute Appendicitis: A Case Report

Kurtzman, MD, et al.

A 37-year-old male with no past medical history presented to the emergency department (ED) with vague abdominal pain as well as 12 days of cyclical fever. He had no significant findings on laboratory workup with the exception of a mild aspartate transaminase and alanine transaminase and relative neutrophilia between outpatient, urgent care, and ultimate ED visit.

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Mediastinitis Secondary to Peripherally Inserted Central Catheter Migration and Perforation after Minor Trauma: A Case Report

Martinez, DO, et al.

We report a case of a fall associated with extraluminal PICC migration and perforation causing mediastinitis and severe sepsis after total parenteral nutrition (TPN) infusion in a 54-year-old woman. Our patient required a right-sided PICC for long-term home TPN due to severe malnutrition following gastric bypass surgery. During a routine home care visit our patient was found tachypneic, hypoxic, and short of breath.

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Testicular Torsion in Monorchism Diagnosed with Point-of-care Ultrasound: A Case Report

Correa, MD, et al.

A 20-year-old otherwise healthy male, with a history of monorchism, presented to the emergency department with vague testicular pain. A POCUS was performed, which demonstrated attenuated arterial flow of the patient’s single testicle as well as twisting (“whirlpool sign”) of the spermatic cord, both highly specific ultrasonographic findings of testicular torsion.

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Blunt Chest Trauma Causing a Displaced Sternal Fracture and ST-elevation Myocardial Infarction: A Case Report

Nasser, MD, et al.

In this case report, we present a 52-year-old male who was brought to the ED with complaints of chest pain and pressure after a motor vehicle collision. He was subsequently found to have both a displaced sternal fracture and simultaneous acute myocardial infarction with 100% occlusion of the mid left anterior descending artery without dissection requiring stent placement.

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Unmasking Long QT Syndrome in the Emergency Department: A Case Report

Leslie, MD, et al.

A 44-year-old female with well-controlled hypertension and asthma presented with chest tightness. An initial electrocardiogram yielded a normal corrected QT interval of 423 milliseconds (ms) (normal <480 ms in females). Albuterol was administered and induced agitation, tremulousness, and tachycardia.

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Septic Malleolar Bursitis in a Patient with an Ankle Electronic Monitoring Device: A Case Report

Besinger, MD, et al.

We describe a 41-year-old male under house arrest with an electronic monitoring device on his right ankle who presented to our emergency department with several days of progressive pain and swelling over the medial malleolus. Point-of-care ultrasound revealed a thick-walled cystic structure consistent with medial malleolar bursitis. Bursal aspiration was performed. Fluid culture yielded Staphylococcus aureus.

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Don’t Forget the Flu – Determining the Etiology of Infective Myositis in a Child: A Case Report

Crowley, BA, et al.

The following case report describes a three-year-old female diagnosed with a recent upper respiratory tract infection presenting to the emergency department with complaints of fatigue and inability to walk. She was diagnosed with an influenza-like illness three days prior by her pediatrician, the symptoms of which had mostly resolved by the time of presentation.

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

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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.