Clinical Practice and Cases in Emergency Medicine最新文献

Dynamic Supraglottic Airway Collapse Diagnosed Using Airway Point-of-care Ultrasound: A Case Report. 动态声门上气道塌陷诊断气道即时超声：1例报告。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2026-08-01 DOI: 10.5811/cpcem.61946

Arihant Jain, Anas Mohammed Muthanikkatt, S Manu Ayyan

{"title":"Dynamic Supraglottic Airway Collapse Diagnosed Using Airway Point-of-care Ultrasound: A Case Report.","authors":"Arihant Jain, Anas Mohammed Muthanikkatt, S Manu Ayyan","doi":"10.5811/cpcem.61946","DOIUrl":"10.5811/cpcem.61946","url":null,"abstract":"Introduction: Acquired idiopathic laryngomalacia causing dynamic airway collapse is rare in adolescents and may be overlooked because it mimics more common causes of acute dyspnoea and stridor in the emergency department (ED). Airway point-of-care ultrasound (POCUS) provides a rapid, non-invasive means to visualize dynamic supraglottic obstruction when laryngoscopy is not immediately feasible or tolerated.Case report: A 13-year-old boy presented with sudden-onset respiratory distress and dyspnoea that worsened on lying flat and improved when sitting upright, without history of fever, trauma, allergy, or foreign body aspiration, and with similar prior self-limiting episodes. He was anxious with nasal flaring, subcostal retractions, tachypnoea, tachycardia, distended neck veins, and a squeaky tracheal inspiratory sound, yet he maintained normal oxygen saturation with equal air entry on auscultation. Airway POCUS showed abnormal downward displacement of the epiglottis with every distressful inspiration, indicating dynamic airway collapse, and non-contrast computed tomography of the neck demonstrated a heart-shaped, mid-epiglottis deformity consistent with acquired idiopathic laryngomalacia. The patient was given supportive treatment to reduce mucosal oedema, resulting in gradual symptom resolution, and after two days of observation and otorhinolaryngology evaluation he was discharged in stable condition.Conclusion: Acquired idiopathic laryngomalacia should be considered in adolescents with unexplained positional respiratory distress and discordant findings of significant work of breathing but preserved oxygenation. Airway point-of-care ultrasound can delineate real-time dynamic laryngeal abnormalities at the bedside, thereby facilitating early diagnosis and appropriate management of dynamic airway collapse in the emergency department.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"328-332"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13517970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148832785","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

Emergency Department Presentation of Duloxetine-induced Acute Extrapyramidal Symptoms: A Case Report. 度洛西汀致急性锥体外系症状的急诊科报告1例

Clinical Practice and Cases in Emergency Medicine Pub Date : 2026-08-01 DOI: 10.5811/cpcem.56947

Michael W Shulby, Christina M Powell

引用次数: 0

Purulent Pericarditis Identified with Point-of-Care Echocardiography: A Case Report. 点位超声心动图诊断化脓性心包炎1例报告。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2026-08-01 DOI: 10.5811/cpcem.62984

Daniel Baquet, Aaron Blevins, Dillon Casey, Casey Glass, Jordan Seaback, Jacob Schoeneck

{"title":"Purulent Pericarditis Identified with Point-of-Care Echocardiography: A Case Report.","authors":"Daniel Baquet, Aaron Blevins, Dillon Casey, Casey Glass, Jordan Seaback, Jacob Schoeneck","doi":"10.5811/cpcem.62984","DOIUrl":"10.5811/cpcem.62984","url":null,"abstract":"Introduction: Purulent pericarditis is a rare subset of pericarditis that can result in serious morbidity and mortality. Presenting symptoms are often nonspecific, and a high index of suspicion must be maintained to reach an early diagnosis. Point-of-care ultrasound can be pivotal in the emergency department evaluation of purulent pericarditis, providing key information including characteristics of the effusion and a sonographic assessment for signs of tamponade. We present a case of purulent pericarditis first detected using point-of-care ultrasound in the emergency department.Case report: A 55-year-old male presented with chest pain and dyspnea and was found to have cardiac tamponade secondary to purulent pericarditis.Conclusion: Cases of purulent pericarditis are rare but should be recognized by emergency clinicians. Point-of-care ultrasound is a powerful tool to assist in early diagnosis of pericardial effusion, allowing assessment for signs of cardiac tamponade. Early management with broad spectrum antibiotics and cardiology consultation are mainstays of treatment and can significantly improve outcomes.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"388-391"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833057","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

