Clinical Practice and Cases in Emergency Medicine最新文献

Physician-Assisted Dying Witnessed by Emergency Medical Services: A Case Report. 急诊医疗机构见证的医师协助死亡一例报告

Clinical Practice and Cases in Emergency Medicine Pub Date : 2025-05-01 DOI: 10.5811/cpcem.38060

Saahith Potluri, Tharun Potluri, Jose Victor Nable, Paul Peng, Kusum Punjabi

{"title":"Physician-Assisted Dying Witnessed by Emergency Medical Services: A Case Report.","authors":"Saahith Potluri, Tharun Potluri, Jose Victor Nable, Paul Peng, Kusum Punjabi","doi":"10.5811/cpcem.38060","DOIUrl":"10.5811/cpcem.38060","url":null,"abstract":"Introduction: Physician-assisted dying (PAD) is a practice that allows terminally ill patients to self-administer prescribed lethal medication. In the 11 states in the United States where PAD is legal, the incidence of PAD cases is rapidly rising. Despite most of these cases occurring in the out-of-hospital setting, states lack specific emergency medical services (EMS) protocols to guide prehospital responders who may encounter PAD in the field. We report a case in which a patient called 9-1-1 for a medical emergency and requested to ingest her prescribed lethal medication while in EMS care.Case presentation: Emergency medical services was dispatched for a 56-year-old female bleeding from her tracheostomy stoma. Despite the EMS responders' recommendation, the patient refused transport and instead requested to ingest her PAD medication. The crew, unfamiliar with PAD laws, were unsure whether they could legally honor the patient's refusal. Clinicians consulted with online medical control, who were also unaware of PAD. After extensive deliberation, the crew decided to honor the patient's refusal and thoroughly document the situation. The patient self-administered her medication as EMS cleared the scene.Conclusion: This case highlights logistical challenges and ethical dilemmas faced by EMS responders and underscores the complexity of balancing patient autonomy with legal and medical responsibilities in prehospital situations involving PAD. As PAD becomes increasingly prevalent, equipping EMS responders with clear protocols and providing ongoing education about prehospital PAD cases are vital for preserving patient rights while protecting the responders from legal and ethical uncertainty.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"9 2","pages":"182-187"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Retroperitoneal Necrotizing Fasciitis Following Prolonged Physical Activity: A Case Report. 长期运动后腹膜后坏死性筋膜炎1例报告。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2025-05-01 DOI: 10.5811/cpcem.34862

Jordan R Pollock, Edmundo Chantler, Bhavesh Patel, Nelly Tan, Wayne Martini

{"title":"Retroperitoneal Necrotizing Fasciitis Following Prolonged Physical Activity: A Case Report.","authors":"Jordan R Pollock, Edmundo Chantler, Bhavesh Patel, Nelly Tan, Wayne Martini","doi":"10.5811/cpcem.34862","DOIUrl":"10.5811/cpcem.34862","url":null,"abstract":"Introduction: Retroperitoneal necrotizing fasciitis is a rare, rapidly progressive, and often fatal infection of the retroperitoneum. In many cases the source of infection is unclear, and cutaneous signs of necrotizing fasciitis may be absent.Case report: We present the case of a 64-year-old female with a history of hypertension, hyperlipidemia, and breast cancer who developed acute kidney injury (AKI) and retroperitoneal necrotizing fasciitis following a 20-mile bike ride. The patient's initial symptoms included severe muscle aches, nausea, vomiting, and flank pain. Diagnostic imaging and laboratory results indicated myositis and severe AKI. Despite aggressive treatment with antibiotics, intravenous fluids, and pain management, the patient developed septic shock and multiorgan failure, ultimately leading to her death.Conclusion: This case highlights the rapid progression and complexity of managing necrotizing fasciitis and AKI in the context of rhabdomyolysis. Early recognition and aggressive management are crucial in cases of suspected necrotizing fasciitis and AKI. Patients may not initially present with cutaneous findings suggestive of necrotizing fasciitis. Early involvement of a multidisciplinary team can improve patient outcomes in complex and rapidly deteriorating patients.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"9 2","pages":"211-214"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Gastrosplenic Fistula in the Setting of Undiagnosed Lymphoma: A Case Report. 未确诊淋巴瘤并发胃脾瘘1例。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2025-05-01 DOI: 10.5811/cpcem.34864

