JEM reports Pub Date : 2024-11-20 DOI: 10.1016/j.jemrpt.2024.100127

Amna Nawaz , Denise Elizondo , Rebecca G. Theophanous

{"title":"Spontaneous perinephric hematoma in an emergency department patient with flank pain: A case report","authors":"Amna Nawaz , Denise Elizondo , Rebecca G. Theophanous","doi":"10.1016/j.jemrpt.2024.100127","DOIUrl":"10.1016/j.jemrpt.2024.100127","url":null,"abstract":"<div><h3>Background</h3><div>Perinephric hematomas are defined by hemorrhage originating from the kidney parenchyma into the subcapsular and perirenal spaces. Spontaneous perinephric hematomas are rare and usually occur due to an underlying renal mass, vascular abnormality, coagulation disorder, or inflammatory disorder. The classic clinical presentation includes acute flank pain, hemorrhagic shock, and detection of a renal mass. Diagnosis is by computed tomography (CT), ultrasound, or angiography.</div></div><div><h3>Case report</h3><div>A 74-year-old male with coronary artery disease, severe heart failure, and atrial fibrillation/flutter on apixaban presented to the emergency department (ED) with left-sided abdominal and back pain for two weeks. He denied urinary symptoms, fever, or vomiting. The patient was hypotensive with low hemoglobin (8.9g/dL), thus he received blood transfusions and apixaban reversal for hemorrhagic shock. CT scan diagnosed a 10x9 cm perinephric hematoma, and he was transferred to our hospital’s ED. Point-of-care ultrasound demonstrated a left perinephric hematoma and clotted blood in the splenorenal recess. Urology and interventional radiology (IR) were consulted, with emergent transport to IR for angiogram and left coil embolization then intensive care unit admission.</div></div><div><h3>Why should an emergency medicine physician be aware of this</h3><div>This case describes important diagnostic testing and bedside ultrasound utility in expediting care for patients with renal pathology. It describes a case of spontaneous renal hemorrhage and management steps including IR embolization, urology involvement, and evaluation for surgical intervention. Finally, we emphasize potential serious complications including chronic renal failure, pyelonephritis, renal obstruction, and permanent kidney distortion if disease is not recognized and treated early.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100127"},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706881","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

Symptomatic complete heart block: A rare complication of anterior myocardial infarction in a young, fit male: A case report 症状性完全性心脏传导阻滞：体格健壮的年轻男性前心肌梗死的罕见并发症：病例报告

JEM reports Pub Date : 2024-11-19 DOI: 10.1016/j.jemrpt.2024.100129

Huang Huiling , Lee Keyao , Zhang Yuan Helen

{"title":"Symptomatic complete heart block: A rare complication of anterior myocardial infarction in a young, fit male: A case report","authors":"Huang Huiling , Lee Keyao , Zhang Yuan Helen","doi":"10.1016/j.jemrpt.2024.100129","DOIUrl":"10.1016/j.jemrpt.2024.100129","url":null,"abstract":"<div><h3>Background</h3><div>Acute myocardial infarction (AMI) is a major cause of morbidity and mortality, typically affecting older individuals with multiple cardiovascular comorbidities. Complete heart block (CHB) is a rare but serious complication of AMI, requiring prompt intervention. We present a case of AMI involving total occlusion of the proximal left anterior descending (LAD) coronary artery, leading to CHB and alternating bundle branch blocks, requiring temporary pacing. The patient was discharged with good outcomes.</div></div><div><h3>Case report</h3><div>A 41-year-old Indian male with no significant past medical history presented with chest discomfort and abnormal electrocardiogram (ECG) findings. Emergency percutaneous coronary intervention (PCI) revealed critical proximal LAD occlusion and moderate disease in the other coronary arteries. The patient developed trifascicular block and subsequent episodes of alternating right and left bundle branch block, necessitating temporary pacing. Despite the complex arrhythmias resulting from his anterior AMI and the transient need for a temporary pacing wire, the patient showed remarkable improvement post-revascularization, with no requirement for a permanent pacemaker at discharge.</div></div><div><h3>Why should an Emergency Physician be aware of this?</h3><div>This case highlights that CHB can occur with anterior, not just inferior MI. When associated with anterior MI, there is extensive myocardial injury and a high risk of conduction abnormalities, which can potentially be permanent. While AMI can cause a range of complications, CHB tends to be rarer in LAD occlusion based on the anatomy it supplies. Recognizing and promptly treating both the primary lesion and its complications especially in the younger patients, can improve outcomes.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100129"},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706882","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 of monocular visual impairment 单眼视力障碍病例

