Clinical Practice and Cases in Emergency Medicine最新文献_第2页

Catecholaminergic Polymorphic Ventricular Tachycardia in a 16-year-old: Case Report. 16岁儿童儿茶酚胺能多形性室性心动过速一例报告。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2025-05-01 DOI: 10.5811/cpcem.34847

John Wahhab, Ani Oganesyan, Krishi Korrapati

{"title":"Catecholaminergic Polymorphic Ventricular Tachycardia in a 16-year-old: Case Report.","authors":"John Wahhab, Ani Oganesyan, Krishi Korrapati","doi":"10.5811/cpcem.34847","DOIUrl":"10.5811/cpcem.34847","url":null,"abstract":"Introduction: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare, inheritable cardiac disorder associated with stress- or exercise-induced syncope or cardiac arrest in children and young adults. Diagnosis of CPVT is often missed or delayed due to variable presentation and normal cardiac imaging and electrocardiogram results, with about 40% of patients dying within 10 years of diagnosis. This case underscores the importance of cross-departmental communication when managing complex pediatric cases, especially when using an interpreter.Case report: A 16-year-old male presented to the hospital with cardiac arrest in ventricular fibrillation following collapse despite a history of treatment with flecainide and nadolol. He was resuscitated, stabilized with antiarrhythmic drips, received an implantable cardioverter defibrillator, and was discharged neurologically intact nine days later. It is vital for physicians to consider CPVT in young patients with syncope to prevent errors in diagnosis of this highly fatal disease.Conclusion: Catecholaminergic polymorphic ventricular tachycardia is a rare genetic disease with significant morbidity and mortality. Treatment decisions for acute CPVT often occur without prior knowledge of the disease; so, in patients diagnosed with CPVT, physicians should implement appropriate therapeutic options to prevent future cardiac events. For patients who remain symptomatic despite compliance with beta blockers and/or other antiarrhythmic therapy, interventions such as placement of an implantable cardioverter defibrillator or sympathetic denervation may be necessary to prevent life-threatening arrhythmias. This case also underscores the importance of obtaining a detailed family history and coordinating care with other physicians in cases where history is limited.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"9 2","pages":"220-222"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119972","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: 2-PAM or not 2-PAM. 病例报告：2-PAM或非2-PAM。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2025-05-01 DOI: 10.5811/cpcem.39703

Madelyn Huttner, Kahra Nix, Caitlyn Blair, Matthew Eisenstat

{"title":"Case Report: 2-PAM or not 2-PAM.","authors":"Madelyn Huttner, Kahra Nix, Caitlyn Blair, Matthew Eisenstat","doi":"10.5811/cpcem.39703","DOIUrl":"10.5811/cpcem.39703","url":null,"abstract":"Introduction: Organophosphates (OP) are used as pest control agents worldwide and have been seen in accidental and intentional poisonings.Case report: A patient presented after intentional ingestion of the OP Orthene (50% acephate). Due to copious secretions, the patient was intubated and given atropine by the paramedic before transport. In the emergency department he displayed both muscarinic and nicotinic effects from OP ingestion. The patient was given multiple doses of atropine and a pralidoxime bolus. He was extubated and transferred to psychiatry two days later.Conclusion: Acute OP exposure is a rare but complex presentation in the United States. In the United States there are bans on several organophosphate varieties, which have reduced the number and severity of OP toxicities. Acephate is generally considered a safer OP by United States regulators and the World Health Organization. In this case report, we describe an OP exposure with marked symptoms requiring intubation and successful treatment with atropine and pralidoxime. We also discuss the role of oximes in acephate toxicity.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"9 2","pages":"203-206"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121077","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 Case Report of a Rare, but Important, Cause of Delerium Presenting to an Emergency Department. 急诊科报告一例罕见但重要的谵妄病因。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2025-05-01 DOI: 10.5811/cpcem.31059

Daniel G Miller

引用次数: 0

Bell Palsy Mimics: Lessons from Four Malpractice Cases. 贝尔麻痹模拟：从四个医疗事故案例中吸取教训。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2025-05-01 DOI: 10.5811/cpcem.38451

