J Emerg Med
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Case Reports
Thrombosis of Inferior Vena Cava Diagnosed Using Point-of-Care Ultrasound After Pediatric Near-Syncope.
Venous thromboembolism (VTE) is extremely rare but under recognized in the pediatric population. Although the literature on the use of ultrasound to detect VTEs in adults is plentiful, little has been documented on its use in the pediatric population. ⋯ We present a case of a healthy 16-year-old female who presented to our emergency department with 3 months of dyspnea on exertion and one episode of near-syncope. Point-of-care cardiac ultrasound identified an inferior vena cava thrombosis. Subsequent computed tomography angiography diagnosed concurrent bilateral pulmonary emboli (PE). The patient's identical twin sister presented with similar symptoms shortly thereafter and was also diagnosed with VTE and bilateral PE. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case demonstrates an instance of VTE and pulmonary embolism in twin adolescent girls. Physical examination findings, electrocardiogram, chest x-ray study, and several previous evaluations did not reveal the diagnosis. Point of care ultrasound was used to correctly diagnosis VTE and for heightened concern for a pulmonary embolism.
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As decontamination trends have evolved, gastric lavage (GL) has become a rare procedure. The current information regarding use, outcomes, and complications of GL could help refine indications for this invasive procedure. ⋯ Toxic agents for which GL was performed reflected a broad spectrum of potential hazards, some of which are not life-threatening or have effective treatments. Continuing emergency physician and poison center staff education is required to assist in patient selection.
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Injury secondary to epileptic seizure is widely documented in the literature. In particular, uncontrolled muscular contractions generated during a seizure can lead to a variety of musculoskeletal injuries. ⋯ We present the case of a 16-year-old male who presented on two separate occasions after a tonic-clonic seizure with hip pain, an antalgic gait, and marked discomfort on hip flexion. Radiologic investigation revealed an acute isolated fracture of the lesser trochanters. Such fractures in adolescents are normally secondary to athletic injury and in adults are mainly associated with the presence of metastatic bone disease. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We present this case with its previously undocumented mechanism to highlight the injury to frontline emergency medical teams, create awareness of its presentation, and to discuss its potential mechanism and treatment.
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Approximately 1% of emergency department (ED) visits are due to anaphylaxis. Symptoms can include skin rash, facial and laryngeal edema, dyspnea, vomiting, hypotension, and shock. A transient loss of consciousness can also be a manifestation of anaphylaxis. A variety of electrocardiographic changes due to anaphylaxis have been described for Kounis syndrome, also known as allergic angina. ⋯ Here we describe the case of a male patient presenting at an ED with syncope, anaphylactic shock, and ST-segment elevation on electrocardiogram (ECG). The diagnostic workup led to the diagnosis of ruptured hepatic echinococcal cyst complicated by anaphylactic shock and syncope. ECG alterations were a manifestation of anaphylaxis, as defined by the type I Kounis syndrome. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Kounis syndrome represents an underestimated disease. Its prompt diagnosis in an ED has important clinical and therapeutic implications, such as modifications in the anaphylaxis treatment protocol, that is, adrenaline should be avoided because it could worsen vasospasm and myocardial ischemia.