Clinical Practice and Cases in Emergency Medicine最新文献_第7页

53-year-old Woman with Opsoclonus-Myoclonus Syndrome. 53岁女性伴有眼阵挛-肌阵挛综合征。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2026-05-01 DOI: 10.5811/cpcem.53141

Taylor Stephens, Bryan Imhoff, Janak Patel

引用次数: 0

Fatal Gastric Perforation Caused by Undiagnosed Trichobezoar in an Adolescent: A Case Report. 青少年未确诊毛癣致致致死性胃穿孔1例。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2026-05-01 DOI: 10.5811/cpcem.52931

Mert Gültekin, Ayça Erinmez, Yunus Emre Karpuz

{"title":"Fatal Gastric Perforation Caused by Undiagnosed Trichobezoar in an Adolescent: A Case Report.","authors":"Mert Gültekin, Ayça Erinmez, Yunus Emre Karpuz","doi":"10.5811/cpcem.52931","DOIUrl":"10.5811/cpcem.52931","url":null,"abstract":"Introduction: Trichobezoar is a rare gastrointestinal condition typically caused by ingestion of hair, which most often affects adolescent females. Its clinical presentation is frequently nonspecific, with symptoms such as abdominal pain, constipation, or early satiety, which can delay recognition until severe complications such as obstruction or perforation develop.Case report: We present the case of a 14-year-old girl who developed a massive trichobezoar resulting in gastric perforation and death. She had a three-month history of intermittent constipation and multiple healthcare visits without definitive diagnosis. On arrival to the emergency department, she was in cardiopulmonary arrest. Computed tomography revealed a large intragastric mass with associated pneumoperitoneum. Emergency laparotomy confirmed a trichobezoar with gastric perforation and diffuse peritonitis. Despite prompt surgical and resuscitative intervention, the patient could not be revived.Conclusion: This case underscores the importance for emergency physicians to maintain clinical vigilance when adolescents present with persistent, unexplained gastrointestinal symptoms. Trichobezoar should be considered in the differential diagnosis, even in the absence of psychiatric history. A low threshold for advanced imaging is warranted, as early recognition and intervention may prevent fatal complications such as gastric perforation and septic shock.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 2","pages":"195-199"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353876","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

Point-of-Care Ultrasound After Non-fatal Drowning in Rural Western Nepal: A Case Report. 在尼泊尔西部农村非致命性溺水后的点护理超声：一个病例报告。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2026-05-01 DOI: 10.5811/cpcem.50737

Rochak Kansakar, Elijah J Katz, Justin Zhao, Evan Weldon

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Hemothorax from a Thoracic Chalk-Stick Fracture in Ankylosing Spondylitis: A Case Report. 强直性脊柱炎胸椎粉状骨折致血胸1例。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2026-05-01 DOI: 10.5811/cpcem.47257

Armin Dehkordi, Daniel Aloise, Eric Scheppke, Mary Christodoulou, Grayson Gigliotti, Tony Zitek

{"title":"Hemothorax from a Thoracic Chalk-Stick Fracture in Ankylosing Spondylitis: A Case Report.","authors":"Armin Dehkordi, Daniel Aloise, Eric Scheppke, Mary Christodoulou, Grayson Gigliotti, Tony Zitek","doi":"10.5811/cpcem.47257","DOIUrl":"10.5811/cpcem.47257","url":null,"abstract":"Introduction: Chalk-stick fractures are transverse spinal injuries seen in patients with ankylosing spondylitis due to chronic inflammation and spinal rigidity. These fractures may result from minor trauma and are associated with potentially fatal complications. While spinal fractures in ankylosing spondylitis are well recognized, thoracic chalk-stick fractures complicated by hemothorax from vascular injury remain exceedingly rare. We present a case of an elderly male with ankylosing spondylitis who sustained a thoracic chalk-stick fracture following a ground-level fall, complicated by hemothorax and hemorrhagic shock. This case highlights a rarely reported but life-threatening complication and emphasizes the importance of early imaging and high clinical suspicion in this high-risk population-even after minor trauma.Case report: A 90-year-old male with known history of ankylosing spondylitis presented to the emergency department after a ground-level fall associated with syncope. He had thoracic back pain, dyspnea, and hypotension. Computed tomography revealed a thoracic vertebra 11 chalk-stick fracture with interspinous vascular injury and a large, right-sided hemothorax. The patient underwent emergent chest tube placement, blood transfusion, and vasopressor support, which initially stabilized his condition. However, his hospital course was complicated by multiple comorbidities, and he ultimately died after prolonged critical care.Conclusion: This case illustrates the potential for catastrophic vascular complications from minor trauma in patients with ankylosing spondylitis. Thoracic chalk-stick fractures may result in life-threatening hemothorax and hemorrhagic shock. Emergency physicians should maintain a high index of suspicion and obtain early radiographic imaging to facilitate timely diagnosis and intervention in this high-risk population.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 2","pages":"141-145"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353996","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

