The American journal of emergency medicine
-
A 75-year-old male patient suffered a chest degloving injury when he fell on his back and was run over by a small farm tractor he was pulling. At the time of patient admission, the paradoxical motion of the right chest wall was remarkable; and he had an open fracture of the right humerus, a dislocation of the right ankle, and a laceration of the right forearm. ⋯ Because the right flail chest was severe and there was a large amount of air leakage that continued under positive-pressure ventilation for pneumatic stabilization, we performed surgical fixation of the ribs and repaired the lung injury on the fifth hospital day. The patient's postoperative course was uneventful.
-
Mollaret meningitis is a syndrome characterized by recurrent bouts of meningitis that occur over a period of several years in an affected patient. Also known as recurrent lymphocytic meningitis, this entity involves repeated episodes of headache, stiff neck, fever, and cerebrospinal fluid pleocytosis. Herpes simplex virus type 2 is the most frequently implicated causative agent, and treatment involves the use of antiviral medications. ⋯ The patient's family history was significant for a brother who also had multiple episodes of aseptic meningitis during a period of several years. This represents the first published report of a possible familial association involving Mollaret meningitis. It is likely that Mollaret meningitis is underrecognized among emergency physicians, and improved recognition of this entity may limit unwarranted antibiotic use and shorten or eliminate unnecessary hospital admission.
-
Case Reports
Evaluation of proper above-the-diaphragm central venous catheter placement: the saline flush test.
hest radiographs are routinely obtained after the insertion of above-the-diaphragm central venous catheters to confirm placement and detect mechanical complications. At times, performing the radiograph can be time-consuming and findings may be inaccurate. We present a case of a patient with difficult access who required emergent resuscitation. ⋯ Other investigators have demonstrated different methods to confirm central venous catheter placement by bedside ultrasound, utilizing multiple views, Doppler technology, or microbubble contrast. This novel technique, as described here, is most simple. Further research is needed to demonstrate accuracy and utility.
-
Identifying acute pyelonephritis (APN) with early obstructive uropathy is clinically important in the emergency department (ED) because obstructive urolithiasis is an independent risk factor for inpatient death, prolonged hospitalization, and failure of outpatient APN therapy. Furthermore, diagnosis of an early obstructive uropathy can be difficult when based solely on clinical findings. Clinicians may assume the cause of the patient's symptoms to be APN alone, without considering the concurrent presence of an obstructing stone. ⋯ In this case, hydronephrosis on bedside ultrasound examination was an indirect marker of a distal ureteral obstruction. By detecting the presence of hydronephrosis in patients with APN, emergency physicians may dramatically increase their ability to identify those patients that need further radiographic investigation and ultimately decrease the rate of outpatient treatment failure. Further surveillance data are needed to determine the statistical characteristics of this novel screening test and if routine renal evaluation of all patients with APN is warranted.
-
Acute hepatotoxicity is a rare but potentially fatal complication of amiodarone use. Although oral long-term use of the drug is frequently complicated by an asymptomatic rise in serum aminotransferase concentrations, acute hepatotoxicity during intravenous loading is much less frequent and potentially fatal. We report a case of liver injury after intravenous administration in a patient with atrial fibrillation.