A Diagnostic Pitfall in the Emergency Department -Aortic Dissection Masquerading as Acute Paraplegia: A Case Report. 急诊科的诊断陷阱——主动脉夹层伪装成急性截瘫1例报告。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2026-08-01 DOI: 10.5811/cpcem.61883

Sindujaa Nagarajan, Ezhilkugan Ganessane, B G Kowsthubha, Anukarthika Somasundaram, Nathan Balamurugan

{"title":"A Diagnostic Pitfall in the Emergency Department -Aortic Dissection Masquerading as Acute Paraplegia: A Case Report.","authors":"Sindujaa Nagarajan, Ezhilkugan Ganessane, B G Kowsthubha, Anukarthika Somasundaram, Nathan Balamurugan","doi":"10.5811/cpcem.61883","DOIUrl":"10.5811/cpcem.61883","url":null,"abstract":"Introduction: Acute aortic dissection is a life-threatening emergency with a wide spectrum of clinical presentations. Neurological deficits as the initial manifestation of aortic dissection are uncommon and may result in delayed or missed diagnosis. This case describes aortic dissection presenting primarily as acute paraplegia without persistent chest pain or other classic features.Case report: We report a 52-year-old male who presented with sudden-onset paraplegia. Neurological examination revealed flaccid paralysis of both lower limbs, with loss of pain and temperature sensation below the first lumbar dermatome and preserved dorsal column modalities. The patient was hypertensive on presentation. A clinical diagnosis of anterior spinal artery syndrome was made. Contrast-enhanced computed tomography of the chest and abdomen demonstrated a Stanford type A aortic dissection. The patient was counseled regarding the need for urgent surgical repair but declined operative intervention and opted for conservative management. His hospital course was complicated by progressive renal failure, and he subsequently succumbed to it.Conclusion: This case underscores the importance of considering aortic dissection in patients presenting with acute, nontraumatic paraplegia, even in the absence of persistent chest pain or other classic features.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"380-384"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13517984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833071","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

Yellow Granular Material in Hair: A Bedside Clue to Overdose from Cold Medication Containing Acetaminophen. 头发中的黄色颗粒物质：含有对乙酰氨基酚的感冒药过量的床边线索。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2026-08-01 DOI: 10.5811/cpcem.61356

So Sakamoto

{"title":"Yellow Granular Material in Hair: A Bedside Clue to Overdose from Cold Medication Containing Acetaminophen.","authors":"So Sakamoto","doi":"10.5811/cpcem.61356","DOIUrl":"10.5811/cpcem.61356","url":null,"abstract":"Case presentation: A 28-year-old woman was brought to the emergency department after being found collapsed at home. Because she was unable to provide a history, contextual bedside clues were important during the initial assessment. Bright yellow granular material with a medicinal odor was noted adherent to her hair. This unusual finding raised suspicion of overdose with an acetaminophen-containing over-the-counter (OTC) cold medication. Her serum acetaminophen concentration was elevated at 135 micrograms per milliliter, and N-acetylcysteine was promptly administered. She did not develop hepatic injury and was discharged after recovery.Discussion: This case highlights the diagnostic value of visible bedside clues when history is initially unavailable. The yellow residue was not pathognomonic, and no chemical analysis of the material was performed. However, in the context of the increasing incidence of overdoses involving OTC medications in Japan, especially among young women, the finding was clinically sufficient to raise suspicion for possible ingestion of an OTC combination cold medication containing acetaminophen. This mattered because it directly prompted serum acetaminophen measurement and timely antidotal treatment with N-acetylcysteine, which can prevent or mitigate acetaminophen-induced liver injury.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"414-416"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833164","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

Use of Balloon Tamponade Device for Aortoesophageal Fistula: A Case Report. 球囊填塞治疗主动脉食管瘘1例报告。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2026-08-01 DOI: 10.5811/cpcem.62142

Erich Burton, Trenton Wray

{"title":"Use of Balloon Tamponade Device for Aortoesophageal Fistula: A Case Report.","authors":"Erich Burton, Trenton Wray","doi":"10.5811/cpcem.62142","DOIUrl":"10.5811/cpcem.62142","url":null,"abstract":"Introduction: Aortoesophageal fistula is a rare but life-threatening hemorrhagic complication of thoracic endovascular aortic repair. Without intervention, mortality approaches 100%. Our case highlights the utility of using an esophageal-gastric balloon tamponade device for hemostasis.Case report: We report the case of a 70-year-old man who presented after a sentinel episode of hematemesis six days after thoracic endovascular aortic repair. Shortly after admission, the patient developed massive hematemesis and hemorrhagic shock from an aortoesophageal fistula. Hemorrhage was temporarily controlled via bedside placement of a Minnesota tube, a type of balloon tamponade device, by two emergency medicine and critical care physicians, allowing for hemostasis, resuscitation, and definitive diagnosis with esophagogastroduodenoscopy. The device successfully bridged the patient to the operating room, where he underwent definitive endovascular control of the hemorrhage and repair of the aortoesophageal fistula.Conclusion: Our case highlights the utility and pragmatism of using a balloon tamponade device for massive hematemesis in nonvariceal hemorrhage. It also supports the placement of the device for non-variceal hemorrhage by nonspecialists, including critical care and emergency physicians.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"363-366"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833166","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