Catching Silent Heart Killers-How Bedside Ultrasound Revealed Hidden Endocarditis: A Case Report. 捕捉沉默的心脏杀手——床边超声如何揭示隐藏的心内膜炎：一例报告。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2026-05-01 DOI: 10.5811/cpcem.49037

Reshvinder Dhillon, Sarah McMullin

{"title":"Catching Silent Heart Killers-How Bedside Ultrasound Revealed Hidden Endocarditis: A Case Report.","authors":"Reshvinder Dhillon, Sarah McMullin","doi":"10.5811/cpcem.49037","DOIUrl":"10.5811/cpcem.49037","url":null,"abstract":"Introduction: In this report we highlight the emerging role of pediatric cardiac point-of-care ultrasound (POCUS) in rapidly diagnosing infective endocarditis, using a clinical case as illustration.Case report: A six-year-old girl with a known ventricular septal defect presented with worsening respiratory symptoms, fevers, abdominal pain, and decreased oral intake. Initial POCUS, performed by an emergency physician, indicated a suspicious echogenic mass in the right atrium, prompting formal echocardiography. Further imaging and cultures confirmed infective endocarditis due to methicillin-sensitive Staphylococcus aureus.Conclusion: This case underscores the utility of pediatric cardiac POCUS as a rapid bedside diagnostic tool for infective endocarditis in emergency settings, leading to early diagnosis and management. Although POCUS cannot replace comprehensive echocardiography, its immediate availability significantly accelerates diagnosis and management initiation, particularly in pediatric patients with congenital heart conditions who are at increased risk for the condition. Ongoing training and standardized protocols will enhance its efficacy. Clinicians should recognize the strengths and limitations of POCUS, integrating it into broader diagnostic workflows for pediatric infective endocarditis.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 2","pages":"132-136"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353905","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

Minimally Symptomatic Severe Hyponatremia: Two Case Reports. 轻度症状严重低钠血症2例报告。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2026-05-01 DOI: 10.5811/cpcem.47041

Jordan Richardson, Neha Raukar, Luke Wood

{"title":"Minimally Symptomatic Severe Hyponatremia: Two Case Reports.","authors":"Jordan Richardson, Neha Raukar, Luke Wood","doi":"10.5811/cpcem.47041","DOIUrl":"10.5811/cpcem.47041","url":null,"abstract":"Introduction: Hyponatremia is a common and often vexing electrolyte abnormality seen in the emergency setting. The severity of a patient's symptoms is often dictated by the acuity of hyponatremia development and degree of serum sodium deficit, with patients typically demonstrating more severe neurological symptoms in acute-onset severe hyponatremia. Patients prescribed chlorthalidone are at particular risk of developing hyponatremia, especially in the setting of a secondary insult.Case report: We describe two patients presenting to the emergency department with severe hyponatremia who were taking chlorthalidone. Both patients had clinical symptoms that were mild given the degree of their hyponatremia. Additionally, each patient had a secondary insult affecting their volume status that was an important contributing factor in the development of hyponatremia.Conclusion: Thiazide diuretic use, particularly chlorthalidone, is an important consideration when evaluating patients with new-onset hyponatremia, especially in the setting of excess volume losses or increased consumption of water. These cases demonstrate how patients with severe hyponatremia can present with atypical or mild clinical symptoms and often do not demonstrate significant neurological symptoms such as seizures.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 2","pages":"150-153"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354070","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

Methicillin-Resistant Staphylococcus Aureus Septic Internal Jugular Thrombophlebitis: A Case Report. 耐甲氧西林金黄色葡萄球菌脓毒性颈内静脉血栓性炎1例报告。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2026-05-01 DOI: 10.5811/cpcem.42505

Daniel Kowalczyk, George Ubiñas

引用次数: 0

Atypical Presentation of Metformin-associated Lactic Acidosis: A Case Report. 二甲双胍相关乳酸酸中毒的不典型表现：1例报告。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2026-05-01 DOI: 10.5811/cpcem.50572

