Complications of a Ruptured Ectopic Pregnancy
BY GREGORY TAYLOR, DO, & JACKLYN MCPARLANE, DOA 31-year-old woman with a significant medical history for one ectopic pregnancy and five spontaneous abortions presented with abdominal pain and vaginal bleeding. Her symptoms started abruptly two days earlier, and the pain was located in the right lower quadrant, which had become diffuse and she described as sharp. She was also experiencing nausea, vomiting, and vaginal bleeding.She stated she had been spotting for five days and soaking up to four pads a day. Her last menstrual period was two months before, and a home pregnancy test was positive. Her presentation wa...
Source: The Case Files - July 11, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research
A True Hematologic Emergency
BY GREGORY TAYLOR, DO, & JACKLYN MCPARLANE, DOA 33-year-old woman with a past medical history of sickle cell SS presented to the emergency department with chest pain, difficulty breathing, and a cough for two days. Her chest pain was diffuse, without radiation, and partially reproducible. Her cough was nonproductive, and she also reported fever and chills.The patient noted this was different from her normal back and leg pain from past sickle cell crises. She was following up with a sickle cell specialist, and was compliant with her hydroxyurea treatment.Her temperature was 102.8°F, blood pressure was 94/60 mm...
Source: The Case Files - June 26, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research
Complications of Ketamine Abuse
BY STUART ETENGOFF, DO, & ABDULLAH BOKHARI, AB, DOA 20-year-old Caucasian man presented via EMS with a chief complaint of withdrawal from ketamine and secondary complaints of abdominal pain, blood in his urine, and painful urination with urgency for two days.He said he had been using ketamine intravenously daily for the past five days, up to 35 grams over the past week. His last use was 24 hours prior to presentation to the ED. He stated that he had been using ketamine regularly for four years and that he has used it intravenously, orally, and intranasally.He reported a history of ADHD and a family his...
Source: The Case Files - June 19, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research
A Curious Cause of Pulmonary Embolism
BY BRUNA ALMEIDA, & AHMED RAZIUDDIN, MDA 30-year-old man presented to the ED with dyspnea and pleuritic chest pain radiating to his left shoulder that had started three days before. He was at a “sex party” four days earlier, and had used amphetamines and gamma-hydroxybutyric acid (GHB, also called Liquid G).The patient said deep breaths and movement worsened his pain. He also had exertional shortness of breath and occasional palpitations. He denied fever, cough, loss of consciousness, recent surgery, and prolonged immobilization. The patient had no personal or family history of DVT, PE, or cardiac conditions. He...
Source: The Case Files - May 15, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research
An Unusual Diagnosis Presenting as SOB and Pleural Effusions
BY ANDRZEJ KIELTYKA, PA; PARDEEP THANDI, MD; & ANUMEHA SINGH, MDA 56-year-old man presented to the emergency department with shortness of breath for one month and pleural effusions on an outpatient chest x-ray. He had been taking adalimumab, methotrexate, and steroids for arthritis and Sjogren's syndrome.A right pleural effusion in a patient with nephrotic syndrome.His monoclonal gammopathy of undetermined significance (MGUS) was monitored annually, but no medical intervention beyond surveillance was required. He had excessive thirst but normal urine output. He noted face and hand swelling in the morning that gave w...
Source: The Case Files - May 9, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research
Severe Symptoms, but a Truly Treatable Disease
BY NOURA MAHDI; DARRON LEWIS; JEREMY OSBORNE; & AHMED RAZIUDDIN, MDA 73-year-old man was brought to the emergency department from his nursing home for rectal bleeding and anemia. The patient mentioned he had had episodes of bright red rectal bleeding and constipation for a few months. A colonoscopy had been done prior to the visit, which revealed a large intestine tumor and biopsy confirming adenocarcinoma. He was awaiting an appointment with his surgeon.The patient reported bloody rectal leakage, and a CBC done at the nursing home showed a hemoglobin level of 7.2. He also complained of dyspnea but denied any other ...