Elderly Male with a Painful Red Eye. 老年男性有痛苦的红眼。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2026-08-01 DOI: 10.5811/cpcem.6593

Diala Dahdal, Ahmed Nama, Wenyu Deng, Barry Hahn

引用次数: 0

Emergency Department Transvenous Pacemaker Placement Complicated by Tricuspid Mass. 急诊部经静脉放置起搏器并发三尖瓣肿块。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2026-08-01 DOI: 10.5811/cpcem.53214

Kevin Molyneux, Nick Krejchi, Matthew Fulton, Mina Youssef

{"title":"Emergency Department Transvenous Pacemaker Placement Complicated by Tricuspid Mass.","authors":"Kevin Molyneux, Nick Krejchi, Matthew Fulton, Mina Youssef","doi":"10.5811/cpcem.53214","DOIUrl":"10.5811/cpcem.53214","url":null,"abstract":"Case presentation: Temporary transvenous pacemaker placement is frequently performed in the emergency department for the management of symptomatic bradyarrhythmias. We report the case of a 93-year-old male who presented with profound bradycardia, hypotension, and altered mental status requiring emergent pacing. Initial transcutaneous pacing achieved hemodynamic improvement but necessitated escalation to transvenous pacing due to patient discomfort and high current requirements. During attempted transvenous pacemaker placement, resistance was encountered and capture could not be achieved despite appropriate technique. Subsequent cardiology consultation and imaging revealed an undiagnosed tricuspid valve myxoma obstructing catheter advancement.Discussion: This case highlights a rare mechanical complication of transvenous pacemaker placement caused by an intracardiac mass. Awareness of structural cardiac pathology as a potential cause of pacemaker placement failure is critical, particularly when resistance is encountered despite correct procedural technique.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"421-423"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13517983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148832861","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

Nontraumatic First Rib Fracture in a Young Weightlifter Resulting in Winged Scapula: A Case Report. 一名年轻举重运动员非外伤性第一肋骨骨折导致肩胛骨有翼：一例报告。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2026-08-01 DOI: 10.5811/cpcem.49035

Jessica Remy, Nicole Prendergast

{"title":"Nontraumatic First Rib Fracture in a Young Weightlifter Resulting in Winged Scapula: A Case Report.","authors":"Jessica Remy, Nicole Prendergast","doi":"10.5811/cpcem.49035","DOIUrl":"10.5811/cpcem.49035","url":null,"abstract":"Introduction: Shoulder pain is a common emergency department (ED) presentation. Scapular winging is a rare condition often associated with long thoracic nerve injury. This case report describes an even rarer case of dorsal scapular nerve injury caused by a nontraumatic first rib fracture in a young weightlifter, an injury mechanism not previously reported in the literature.Case report: A 17-year-old male presented to the ED with left shoulder pain following weightlifting. Physical examination demonstrated scapular winging, and a clinical diagnosis of dorsal scapular neuropraxia was made. Imaging revealed a nontraumatic first rib fracture. The patient was treated conservatively with nonsteroidal anti-inflammatory drugs and rest, resulting in complete resolution of symptoms within two weeks at clinic follow-up.Conclusion: To our knowledge, this is the first case in the emergency medicine literature of a nontraumatic rib fracture with associated dorsal scapular nerve injury and scapular winging. This case highlights the importance of thorough visual inspection and movement assessment by emergency physicians in patients presenting with shoulder pain, as key findings such as scapular asymmetry and neurologic injuries may otherwise be missed. Recognizing rare injuries like nontraumatic first rib fractures with associated neurologic deficits is critical for timely diagnosis and management, which can lead to excellent outcomes.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"247-251"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833053","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

Ruptured Abdominal Aortic Aneurysm Identified on Point-of-Care Ultrasound. 当场超声诊断腹主动脉瘤破裂。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2026-08-01 DOI: 10.5811/cpcem.61897

Michael H Sherman

引用次数: 0