Mackenzie Lecher, Brian Lecher, Lindsay Tjiattas-Saleski

{"title":"Gastrosplenic Fistula in the Setting of Undiagnosed Lymphoma: A Case Report.","authors":"Mackenzie Lecher, Brian Lecher, Lindsay Tjiattas-Saleski","doi":"10.5811/cpcem.34864","DOIUrl":"10.5811/cpcem.34864","url":null,"abstract":"Introduction: A gastrosplenic fistula (GSF) is a pathologic connection between the spleen and stomach that can lead to life-threatening complications. A GSF can arise spontaneously but is often secondary to a variety of etiologies. Most commonly, GSFs arise from gastric or splenic non-Hodgkin diffuse large B-cell lymphomas (DLBCL). Only 46 cases of GSFs have been published to date, and due to its rarity extensive literature review is insufficient for characterization of GSFs.Case report: This case discusses a patient with intermittent abdominal pain and weight loss, which led to the diagnosis and treatment of a GSF and DLBCL. The patient later went into remission for his DLBCL but succumbed to respiratory failure from a secondary abdominal-pleural fistula formation. Gastrosplenic fistulas have the potential to cause fatal, massive, upper gastrointestinal hemorrhages, infections, other fistulas, or esophageal obstructions. A delay in diagnosis corresponds with a higher morbidity and mortality; thus, prompt detection and treatment are imperative. The management of GSFs is complex and requires a multidisciplinary approach to care.Conclusion: In this report we review GSFs in the emergency care setting with the goal of increasing awareness to facilitate their diagnosis.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"9 2","pages":"161-164"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Case Report: ST-Elevation Myocardial Infarction in Third Trimester Pregnancy. 病例报告：st段抬高型心肌梗死在妊娠晚期。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2025-05-01 DOI: 10.5811/cpcem.41487

Luis Martinez, Emmelyn J Samones, Michael Kiemeney, William Michael Downes

{"title":"Case Report: ST-Elevation Myocardial Infarction in Third Trimester Pregnancy.","authors":"Luis Martinez, Emmelyn J Samones, Michael Kiemeney, William Michael Downes","doi":"10.5811/cpcem.41487","DOIUrl":"10.5811/cpcem.41487","url":null,"abstract":"Introduction: While rare in pregnancy, acute coronary syndrome (ACS) does happen. It has been found to be more common in individuals with risk factors. A case of chest pain in a previously healthy female in her third trimester demonstrates the importance of keeping ACS high on the differential list.Case report: A 26-year-old pregnant female gravida five, para three at 37 weeks gestation with a past medical history of diet-controlled gestational diabetes, obesity, and family history of myocardial infarction (MI) presented to an outside hospital for chest pain and was transferred to the closest ST-elevation myocardial infarction (STEMI) receiving emergency department (ED) after she was found to have an electrocardiogram (ECG) concerning for acute STEMI. On arrival to the ED, STEMI protocol was activated based on ST-segment elevations on inferior and antero-lateral leads on the ECG. Bedside assessment of the fetus by obstetrics showed a viable intrauterine pregnancy, and the patient was taken to the cardiac catheterization lab. She was found to have a 100% thrombotic occlusion in the ostium of the right posterolateral artery, and percutaneous coronary intervention was performed. The patient was discharged with plans for cesarean section at 39 weeks.Conclusion: This case highlights the need for early STEMI activation and consultation with obstetrics when a pregnant patient presents with an ECG suggestive of STEMI. It also emphasizes the importance of maintaining a high level of suspicion for STEMI in pregnant patients presenting with chest pain. Although rare-0.6 in 10,000 pregnancies-mortality rates range from 5.1-37% throughout pregnancy and postpartum. It is important to remember that pregnancy does not preclude a patient from undergoing standard treatment of acute MI.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"9 2","pages":"232-235"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Successful Treatment of Paradoxical Vocal Cord Motion with Sub-dissociative Dose Ketamine: Case Report. 亚游离剂量氯胺酮成功治疗声带矛盾运动一例报告。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2025-05-01 DOI: 10.5811/cpcem.24830

