Clinical Practice and Cases in Emergency Medicine最新文献

{"title":"Incidental Wolff-Parkinson-White Syndrome Discovered Following Dicyclomine Use: A Case Report.","authors":"John Wahhab, Natalie Loveridge, Manar Siaj","doi":"10.5811/cpcem.53127","DOIUrl":"10.5811/cpcem.53127","url":null,"abstract":"<p><strong>Introduction: </strong>Wolff-Parkinson-White syndrome is a congenital conduction disorder involving an accessory pathway that predisposes patients to reentrant tachyarrhythmias and, in rare cases, sudden cardiac death. While often asymptomatic, it may predispose patients to serious tachyarrhythmias, particularly under conditions that enhance atrioventricular (AV) conduction. Risk stratification using noninvasive and invasive tools such as electrophysiologic studies is critical to identifying high-risk individuals and guiding treatment decisions such as catheter ablation. Pharmacologic agents that alter autonomic tone may unmask latent pre-excitation. Dicyclomine, an anticholinergic agent used for gastrointestinal disorders, is not an AV-nodal blocking drug but exerts vagolytic effects that can increase sinus rate and AV nodal conduction. Dicyclomine's vagolytic effects and potential for interaction with other proarrhythmic drugs warrant caution in patients with conduction abnormalities, structural heart disease, or autonomic sensitivity.</p><p><strong>Case report: </strong>We report a case of a 36-year-old male who presented to the emergency department with abdominal symptoms and was incidentally found to have Wolff-Parkinson-White pattern following administration of intramuscular dicyclomine.</p><p><strong>Conclusion: </strong>This case highlights the potential importance of cardiac monitoring, even in patients with non-cardiac chief complaints, particularly when anticholinergic agents are administered.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"280-283"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13517993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148832954","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}

{"title":"Berberine Poisoning with Polymorphic Ventricular Tachycardia: A Case Report.","authors":"Melson P Mesmin, Marit S Tweet, Sharon H Kim, Tyler J Fulks","doi":"10.5811/cpcem.56949","DOIUrl":"10.5811/cpcem.56949","url":null,"abstract":"<p><strong>Introduction: </strong>Natural supplements are readily available without a prescription and are not regulated by the United States Food and Drug Administration. The popularity of berberine, a bioactive compound used for centuries in traditional Chinese medicine, has surged due to its proposed benefits in glycemic control and cardiovascular health. However, use of berberine may lead to possible negative electrophysiologic changes.</p><p><strong>Case report: </strong>A 92-year-old male presented to the emergency department (ED) with chief complaints of tremors, urinary incontinence, and brief syncopal episodes that began approximately two weeks after starting berberine. In the ED he had multiple episodes of polymorphic ventricular tachycardia with pulselessness requiring immediate cardioversion, with a rapid return of spontaneous circulation between episodes. Amiodarone was started; however, despite this, he continued to have persistent episodes. Finally, the episodes resolved after starting lidocaine and isoproterenol in the intensive care unit. The patient's workup was notable for heart rate-corrected QT interval (QTc) prolongation (QTc 616 milliseconds (ms) [male reference range, QTc < 430 ms]) confirming the polymorphic ventricular tachycardia as torsades de pointes. His cardiac evaluation was otherwise normal, including a normal ejection fraction on a transthoracic echocardiogram. Withholding berberine and supportive management resulted in an improved QTc. On hospital day 3, the QTc was 454 ms. The patient had a short inpatient admission and was discharged without any further episodes.</p><p><strong>Conclusion: </strong>Berberine has numerous effects and is purported to have beneficial effects and cardioprotective properties. Due to induced bradycardia and QT prolongation, patients who take berberine can be vulnerable to life-threatening arrhythmias, such as the R-on-T phenomenon in our patient's case. Additional research on berberine is needed to better inform clinician-patient discussions about its use.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"392-394"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13517994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148832196","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}

