The American journal of emergency medicine
-
Case Reports
Pseudo-Wellens' syndrome and intermittent left bundle branch block in acute cholecystitis.
We present a case of a 54-year-old male patient who was admitted to our Emergency Department (ED) with localized epigastric pain. Inflammation markers, ultrasound, and CT scan were inconsistent with an initial diagnosis of cholecystitis. However, there was additional evidence of cholecystolithiasis. ⋯ A laparoscopic study confirmed acute cholecystitis. Coronary angiography showed no pathological processes associated with ACS. ECG abnormalities were initially ongoing, but were no longer detectable during an 8month follow up assessment.
-
Patients who experience trauma with severe hemorrhage requiring immediate surgery and massive blood transfusion often present with markedly abnormal laboratory values. These cases require valuable resources; however, little is known regarding prognostic factors that correlate with mortality. The purpose of this study was to determine whether abnormal initial arterial blood gas (ABG) pH, a marker for severe blood loss, could serve as a prognostic indicator for these patients. ⋯ Consideration should be given to initial pH values when resuscitating "red blanket" patients. However, the pH values alone cannot reliably be used to determine clinical futility in individual patients in the early period after injury.
-
Complications from influenza have been documented in the literature, but this patient case represents a rare and potentially deadly result in an otherwise healthy adult. Providers in the emergency department should be vigilant when assessing patients with influenza symptoms and monitoring those that don't always present with common symptoms and complaints. This patient's cerebral edema and tonsillar herniation was life-threatening and was caused from the influenza B virus.
-
Epistaxis is commonly managed with RapidRhino in emergency departments. We report a case of RapidRhino herniation during air inflation in a 99-year-old female, leading to significant airway obstruction. Upon re-inflation of the RapidRhino for persistent epistaxis, our patient suddenly developed acute respiratory distress. ⋯ Immediate deflation of the RapidRhino results in spontaneous resolution of the respiratory distress. We hypothesise that the RapidRhino has herniated posteriorly into the oropharynx through excessive air inflation, potentially compounded by a product defect. Our case highlights a fatal consequence of RapidRhino application where emergency physicians should be cautious of, especially among inexperienced users.