Keaton Cameron-Burr, Elizabeth Terry-Kantor, Taneshia Wilson

{"title":"Successful Treatment of Paradoxical Vocal Cord Motion with Sub-dissociative Dose Ketamine: Case Report.","authors":"Keaton Cameron-Burr, Elizabeth Terry-Kantor, Taneshia Wilson","doi":"10.5811/cpcem.24830","DOIUrl":"10.5811/cpcem.24830","url":null,"abstract":"Introduction: Paradoxical vocal cord motion (PVCM) is a primarily neuropsychiatric condition that causes inappropriate adduction of the vocal cords during respiration. This condition is commonly misdiagnosed and treated as refractory asthma or upper airway obstruction requiring intensive care unit-level of care. Recent expert opinion suggests that ketamine administration may promote PVCM symptom resolution; however, this phenomenon has not yet been documented in the literature.Case report: This is the case of a 23-year-old female who presented to the emergency department (ED) with acute PVCM exacerbation. After failing to respond to standard-of-care therapies including benzodiazepines, the patient was administered intravenous, sub-dissociative dose ketamine, which led to symptom resolution and discharge.Conclusion: Sub-dissociative dose ketamine may be a safe and effective therapy for PVCM exacerbations in the ED. In this report we explore the patient factors that likely mediated the clinical outcome in this case.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"9 2","pages":"169-172"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Unraveling an Enigmatic Triad: A Case Report of Concurrent Neurosyphilis, Ocular Syphilis, and Otosyphilis in a Patient with HIV. 解开一个神秘的三位一体：一个HIV患者并发神经梅毒、眼梅毒和耳梅毒的病例报告。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2025-05-01 DOI: 10.5811/cpcem.21309

Peter Njouda Shitebongnju, Alexander A Bobrov

{"title":"Unraveling an Enigmatic Triad: A Case Report of Concurrent Neurosyphilis, Ocular Syphilis, and Otosyphilis in a Patient with HIV.","authors":"Peter Njouda Shitebongnju, Alexander A Bobrov","doi":"10.5811/cpcem.21309","DOIUrl":"10.5811/cpcem.21309","url":null,"abstract":"Introduction: Patients with HIV disease, regardless of the phase of infection, can present with overlapping stages and less distinct signs of syphilis, complicating diagnosis and treatment. Treponema pallidum, the bacterium responsible for syphilis, can lead to neurosyphilis, ocular syphilis, and otosyphilis when left untreated. Therefore, early detection of syphilis coinfection in HIV patients and timely treatment have demonstrated prompt improvement of symptoms, mitigating the risk of serious complications.Case report: We report the case of a 39-year-old previously incarcerated male with a significant history of HIV on antiretroviral therapy and previous methamphetamine abuse referred to the emergency department from an ophthalmologist with a diagnosis of anterior uveitis and papilledema. The patient reported experiencing blurry vision, tinnitus, and memory difficulties. A thorough history and physical examination, along with diagnostic procedures, including lumbar puncture and cerebrospinal fluid analysis, corroborated the diagnosis of neurosyphilis with otic and ocular involvement. The patient underwent a 14-day course of intravenous aqueous crystalline penicillin G, resulting in symptom improvement.Conclusion: Given the prevalence of syphilis and its diverse manifestations, clinicians must maintain a high index of suspicion in patients who engage in high-risk behaviors to facilitate early diagnosis and treatment, which are crucial for optimal outcomes and enhanced prognosis.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"9 2","pages":"173-177"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

BRASH Syndrome in the Absence of Chronic Kidney Disease: A Case Report. 无慢性肾脏疾病的BRASH综合征1例报告

Clinical Practice and Cases in Emergency Medicine Pub Date : 2025-05-01 DOI: 10.5811/cpcem.38090

Anthony Zaffino, Amanda Polsinelli, Adam Purdy

引用次数: 0

Fusobacterium necrophorum Brain Abscess Following Invasive Sinusitis in an Immunocompetent Adult: A Case Report. 免疫功能正常成人侵袭性鼻窦炎致坏死梭杆菌脑脓肿1例报告。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2025-05-01 DOI: 10.5811/cpcem.33523