{"title":"Immunoglobulin A Vasculitis-Associated Ileoileal Intussusception in an Adult Male: Case Report.","authors":"Preet Sawhney, Patrick Frost, Peter Stueve, Eric Boccio","doi":"10.5811/cpcem.63968","DOIUrl":"10.5811/cpcem.63968","url":null,"abstract":"<p><strong>Introduction: </strong>Immunoglobulin A (IgA) vasculitis, formerly known as Henoch-Schönlein purpura, is a small-vessel leukocytoclastic vasculitis caused by IgA immune complex deposition. While it is the most common systemic vasculitis in children, adult cases can present with more severe systemic manifestations. The classic clinical tetrad includes palpable purpura, arthralgia, abdominal pain, and renal involvement. Gastrointestinal symptoms, occurring in approximately two-thirds of cases, result from inflammation of small bowel vessels resulting in bowel wall edema and hemorrhage, which may serve as lead points for intussusception.</p><p><strong>Case report: </strong>A 21-year-old male presented with two days of severe periumbilical abdominal pain, bilateral knee pain, and a nonblanching palpable purpuric rash on his lower extremities. Physical examination revealed a soft but tender abdomen. Lab results were remarkable for leukocytosis. Computed tomography (CT) of the abdomen and pelvis demonstrated small bowel wall thickening and ileoileal intussusception. The patient was initially consented for a partial ileal resection; however, an exploratory laparotomy failed to localize the telescoping segment, suggesting spontaneous resolution. He was observed for 24 hours and discharged with outpatient follow-up.</p><p><strong>Conclusion: </strong>Intussusception is the most common surgical complication of IgA vasculitis. In adults, this condition requires high clinical suspicion and prompt diagnostic imaging with ultrasonography or CT, as small bowel involvement may be inaccessible by contrast enema. This case underscores the importance of recognizing IgA vasculitis-associated intussusception as a critical and potentially self-limiting complication in the adult population.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"399-402"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833046","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}

{"title":"The Floating Threat: A Rare Case Report of Carotid Saddle Thrombus in a Healthy Adult.","authors":"Ariel Droger, Rolando Torres-Castro, Kashan Mahmood, Jason Graf, Sean Serio, Alexander John Scumpia","doi":"10.5811/cpcem.48938","DOIUrl":"10.5811/cpcem.48938","url":null,"abstract":"<p><strong>Introduction: </strong>Carotid free-floating thrombus is a rare and potentially devastating cause of ischemic stroke. Diagnosis remains challenging due to the dynamic nature of the lesion.</p><p><strong>Case report: </strong>We report the case of a 46-year-old female presenting with neck pressure and gait instability, who was found to have a free-floating thrombus at the brachiocephalic-carotid junction. Despite early anticoagulation, she developed biparietal ischemic strokes.</p><p><strong>Conclusion: </strong>This case highlights the challenges in management of carotid free-floating thrombus including appropriate anticoagulation, contraindications to thrombolysis, and the need for multidisciplinary involvement. Emergency physicians must maintain high suspicion for vascular pathology in atypical neurologic presentations and recognize that even optimal medical therapy does not eliminate stroke risk.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"243-246"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13517979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833093","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}

{"title":"Sorely Mistaken-Soft Palatal Myxedema in Decompensated Hypothyroidism Presenting as a Sore Throat: Case Report.","authors":"Gabriella Miller, Bennett Myers","doi":"10.5811/cpcem.53121","DOIUrl":"10.5811/cpcem.53121","url":null,"abstract":"<p><strong>Introduction: </strong>Oropharyngeal myxedema is a rare presenting symptom of decompensated hypothyroidism that can mimic more common causes of sore throat.</p><p><strong>Case report: </strong>We describe a case of an older woman who presented with throat pain and dysphagia, found to have soft palate edema on exam and imaging. Laboratory testing confirmed severe hypothyroidism, and her symptoms eventually resolved with thyroid hormone replacement therapy.</p><p><strong>Conclusion: </strong>This case highlights a rare and under-recognized presentation of a common endocrine disorder. Consider myxedema from severe hypothyroidism in patients with subacute oropharyngeal pain and swelling. Without early recognition and treatment, the patient is at risk for two life-threatening conditions: airway compromise from soft palate myxedema and progression of hypothyroidism to myxedema coma.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"266-268"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833124","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}