JEM reports Pub Date : 2024-11-17 DOI: 10.1016/j.jemrpt.2024.100128

Lev Libet, Edward McCrink, Lawrence Liu

引用次数: 0

Upper gastrointestinal bleeding: A rare presenting sign of pediatric hypothyroidism 上消化道出血：小儿甲状腺功能减退症的罕见症状

JEM reports Pub Date : 2024-11-10 DOI: 10.1016/j.jemrpt.2024.100126

Nicholas Aldredge , Sara A. DiVall , Yongtian T. Tan

{"title":"Upper gastrointestinal bleeding: A rare presenting sign of pediatric hypothyroidism","authors":"Nicholas Aldredge , Sara A. DiVall , Yongtian T. Tan","doi":"10.1016/j.jemrpt.2024.100126","DOIUrl":"10.1016/j.jemrpt.2024.100126","url":null,"abstract":"<div><h3>Background</h3><div>Severe pediatric hypothyroidism is a relatively rare endocrine disorder characterized by inadequate thyroid hormone production or action in children. It can have significant effects on various organ systems, including the gastrointestinal (GI) tract, and cause upper GI bleeding (UGIB). It can be challenging to diagnose as the cause in the emergency department (ED).</div></div><div><h3>Case report</h3><div>We present the case of a 13-year-old previously healthy male presenting with hematemesis as the chief complaint to the pediatric emergency department, who was subsequently found to have severe hypothyroidism based on a constellation of vital sign abnormalities in the absence of other likely etiologies. This case illustrates the importance of considering endocrinopathies as part of the overall differential diagnoses for a pediatric patient presenting with isolated hematemesis, especially if there is a disparity between vital signs and other clinical signs.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Recognizing pediatric hypothyroidism as a potential cause of UGIB presents a particular diagnostic challenge for emergency physicians. Symptoms of pediatric hypothyroidism can be varied, and UGIB in this setting is a rare and poorly understood clinical entity. Timely diagnosis and treatment of hypothyroidism are crucial to prevent further complications and optimize the child's growth and development.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 4","pages":"Article 100126"},"PeriodicalIF":0.0,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142654320","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

Tamsulosin-induced priapism: A case report 坦索罗辛诱发的前列腺增生症：病例报告

JEM reports Pub Date : 2024-11-07 DOI: 10.1016/j.jemrpt.2024.100125

Julie Martino , Zane Elfessi , Heather Webster

{"title":"Tamsulosin-induced priapism: A case report","authors":"Julie Martino , Zane Elfessi , Heather Webster","doi":"10.1016/j.jemrpt.2024.100125","DOIUrl":"10.1016/j.jemrpt.2024.100125","url":null,"abstract":"<div><h3>Background</h3><div>Priapism is a persistent erection generally lasting more than 4 h. Types of priapism include recurrent, ischemic, and non-ischemic and are generally classified based on penile arterial blood flow. Priapism can be induced by hematologic disorders (i.e. sickle cell anemia), infections, recreational drug use, and medication use. Tamsulosin is an α<sub>1A</sub> receptor antagonist commonly used in the treatment of LUTS and benign prostatic hyperplasia (BPH).</div></div><div><h3>Case report</h3><div>We report a case of priapism lasting 48 hours due to tamsulosin. Aspiration and irrigation of the corpus cavernosa and intracavernosal injection of phenylephrine were performed without success. A penile blood gas revealed a pH of 6.92, pCO2 of 108 mmHg, pO2 of 40 mmHg, and HCO3 of 22.2 mmol/L—indicating ischemic priapism. A T-shunt was performed through the glans with moderate detumescence—the penis was able to bend at least 60° in all directions and 90° ventrally. The patient had a computed tomographic angiography (CTA) of the pelvis and a magnetic resonance angiography (MRA) 1 and 3 months later, respectively, which indicated proper flow and the absence of arteriovenous malformations.</div><div>Why should an EM Physician be aware of this?</div><div>Despite its attractive nature for the treatment of LUTS or BPH, because of α<sub>1A</sub> receptor selectivity, tamsulosin should be recognized as a culprit of priapism. Because of the high affinity for the α<sub>1A</sub> receptor, patients on tamsulosin may not respond to traditional medical therapies for priapism and therefore may require surgical intervention.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 4","pages":"Article 100125"},"PeriodicalIF":0.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142654197","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

