The American journal of emergency medicine
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Intracranial complications of pediatric sinusitis are rare but potentially life threatening. These complications include cavernous sinus thrombosis, orbital infection, meningitis, and subdural empyema. Children with these complications may experience significant morbidity from their infection. ⋯ Emergency physicians, pediatricians, and otolaryngologists should maintain a high index of suspicion for this complication of disease when treating patients with sinusitis in the emergency department or outpatient clinic. Early and accurate diagnosis of subdural empyema will lead to prompt treatment and a favorable outcome for the patient. We report a case of subdural empyema secondary to frontal sinusitis in an otherwise healthy immunocompetent adolescent boy.
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Our objective was to quantify the mortality difference between patients with severe sepsis/septic shock (SS/SS) identified in the emergency department (EDI) vs those not identified in the emergency department (NEDI) within our community hospital. ⋯ Emergency department identification of patients with SS/SS in the community hospital significantly improves mortality.
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The management of life-threatening complications in HIV-associated immune reconstitution syndrome is becoming a challenging scenario in emergency practice, especially in the era of highly active antiretroviral therapy paralleled by increased worldwide incidence of HIV infection. Here, we described a 37-year-old woman with acute hypoxic respiratory failure, acute renal failure, and hypercalcemic crisis as the presenting features of HIV-associated immune reconstitution syndrome. In this patient, the restored granulomatous host response toward isolated pulmonary Mycobacterium avium complex infection led to a near-fatal catastrophe. This report reinforces the importance of introducing a rapid, systematic approach of hypercalcemia at the emergency department and the need for clinicians to maintain awareness of this distinct manifestation.
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Case Reports
Lemierre's syndrome and rapidly deteriorating respiratory failure in the emergency department.
Rapidly progressive acute respiratory distress along with life-threatening gram-negative anaerobic sepsis in a young, immunocompetent individual should always raise concern for Lemierre's syndrome. Although still rare, the incidence of Lemierre's syndrome has been increasing over the past 20 years. Lemierre's syndrome is characterized by postanginal septicemia and secondary internal jugular vein suppurative thrombophlebitis. ⋯ We report a case of a 24-year-old patient who presented to the ED with acute respiratory distress with an atypical and rapidly deteriorating course. She was later diagnosed with Lemierre's syndrome and recovered well after antibiotic treatment, respiratory support, and a lengthy intensive care unit stay. This case report represents an atypical presentation of acute respiratory distress and pharyngitis but is classic for Lemierre's syndrome.
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Laryngopyocoeles are rare entities that present as airway obstruction or as neck masses. We present a unique case of a laryngopyocoele in a young patient with a sore throat. A 22-year-old man presented to the emergency department with a sore throat of 1-week duration. ⋯ The patient was admitted to the intensive care unit for airway monitoring and treated conservatively with intravenous antibiotics. The collection did not resolve by day 4, and the patient was taken to the operating room for incision and drainage of the laryngopyocoele. The patient made an uneventful recovery.