JEM reports最新文献_第8页

Unusual clinical course of infectious mononucleosis: Complicating bilateral peritonsillar abscess 传染性单核细胞增多症的异常临床过程:并发双侧囊周脓肿

JEM reports Pub Date : 2023-11-20 DOI: 10.1016/j.jemrpt.2023.100052

Yuji Okazaki, Kenichiro Kashiwa, Toshihisa Ichiba

{"title":"Unusual clinical course of infectious mononucleosis: Complicating bilateral peritonsillar abscess","authors":"Yuji Okazaki, Kenichiro Kashiwa, Toshihisa Ichiba","doi":"10.1016/j.jemrpt.2023.100052","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100052","url":null,"abstract":"<div><h3>Background</h3><p>Infectious mononucleosis (IM) caused by Epstein-Barr virus typically presents with fever, pharyngitis, and lymphadenopathy, and most patients recover within a few weeks. However, bilateral peritonsillar abscess is a rare but serious complication of IM that can lead to airway compromise and descending mediastinitis. Due to its rarity and similarity in clinical presentation of IM, it may be challenging to diagnose bilateral peritonsillar abscess during the course of IM.</p></div><div><h3>Case report</h3><p>A 21-year-old healthy male who initially presented with fever, sore throat, and abdominal discomfort for ten days was diagnosed with IM based on clinical and laboratory findings. Despite initial treatment, the patient returned to the emergency department three times within one week due to persistent symptoms, and on the third visit, he had difficulty opening his mouth and had worsening odynophagia. Contrast-enhanced computed tomography revealed bilateral peritonsillar abscess, and an emergent incision of the right tonsil was performed. Bacterial culture revealed multiple oral organisms. He was diagnosed with bilateral peritonsillar abscess associated with IM and was discharged without complications.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>This case highlights two important clinical issues: the potential for patients with IM to develop bilateral peritonsillar abscess and the significance of trismus and exacerbation of odynophagia as a clue for identifying this complication. The rarity of this complication may result in delayed diagnosis and treatment, leading to serious complications. Prompt diagnosis and treatment are crucial for preventing potentially life-threatening consequences.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 4","pages":"Article 100052"},"PeriodicalIF":0.0,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232023000482/pdfft?md5=a827fa3d9fbee4a6eabcca24e5b7126f&pid=1-s2.0-S2773232023000482-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138412672","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

Bupivacaine overdose requiring multiple administrations of intravenous lipid emulsion therapy: A case report 布比卡因过量需要多次静脉脂乳治疗:一例报告

JEM reports Pub Date : 2023-11-19 DOI: 10.1016/j.jemrpt.2023.100060

Michael L. Behal , Reba A. Hodge , Matthew C. Blackburn

{"title":"Bupivacaine overdose requiring multiple administrations of intravenous lipid emulsion therapy: A case report","authors":"Michael L. Behal , Reba A. Hodge , Matthew C. Blackburn","doi":"10.1016/j.jemrpt.2023.100060","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100060","url":null,"abstract":"<div><h3>Background</h3><p>Bupivacaine, an amide local anesthetic, is commonly used in intrathecal pumps (IT) for pain and spasticity disorders. Pump malfunctions place patients at risk of bupivacaine overdose and local anesthetic systemic toxicity (LAST); however, there are limited reports of this in the literature.</p></div><div><h3>Case report</h3><p>A 24-year-old male with an IT bupivacaine/baclofen pump presented with weakness, numbness, dyspnea, and somnolence secondary to IT pump malfunction with an unknown amount of bupivacaine/baclofen extravasation into the subcutaneous space. The patient required intubation and vasopressor support but remained persistently hypotensive and bradycardic despite aggressive dose titration. Needle aspiration was performed to remove 14 mL of extravasated drug mixture. Due to persistent hemodynamic instability, intravenous lipid emulsion (ILE) therapy was initiated with 20 % lipid emulsion 1.5 mL/kg bolus followed by a continuous infusion of 0.25 mL/kg/min. The patient became hemodynamically stable following 750mL of ILE therapy and was admitted to the intensive care unit. Five hours after ILE therapy cessation, the patient again became hemodynamically unstable, and ILE was re-initiated with a bolus and continuous infusion. Sustained hemodynamic stability was achieved after an additional 450mL of ILE.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>IT pump malfunction involving bupivacaine can lead to severe LAST necessitating ILE therapy. Clinicians should be aware of the potential for drug deposition leading to prolonged or recurrent hemodynamic instability requiring repeated administration of ILE therapy.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 4","pages":"Article 100060"},"PeriodicalIF":0.0,"publicationDate":"2023-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232023000561/pdfft?md5=8db2ee0d9f2cebaa1596f7fbdeb5b23a&pid=1-s2.0-S2773232023000561-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138395467","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

