J Emerg Med
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Patients leaving the emergency department (ED) before treatment completion (LBTC) is a common universal occurrence. We hypothesized that the characteristics of the Israeli health care system, as well as its policy, intended to reduce the burden of nonurgent ED visits, may have an impact on factors associated with LBTC. ⋯ These findings reflect the strengths of the Israeli health care system. Despite the policy intended to reduce the burden of nonurgent ED visits, there are possible shortcomings in the system that should be addressed.
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Multisystem inflammatory syndrome in children is a phenomenon that has emerged during the coronavirus disease 2019 (COVID-19) pandemic. There are, however, few reported cases of a similar disease in adults. ⋯ We describe a 25-year-old man who presented with prolonged fever and conjunctivitis and was found to have a post-COVID inflammatory syndrome. His symptoms improved with colchicine, steroids, and a truncated course of intravenous immunoglobulin. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Post-COVID inflammatory syndrome has the potential to lead to dangerous complications. In addition, the identification of occult COVID infections could have public health implications.
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Case Reports
Migratory Fish Bone Presented With Extensive Surgical Subcutaneous Emphysema: A Case Report.
Fishbone ingestion represents a common cause for emergency department (ED) referral. In the majority of cases, an observed fishbone can be easily retrieved in the clinic setting. An impacted fishbone in the throat, albeit uncommon, carries potential risks of life-threatening events. Unusual complications caused by a migrated fishbone, including deep neck abscess, airway obstruction, and major vessels injury, are greatly influenced by the type of ingested fishbone and time between onset and presentation. ⋯ Here we report an unusual case of surgical subcutaneous emphysema after multiple attempts of purging to remove an ingested fishbone. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Fishbone foreign body is a common presentation to the ED. A thorough history and examination for the migratory foreign body is essential, as the complications are consequential.
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Obstructive shock is an uncommon presentation to the emergency department (ED) and is most often caused by an acute pulmonary embolism. A very rare cause of obstructive shock is extensive deep venous thrombosis, otherwise known as phlegmasia cerulea dolens. We present a case of obstructive shock caused by placement of an inferior vena cava filter complicated by acute occlusion with extensive deep venous thrombosis. ⋯ A 57-year-old man presented to the ED with hypotension, lethargy, and chronic leg pain. The day prior he had an inferior vena cava filter placed and was taken off his anticoagulation approximately 1 week prior. Massive pulmonary embolism was excluded as the cause based on point-of-care ultrasound showing absence of right heart strain. His initial resuscitation and evaluation did not determine the cause of his shock and he was empirically treated for sepsis. After adequate blood pressure was achieved with norepinephrine, his lower extremities were noted to be cyanotic and an ultrasound revealed the diagnosis of phlegmasia cerulea dolens. The shock state resolved after catheter-directed thrombolysis. Why Should an Emergency Physician Be Aware of This? Although unique, this case highlights an alternative cause of obstructive shock and informs emergency physicians about a potential deadly complication of a common procedure.
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Babesiosis, a tick-borne illness spread by Ixodes scapularis, is an emerging infectious disease in the Northeastern and upper Midwestern United States. Infection can present as a flu-like illness with anemia, thrombocytopenia, and jaundice. This disease can even be fatal in the immunocompromised or highly infected patient. Co-infection with other tick-borne illnesses is common, and prompt treatment with antiprotozoal agents and antibiotics is indicated to prevent adverse outcomes. ⋯ We describe a patient who presented to the emergency department with flu-like symptoms, but had history concerning for environmental exposure to babesiosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early detection is important to prevent severe sequalae of the disease. This is a disease that can imitate a viral syndrome but should be considered in the differential for a patient with a concerning history.