Rachel Lindor, Summer Ghaith

{"title":"Bell Palsy Mimics: Lessons from Four Malpractice Cases.","authors":"Rachel Lindor, Summer Ghaith","doi":"10.5811/cpcem.38451","DOIUrl":"10.5811/cpcem.38451","url":null,"abstract":"Introduction: Bell palsy, an idiopathic dysfunction of the seventh cranial nerve, is the leading cause of unilateral facial paralysis, although other more serious entities such as stroke, infection, and tumor may present similarly, leading to both medical and legal risks in cases of misdiagnosis.Case series: We present four malpractice cases revolving around misdiagnosis of Bell palsy. These cases alleged failure to diagnose, failure to obtain informed consent, and failure to provide appropriate discharge instructions. Outcomes ranged from a jury verdict in favor of the physician, to an out-of-court settlment for $400,000, to a jury verdict in favor of the patieint for over $3.1 million.Conclusion: Bell palsy is the most common cause of unilateral facial paralysis. While the diagnosis can be made at the bedside without advanced testing, doing so requires a clear understanding of the pathophysiology of the disease, an appreciation for the role of advanced diagnostics, and thorough documentation of a supportive history and physical exam. Misdiagnosis or mismanagement confers both clinical and legal risks.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"9 2","pages":"125-128"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121057","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

Chronic Nitrous Oxide Toxicity Despite Elevated Serum Vitamin B₁₂ Level: A Case Report. 尽管血清维生素B12水平升高，慢性氧化亚氮中毒：一例报告。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2025-05-01 DOI: 10.5811/cpcem.39674

Jessica Graves, John Hafner

{"title":"Chronic Nitrous Oxide Toxicity Despite Elevated Serum Vitamin B12 Level: A Case Report.","authors":"Jessica Graves, John Hafner","doi":"10.5811/cpcem.39674","DOIUrl":"10.5811/cpcem.39674","url":null,"abstract":"Introduction: Nitrous oxide (N2O) toxicity is an uncommon but important-to-recognize presentation of neurologic deficits and hematologic abnormalities, which may never resolve in some patients. In the United States, nitrous oxide is legal to possess and easily obtainable for purchase in stores and online. Nitrous oxide abuse and its long-term sequelae must be recognized by the emergency physician to ensure proper follow-up and maximize neurologic outcomes.Case report: A 28-year-old male with past medical history of alcoholism and polysubstance abuse presented to the emergency department with progressive paresthesias, shortness of breath, and neurologic complaints following daily inhalation of N2O for three weeks. He was diagnosed with N2O toxicity due to functional vitamin B12 deficiency in the setting of elevated B12 levels from prophylactic self-supplementation.Conclusion: While most recreational users of nitrous oxide will experience transient neurologic symptoms resolving within minutes of cessation, frequent or heavy users may develop permanent neurotoxicity. Exposed patients require close follow-up with neurology and vitamin B12 supplementation to maximize neurologic recovery. In this patient, there was persistence of neurologic symptoms over 24 hours after cessation of use despite self-supplementation of vitamin B12.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"9 2","pages":"134-137"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120205","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 Point-of-care Ultrasound for Placement of a Gastric Tamponade Balloon. 使用即时超声放置胃填塞球囊。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2025-05-01 DOI: 10.5811/cpcem.24999