Airbag associated ocular alkaline chemical injury: A case report 安全气囊相关性眼部碱性化学损伤1例

JEM reports Pub Date : 2023-11-18 DOI: 10.1016/j.jemrpt.2023.100053

John P. Korducki , Nicholas Maxwell , Howard R. Day , Aaron J. Lacy

{"title":"Airbag associated ocular alkaline chemical injury: A case report","authors":"John P. Korducki , Nicholas Maxwell , Howard R. Day , Aaron J. Lacy","doi":"10.1016/j.jemrpt.2023.100053","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100053","url":null,"abstract":"<div><h3>Background</h3><p>Airbags are a life-saving apparatus for patients involved in motor vehicle collisions (MVC). However, part of that apparatus includes the presence of alkaline chemicals that can induce ocular injury. Traumatic eye injuries are well documented in the literature in the setting of MVCs, yet ocular alkali burns are under-recognized and a dearth of case reports exists.</p></div><div><h3>Case report</h3><p>A 26-year-old male presented following an MVC complaining of severe unilateral eye pain in the setting of direct airbag related trauma. Ocular pH testing later revealed an alkaline injury of the right eye. Ocular irrigation was initiated in the emergency department until the pH reached normal levels.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>Recognition of airbag-associated alkaline chemical burns of the eye in the setting of an MVC and appropriate management are imperative to avoid deleterious outcomes such as permanent vision loss.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 4","pages":"Article 100053"},"PeriodicalIF":0.0,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232023000494/pdfft?md5=0df7ac0beb56abe88fa56e8acee23316&pid=1-s2.0-S2773232023000494-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138395468","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

How to pull off nasal magnetic foreign body removal in the emergency department 如何在急诊科完成鼻腔磁性异物去除术

JEM reports Pub Date : 2023-11-18 DOI: 10.1016/j.jemrpt.2023.100057

Jamie L. Holland, Danny G. Thomas

{"title":"How to pull off nasal magnetic foreign body removal in the emergency department","authors":"Jamie L. Holland, Danny G. Thomas","doi":"10.1016/j.jemrpt.2023.100057","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100057","url":null,"abstract":"<div><h3>Background</h3><p>Nasal foreign body removal is a common procedure performed in the emergency department. However, the removal of magnetic nasal foreign bodies presents a unique challenge, and traditional removal techniques are often unsuccessful. These patients frequently warrant otolaryngology consultation (OC) and foreign body removal under general anesthesia.</p></div><div><h3>Discussion</h3><p>This case report describes an innovative technique for removal of two magnetic foreign bodies across the nasal septum in a pediatric patient presenting to the emergency department by utilizing equipment commonly on hand, including a small Magill forceps and the plastic handle of an 11-blade scalpel. The tapered/wedge shaped handle of the 11-blade scalpel was directed towards and glided between the nasal septum and the magnetic foreign body, thus separating them. The magnets were then drawn to the metal forceps by magnetic attraction.</p></div><div><h3>Conclusion</h3><p>The use of the technique described here can result in successful magnetic foreign body removal in the emergency department, reduce the likelihood of tissue trauma, and avoid the need for OC and removal under general anesthesia.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 4","pages":"Article 100057"},"PeriodicalIF":0.0,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773232023000536/pdfft?md5=df7f8fa86d2168580ec36ac3e29056d9&pid=1-s2.0-S2773232023000536-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138412673","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 cause of sudden-onset pleuritic chest pain: Torsion of extralobar pulmonary sequestration 突发性胸膜炎性胸痛的不寻常原因:叶外肺隔离扭转