{"title":"Use of Corrected QT Cutoffs Derived from Biological Variation to Predict Adverse Events Due to Antipsychotic Drugs: Case Report.","authors":"Alan H B Wu, Melissa Alamillo, Kayla Kendrick","doi":"10.5811/cpcem.48764","DOIUrl":"10.5811/cpcem.48764","url":null,"abstract":"<p><strong>Introduction: </strong>The use of antipsychotic drugs can prolong the corrected QT (QTc) interval of the electrocardiogram and cause a life-threatening ventricular arrhythmia. There is no consensus as to what is considered normal or what cutoff indicates QTc prolongation. However, recent literature has described the biological variation of the QTc interval from healthy subjects, with researchers concluding that the best approach at establishing a normal range is to determine an individual baseline interval during health.</p><p><strong>Case report: </strong>A baseline QTc interval (460 milliseconds) had been determined for a 42-year-old female with a history of schizophrenia and depression who was prescribed antipsychotic drugs including escitalopram, olanzapine, haloperidol, clonazepam and divalproex over the course of four years. Over that time frame, she was admitted on 20 occasions with chest pain, but her QTc interval was at or above her baseline level. Acute coronary syndrome was ruled out for each episode. Her medication history was not altered or discontinued until her QTc was greatly prolonged at 530 milliseconds several years later. Fortunately, she did not suffer torsades de pointes.</p><p><strong>Conclusion: </strong>This case illustrates how results from biological variation studies and a personalized reference level can be helpful to alert physicians earlier of the presence of a potentially toxic condition.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"374-379"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13517987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833194","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}

{"title":"Case Report: Lidocaine Toxicity Presenting with Focal Neurologic Findings.","authors":"Timothy Yeung, Isaac Estrada, Tammy H Phan, Emmelyn J Samones, Sharmin Kalam","doi":"10.5811/cpcem.62132","DOIUrl":"10.5811/cpcem.62132","url":null,"abstract":"<p><strong>Introduction: </strong>Lidocaine toxicity is a rare but potentially dangerous consequence of a frequently used medication. Most commonly, it has generalized neurologic and cardiac effects. Discontinuation of lidocaine is sufficient with less severe symptoms. With more severe symptoms, such as seizures and arrhythmia, intravenous (IV) lipid emulsion therapy can be used. To date, lidocaine toxicity presenting as focal neurologic deficits has rarely been documented in the literature. In the case reported here, the patient was receiving lidocaine injections when she developed palpitations and left arm and facial weakness and numbness, which resolved after IV lipid emulsion therapy.</p><p><strong>Case report: </strong>A 52-year-old female with a past medical history of migraines, cholecystectomy, nephrolithiasis, and hypothyroidism presented to the emergency department (ED) via ambulance from her dental office with acute neurologic symptoms. While receiving an injection of lidocaine intraorally at the dental office, she experienced palpitations and left arm and left facial weakness with numbness. She continued to have symptoms upon arrival to the ED. Given concern for acute stroke, she underwent imaging, which was negative for large vessel occlusions or hemorrhage. She was given IV lipid emulsion therapy for suspected lidocaine toxicity with resolution of symptoms. She was cleared by oral and maxillofacial surgery and discharged with outpatient follow-up.</p><p><strong>Conclusion: </strong>We identified a patient who developed neurologic symptoms during lidocaine administration, with no radiographic evidence for stroke. Given the timing of symptoms and lidocaine administration, we administered IV lipid emulsion therapy with resolution of the patient's symptoms. Thus, we strongly suspect our patient had lidocaine toxicity with focal neurologic findings.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"367-369"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13517975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148832634","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}

