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An 80-year-old man with acute onset of right upper limb weakness
An 80-year-old man with a history of hypertension was referred under the suspicion of stroke. He suffered from acute onset of right upper limb weakness 4 h before presenting to our emergency department. He did not have dysarthria, facial palsy or positive pronator sign. But decreased right radial pulse and cold upper limb with cyanosis were noted. Emergent CT angiography was performed and revealed isolated spontaneous right subclavian artery dissection (figure 1A), which extended to axillary artery with compression of true lumen by thrombosed false lumen (figure 1B). He then received heparinisation treatment and the w...
Source: Emergency Medicine Journal - May 13, 2013 Category: Emergency Medicine Authors: Hsieh, M.-S., Hung, Y.-Y., Hu, S.-Y., Tsan, Y.-T. Tags: Open access, Drugs: cardiovascular system, Stroke, Hypertension, Radiology, Clinical diagnostic tests, Radiology (diagnostics), Ethics Images in emergency medicine Source Type: research

A Serious Diagnosis Lacking Common Symptoms
​BY JENNIFER TUONG; IVAN KHARCHENKO; JEAN LUC AGARD; & AHMED RAZIUDDIN, MDA 65-year-old man who had HIV well-controlled with highly active antiretroviral therapy, hypertension, sciatica, and restless leg syndrome presented to the emergency department with left leg pain. He also had had chemotherapy and radiation for anal cancer. The patient said the pain had started 45 minutes earlier when he was sitting on the toilet.He described the pain as sore in quality and 10/10 on the pain scale. He reported that it had started in his lower back and radiated to his left leg. He said he had had no trauma or weakness to the regi...
Source: The Case Files - May 28, 2019 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

Intracerebral hemorrhage in a middle aged cocaine user despite normal blood pressures
We report the case of a 40-year-old woman with a not declared at admission with a 4 year history of intranasal cocaine hydrochloride who developed an intracerebral subcortical spontaneous hemorragie. She documented a normal blood pressure and a CT angiography did not shown vascular abnormalities and excluded the presence of arterial aneurisms.
Source: The American Journal of Emergency Medicine - September 2, 2016 Category: Emergency Medicine Authors: Antonio Siniscalchi, Walter Lentidoro, Ermanno Pisanil, Giovamabattista De Sarro, Luca Gallelli Tags: Case Report Source Type: research

Intracerebral hemorrhage in a middle-aged cocaine user despite normal blood pressures
We report the case of a 40-year-old woman who did not declare at admission her 4-year history of intranasal cocaine hydrochloride and developed an intracerebral subcortical spontaneous hemorrhage. She documented a normal blood pressure, and computer tomography angiography did not show vascular abnormalities and excluded the presence of arterial aneurisms.
Source: The American Journal of Emergency Medicine - September 2, 2016 Category: Emergency Medicine Authors: Antonio Siniscalchi, Walter Lentidoro, Ermanno Pisanil, Giovamabattista De Sarro, Luca Gallelli Tags: Case Report Source Type: research

Fool Me Once: An Uncommon Presentation of PE
​BY FREDDIE IRIZARRY-DELGADO; VAROON KAKAIYA; & AHMED RAZIUDDIN, MDAn 86-year-old African-American woman was brought to the ED by her daughter after two days of nutritional neglect, abdominal pain, and altered mental status. Her daughter said her mother felt lightheaded, appeared dehydrated, and vomited nonbilious watery fluid once. The patient had a history of diabetes mellitus type 2, DVT/PE, dementia, and early signs of parkinsonism.Her vital signs were remarkable only for tachypnea (24 bpm). Her troponin I was markedly elevated at 1.7 ng/mL. A D-dimer was ordered because of her history of unprovoked DVT/PE, and i...
Source: The Case Files - November 27, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Not Just Acid Reflux: The Need to Think Worst First
Discussion Heart disease is the leading cause of death in the United States.1 This year, 720,000 Americans will have a new coronary event—defined as first hospitalized myocardial infarction (MI) or coronary heart disease death—and around 335,000 will have a recurrent event. Approximately 35% of people who experience a coronary event in a given year and around 14% of patients who have an acute coronary syndrome will die from it.1 Roughly 60% of patients with an acute coronary syndrome are transported to the emergency department via ambulance.2–4. Up to one-third of patients experiencing an MI may not complain of chest...
Source: JEMS Special Topics - January 13, 2019 Category: Emergency Medicine Authors: Stephen Sanko, MD, FACEP Tags: Exclusive Articles Cardiac & Resuscitation Source Type: news

Diagnosis and management of acute aortic syndromes in the emergency department
AbstractAcute aortic syndromes (AASs) are deadly cardiovascular emergencies involving the thoracic aorta. AASs are relatively rare conditions, have unspecific signs and symptoms (including truncal pain, syncope, neurologic deficit and limb ischemia) and require contrast-enhanced tomography angiography (CTA) of the chest and abdomen for conclusive diagnosis and subsequent therapeutic planning. In the Emergency Department (ED), most patients with potential signs/symptoms of AASs are finally found affected by other alternative diagnoses. Hence, misdiagnosis and delayed diagnosis of AASs are major concerns. In critically ill p...
Source: Internal and Emergency Medicine - April 30, 2020 Category: Emergency Medicine Source Type: research