Source: The Case Files - March 20, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research
Care after Return of Spontaneous Circulation
BY TRAVIS SMITH, MD, & MATTHEW ZUCKERMAN, MDParamedics were called for a 42-year-old woman found at a motel by her significant other. The patient was alone at the time of EMS arrival. She was pulseless and apneic, so chest compressions were started, and the cardiac monitor showed pulseless electrical activity.Initial ECG showing STE in the anterior leads with ST depression in the inferior leads.The paramedics gave her 1 mg of epinephrine IV and 1 mg of naloxone IV without obvious response. A laryngeal mask airway was placed, and oxygen was delivered by bag valve mask. She received eight rounds of chest compress...
Source: The Case Files - March 13, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research
When the Treatment Could Lead to Death
BY KEVAL PATEL, & AHMED RAZIUDDIN, MDA 41-year-old man with a past medical history of bipolar disorder, PTSD, and alcohol abuse presented to the emergency department for an erection that wouldn't go away. He said his erection had persisted for 28 hours and was starting to be painful. He had taken trazodone the day before but was unable to recall the dosage. He denied any erectile dysfunction in the past when he was on trazodone a year before.Physical examination showed an uncomfortable-appearing man lying supine in bed but in no acute distress. The physical exam was normal except for the genitourinary exam, which re...
Source: The Case Files - February 20, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research
When You Can't See the Bleeding
BY MARIA AHMAD, & AHMED RAZIUDDIN, MDA 50-year-old woman presented to the ED at 10 a.m. one day complaining of severe left upper quadrant and left flank pain since 2 a.m. the night before. The pain was associated with nausea and four episodes of vomiting, and she described it as nonradiating, sharp, and stabbing. The patient was in obvious distress and diaphoretic. She confirmed that she had never had surgery and was not taking any medications. Her first set of vital signs included an oral temperature of 97.4°F; blood pressure of 105/92 mm Hg; pulse of 106 bpm; respiratory rate of 28 bpm; mean arterial pressure ...
Source: The Case Files - February 13, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research
A Common Emergency with an Uncommon Twist
BY ADAM JONES, MD, & LUKE METZKER, DOAbdominal compartment syndrome is a recognized emergency following abdominal trauma and surgery, but apparently it can also be spontaneous. A 58-year-old mentally delayed and autistic man presented to the ED with acute onset severe abdominal pain, a rigid abdomen, and respiratory failure. His lower extremities were mottled, and he was obviously in acute distress. He was intubated, and an orogastric tube was placed in preparation for exploratory surgery.Initial chest x-ray showing severe gastric distension.After the tube was placed, the patient's abdomen decompressed and color ret...
Source: The Case Files - January 30, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research
Ocular Complaint Leads to an Unusual Diagnosis
BY GURDEEP SINGH NAGI, MD; BHAVINI TAILOR, MD; & AHMED RAZIUDDIN, MDA 40-year-old man with no significant past medical history presented to the emergency department with visual problems. He said he had noticed about four days earlier a dark red circle over any object on which he tried to focus. The condition had been constant and had not improved or worsened over the past few days. He also said it did not matter whether he was focusing on an object that was near or far.The patient had seen an optometrist who recommended he have blood work done, but did not specify what exactly to ...
Source: The Case Files - December 28, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
A Rare Complication of a Common Disease
BY ANUMEHA SINGH, MD, & ANDREJ KIELTYKA, PASymptomatic bradycardia is usually reserved for the over-the-hill crowd, but it is not entirely unheard of in the young and healthy. A 21-year-old African American man was sent to the emergency department by his primary care provider. The patient had no previous medical issues, normal vital signs, and was fine until about a week prior. He had quickly worsening shortness of breath while climbing the stairs to get to his dorm bedroom. The young man denied having been out in the woods or noting tick bites. He had no family history of cardiomyopathy or early cardiac events.T...
Source: The Case Files - December 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
An Infection that Vaccine Doesn't Prevent over Time
BY NATALIE CAZEAU, MSC; ERICA ROMAN HERNANDEZ; KINZA IJAZ; AMY SCHEUERMANN; AHMED RAZIUDDIN, MDA 43-year-old man presented to the ED with a rash in a C7 dermatomal pattern that was burning and painful. The patient said the rash began three weeks before the ED visit as a group of little blisters on his right upper back and extending down his right arm. The patient was worried and in mild distress as the rash continued to burn, and he reported numbness to the area. He mentioned he had received the shingles vaccine in the past.The patient's rash was yellow, crusty, and tender upon palpation. The area was hyperke...
Source: The Case Files - October 25, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
