Clinical Practice and Cases in Emergency Medicine最新文献

{"title":"Neurotoxic Snakebite Presenting with Early Neck Pain and Muscle Weakness: A Case Report of a Diagnostic Pitfall.","authors":"T Neithiya, Jayan Jayapalan Nair, Krishnadutt Chavali","doi":"10.5811/cpcem.47366","DOIUrl":"10.5811/cpcem.47366","url":null,"abstract":"<p><strong>Introduction: </strong>Neurotoxic envenomation often presents with non-specific neurological symptoms and minimal local signs, which can delay appropriate diagnosis and treatment. This is the first reported case of a neurotoxic snakebite presenting with an atypical symptom of unilateral neck pain.</p><p><strong>Case report: </strong>A 12-year-old girl was referred to our emergency centre with neck weakness progressing to quadriplegia, attributed to a fall while playing. A diagnosis of acute flaccid paralysis secondary to cervical trauma was made and treated at the first hospital; however, she developed respiratory distress and was transferred to our centre. Clinical examination and computed tomography ruled out cervical cord injury. A diagnosis of neurotoxic envenomation was considered, given our centre's high snakebite burden and the symptom of descending flaccid paralysis. Despite initiating antivenom and supportive treatment, the patient died. As the death was sudden and unexplained, medicolegal autopsy was done. Meticulous examination revealed a suspicious mark over the right foot. Chemical analysis on a skin sample from the site tested positive for snake venom, confirming envenomation.</p><p><strong>Conclusion: </strong>This case highlights the diagnostic challenge posed by atypical presentations of neurotoxic snakebite, especially in the absence of a clear history. In endemic areas, flaccid paralysis should prompt clinical suspicion of snakebite. Early recognition and timely administration of antivenom are crucial to prevent fatal outcomes. This case also underscores the need for strengthening diagnostic tools and forensic confirmation to avoid missed or delayed diagnoses, which carry serious medicolegal and public health implications.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 2","pages":"128-131"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354043","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":"Myocardial Crypts on Ultrasound in a Young Female with Exertional Syncope.","authors":"Christopher Allen, Alexandra Gubbels, Youyou Duanmu, Jody Vogel","doi":"10.5811/cpcem.48812","DOIUrl":"10.5811/cpcem.48812","url":null,"abstract":"<p><strong>Case presentation: </strong>A 20-year-old female with no past medical history presented to the emergency department (ED) after an episode of exertional syncope. Physical examination, vital signs, and electrocardiogram were unremarkable. Point-of-care ultrasound revealed abnormal invaginations in the interventricular septum. Laboratory evaluation was significant for markedly elevated troponin concerning for cardiac arrest. She was admitted to cardiology with suspicion for genetic cardiomyopathy. The patient underwent placement of an implantable cardioverter defibrillator after cardiac magnetic resonance imaging redemonstrated the septal invaginations known as myocardial crypts. Genetic studies later revealed sarcomere gene mutations associated with hypertrophic cardiomyopathy.</p><p><strong>Discussion: </strong>Myocardial crypts, which are invaginations within the myocardium, are considered early morphological markers for hypertrophic cardiomyopathy and may precede the development of overt hypertrophy. The presence of myocardial crypts and syncope is highly concerning for evolving hypertrophic cardiomyopathy. In this case, identifying myocardial crypts on ED point-of-care ultrasound, in conjunction with clinical context, facilitated further confirmatory diagnostics and timely intervention with placement of an implantable cardioverter defibrillator.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 2","pages":"211-213"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354031","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":"Bucket Handle Injury in Blunt Abdominal Trauma.","authors":"Bhargavesh Gottam, C Eric McCoy","doi":"10.5811/cpcem.48848","DOIUrl":"10.5811/cpcem.48848","url":null,"abstract":"<p><strong>Case presentation: </strong>A 52-year-old man involved in a high-speed car crash presented with hypotension, abdominal and back pain, and seatbelt bruising. Imaging revealed a mesenteric bucket-handle injury with active bleeding. He received resuscitation and was taken emergently to the operating room for a sigmoid colectomy with primary anastomosis.</p><p><strong>Discussion: </strong>In patients with blunt abdominal trauma, 1-6% are diagnosed with mesenteric or hollow visceral injuries; the bucket handle injury is a subtype of these injuries. These injuries often present subtly and may be missed on initial evaluation, particularly when the extended focused assessment with sonography for trauma is negative. Unexplained hemodynamic instability should prompt further investigation, as delayed diagnosis can lead to bowel ischemia or infarction. Early recognition and surgical intervention are critical to reducing morbidity and mortality in these patients.