J Emerg Med
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The world's first electric ambulance was the St. Louis electric ambulance car, developed in 1893, put in service on December 27, 1894, and cancelled because of funding shortages in mid-1895. Its history is briefly reconstructed, and its legacy appreciated.
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Case Reports
Massive Pneumomediastinum and Subcutaneous Emphysema Secondary to Foreign Body Aspiration.
Spontaneous pneumomediastinum (SPM) occurs in cases of mediastinal leaks that are not caused by trauma, mechanical ventilation, or other surgical procedures. In most cases, in the pediatric population a trigger can be identified, most commonly asthma. SPM caused by foreign body aspiration is not a common entity. It is usually a benign condition that generally resolves without severe sequela, but in some cases, severe morbidity and mortality have been documented. Treatment is usually conservative and includes rest, analgesics, and treatment of any underlying pathologies. ⋯ We report a case of a 19-month-old boy who presented to the emergency department with acute facial swelling and wheezing with no history of foreign body aspiration. This misleading presentation led the medical staff in the emergency department to initially treat the patient for anaphylaxis. The diagnosis was made only after imaging modalities demonstrated SPM with a suspected foreign body in the right main stem bronchus. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Providers should consider SPM from an aspirated foreign body in young children with respiratory distress and acute facial swelling, especially when crepitus is present. © 2021 Elsevier Inc.
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The presence of abrupt anisocoria in clinical examination usually leads to the performance of urgent neuroimaging studies to exclude intracranial hemorrhage, although unilateral mydriasis might be the result of other benign etiologies. ⋯ In this work, we report an illustrative case of a patient presenting with sudden-onset anisocoria while receiving ipratropium bromide nebulization in the emergency department to treat acute asthma. No other abnormalities were found on neurological examination and the computed tomography scan was normal. As a muscarinic antagonist, ipratropium bromide can produce mydriasis if accidentally instilled on one eye, thus leading to the suspicion of pharmacologic mydriasis. The pupils became isocoric after the discontinuation of the drug. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: A careful neurological examination and the history of treatment with mydriatic drugs might avoid unnecessary tests and radiation exposure.
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Altered mental status is a common cause for presentation to the emergency department with a broad differential diagnosis. ⋯ We present a unique case of altered mental status in a previously healthy man that was found to be secondary to primary central nervous system acute lymphoblastic leukemia. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Lumbar puncture remains a critical tool for emergency physicians in the diagnosis of central nervous system pathologies.
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Novel coronavirus disease 2019 (COVID-19) has affected more than 89 million people worldwide. As the pandemic rages on, more complications of the disease are being recognized, including stroke, cardiovascular disease, thromboembolic events, encephalopathy, seizures, and more. Peripheral nervous system involvement, particularly Guillain-Barré syndrome (GBS), is of special interest, given the increasing reports of cases related to COVID-19. Because of the potentially delayed onset of symptoms of polyradiculoneuropathy and weakness after the traditional COVID-19 symptoms, it is vitally important for emergency physicians to be vigilant and to consider GBS as part of their differential diagnosis. GBS usually occurs after an infectious insult, and a variety of culprit pathogens have been identified in the literature. ⋯ We describe the case of a 35-year-old man who developed GBS after being diagnosed with COVID-19 infection. The patient displayed classic symptoms of neuropathy, areflexia, and lower extremity weakness. Cerebrospinal fluid evaluation demonstrated albuminocytologic dissociation seen in GBS, although anti-ganglioside autoantibodies were negative. These antibodies are often negative and do not exclude the diagnosis. The patient responded clinically to intravenous immunoglobulin therapy and was discharged home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report contributes further evidence that COVID-19 joins other organisms as causes of GBS. Emergency physicians are the first point of contact for many patients. Increased awareness of this complication of COVID-19 will lead to higher detection. Prompt recognition could lead to speedier and more complete neurologic recovery of affected patients.