J Emerg Med
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Spontaneous coronary artery dissection (SCAD) is an infrequently recognized but potentially fatal cause of acute coronary syndrome (ACS) that disproportionately affects women. Little is currently known about how patients with SCAD initially present. ⋯ Patients with SCAD present with similar symptoms compared to patients with ACS caused by atherosclerotic disease, but have different risk profiles. Providers should consider SCAD in patients presenting with symptoms concerning for ACS, especially in younger female patients without traditional cardiovascular disease risk factors, as their risk may be significantly underestimated with commonly used ACS risk-stratifiers.
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Case Reports
A Case Report of Infectious Sacroiliitis in an Adult Presenting to the Emergency Department with Inability to Walk.
Infectious sacroiliitis (ISI) is an uncommon cause of back and hip pain in which the sacroiliac joint, either unilateral or bilateral, is inflamed from an infectious source. Historically, this has been an easily missed diagnosis due to nonspecific presenting symptoms along with subtle nondistinguishable laboratory abnormalities. ⋯ We describe an injection drug user presenting with right-sided ISI who presented with hip and back pain and inability to walk. The patient had tenderness over his right sacroiliac joint, and despite negative plain radiographs, a magnetic resonance imaging (MRI) scan was obtained from the Emergency Department (ED) given the patient's risk factors for infection. Concerning findings of ISI on this MRI led to a computed tomography-guided biopsy during the patient's hospital admission, which revealed alpha-hemolytic Streptococcus as the responsible pathogen. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Infectious sacroiliitis is a rare condition that is difficult to diagnose, and carries increasing morbidity when diagnosis is delayed. We aim to increase awareness through a case report of a patient encountered in the ED.
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Fungal nervous system infection can be a difficult diagnosis to make, due to the fact that there are no specific manifestations of the disease and laboratory confirmation is difficult to confirm. ⋯ We report a young male who presented to our emergency department with a variety of unilateral visual field complaints. While he initially denied recent IV drug abuse, his physical examination was highly suggestive of a fungal infection known to result from brown heroin use. He was ultimately diagnosed with meningitis, ventriculitis, and endogenous endophthalmitis believed to result from a Candida species. The response to treatment with vitrectomy and broad-spectrum antimicrobials gave support to the presumed diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We provide a rarely described report of a possible complication from the use of IV brown heroin that led to a central nervous system infection involving vision loss by fungal infection.
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The development of novel oral anticoagulants (NOACs) has revolutionized oral anticoagulation. Rapid incorporation of NOACs into general practice has heightened the demand for directed reversal agents. Idarucizumab is a targeted reversal agent that is approved for the urgent reversal of the anticoagulant effects of dabigatran. While it is a welcome addition to reversal strategies of dabigatran, a number of clinical questions exist regarding its place in therapy. ⋯ The initial data suggest a definite role for idarucizumab in treatment of bleeding associated with dabigatran. As more clinical practice experience is gained with the agent and the remaining data on its use are released, clinicians can better guide the clinical use of idarucizumab. At present, there is currently not enough evidence for idarucizumab to be used as monotherapy.
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Many emergency physicians gain familiarity with the laryngeal anatomy only during the brief view achieved during rapid sequence induction and intubation. Awake laryngoscopy in the emergency department (ED) is an important and clinically underutilized procedure. ⋯ We discuss two clinical scenarios, indications/contraindications, patient selection, and steps to performing two approaches to awake laryngoscopy in the ED.