The American journal of emergency medicine
-
Hyperkalemia and acute renal failure are the life-threatening complications of crush injuries. Vigilant prehospital emergency care is vital to reduce the complications. We report and discuss 2 cases diagnosed as crush syndrome after earthquake, in order to illustrate the value of prehospital application of tourniquets to prevent hyperkalemia accompanying extremity crush injuries. ⋯ The prehospital tourniquet had been used to avoid uncontrollable hemorrhage and release of toxic metabolites into the circulation in case 2. Providers need to be fully aware of the risk of hyperkalemia in the field for patients with crush syndrome. Tourniquet application is strongly recommended in the prehospital setting for severe crush injuries.
-
Spontaneous spinal epidural hematoma accounts for most cases of spinal epidural hematoma, but very few cases of recurrent spontaneous spinal epidural hematoma have been published to date. We herein report a case of a 20-year-old man who presented with 10-day history of pain in the interscapular region, followed by paraparesis and sensory loss below umbilicus along with urinary retention. The patient gave history of 2 similar episodes in the last 3 months, with complete spontaneous recovery. ⋯ On reviewing previous 2 magnetic resonance images of dorsal spine, it was apparent that the patient had recurrent hematoma at the same site. Thus, a provisional diagnosis of recurrent spontaneous spinal hematoma at the level of upper dorsal spine was kept and was managed accordingly. Patient with recurrent spontaneous spinal epidural hematoma should be educated about the nature of the disease and advised to consult a neurosurgeon as early as possible in case of a relapse, so that they can undergo surgical management preferably within 8 hours and not later than 36 hours.
-
Case Reports
Diagnosis of metacarpal fracture with equivocal x-ray by point-of-care ultrasound: a case report.
Metacarpal fractures represent a very common injury among patients presenting to the emergency department. Diagnosis is of utmost importance given the high morbidity associated with lack of full hand function. We report a case of a 37-year-old man who sustained extremity trauma after a mechanical fall. ⋯ X-ray of the hand was equivocal for a metacarpal fracture; however, point-of-care ultrasound revealed disruption of the bony cortex confirming the diagnosis. The patient was splinted and referred for follow-up with a hand specialist. Point-of-care ultrasound may be useful for the diagnosis of hand fractures, which may reduce health care costs and radiation exposure in the future.
-
Dengue fever is an acute febrile viral disease caused by the bite of Aedes aegypti mosquito. It is a major health problem especially in tropical and subtropical areas including South East Asia and Pakistan. In the past few years, dengue fever has been endemic in Northern Punjab. ⋯ Rectus sheath hematoma is an uncommon and often clinically misdiagnosed cause of abdominal pain. It is the result of bleeding into the rectus sheath from damage to the superior or inferior epigastric artery or their branches or from a direct tear of the rectus muscle. It can mimic almost any abdominal condition (See Fig.) (See Table).
-
Venous thromboembolism (VTE) is serious medical condition, which might be caused by psychotropic medications. Previously, antipsychotic-induced VTE due to olanzapine, risperidone, clozapine, and amisulpiride was reported. In this report, we present 2 cases of paliperidone-induced VTE.