Volume 15, Issue 4, July 2014
Caleb P. Canders, MD et al.
A 63-year-old man presented with abdominal distension and shortness of breath for two days. He reported flatus and denied chest pain, anorexia, vomiting, or abdominal pain.
Volume 15, Issue 4, July 2014
Landon A. Jones, MD et al.
A 37 year-old male presented after an altercation in which he was dragged by a vehicle. The patient was intoxicated and asking repetitive questions. He demonstrated significant facial trauma—including frank bloody discharge from both ears and dental trauma.
Volume 15, Issue 4, July 2014
Meghan Galer, MD et al.
A healthy 58-year-old man presented to the emergency department with right arm weakness first noticed while playing hockey that day. He could not recall the onset of injury, but endorsed several weeks of antecedent intermittent right shoulder discomfort.
Volume 15, Issue 2, March 2014
Amar Patel, MD et al.
A 58-year-old male with schizophrenia presented to the emergency department after being shot by law enforcement with two bean bag rounds. He was shot once in the upper abdomen.
Volume 15, Issue 2, March 2014
Christopher Coyne, MD et al.
A previously healthy 48 year-old male presented to the hospital with a 4-week history of “pimples” on his scrotum. This condition had progressively worsened, resulting in increased pain, swelling and redness to the genital region and buttocks.
Volume 15, Issue 2, March 2014
Nathan J. Cleveland, MD, MS et al.
A 28-year-old female was transferred to the emergency department from her physician’s office for further evaluation of tachycardia. She was being seen for a recent illness which included nausea, vomiting, diarrhea and fevers. The patient endorsed fatigue, dyspnea on exertion, and extremity edema. She had no chest pain or cough. Exam revealed a pale, fatigued, mildly ill-appearing female with bilateral lower extremity edema and diminished breath sounds on the right.
Volume 15, Issue 2, March 2014
Jayten Shook, DO et al.
A 25-year-old woman presented to the emergency department (ED) with 4 days of progressive, left-sided neck pain and swelling. Additional symptoms included sore throat, dysphagia and left otalgia.
Volume 15, Issue 2, March 2014
Carlos J. Roldan, MD et al.
The use of phenytoin (PHT) as a cocaine adulterant was reported decades ago; that practice is still current. Ironically PHT has also been used for the treatment of cocaine dependence. A drug smuggler developed PHT toxicity after swallowing several rocks of crack. We investigated the current trends of PHT as a cocaine adulterant and its toxicological implications. We also reviewed the clinical use of PTH in relation to cocaine. The use of PHT as cocaine cut is a current practice. This may affect the clinical manifestations and the management of the cocaine-related visits to the emergency department.
Volume 15, Issue 2, March 2014
David Bell, MD, PhD et al.
This case report details the emergency department course of a 34 year-old female who presented with abdominal pain and vaginal bleeding after reportedly falling one week earlier. She was subsequently found to have a drinking straw within her uterus next to an eight week-old live intrauterine pregnancy on ultrasound. This case report and discussion reviews the literature on retained foreign bodies in pregnancy while addressing the added complications of an evasive patient and a difficult consultant with significant intra-specialty disagreement.
Volume 15, Issue 2, March 2014
Linda Joseph, MD et al.
Deep sternal wound infections (DSWI) are infections of the sternum, mediastinum, or the muscle, fascia and soft tissue that overlie the sternum, typically occurring within a month of cardiac surgery. They are infrequent though severe complications of cardiac surgery. Diagnosis is made by the clinical presentation of fever, chest pain, or sternal instability in the setting of wound drainage, positive wound cultures, or chest radiographic findings.
Volume 15, Issue 2, March 2014
Robert W. Derlet, MD et al.
We report the case of a 32-year-old male recently diagnosed with type 2 diabetes treated at an urban university emergency department (ED) crowded to 250% over capacity. His initial symptoms of shortness of breath and feeling ill for several days were evaluated with chest radiograph, electrocardiogram (EKG), and laboratory studies, which suggested mild diabetic ketoacidosis. His medical care in the ED was conducted in a crowded hallway.
Volume 15, Issue 2, March 2014
Ryan P. Offman, DO et al.
We present an interesting case of a patient with a previously known diaphragmatic hernia in which the colon became incarcerated, ischemic and finally perforated. She had no prior history of abdominal pain or vomiting, yet she presented with cardiovascular collapse. She was quickly diagnosed with a tension pneumothorax and treated accordingly. To our knowledge, this is the only case report of a tension pneumothorax associated with perforated bowel that was not in the setting of trauma or colonoscopy.
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.
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.
Volume 15, Issue 2, March 2014
Deborah B. Diercks, MD, MSc et al.
Contrast-induced nephropathy is a result of injury to the proximal tubules caused by oxidative stress and ischemia. Metabolomics is a novel technique that has been used to identify renal damage from drug toxicities. The objective of this study is to analyze the metabolic changes in the urine after dosing with intravenous (IV) contrast for computed tomograph (CT) of the chest.
Volume XV, Issue 1, February 2014
Francis M. Fesmire, MD et al.
Examination on arrival to the emergency department revealed altered mental status, right hemiplegia, forced leftward gaze, and complete aphasia. Patient was ineligible for tissue plasminogen (TPA) therapy due to unknown time of symptom onset. Computed University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee Figure 1. Transverse (left) and coronal (right) computed tomography angiogram demonstrating abrupt cutoff of the left middle cerebral artery at the site of the thrombus (marked by arrows). Tomography angiogram (CTA) revealed occlusion of the left middle cerebral artery (MCA) with acute thrombus (Figure 1).
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.
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.
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.
An approximately 30 year-old Ugandan male was found unresponsive on an American base in Iraq. The patient was altered and combative with no signs of trauma. A chest x-ray was performed showing an enlarged cardiac silhouette and pulmonary edema. The patient required intubation during which a large amount of edema fluid was produced.
A previously healthy 30-year-old woman (gravida 1 para 1) presented to the emergency department (ED) with 5 days of lower abdominal pain, fever, and nausea. On examination, she had a temperature of 37.6° Celsius, pulse 116 beats/ minute, blood pressure 123/65 mmHg, respiratory rate 18 breaths/minute, and oxygen saturation 98% on room air. On bimanual examination, the patient exhibited bilateral adnexal tenderness, but no cervical motion tenderness. Relevant laboratory studies included negative urine beta-hCG, white blood cell count 17.4×103/μL and lactate 2.4 mmol/L.
A previously healthy 14-year-old male presented to the emergency department (ED) complaining of 2 days of subacute onset, right-anterior pleuritic chest pain. He reported an associated dry cough, but denied fever, sputum, hemoptysis, shortness of breath, orthopnea, leg swelling, weight loss or night sweats. The patient had no known sick contacts, and had no identifiable cardiac or thromboembolic risk factors.
A 67-year-old man presented with painful oral and skin lesions developing over the last 2 months. The lesions initially formed in his mouth and lips, and slowly spread to his torso, groin, and extremities (Figure 1). The lesions began as blisters that broke easily and were exquisitely painful to light touch.
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.