JEM reports Pub Date : 2023-09-01 DOI: 10.1016/j.jemrpt.2023.100043

Yuji Okazaki , Toshihisa Ichiba , Yuho Maki

{"title":"Unusual cause of sudden-onset pleuritic chest pain: Torsion of extralobar pulmonary sequestration","authors":"Yuji Okazaki , Toshihisa Ichiba , Yuho Maki","doi":"10.1016/j.jemrpt.2023.100043","DOIUrl":"10.1016/j.jemrpt.2023.100043","url":null,"abstract":"<div><h3>Background</h3><p>Extralobar pulmonary sequestration (EPS) is often diagnosed in neonates due to accompanying congenital anomalies. However, even in adulthood, this condition can, in rare cases, be complicated with torsion and may present with pleuritic chest pain at an emergency department in an undiagnosed state. We describe a case with torsion of ELS in a healthy adult female.</p></div><div><h3>Case report</h3><p>A 21-year-old woman presented with acute-onset back pain and pleuritic chest pain at our emergency department and was initially diagnosed with pleurisy based on normal results of investigations. However, she revisited our department due to flare-ups of pain, and a subsequent CT scan revealed an expanding homogeneous opacity in the left lower lobe of the lung. Magnetic resonance imaging (MRI) confirmed the presence of an encapsulated mass with a hypointense signal on T2-weighted imaging and a feeding artery from the aorta to the mass, leading to a preoperative diagnosis of EPS with hemorrhagic infarction. Video-assisted thoracoscopic surgery was performed, and the cause of hemorrhagic infarction was found to be a torsion. The diagnosis was confirmed histologically.</p></div><div><h3>Why should an emergency physician be aware of this?</h3><p>This case highlights the importance of recognizing torsion of EPS as an unusual cause of pleuritic chest pain and emphasizes the need for early diagnosis in order to perform surgery as soon as possible. Changes in CT findings of torsion of EPS over time can help physicians understand this rare condition. MRI may also be useful for the perioperative diagnosis.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 3","pages":"Article 100043"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48021399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Expanding the differential of adolescent hip pain to include arteriovenous malformations 扩大青少年髋关节疼痛的鉴别包括动静脉畸形

JEM reports Pub Date : 2023-09-01 DOI: 10.1016/j.jemrpt.2023.100033

Brenda Sokup , Michael Cydylo , Ivan Ivanov , Adam Rhodes

引用次数: 0

Aims and Scope 目标和范围

JEM reports Pub Date : 2023-09-01 DOI: 10.1016/S2773-2320(23)00047-0

引用次数: 0

Re-presentations to the emergency department post COVID-19 admission in Australia 澳大利亚新冠肺炎入院后再次向急诊科提交

JEM reports Pub Date : 2023-09-01 DOI: 10.1016/j.jemrpt.2023.100049

Zahra Al Haloob , George Braitberg , Anthony Tu Tran , Joe Anthony Rotella , Anselm Wong