{"title":"Differentiating Weakness-an Atypical Presentation of Acute Neuromuscular Paralysis: A Case Report.","authors":"Jack Golder, Lindsay Tjiattas-Saleski","doi":"10.5811/cpcem.53160","DOIUrl":"10.5811/cpcem.53160","url":null,"abstract":"<p><strong>Introduction: </strong>Spinal cord infarction is a rare but critical cause of acute neuromuscular paralysis, accounting for approximately 1.2% of all strokes. Timely diagnosis is essential but challenging due to its clinical overlap with more common etiologies. Failure to promptly identify spinal cord infarction can result in irreversible neurological deficits and missed opportunities for secondary prevention.</p><p><strong>Case report: </strong>A 66-year-old female presented to the emergency department with progressive bilateral limb weakness, numbness, and urinary incontinence. The examination revealed symmetric weakness, impaired coordination, and diffuse sensory loss. She was admitted and empirically treated with intravenous immunoglobulin for suspected atypical acute inflammatory demyelinating polyneuropathy. Despite mild improvement, worsening hyperreflexia and spasticity raised concern for a central process. Cervical magnetic resonance imaging revealed extensive cord edema, and further workup identified a cerebellar infarct and a patent foramen ovale, suggesting an embolic source. Evolving myelomalacia on follow-up imaging confirmed a diagnosis of anterior spinal artery infarction. The patient was started on secondary stroke prevention and discharged to rehabilitation with persistent motor and autonomic deficits.</p><p><strong>Conclusion: </strong>Spinal cord infarction may initially resemble peripheral neuropathy, leading to misdiagnosis and delayed treatment. This case highlights the importance of repeat imaging and reconsideration of central causes in atypical or evolving presentations. Emergency physicians should maintain a high index of suspicion for spinal cord infarction in cases of rapidly progressive paralysis. Early imaging and multidisciplinary evaluation are critical to minimize long-term morbidity.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"295-300"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13517995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148832844","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}

{"title":"Fishing Hook Globe Injury Diagnosed with Point-of-care Ultrasound: A Case Report.","authors":"Jeremy Carter, John Robert Zatarain, Mia Zatarain, Paul Koscumb, Krishna Paul, Dietrich Jehle","doi":"10.5811/cpcem.53929","DOIUrl":"10.5811/cpcem.53929","url":null,"abstract":"<p><strong>Introduction: </strong>Globe injuries constitute true ophthalmologic emergencies and require prompt surgical intervention. When direct physical examination is limited, due to trauma or swelling, point-of-care ultrasound (POCUS) can serve as a valuable adjunct in evaluating globe integrity.</p><p><strong>Case report: </strong>We report the case of a 31-year-old male who presented to the emergency department with a barbed fishing hook embedded in his right eyelid. The patient reported pain localized to the eyelid but denied any visual disturbances or direct eye involvement. On examination, a large fishing hook embedded in the right upper eyelid was visualized. His eye was swollen, and he was unable to fully open it, limiting direct assessment of the globe. Given the limited exam, POCUS of the right eye revealed a foreign body traversing the anterior chamber toward the lens, raising concern for globe injury. Ophthalmology was consulted, and computed tomography of the orbits was obtained. The following morning, the patient underwent surgical removal of the barbed fishing hook and repair of the globe.</p><p><strong>Conclusion: </strong>Point-of-care ultrasonography is a valuable diagnostic adjunct in the evaluation of traumatic eye injuries and useful when physical examination is limited. In this case, POCUS was used to differentiate an intraocular foreign body and globe injury from eyelid foreign body. While POCUS is not routinely recommended in cases of suspected globe rupture, when physical exam is unclear it may be a useful adjunct.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"255-257"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148832881","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}

{"title":"Seven-year-old Girl with Vomiting, Diarrhea, and Decreased Oral Intake.","authors":"Mary Girgis, Kathleen Stephanos, Laura J Bontempo, T Andrew Windsor","doi":"10.5811/cpcem.64687","DOIUrl":"10.5811/cpcem.64687","url":null,"abstract":"<p><p>A seven-year-old girl presented to the pediatric emergency department with three days of nonbloody, nonbilious vomiting, nonbloody diarrhea, and decreased oral intake. She also had weight loss and fatigue over the preceding month. The examination showed persistent tachycardia despite antipyretics and fluids. This presentation addresses the many causes of persistent tachycardia in a child with a diagnostic test sent from the emergency department revealing the ultimate diagnosis.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"227-231"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13517974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833098","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}