J Emerg Med
-
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.
-
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.
-
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.
-
Hyperglycemic hyperosmolar state is a life-threatening complication of diabetes mellitus. Therefore, it is important for emergency physicians to be aware of this unique diagnosis and treatment considerations. ⋯ Hyperglycemic hyperosmolar state is associated with significant morbidity and mortality. It is important for clinicians to be aware of the current evidence regarding the diagnosis, management, and disposition of these patients.
-
Isolated complaint of dysuria in an adolescent is a rare presentation for acute perforated appendicitis. Acute appendicitis typically involves vague periumbical pain that migrates to the right lower quadrant, associated with pain, nausea, and loss of appetite. There have been case reports of associated pyuria and dysuria in addition to classical symptoms, but to our knowledge, this is the first case with isolated dysuria presenting to an emergency department (ED). ⋯ A 14-year-old boy presented to the ED with 3 days of dysuria and subsequent sensation of urinary retention. Urine dip showed occult blood without white cells or nitrites. A bedside renal/bladder point-of-care ultrasound (POCUS) did not show evidence of obstruction. However, it did reveal a retrovesicular fluid collection with an echogenic foci inside suspicious for abscess, likely secondary to ruptured appendicitis. This diagnosis was confirmed with a dedicated right lower quadrant ultrasound, with resultant treatment with i.v. antibiotics and eventual surgical resection of the appendix. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pediatric and adolescent patients may present with extremely atypical symptoms of a common disease process. In this case, early use of POCUS in the ED helped to quickly identify an acute surgical process and focus diagnostic and therapeutic interventions.