{"title":"Re-presentations to the emergency department post COVID-19 admission in Australia","authors":"Zahra Al Haloob , George Braitberg , Anthony Tu Tran , Joe Anthony Rotella , Anselm Wong","doi":"10.1016/j.jemrpt.2023.100049","DOIUrl":"https://doi.org/10.1016/j.jemrpt.2023.100049","url":null,"abstract":"<div><h3>Background</h3><p>Little is known on the frequency and nature of re-presentations to emergency departments post initial COVID admission.</p></div><div><h3>Objectives</h3><p>The aim of the study was to determine the characteristics and outcomes of patients with subsequent presentations to an Emergency Department (ED) following positive COVID-19 PCR diagnosis.</p></div><div><h3>Methods</h3><p>A retrospective chart review of patients admitted to Austin Health ED who had a confirmed positive COVID-19 PCR, for the period July 2020–August 2020 and October 2021 was undertaken. All patients who had a re-presentation 6 months post initial hospital discharge were included. The primary outcomes were number of subsequent presentations, diagnoses and symptoms.</p></div><div><h3>Results</h3><p>Among the 254 patients who met the inclusion criteria, 127 tested positive during the 2020 period, and 126 tested positive during the 2021 period. During the 2020 period, 17 of 127 (13%) patients had subsequent presentations to ED. During October 2021, 23 of 126 (18%) patients had subsequent presentations to ED. There were often multiple re-presentations to ED (range 2–9). During both periods, the most common representing symptom was shortness of breath (2020: 60% vs 2021: 59%). The most common re-presentation diagnosis was Post COVID syndrome (12% in 2020 vs 10% in 2021).</p></div><div><h3>Conclusion</h3><p>There was a high proportion of ED re-presentations post initial COVID admission, with patients often having multiple re-presentations. Post COVID syndrome was the commonest re-presentation diagnosis. This and other complications have the potential to become more frequently diagnosed in the coming years contributing to the increasing demand on emergency departments.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 3","pages":"Article 100049"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49839747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Business-centric healthcare's effects on the doctor-patient relationship in the emergency department 以商业为中心的医疗保健对急诊科医患关系的影响

JEM reports Pub Date : 2023-09-01 DOI: 10.1016/j.jemrpt.2023.100032

Daniel R. Martin , Kenneth V. Iserson , John C. Moskop

引用次数: 0

Craniopharyngioma presenting as a stroke mimic, a case report 颅咽管瘤表现为类似中风的一例报告

JEM reports Pub Date : 2023-09-01 DOI: 10.1016/j.jemrpt.2023.100042

Zachary Boivin , Chandler Ford , Andrew Franco

{"title":"Craniopharyngioma presenting as a stroke mimic, a case report","authors":"Zachary Boivin , Chandler Ford , Andrew Franco","doi":"10.1016/j.jemrpt.2023.100042","DOIUrl":"10.1016/j.jemrpt.2023.100042","url":null,"abstract":"<div><h3>Background</h3><p>Craniopharyngioma is a rare condition which can present with a multitude of symptoms from increased intracranial pressure, endocrine disorder, visual deficits, and hypothalamic dysfunction, making it difficult to diagnose. In this case, our patient presented with symptoms concerning for a stroke, creating diagnostic uncertainty.</p></div><div><h3>Case report</h3><p>A 71-year-old male developed decreased grip strength in his right hand and word finding difficulties over a period of several hours, and upon arrival to the emergency department was triaged as a potential stroke. On initial imaging he appeared to have a hemorrhage in the area of the sella turcica. Subsequently, multidisciplinary input resulted in a preliminary diagnosis of craniopharyngioma. The patient's laboratory results raised concern for adrenal insufficiency, and the patient's vital sign abnormalities of bradycardia, hypotension, and hypothermia resolved with corticosteroids. The patient was discharged home after a brief hospital stay, and neurosurgery recommended outpatient follow up to excise the mass.</p></div><div><h3>Why should an emergency physician be aware of this</h3><p>We could find no literature describing craniopharyngioma as a stroke mimic, and given the patient's initial presentation with right hand weakness and word finding difficulty, there was high concern for stroke. The patient's imaging showed what appeared to be an intracranial hemorrhage, further confounding the clinical picture. The patient's subsequent development of vital signs and laboratory results consistent with adrenal crisis helped us arrive at the final diagnosis. Emergency physicians should avoid anchoring bias in the treatment of patients with stroke-like symptoms and be familiar with the complex presentations of craniopharyngioma.</p></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"2 3","pages":"Article 100042"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46566340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0