Andres V Somoza, Christina T Hanos, Jesse W St Clair, Courtney L James

{"title":"Fusobacterium necrophorum Brain Abscess Following Invasive Sinusitis in an Immunocompetent Adult: A Case Report.","authors":"Andres V Somoza, Christina T Hanos, Jesse W St Clair, Courtney L James","doi":"10.5811/cpcem.33523","DOIUrl":"10.5811/cpcem.33523","url":null,"abstract":"Introduction: A brain abscess is a localized collection of purulent infection within the brain parenchyma. It most often occurs due to contiguous spread from sinus, otogenic, and odontogenic infections; however, it can also develop from direct intracranial contact via trauma or surgery. Fusobacterium necrophorum, an obligate anaerobic, gram-negative bacillus, is part of the normal flora of the oral cavity. Given its inherent location, F necrophorum has been shown to contribute to complications stemming from infection of the tonsils, pharynx, and teeth. Invasive infections of F necrophorum are seldomly seen in immunocompetent patients.Case report: We report a case of a previously healthy 20-year-old man who presented to our emergency department with headache, facial pain, and neck stiffness. He was ultimately found to have an F necrophorum intracranial abscess and underwent right frontal craniotomy with evacuation of epidural abscess and partial sinus obliteration. He was placed on broad-spectrum antibiotics, including vancomycin, cefepime, and metronidazole for six weeks. His treatment course was complicated by recurrence of intraparenchymal abscess requiring repeat craniotomy with abscess evacuation and advancement of antibiotic regimen to meropenem. To our knowledge, there are no reported cases in the literature of monomicrobial F necrophorum brain abscesses arising secondary to invasive sinusitis in immunocompetent adults.Conclusion: This report highlights the clinical presentation, diagnostic strategies, management challenges, clinical outcomes, and complications of invasive sinusitis leading to brain abscess formation in an otherwise healthy adult male.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"9 2","pages":"149-153"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Inferior Vena Cava Tumor Thrombus in the Emergency Department: A Case Report. 急诊科下腔静脉肿瘤血栓1例

Clinical Practice and Cases in Emergency Medicine Pub Date : 2025-05-01 DOI: 10.5811/cpcem.38065

Victor Cisneros, Leila Danishgar, Nisan Verma, Ami Kurzweil

引用次数: 0

Lidocaine for Sodium Channel Toxicity in Diphenhydramine Overdose: Case Report. 利多卡因治疗苯海拉明过量钠通道毒性：病例报告。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2025-05-01 DOI: 10.5811/cpcem.41491

Kassem Makki, David Mandil, Roger Hopson, Maxim Kashin, Roger Rothenberg, Noah Reisman, Brenna Farmer

{"title":"Lidocaine for Sodium Channel Toxicity in Diphenhydramine Overdose: Case Report.","authors":"Kassem Makki, David Mandil, Roger Hopson, Maxim Kashin, Roger Rothenberg, Noah Reisman, Brenna Farmer","doi":"10.5811/cpcem.41491","DOIUrl":"10.5811/cpcem.41491","url":null,"abstract":"Introduction: Diphenhydramine overdose is a growing concern, particularly among adolescents influenced by online challenges. Traditionally managed with supportive care and sodium bicarbonate, severe cases may exhibit refractory symptoms due to sodium channel toxicity, necessitating alternative treatments.Case report: A 28-year-old male with a history of anxiety and depression presented to the emergency department unresponsive, next to an empty bottle of diphenhydramine and wine bottles. Vital signs indicated hypotension and hypoxia. The patient was intubated and administered vasopressors. Initial electrocardiogram (ECG) showed a widened QRS complex and terminal R wave in lead aVR, suggesting sodium channel blockade. Treatment with multiple boluses of sodium bicarbonate was ineffective. Lidocaine (95 milligrams intravenously) was administered, resulting in improved ECG findings and patient stabilization. Subsequent care focused on supportive measures and treatment for aspiration pneumonia. The patient was extubated on day two and discharged on day seven to a behavioral health facility.Conclusion: This case underscores the effectiveness of lidocaine as a secondary treatment for diphenhydramine-induced sodium channel toxicity when standard sodium bicarbonate therapy fails. Lidocaine's ability to restore myocardial conduction illustrates its potential as a critical intervention in toxicological emergencies.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"9 2","pages":"223-227"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0