The American journal of emergency medicine
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Case Reports
Irreversible third-degree heart block and pacemaker implant in a case of flecainide toxicity.
An 82-year-old white woman was seen in the emergency department (ED) after ingesting 400 mg of flecainide in an attempt to treat an episode of dizziness and palpitations that occurred while she was gardening. Consequently, she developed bradycardia, hypotension, and complete heart block. ⋯ After further evaluation, a permanent pacemaker was implanted during her admission. External pacing wires may be useful in the treatment of complete heart block in cases of flecainide poisoning when a patient is unresponsive to drug therapy provided in the ED.
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Anisakiasis, a parasitic infection by larvae of the nematode Anisakis found in raw or undercooked saltwater fish, mostly involves stomach but rarely small intestine. We report a rare case of a 61-year-old man who presented with abdominal pain and developed small bowel obstruction caused by intestinal anisakiasis. Abdominal computed tomography revealed segmental edema of the intestinal wall with proximal dilatation. ⋯ It is often clinically challenging to consider intestinal anisakiasis in the differential diagnosis because of its nonspecific abdominal symptoms and findings. Although gastrointestinal anisakiasis is still rare in the United States, the incidence is expected to rise given the growing popularity of Japanese cuisine such as sushi or sashimi. Anisakiasis should be considered as one of the differential diagnoses in patients with nonspecific abdominal symptoms after consumption of raw or undercooked fish.
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We present a case of a patient presenting with posterior reversible encephalopathy syndrome to the emergency department. We discuss the various symptoms that lead to the identification of posterior reversible encephalopathy syndrome and the important clinical clues. Posterior reversible encephalopathy syndrome is a very uncommon diagnosis/clinical presentation that requires the understanding of the condition and awareness in distinct/specific patient populations. Without this understanding, the diagnosis may be missed and appropriate management delayed.