J Emerg Med
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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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There is a dearth of epidemiological data on ethnic disparities among older patients with COVID-19. The objective of this study was to characterize ethnic differences in clinical presentation and outcomes from COVID-19 among older U.S. adults. ⋯ These preliminary data show that older Hispanic patients relative to non-Hispanic patients with COVID-19 presenting to a GED did not experience worse outcomes, including hospitalization, ICU admission, 30-day return visits to the GED, or death.
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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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Coronavirus Disease 2019 (COVID-19) is a disease that presents with acute respiratory symptoms that are well documented and sequelae that are yet to be fully understood. ⋯ We present the case of a 51-year old woman, recently diagnosed with COVID-19, who presented with symptoms including chest pain, palpitations, difficulty swallowing, and anterior neck discomfort. We ultimately diagnosed her with COVID-19-induced thyroiditis and discharged her on propranolol and nonsteroidal anti-inflammatory medication. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Thyroiditis can present with symptoms similar to other etiologies like pulmonary embolism. We discuss the process of evaluating and treating thyroiditis. We further discuss the risk of administering iodinated contrast media that could further exacerbate thyroid dysfunction.
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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.