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 2","pages":"219-221"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353957","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 Value of Point-of-care Ocular Ultrasound in Physician-in-triage Model: A Case Series.","authors":"Christopher Thom, Benton Spirek, Gitansh Bhargava, James Moak","doi":"10.5811/cpcem.50714","DOIUrl":"10.5811/cpcem.50714","url":null,"abstract":"<p><strong>Introduction: </strong>Physician-in-triage (PIT) models have become increasingly common in emergency medicine. The goal is to facilitate rapid patient evaluation and improve key operational emergency department (ED) metrics. However, there is limited time for the PIT encounter, which often involves an abbreviated patient evaluation. Point-of-care ultrasound (POCUS) has been shown to improve patient care and speed diagnosis in a variety of scenarios. Although physicians working within a PIT model must remain mindful of time constraints, POCUS can help identify time-sensitive diagnoses and guide appropriate initial testing during certain encounters. Ocular POCUS can be particularly impactful on timely diagnosis and appropriate deployment of ED resources.</p><p><strong>Case series: </strong>We present three cases of acute monocular vision loss wherein the PIT physician used ocular POCUS to arrive at the correct initial diagnosis. This led to the appropriate deployment of ED stroke and neurology resources in the case of acute central retinal artery occlusion, while avoiding this unnecessary use of these resources in two cases where it was not indicated.</p><p><strong>Conclusion: </strong>Use of point-of-care ultrasound in PIT models should be thoughtfully employed in cases where immediate diagnosis is required, as well as when POCUS results will likely alter subsequent diagnostic testing pathways. Ocular POCUS in PIT can rapidly differentiate neurologic causes of monocular vision loss from primary ophthalmic conditions.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 2","pages":"111-115"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353992","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":"Meningococcemia in a Boy with Dense Deposit Disease Receiving the C5 Complement Inhibitor Ravulizumab: A Case Report.","authors":"Andrew J Gonedes, Alexandra Martinez, Allan M Greissman, Hanan Atia, Eric Boccio","doi":"10.5811/cpcem.52835","DOIUrl":"10.5811/cpcem.52835","url":null,"abstract":"<p><strong>Introduction: </strong>Dense deposit disease, also known as C3 glomerulopathy, is a rare renal disorder caused by abnormal complement deposition in the glomerular basement membrane. Patients often require long-term immunosuppressive therapy and, in some cases, complement inhibitors such as ravulizumab. While effective at limiting renal damage, complement blockade significantly increases susceptibility to invasive infections from encapsulated bacteria, particularly Neisseria meningitidis. Despite immunization and antimicrobial prophylaxis, these patients remain incompletely protected. We describe a case of meningococcemia in a fully vaccinated adolescent with dense deposit disease on ravulizumab therapy.</p><p><strong>Case report: </strong>A 17-year-old male with a history of dense deposit disease on mycophenolate mofetil and ravulizumab presented to the pediatric emergency department with fever, vomiting, altered mental status, and a rapidly evolving petechial-purpuric rash. He was fully immunized with both meningococcal conjugate and serogroup B vaccines. Initial evaluation revealed fever, hypotension, and altered level of consciousness. Laboratory studies showed leukocytosis, elevated inflammatory markers, and blood cultures subsequently confirmed N. meningitidis. Empiric ceftriaxone and vancomycin were initiated, later narrowed to ceftriaxone. Supportive management included intravenous (IV) fluids, vasopressors, IV immunoglobulin, and dexamethasone. The patient demonstrated rapid improvement, with resolution of hemodynamic instability and normalization of kidney function. He was discharged on hospital day eight with prophylactic penicillin and close outpatient follow-up.</p><p><strong>Conclusion: </strong>This case underscores the risk associated with complement inhibition, even in fully vaccinated individuals. Clinicians must maintain high vigilance for meningococcal disease in immunocompromised patients and initiate early aggressive therapy to optimize outcomes.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 2","pages":"174-177"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354067","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":"More than Just a Bag-Purple Urine Bag Syndrome as a Manifestation of Vulnerability in Geriatric Patients: A Case Report.","authors":"Lindsey White, Megan Rivera, Christopher J Nash, Sreeja Natesan","doi":"10.5811/cpcem.50688","DOIUrl":"10.5811/cpcem.50688","url":null,"abstract":"<p><strong>Introduction: </strong>Purple urine bag syndrome (PUBS) is an uncommon yet visually striking condition observed in patients with long-term urinary catheters. It is associated with urinary tract infections caused by bacteria that metabolize tryptophan into indigo and indirubin pigments. Although typically benign, PUBS can signal underlying medical and social vulnerability.</p><p><strong>Case report: </strong>We describe a 78-year-old woman with multiple sclerosis and chronic suprapubic catheterization who presented with failure to thrive and concerns for caregiver fatigue. A striking finding on arrival was the deep purple discoloration of her urine in the Foley bag, consistent with PUBS. Additionally, she was tachycardic and had extensive, unstageable pressure ulcers. Laboratory studies revealed leukocytosis, lactic acidosis, and acute kidney injury. Imaging suggested sacral osteomyelitis, stercoral colitis, and aspiration pneumonia. Blood cultures grew Streptococcus dysgalactiae, and she was treated empirically with broad-spectrum antibiotics. After goals-of-care discussions, she was transitioned to hospice and died shortly after discharge.