Patrick Minges, Martina Diaz McDermott, Jazmyn Shaw

{"title":"Use of Point-of-care Ultrasound for Placement of a Gastric Tamponade Balloon.","authors":"Patrick Minges, Martina Diaz McDermott, Jazmyn Shaw","doi":"10.5811/cpcem.24999","DOIUrl":"10.5811/cpcem.24999","url":null,"abstract":"Case presentation: A 30-year-old female with a history of alcoholic cirrhosis and esophageal varices presented with massive hematemesis. A gastric balloon tamponade device was subsequently placed to temporize variceal hemorrhage, and point-of-care ultrasound (POCUS) was used to confirm the appropriate placement of the gastric balloon before complete inflation. We describe a novel use of ultrasound for use in severely ill patients with gastrointestinal (GI) bleeding.Discussion: A fluid-filled and distended stomach has long been recognized as a cause of a false-positive focused assessment with sonography in trauma exam but may also be a vital piece of information in the scenario of a patient with suspected upper GI hemorrhage. There is very little description in the literature of using POCUS to confirm the appropriate placement of a gastric tamponade balloon with none by emergency physicians.. Ultrasound may offer advantages over plain radiography in this application given its speed and safety; thus, its utility for this task is worth further investigation.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"9 2","pages":"239-241"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120986","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 of Post-Appendectomy Fungal Osteomyelitis: A Rare Complication in a Healthy Patient. 阑尾切除术后真菌性骨髓炎病例报告：一种罕见的健康并发症。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2025-05-01 DOI: 10.5811/cpcem.35473

Cameron Juybari, Andras Muranyi, Emmelyn J Samones, Mindi Guptill

{"title":"Case Report of Post-Appendectomy Fungal Osteomyelitis: A Rare Complication in a Healthy Patient.","authors":"Cameron Juybari, Andras Muranyi, Emmelyn J Samones, Mindi Guptill","doi":"10.5811/cpcem.35473","DOIUrl":"10.5811/cpcem.35473","url":null,"abstract":"Introduction: Osteomyelitis is a bone infection that presents with swelling, erythema, pain, and possible systemic symptoms. Immunocompromised patients are at higher risk of developing osteomyelitis. Fungal pathogens are a rare etiology for these infections with very few case reports published compared to infections due to bacterial pathogens. Work up should include imaging studies to investigate infections when there is clinical suspicion for osteomyelitis. Bone biopsy is performed to identify the causative agent with bacterial infections being the most common. Osteomyelitis can be treated both surgically with debridement or amputation and medically with extended courses of antimicrobials or antifungals. Our case describes fungal foot osteomyelitis after an uncomplicated appendectomy.Case report: A 19-year-old previously healthy female underwent laparoscopic appendectomy for nonperforated, non-gangrenous appendicitis. Fourteen days later, she developed gradually worsening right foot pain, swelling, and erythema. After multiple failed treatments for the management of osteomyelitis, bone biopsies and courses of antibiotics, patient was ultimately diagnosed with a rare osteomyelitis secondary to Coccidioides species, which was managed and improved with antifungals.Conclusion: Bacterial osteomyelitis has been described in two English case reports as a postoperative complication of appendectomy, particularly when the appendicitis is perforated, gangrenous, or purulent. Fungal osteomyelitis is an even rarer cause of postoperative bone infection in immunocompetent patients. The goal for treatment is surgical intervention or pharmacologic management. Emergency department physicians should maintain a high suspicion for fungal osteomyelitis when otherwise healthy patients present multiple times for failing outpatient antibiotic regimens.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"9 2","pages":"141-145"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121100","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

Unusual Complications in Cocaine Stuffers: A Case Report. 可卡因填充物的异常并发症：一例报告。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2025-05-01 DOI: 10.5811/cpcem.39681

Hassan Al-Balushi, Andres Guzman-Soto, Kyle Suen, Al Yaqdhan Al Atbi, Ziad Kazzi, Jonathan de Olano, Todd Taylor

{"title":"Unusual Complications in Cocaine Stuffers: A Case Report.","authors":"Hassan Al-Balushi, Andres Guzman-Soto, Kyle Suen, Al Yaqdhan Al Atbi, Ziad Kazzi, Jonathan de Olano, Todd Taylor","doi":"10.5811/cpcem.39681","DOIUrl":"10.5811/cpcem.39681","url":null,"abstract":"Introduction: Body stuffing is defined as ingesting small quantities of drugs in poorly sealed packets, often to avoid repercussions from law enforcement. Cocaine is one of the drugs most commonly involved. Complications reported with stuffing include aspiration, esophageal obstruction, and fatal toxicity. Survival from mechanical airway obstruction due to drug stuffing has not been reported.Case report: We present a case of a 32-year-old male who was a cocaine body stuffer, complicated by agitated delirium, cardiotoxicity, and airway obstruction requiring resuscitation, followed by a surgical tracheostomy to retrieve the obstructing cocaine bag. The patient's hospital course was further complicated by rhabdomyolysis and acute kidney injury requiring dialysis. He was discharged in stable condition after a four-week hospital stay.Conclusion: This case highlights the severe risks of cocaine body stuffing, including airway obstruction and cocaine-induced arrhythmias. Endotracheal intubation in such cases warrants a careful airway assessment to mitigate the risks of obstructive complications.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"9 2","pages":"193-195"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120923","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 Case of Prehospital Magnesium Sulfate Extravasation. 院前硫酸镁外渗1例。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2025-05-01 DOI: 10.5811/cpcem.34874