Elizabeth Welsch, Jerome Evans, Alexander Yoxall, Anna Culhane

{"title":"Atypical Presentation of Metformin-associated Lactic Acidosis: A Case Report.","authors":"Elizabeth Welsch, Jerome Evans, Alexander Yoxall, Anna Culhane","doi":"10.5811/cpcem.50572","DOIUrl":"10.5811/cpcem.50572","url":null,"abstract":"Introduction: Metformin, a first-line type two diabetes medication, is generally considered safe and effective. However, it is rarely associated with life-threatening lactic acidosis. This generally presents in patients with gastrointestinal upset as a primary complaint. It is most common in patients with underlying chronic kidney disease. Prevention of associated mortality requires early diagnosis and intervention with fluids, bicarbonate, vasopressors, and hemodialysis.Case report: This is a notable presentation of metformin toxicity, as the 68-year-old male patient presented with an atypical chief complaint of dyspnea and no history of kidney disease. Physical exam was notable for tachypnea and clear breath sounds. Labs revealed anion gap metabolic acidosis from an accumulation of lactic acid and acute renal failure. Other causes of lactic acid metabolic acidosis were considered and ruled out. Nephrology was consulted and pharmacological therapies started as the patient transitioned to the intensive care unit for emergent hemodialysis. He eventually regained renal function and was discharged. His metformin level returned several weeks later significantly elevated.Conclusion: Emergency physicians should maintain metformin toxicity on the differential for patients on metformin presenting with dyspnea and anion gap metabolic acidosis with elevated serum lactic acid concentrations. Other sources of lactic acidosis should be ruled out, and corrective therapies, including renal replacement therapies, should be started immediately. Additionally, it is essential to determine a patient's kidney function before being prescribed metformin and to have the patient serially monitored as an outpatient.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 2","pages":"182-186"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353893","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

Pneumocephalus Secondary to Sternutation: A Case Report. 继发肺气肿1例报告。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2026-05-01 DOI: 10.5811/cpcem.48669

Tushar Tejpal, John Ashurst, Danielle Barnett-Trapp

{"title":"Pneumocephalus Secondary to Sternutation: A Case Report.","authors":"Tushar Tejpal, John Ashurst, Danielle Barnett-Trapp","doi":"10.5811/cpcem.48669","DOIUrl":"10.5811/cpcem.48669","url":null,"abstract":"Introduction: Sternutation is a physiological reflex that clears the upper respiratory tract through forceful air expulsion. Although it is typically considered benign, sternutation can generate substantial pressure and airflow that can result in barotrauma, including pneumocephalus.Case report: A 67-year-old female presented with shortness of breath, rhinorrhea, and a headache following sneezing. Physical exam revealed no signs of trauma or neurological deficits but did note clear rhinorrhea bilaterally. Computed tomography (CT) of the head revealed extensive extra-axial intracranial gas bilaterally, and the patient was admitted for further management. While admitted, otolaryngology was consulted and surgically corrected a right cribriform meningoencephalocele with an active cerebrospinal fluid leak. At follow-up the patient had no residual rhinorrhea symptoms or focal neurological findings.Conclusion: One proposed mechanism of sternutation-induced pneumocephalus involves the \"one-way-ball-valve\" effect, whereby elevated sinus pressure during sternutation forces air through a dural defect, trapping it within the cranial cavity. Diagnosis is typically made with non-contrast CT and treatment depends on severity, ranging from conservative oxygen therapy to urgent surgical intervention. Indications on CT, such as the Mount Fuji sign, air bubble sign, and the peaking sign, help differentiate tension pneumocephalus from less severe forms. This case adds to the growing literature on sternutation-induced pneumocephalus and highlights the importance of recognizing sternutation as a potential source for serious intracranial pathology.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 2","pages":"124-127"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354010","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

Atrial Fibrillation in a Young Patient Using High-dose Oral Diclofenac: A Case Report. 服用大剂量双氯芬酸的年轻患者心房颤动1例。

Clinical Practice and Cases in Emergency Medicine Pub Date : 2026-05-01 DOI: 10.5811/cpcem.52890

Sabri Onur Çağlar, Hilal Çağlar, Serdar Hira

{"title":"Atrial Fibrillation in a Young Patient Using High-dose Oral Diclofenac: A Case Report.","authors":"Sabri Onur Çağlar, Hilal Çağlar, Serdar Hira","doi":"10.5811/cpcem.52890","DOIUrl":"10.5811/cpcem.52890","url":null,"abstract":"Introduction: Diclofenac sodium is a widely used medication for its analgesic and anti-inflammatory properties. Although the adverse effects of diclofenac are well described, diclofenac-associated new-onset atrial fibrillation in a young, healthy adult has not been previously reported.Case report: A 22-year-old man with severe pain following an ankle injury used diclofenac sodium at a dose of 50 mg orally three times daily for one week. At the end of the week, he presented to the emergency department (ED) complaining of palpitations for a few hours. The patient had no past medical history. His physical examination revealed no pathologic signs except for tachycardia and an irregularly irregular pulse rate. An electrocardiogram showed an irregularly irregular rhythm with a ventricular rate of 128 beats per minute (bpm) (rapid ventricular response) and absent P waves, consistent with atrial fibrillation. The patient was monitored in the ED, and a standard regimen of intravenous amiodarone was initiated for rate control. Approximately three hours after initiation, sinus rhythm returned and his heart rate stabilized at 60 bpm.Conclusion: This case report describes a possible association between diclofenac use and new-onset atrial fibrillation in a young, previously healthy individual. The findings highlight the need for awareness of the potential arrhythmogenic effects of diclofenac and underscore the importance of taking a careful drug history in patients presenting with unexplained atrial fibrillation.","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 2","pages":"166-169"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353907","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