</p><p><strong>Conclusion: </strong>While purple urine bag syndrome is often benign, its presence should prompt clinicians to evaluate for serious underlying disease, particularly in debilitated or high-risk patients. It is classically associated with chronic catheterization, alkaline urine, and infections involving organisms such as Providencia stuartii, Klebsiella pneumoniae, and Proteus mirabilis. This case highlights PUBS as a visible marker of potentially severe, multisystem pathology requiring timely and comprehensive assessment. Moreover, it underscores the role of social determinants of health such as inadequate home support, caregiver strain, and fragmented post-discharge care in exacerbating clinical decline. Recognition of these factors is essential for holistic care planning in frail older adults.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 2","pages":"120-123"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353999","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":"A Case Report of Delayed, Severe, Paroxysmal Muscle Cramping After Chilean Rose Tarantula (Grammostola rosea) Envenomation.","authors":"Luis A Roque","doi":"10.5811/63007","DOIUrl":"10.5811/63007","url":null,"abstract":"","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 2","pages":"222"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353954","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":"A Case of Ureter Herniation in the Petit Triangle.","authors":"Atsuhito Tanaka, Yuka Kamitani","doi":"10.5811/cpcem.49084","DOIUrl":"10.5811/cpcem.49084","url":null,"abstract":"<p><strong>Case presentation: </strong>An 88-year-old man was brought to our emergency department due to altered mental status and hemodynamic shock due to a urinary tract infection. Computed tomography showed an incarcerated ureter in the Petit triangle. Urology was consulted, and the hernia was reduced back into the retroperitoneal cavity.</p><p><strong>Discussion: </strong>Petit hernia is rare; moreover, there is no literature to our knowledge discussing the ureter as the herniated structure. Interventional radiology can be considered as a reductive option.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 2","pages":"214-216"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353880","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":"Ventricular Tachycardia Following Kratom Ingestion Requiring Extracorporeal Membrane Oxygenation in a Young Woman: Case Report.","authors":"Megan McLin-Evans, Jenner Tiscareno, Laura Lee Beneke","doi":"10.5811/cpcem.51542","DOIUrl":"10.5811/cpcem.51542","url":null,"abstract":"<p><strong>Introduction: </strong>Kratom (Mitragyna speciosa) is an unregulated herbal supplement increasingly associated with severe toxicity. Concentrated liquid formulations pose risks, with emerging reports of seizures, hepatotoxicity, and arrhythmias.</p><p><strong>Case report: </strong>A previously healthy 24-year-old woman ingested a highly concentrated kratom extract and developed seizure-like activity followed by pulseless monomorphic ventricular tachycardia. She underwent approximately 45 minutes of resuscitation, including multiple defibrillations, dual-sequential shocks, amiodarone, lidocaine, magnesium, calcium, sodium bicarbonate, potassium repletion, epinephrine, and esmolol. Persistent instability prompted consultation with cardiology and cardiothoracic surgery, and she was cannulated for venoarterial extracorporeal membrane oxygenation (ECMO) in the emergency department. Lab studies showed profound hypokalemia, acidosis, and elevated lactate. Urine toxicology confirmed mitragynine. She stabilized on ECMO, was decannulated on hospital day two, extubated on day three, and discharged home neurologically intact on day seven.</p><p><strong>Conclusion: </strong>Concentrated kratom extracts can precipitate life-threatening ventricular arrhythmias in previously healthy individuals. Emergency physicians should consider kratom in unexplained cardiac arrests and recognize the role of advanced support, including ECMO, in refractory toxicologic arrests.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 2","pages":"204-207"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354053","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":"Foreign Body-induced Pancreatitis-Multimodal Imaging and Multispecialty Collaboration: A Case Report.","authors":"Nital Vaghela, Mohamad K Abou Chaar, Steven C Mahnke, Ceylan Colak, Daniel Stephens, Tobias Kummer","doi":"10.5811/cpcem.52940","DOIUrl":"10.5811/cpcem.52940","url":null,"abstract":"<p><strong>Introduction: </strong>Foreign body-induced pancreatitis is rare and diagnostically challenging, often presenting with non-specific symptoms and no clear history, unlike typical causes.</p><p><strong>Case report: </strong>A 70-year-old man presented with vomiting and abdominal tenderness. Imaging revealed a 4-cm sharp foreign body near the pancreatic head causing inflammation. Endoscopy and endoscopic ultrasound failed to locate the object. Surgical exploration with intraoperative ultrasound identified and removed the foreign body at the pylorus-duodenal junction. The patient recovered without complications.</p><p><strong>Conclusion: </strong>Early diagnosis, multimodal imaging, and surgical collaboration are essential for optimal management of foreign body-induced pancreatitis.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 2","pages":"187-190"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353951","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}