Double duty: Successful management of a late second trimester severe burn 双重职责：成功救治一名孕晚期重度烧伤患者

JEM reports Pub Date : 2024-10-29 DOI: 10.1016/j.jemrpt.2024.100124

Mel Ebeling , Janet Julson , Emily W. Baird , Ashley Shea , Samantha Baker

{"title":"Double duty: Successful management of a late second trimester severe burn","authors":"Mel Ebeling , Janet Julson , Emily W. Baird , Ashley Shea , Samantha Baker","doi":"10.1016/j.jemrpt.2024.100124","DOIUrl":"10.1016/j.jemrpt.2024.100124","url":null,"abstract":"<div><h3>Background</h3><div>Thermal burns during pregnancy are rare but life-threatening emergencies associated with significant morbidity and mortality. Currently, principles of management center around fluid resuscitation based on formulas established for nonpregnant patients and supportive care, as data on the optimal management of pregnant burn patients is limited.</div></div><div><h3>Case report</h3><div>We present the case of a 23-year-old G2P1 at 26 weeks gestational age who presented to the emergency department with 52 % total body surface area (TBSA) burns and inhalation injury sustained during a house fire. She was initially managed with both standard burn fluid resuscitation and vasopressors to maintain perfusion before undergoing an emergent delivery 3 h after her initial presentation. Ultimately, she underwent five surgical debridements with split-thickness skin grafting before being discharged on hospital day 60. Her infant was treated for prematurity-associated respiratory distress syndrome and was discharged on hospital day 82 without any other major complications.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Thermal burns in pregnancy are high-risk, low-frequency events that require the competent, rapid consideration of numerous factors to optimize outcomes for both the mother and fetus. This case describes the effective management of maternal hemodynamics with early standard fluid resuscitation and vasopressors, though highlights the need for future studies identifying the role of fluids and vasopressors in supporting pregnant patients with burn injuries and their fetuses.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 4","pages":"Article 100124"},"PeriodicalIF":0.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553137","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

Prolonged fever complicated by petechiae in an immunocompetent adult with primary CMV infection: A case report 一名免疫功能正常的成年人因原发性巨细胞病毒感染而长期发热并伴有瘀斑：病例报告

