Given the current epidemic of opiate use, addiction, and death from overdose in the United States,1-3 non-opioid therapies to treat pain are needed to avoid exposing patients to the risk of opioid dependence. We discuss the use of manual trigger point therapy by emergency providers and physical therapists in the emergency department (ED), as an underused non-opioid treatment for pain management in the ED.
We present a case of a 32-year-old male presenting in acute loperamide overdose and subsequent cardiac dysrhythmia with focal wall motion abnormalities on echocardiogram. This finding has not been previously reported in the literature and is unique in this clinical presentation.
Cardiac tamponade is a medical emergency that requires immediate treatment. Caused by the development of fluid in the pericardial space, it can result in a severe decrease in cardiac output.
A healthy 18-year-old male presented to the emergency department with chest pain, palpitations, and dyspnea. His exam was unremarkable; however, point-of-care ultrasound (POCUS) revealed right ventricular strain with a D-sign and enlarged right ventricle.
Chronic mesenteric ischemia (CMI) is a rare cause of abdominal pain with the potential for significant morbidity and mortality. An infrequently described complication of CMI is acalculous cholecystitis.
A 38-year-old female presented to the emergency department (ED) with acute-onset right lower quadrant abdominal pain following two days of nausea and vomiting. Physical examination revealed right lower quadrant tenderness to palpation, rebound tenderness, and guarding.
BRASH (bradycardia, renal failure, atrioventricular-node blockers, shock, and hyperkalemia) syndrome is a recently coined term for a condition that describes the severe bradycardia and shock associated with hyperkalemia in patients on atrioventricular (AV)-node blocking agents.
A 53-year-old male presented with pain in the right elbow that was sudden in onset and progressively worsening over approximately eight hours. The pain was exacerbated with any movement of the elbow.
We discuss the homicide of a 31-year-old male killed by a penetrating injury of the right ventricle via air weapon, which led to pericardial tamponade. In addition, we review the literature.
Cranial vascular malformations can cause symptoms of headache, stroke, transient ischemic attack, or other cerebrovascular disorders due to steal phenomenon. Subclavian steal phenomenon is a localized change in cerebral perfusion from a cranial arteriovenous malformation (AVM).
Tethered spinal cord syndrome refers to signs and symptoms of motor and sensory dysfunction related to increased tension on the spinal cord due to its abnormal attachment; it has classically been associated with a low-lying conus medullaris.
Twiddler’s syndrome refers to a rare condition in which a pacemaker or automatic implantable cardioverter-defibrillator (AICD) malfunctions due to coiling of the device in the skin pocket and resultant lead displacement.
This is a report of a female with acute onset odynophagia after a meal, with a normal laryngoscopic exam that used flexible fiberoptics. Evidence of a metallic linear density was present in the retropharynx on computed tomography imaging, most consistent with a wire from a grill wire brush.
A 75-year old female presented in cardiac arrest with a right tibial intraosseous (IO) catheter through which prehospital medications were administered.
We discuss a 61-year-old male with a history of atrial fibrillation who presented with severe abdominal pain out of proportion to exam. The patient was diagnosed promptly and successfully managed non-operatively.
A 52-year-old man presented to the emergency department with two days of intermittent, substernal, crushing chest pain radiating to his right shoulder that woke him from sleep. His medical history included Evan’s syndrome, hypertension, beta-thalassemia, and situs inversus.
We present here a case of this little-known cause of acute vision loss, and an example of Munson’s sign, which is a v-shaped protrusion of the lower eyelid on downward gaze that is characteristic of advanced keratoconus. We hope to highlight Munson’s sign as a simple identifier of keratoconus in an otherwise undiagnosed individual suspected of having acute corneal hydrops.
This case discusses a 95-year-old-female with a history of cerebral vascular accident who presented with acute onset respiratory distress with inspiratory stridor. The patient denied any episodes of choking or foreign body sensation.
This case highlights the importance of obtaining CT angiography dedicated to the aorta in the setting of high clinical suspicion for aortic disease if initial CT pulmonary angiogram is negative for aortic disease.
We present a case of a patient who underwent ultrasound evaluation for potential blunt ocular trauma. She was found to have multiple, freely mobile, scintillating hyperechoic opacities within the vitreous that was diagnosed as asteroid hyalosis, a rare but benign condition easily confused with vitreous hemorrhage, retinal detachment, lens dislocation, or foreign body on ocular ultrasound.
An eight-year-old boy presented to the emergency department for a first-time seizure. The patient had only signs of mild dehydration on physical exam and had an uneventful postictal recovery. First-time seizures in pediatric patients are often benign and require only an outpatient workup; some are dangerous.
One of the more common and well-described causes in the literature is exposure to topical benzocaine during medical procedures. We present a case series of acute acquired methemoglobinemia from a food source that has not been previously described in the literature: a dessert.
We report a case of anterior loculated pericardial effusion misinterpreted on point-of-care ultrasound as a dilated right ventricle, and suggesting diagnosis of pulmonary embolism (PE), in a patient with renal failure.
A 58-year-old male with no past medical history presented to the emergency department with sudden onset left lower extremity weakness and central chest pain with radiation to his back. Electrocardiogram revealed an acute inferior and posterior ST-segment elevation myocardial infarction (STEMI).
We report a case of a 44-year-old African-American male with STB presenting as an acute exacerbation of chronic low back pain complicated by urinary retention and difficulty ambulating. Our patient had no known predisposing risk factors for tuberculosis.
