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Case Reports in Emergency Medicine
Number of Followers: 23

This is an Open Access Journal

Open Access journal
ISSN (Print) 2090-648X - ISSN (Online) 2090-6498
Published by Hindawi

[340 journals]

Spontaneous Extensive Type A Aortic Dissection in an Older Female with No
Risk Factors: A Rare Clinical Presentation
- Abstract: Background. Aortic dissection (AD) is a rare but serious medical emergency where the aorta’s inner layer tears. Females are less likely to develop it than males, and AD cases with unusual symptoms can be hard to diagnose. Diagnosing AD can be further complicated as its symptoms and electrocardiogram (ECG) changes can mimic acute coronary syndrome, and it is challenging to distinguish it without risk factors. Case Report. This case report describes a 60-year-old female patient who presented with unusual symptoms, including pain in her chest, neck, left arm, and lower extremities. An electrocardiogram (ECG) revealed ST elevation in leads aVR and V1, as well as severe ST depression and T wave inversion in the inferior and lateral leads, which can mimic acute coronary syndrome. Despite initial treatment with nitroglycerin, the patient’s pain worsened, and a CT angiography revealed type A aortic dissection extending from the aortic root to the right external iliac artery. Immediate surgery was recommended, which significantly improved the patient’s condition. Conclusions. Be aware of aortic dissection and its symptoms, even if there are no risk factors or recognizable symptoms. Consider aortic dissection as a potential diagnosis if ECG changes are present. Ongoing education can help decrease mortality and increase awareness.
  PubDate: Tue, 26 Dec 2023 07:05:01 +000
Large Thrombus Entrapped in a Patent Foramen Ovale during Inferior Vena
Cava Filter Protection for Venous Thromboembolism
- Abstract: Background. A large thrombus entrapped in the patent foramen ovale (PFO) is an extremely rare condition. Moreover, it is considered even rarer after temporary inferior vena cava filter (TIVCF) placement for the prevention of fatal pulmonary embolism due to venous thromboembolism (VTE). Case Report. A 58-year-old man presented with syncope following chest pain and dyspnea due to PE exacerbation during TIVCF protection, which then led to cardiogenic shock. Echocardiography revealed a large thrombus entrapped in the PFO, and computed tomography (CT) showed a bilateral pulmonary artery embolism. The patient was treated with open surgical embolectomy for a pulmonary artery thrombus and PFO thrombus with simultaneous closure of the PFO. The patient’s postoperative course was uneventful. Results and Conclusion. Surgical embolectomy was useful with respect to the feasibility of resection of both intracardiac thrombus and pulmonary artery thrombus performed simultaneously, contributing to the prevention of systemic embolisms, and echocardiography plays an important role for early diagnosis.
  PubDate: Thu, 31 Aug 2023 13:05:00 +000
Diagnosing Cellulitis of the Penis with Point-of-Care Ultrasonography in a
Resource-Limited Setting
- Abstract: Cellulitis is a potentially serious bacterial skin infection. Penile cellulitis refers to the inflammation of the penile shaft and commonly occurs in uncircumcised, sexually active young adults. We reported the case of a 25-year-old heterosexual circumcised male patient with a two-day history of swelling and pain over the penile shaft. Local examination revealed a diffusely swollen penile shaft, erythematous, warm to the touch, and tender. The penile discharge culture was suggestive of a Streptococcus species infection. Ultrasonography of the penis showed increased echogenicity of the left side of the penile shaft soft tissue with a markedly increased Doppler signal, indicating cellulitis. Based on these findings, the patient was diagnosed with cellulitis of the penis and managed with broad-spectrum antibiotics. Though history and clinical examination are sufficient to diagnose penile cellulitis, our case highlighted that ultrasound could also support the diagnosis of penile cellulitis and help rule out differentials.
  PubDate: Sat, 15 Jul 2023 07:50:00 +000
Digoxin for the Management of Unstable Paroxysmal Supraventricular
Tachycardia in a Patient Who Refused Electrical Cardioversion in a Rural
Hospital
- Abstract: Background. The most frequent atrioventricular tachycardia in the emergency room is atrioventricular nodal reentrant tachycardia (AVNRT). The first treatment option for ending stable narrow QRS complex SVTs is vagal maneuvers and adenosine. When adenosine or vagal maneuvers fail to change a patient’s rhythm to normal sinus rhythm, long-acting AV nodal-blocking medications, including nondihydropyridine calcium channel blockers (verapamil and diltiazem), flecainide, or beta-blockers, are employed. Electricity (synchronized cardioversion) is the preferred form of treatment for unstable patients. Case Presentation. A 40-year-old male patient presented to the Emergency Department of Dubti General Hospital, the Afar regional state in Ethiopia, with a complaint of shortness of breath, palpitation, extreme fatigue, and chest pain of a day’s duration. His blood pressure was 80/50 mmHg, he had cold extremities and a weak radial pulse, and his apical heart rate was fast, making it difficult to count. His electrocardiogram (ECG) showed paroxysmal supraventricular tachycardia (PSVT) with a heart rate of 200. He was a candidate for electrical cardioversion due to unstable PSVT, but he and his family members refused to give consent. Even though he is not indicated for pharmacologic therapy, none of the commonly used drugs were available at the hospital. We managed him with digoxin, and the outcome was positive. Conclusion. Even though we could not find a clear recommendation regarding the use of digoxin for patients with unstable PSVT (AVNRT), by taking into consideration its negative chronotropic effect and its action to suppress the AV nodal conduction velocity, it may reduce the heart rate, and it can be used as an alternative in such difficult scenarios and a resource-limited setting. But this should be further investigated.
  PubDate: Thu, 06 Jul 2023 08:35:00 +000
HHV-6 Meningoencephalitis in a Healthy Adult Female
- Abstract: Introduction. We describe the case of a 47-year-old female who presented to an academic tertiary emergency department with two to three days of worsening fever, headache, malaise, and rigors. A broad infectious workup revealed a diagnosis of Human Herpesvirus 6 (HHV-6) meningoencephalitis without any additional identifiable causes. HHV-6, the virus responsible for the childhood disease roseola, is a common cause of fever, seizures, diarrhea, and a characteristic faint-pink rash in children. Symptomatic HHV-6 infection in adults is far less common. We believe this represents one of only a few reported cases of HHV-6 meningoencephalitis in an immunocompetent host. Case Report. A 47-year-old female presented to the emergency department with two to three days of fever, headache, malaise, and rigors. She had a noncontributory medical, surgical, and family history but had traveled extensively in northeast Africa six months prior. A physical exam was notable for a wide based gait, photophobia, mild nuchal rigidity, and pain with active range of motion of the neck. A broad infectious workup was pursued; however, given headache, fever, and subjective nuchal rigidity, the highest concern was for meningoencephalitis. A lumbar puncture was positive for HHV-6 without any other diagnostic findings to otherwise explain the patient’s symptoms. The patient was discharged on hospital day 3 with improving symptoms. Conclusion. HHV-6 meningoencephalitis has previously been described as a pathogen associated with individuals with immunosuppressive conditions. There have been several prior case reports of symptomatic meningoencephalitis in immune-competent individuals, and we believe this case adds to a growing body of evidence that HHV-6 meningoencephalitis can cause symptomatic infection in a broader patient population.
  PubDate: Tue, 18 Apr 2023 06:20:01 +000

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