The American journal of emergency medicine
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Screening for acute myocardial infarction (AMI) in patients with ventricular pacemakers (VP) is a diagnostic challenge. We report a case where application of the Modified Sgarbossa criteria (mSC) would have immediately identified AMI in a patient with a VP and merited strong advocacy for emergent cardiac catheterization. A 94-year-old male with VP presented to the emergency department (ED) after he had burning sensation in his chest. ⋯ This case report highlighted the benefits of applying mSC to patients with VP, which to authors knowledge remains unvalidated. A significant benefit of mSC is that they are unweighted, thus any positive criteria is suggestive of AMI. While the first EKG yielded an oSC score <3, applying the unweighted mSC to the EKG revealed ≤-0.25 ST/S ratio discordant changes in leads III, aVF, I and aVL would have merited strong advocacy for emergent cardiac catherization.
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Crotalidae envenomation has been managed successfully in emergency departments across the world with antivenom. Over the years, antivenom has evolved and newer agents have been studied with the possibility of eliminating maintenance antivenom therapy. ⋯ The details of this patient's treatment course highlight the possibility that patients who receive F(ab')2AV, may require additional antivenom treatment. Furthermore, it appears that based on our single patient experience, giving FabAV after F(ab')2AV is safe and effective.
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Neutropenic enterocolitis is also known as typhlitis, is characterized by severe inflammation in the bowel loops. It is often seen in immunosuppressed patients, and it has high morbidity and mortality. Although the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily affects the respiratory system and causes COVID-19 (Coronavirus Disease 2019), it may affect hematopoietic and gastrointestinal systems. ⋯ Contrast-enhanced abdominal computed tomography (CT) demonstrated the bowel wall thickening in the cecum and ascending colon compatible with enterocolitis. Moreover, the chest CT showed bilateral, peripheral, and multifocal ground-glass opacities, consistent with COVID-19 pneumonia. We also aimed to emphasize the laboratory, clinical, and CT findings of the patient.