Case Report Archives - Page 16 of 16 - 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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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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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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Severe Neck Pain with Fever: Is it Meningitis?

A 58-year-old male patient presented to the emergency department with complaints of severe neck pain. He admitted to drug use but denied using intravenous (IV) drugs. On exam, he had a fever of 100.7°F, positive Kernig’s sign, and normal neurologic exam. The patient was suspected to have bacterial meningitis and was started on IV antibiotics. The next day the patient developed decreased hand grip. Magnetic resonance imaging of the spine the next day showed a soft-tissue mass impinging on the spinal canal. The patient was subsequently taken to the operating room where the epidural abscess was drained.

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Ultrasound-Guided Hip Arthrocentesis in a Child with Hip Pain and Fever

Children presenting to the emergency department with hip pain and fever are at risk for significant morbidity due to septic arthritis. Distinguishing between septic arthritis and other causes of hip pain may be challenging. Sonographic visualization of the hip with real-time ultrasound-guided arthrocentesis may allow faster differentiation between etiologies, hastening definitive therapy and improving analgesia. This report describes the use of hip sonography in a case of Lyme arthritis. The authors review the medical literature in support of bedside hip sonography and discuss how to perform ultrasound-guided hip arthrocentesis. Clinical findings in septic and Lyme arthritis are also described.

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Molar Pregnancy in the Emergency Department

A 15-year-old female presented to the emergency department with complaints of vaginal bleeding. She was pale, anxious, cool and clammy with tachycardic, thready peripheral pulses and hemoglobin of 2.4g/dL. Her abdomen was gravid appearing, approximately early to mid-second trimester in size. Pelvic examination revealed 2 cm open cervical os with spontaneous discharge of blood, clots and a copious amount of champagne-colored grapelike spongy material. After 2L boluses of normal saline and two units of crossmatched blood, patient was transported to the operating room. Surgical pathology confirmed a complete hydatidiform mole.

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