The American journal of emergency medicine
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A solitary brainstem abscess is a rare fatal intracranial infection, which can be mistaken for an acute stroke complicated with a systemic infection. Dental caries without abscess formation can be a possible source of infection. Herein, we describe the case of a 59-year-old man with dental caries who presented with a 4-day history of progressive dizziness, double vision, gait ataxia, emesis, and left facial and body numbness. ⋯ Magnetic resonance spectroscopy and diffusion-weighted imaging demonstrated a solitary pontine abscess. The neurologic deficits continued improvement after he completed 8 weeks of intravenous antibiotics. The successful nonsurgical treatment of the brainstem abscess in this case was based on high clinical suspicion, early diagnosis, and early combination of corticosteroids and broad spectrum antibiotics.
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Sevoflurane, a potent volatile anesthetic, has been attempted to be used for procedural sedation. Because of lack of a commercially available sedation apparatus for sevoflurane administration, anesthetic gas delivery apparatus should be connected to general anesthetic machine for delivering sevoflurane gas. In this case, deep sedation was maintained during treatment of dental injuries involving the upper lip and incisor by sevoflurane insufflations via a nasal cannula. Especially, this may be advantageous in treating dental injuries involving upper lip and maxillary anterior teeth because the treatment is not disturbed during sevoflurane insufflations via a nasal cannula.
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Compartment syndrome usually occurs in the muscles of an extremity as a consequence of trauma or reperfusion. However, it can also occur from minor injuries with resulting hematoma. We reviewed the charts of 5 individuals who presented to the emergency department after minimal or no known trauma and were ultimately diagnosed with acute compartment syndrome. ⋯ Low-impact trauma can cause acute compartment syndrome in the lower extremities. These cases could be the result of muscle hemorrhage and subsequent hematoma formation, rather than muscle swelling itself. Anticoagulation therapy can increase the risk of hemorrhage.
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There are several causes of ST-segment elevation (STE) besides acute myocardial infarction (MI). ⋯ The diagnosis of false-positive STEMI is not uncommon. Detailed clinical evaluation and electrocardiogram interpretation may avoid partly unnecessary catheterization laboratory activation.
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The QT interval measures the time from the start of the QRS complex to the end of the T wave. Prolongation of the QT interval may lead to malignant ventricular tachydysrhythmias, including torsades de pointes. Causes of QT prolongation include congenital abnormalities of the sodium or potassium channel, electrolyte abnormalities, and medications; idiopathic causes have also been identified. ⋯ For patients with congenital or idiopathic QT interval prolongation, the use of beta-blockers can be considered. Certain subsets of patients benefit from implantation of a cardioverter-defibrillator. Clinicians must remain vigilant for QT interval prolongation when interpreting electrocardiograms, especially in patients presenting with syncope or ventricular arrhythmias.