JEM reports Pub Date : 2024-10-18 DOI: 10.1016/j.jemrpt.2024.100123

Emilie Fraisse , Mads Emil Bruusgaard-Mouritsen , Rasmus Gregersen

{"title":"Prolonged fever complicated by petechiae in an immunocompetent adult with primary CMV infection: A case report","authors":"Emilie Fraisse , Mads Emil Bruusgaard-Mouritsen , Rasmus Gregersen","doi":"10.1016/j.jemrpt.2024.100123","DOIUrl":"10.1016/j.jemrpt.2024.100123","url":null,"abstract":"<div><h3>Background</h3><div>While petechiae can be a sign of a serious underlying condition, the majority are benign. Frequently, an underlying cause is not identified despite extensive diagnostic testing. Petechiae may be caused by CMV infection which is rarely considered in the differential diagnostic process. Most immunocompetent adults with primary CMV infection are asymptomatic or develop a mononucleosis-like syndrome with fever and mild hepatitis.</div></div><div><h3>Case report</h3><div>We report the case of a 30-year-old man who presented to an out-of-hours general physician consult with intermittent fever for three weeks. Examination showed petechiae on the upper extremities. Initial laboratory data revealed lymphocytosis and elevated liver enzyme tests. Further testing showed positive CMV throat swab and CMV/EBV immunoglobulin M and G. His symptoms resolved gradually without any treatment.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>This report shows that primary CMV infection can be a cause of petechiae. Emergency physicians should keep in mind that although uncommon, immunocompetent adults can experience acute symptomatic CMV infections characterized by an extended disease course and testing may avoid unnecessary and extensive diagnostic workup and repeated hospital contacts.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 4","pages":"Article 100123"},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528820","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 voltage Dilemma in electrocardiogram (ECG) 心电图（ECG）中的电压难题

JEM reports Pub Date : 2024-10-16 DOI: 10.1016/j.jemrpt.2024.100121

Ezhilkugan Ganessane , B.G. Kowsthubha , V.T. Amrithanand , Anas Mohammed Muthanikkatt , Vasudha Dinesh

{"title":"The voltage Dilemma in electrocardiogram (ECG)","authors":"Ezhilkugan Ganessane , B.G. Kowsthubha , V.T. Amrithanand , Anas Mohammed Muthanikkatt , Vasudha Dinesh","doi":"10.1016/j.jemrpt.2024.100121","DOIUrl":"10.1016/j.jemrpt.2024.100121","url":null,"abstract":"<div><h3>Background</h3><div>Pericardial effusion involves fluid buildup around the heart, potentially leading to cardiac tamponade—a critical condition that can impair heart function. Symptoms vary widely from mild to life-threatening. An electrocardiogram (ECG) is crucial for initial assessment, but interpreting findings can be challenging, especially when classic signs like low voltage QRS complexes are absent. Recognising new voltage changes from the baseline ECG is crucial even when traditional low voltage criteria are not met. Understanding these nuances and their clinical significance is essential for timely diagnosis and effective treatment, highlighting the importance of careful ECG interpretation by emergency physicians.</div></div><div><h3>Case report</h3><div>A 57-year-old male, diagnosed with chronic kidney disease and recently initiated on anti-tubercular treatment for pulmonary tuberculosis, presented to the emergency department with worsening shortness of breath. The baseline ECG a month prior revealed normal sinus rhythm with right atrial enlargement (RAE) and left ventricular hypertrophy (LVH). Upon presentation, the ECG revealed sinus tachycardia without P pulmonale or LVH, suggesting a potential dynamic change. Point-of-care ultrasound (POCUS) confirmed moderate pericardial effusion with early right ventricular diastolic collapse.</div></div><div><h3><strong><em>Why should an emergency physician be aware of this?</em></strong></h3><div>A new decrease in QRS voltages and sinus tachycardia should prompt suspicion of pericardial effusion. Emergency physicians need to understand the complexity of new voltage changes in ECGs. The challenge lies in relying solely on standard ECG criteria, emphasising the importance of considering individual baseline variations. Recognising such subtle ECG changes is crucial for diagnosing and treating cardiac tamponade early, leading to better patient outcomes.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"3 4","pages":"Article 100121"},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578541","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

Small bowel volvulus associated with mesenteric rent caused by hemorrhaging right common iliac artery aneurysm 右髂总动脉瘤出血引起的肠系膜撕裂伴有小肠肠卷

JEM reports Pub Date : 2024-10-16 DOI: 10.1016/j.jemrpt.2024.100122

Dylan Z. Taylor, Christiaan van Nispen, Brit Long

引用次数: 0

Surgical treatment for Abrus precatorius poisoning case Abrus precatorius 中毒病例的手术治疗

JEM reports Pub Date : 2024-09-28 DOI: 10.1016/j.jemrpt.2024.100118

Lingling Hou

引用次数: 0

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