The American journal of emergency medicine
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Case Reports
An atypical misplacement of a temporary pacing catheter diagnosed and resolved by ultrasound.
Temporary transvenous pacing catheter placement is an important and critical procedure for emergency physicians. Ultrasound can be used to guide placement and to diagnosis correct or incorrect catheter placement. This case report discusses a patient with an acute ST elevation myocardial infarction leading to unstable arrhythmias requiring emergent transvenous cardiac pacing. ⋯ There was some difficulty placing the catheter, but successful capture with a left bundle-branch block pattern was obtained. However, ultrasonographic evaluation after placement showed the pacing wire curled in the Inferior Vena Cava (IVC) with the tip in the right ventricle. Ultrasound examination and guidance can prevent misplacement of the transvenous pacer catheter, which would not be apparent by electrocardiographic means.
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Klebsiella pneumonia is a common human pathogen, and endogenous endophthalmitis is a vision-threatening infection presentedwith pain, redness, decreased vision acuity, and intraocular inflammation. Endogenous endophthalmitis caused by Klebsiella pneumoniae is uncommon and usually happens in patients with immunosuppression conditions. Diabetes is a predisposing risk factor, and liver abscess is a major source of Klebsiella pneumonia endogenous endophthalmitis (KPEE). Here, we report a case of KPEE in a patient who lost his vision in one eye after treatment.
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Exercise-induced anaphylaxis (EIA) and its subtype, food dependent exercise-induced anaphylaxis are uncommon and therefore underdiagnosed forms of physical allergy. Triggers include various degrees of exercise in combination with ingestion of specific food products. Treatment remains identical to that of IgE-mediated allergic reactions. The presentation is commonly underdiagnosed and caries significant fatality risk, and this case should raise the awareness of the attending physician.