Sean Bilodeau, Michael Bohanske, Kate Zimmerman, Eric Wellman, Matthew Sholl

{"title":"A Case of Prehospital Magnesium Sulfate Extravasation.","authors":"Sean Bilodeau, Michael Bohanske, Kate Zimmerman, Eric Wellman, Matthew Sholl","doi":"10.5811/cpcem.34874","DOIUrl":"10.5811/cpcem.34874","url":null,"abstract":"Case presentation: A 73-year-old female with chronic obstructive pulmonary disease presented via emergency medical services (EMS) for shortness of breath. She was found to be hypoxic, tachypneic, and in notable distress by EMS. She was treated with inhaled albuterol, oral dexamethasone, and intravenous (IV) magnesium sulfate. Upon arrival to the emergency department her left hand was noted to have significant bleeding, and on further investigation it was determined that the IV catheter had inadvertently become dislodged causing medication extravasation, causing the magnesium to enter the subcutaneous space. The bleeding was significant and noted to be pulsatile; a tourniquet was applied; vascular damage was noted and was ultimately ligated by the trauma surgery service.Discussion: Intravenous medication administration is ubiquitous with emergency care in both the hospital and prehospital environments. Medication use is paramount to treatment of a vast majority of emergent clinical conditions; furthermore, the route of administration is often via IV in the patient with emergent illness. The placement of IV catheters is a skill that nurses, paramedics, and advanced emergency medical technicians learn early in their training. The care team is tasked with starting IV lines but also in monitoring them and ensuring medication is delivered into the systemic circulation and not elsewhere. Certain medications, notably potassium preparations and vasoactive medications, are known vesicants. We present a case of vascular extravasation of magnesium sulfate, not known for causing tissue damage, which led to significant vascular injury. This case highlights the need for prehospital professionals as well as members of the emergency department care team to be ever vigilant for medication extravasation.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"9 2","pages":"245-247"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121086","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

The Jaw-Locking Case of a Missed Tetanus Booster. 破伤风助推器漏诊的颌锁病例。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2025-05-01 DOI: 10.5811/cpcem.33516

Erica Westlake, Katherine Billings, Ann McMoran, Katherine Selman, Sarab Sodhi

{"title":"The Jaw-Locking Case of a Missed Tetanus Booster.","authors":"Erica Westlake, Katherine Billings, Ann McMoran, Katherine Selman, Sarab Sodhi","doi":"10.5811/cpcem.33516","DOIUrl":"10.5811/cpcem.33516","url":null,"abstract":"Introduction: Tetanus is a now rare disease due to the widespread administration of scheduled and prophylactic vaccines, making it exceptionally uncommon to appear in many emergency departments. Clinical suspicion alone is used to make the diagnosis as there are currently no immediately available diagnostic tests available to the clinician. If left unrecognized and untreated, however, tetanus can lead to airway compromise and death.Case report: We report a case of a young male who presented to the emergency department with intermittent full body spasms and stiffness of the masseter muscles in the setting of recent assaults and lacerations weeks prior who had not received tetanus since 2008. Immediate calls were placed to infectious disease consultants and the patient was treated with intravenous immunoglobulin, tetanus immunization, metronidazole, and ceftriaxone. Further work up revealed rhabdomyolysis, elevated lactate, and unremarkable imaging.Conclusion: Following treatment, the patient's symptoms improved to resolution with completion of therapy, effectively confirming the diagnosis of tetanus.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"9 2","pages":"154-156"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120918","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