Emergency medicine
Esmaeal Rayat Dost; Saeed Barazandehpour; Navid Kalani; Samaneh Abiri
Volume 7, Issue 1 , January 2021, , Pages 71-73
Abstract
Objective: Aortic dissection is an uncommon disorder with a high mortality rate, especially if misdiagnosis and mistreatment are not considered. Case Presentation: We present a 67-year old female with slurred speech and left sided plegia during her brother’s funeral. The patient did not have ...
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Objective: Aortic dissection is an uncommon disorder with a high mortality rate, especially if misdiagnosis and mistreatment are not considered. Case Presentation: We present a 67-year old female with slurred speech and left sided plegia during her brother’s funeral. The patient did not have any chest pain. she was referred to our emergency department by EMS due to being suspicious of cerebrovascular accident (CVA) )as code 724). However, owing to low blood pressure and atypical symptoms of the patient, we did RUSH exam in the emergency department to detect aortic dissection. After doing the Computed tomography (CT) angiography, the diagnosis of aortic dissection was confirmed. As the vascular surgeon was not present in our surgery department, we transferred the patient to Namazi hospital by air ambulance to undergo the surgery. She was discharged from hospital with complete recovery.Conclusion: Aortic dissection symptoms can be manifested in different ways such as pulmonary embolism, ACS, and CVA. Therefore, clinicians must always have the differential diagnosis of aortic dissection in their mind and be aware of its various manifestations.
Emergency medicine
Mustafa Bolatkale; Çağdaş Can; Ahmet Çağdaş Acara; Aydın Sarıhan
Volume 3, Issue 2 , July 2017, , Pages 75-76
Abstract
Preparing to manage weapons of mass destruction events challenges emergency services systems neighboring Syria every day. Understanding injury from explosives is essential for all providers of emergency care in both civilian and military settings. In this case, the authors present a 22-year-old ...
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Preparing to manage weapons of mass destruction events challenges emergency services systems neighboring Syria every day. Understanding injury from explosives is essential for all providers of emergency care in both civilian and military settings. In this case, the authors present a 22-year-old man who was admitted to the emergency department with displaced skull fracture, epidural hemorrhage and cerebral contusion due to barrel bomb tertiary blast effect. A 22-year-old man who complained of pain in the right temporal head region after barrel bomb explosion was admitted in the emergency department. The patient could not remember the explosion and found himself on the ground. In his medical history, there was not a record of any diseases, operations or traumas. Examination of the head revealed scalp hematoma and slump in the skull on the right temporal region. Patients computed tomography (CT) scan showed a displaced skull fracture, epidural hematoma and cerebral contusion.
Emergency medicine
Atul Rai Sharma; Akash Singhal; Anurag Patil; Gladson David Masih
Volume 8, Issue 1 , January 2022, , Pages 66-68
Abstract
Objective: Distal radioulnar joint (DRUJ) subluxation with associated both bones forearm fracture is a rare clinical entity and is easily missed, leading to significant functional limitations.Case Presentation: A 28-year-old male fell on the outstretched hand and suffered left side both bones forearm ...
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Objective: Distal radioulnar joint (DRUJ) subluxation with associated both bones forearm fracture is a rare clinical entity and is easily missed, leading to significant functional limitations.Case Presentation: A 28-year-old male fell on the outstretched hand and suffered left side both bones forearm shaft fracture with ipsilateral DRUJ disruption. Operative intervention in the form of plating was done for both bones forearm shaft fracture and DRUJ was stabilised with one k wire and above elbow plaster splint in full supination was given for 6 weeks. At one-year follow-up, fracture was united and Disabilities of the Arm, Shoulder and Hand (DASH) score was 11.7, and he was well satisfied.Conclusion: DRUJ disruption should be carefully evaluated in all the patients with associated shaft fractures of radius and ulna. Timely diagnosis and optimal intervention may prevent any functional limitations.
Clinical Toxicology
Hamidreza Reihani; Maryam Ziadi Lotfabadi
Volume 7, Issue 1 , January 2021, , Pages 74-76
Abstract
Objective: We are going to alert the emergency physicians to be aware of drugs side effects. Some drugs like methotrexate are not routine drugs, and the symptoms may be miss diagnosed if not completely notified.Case Presentation: We present two patients under treatment with methotrexate. Both of them ...
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Objective: We are going to alert the emergency physicians to be aware of drugs side effects. Some drugs like methotrexate are not routine drugs, and the symptoms may be miss diagnosed if not completely notified.Case Presentation: We present two patients under treatment with methotrexate. Both of them suffered from methotrexate poisoning due to improper use. We discuss the causes of methotrexate poisoning and its prevention.Conclusion: A significant proportion of methotrexate users may not be completely aware of its proper use and the side effects. One of the important ways to prevent the toxicity of methotrexate is educating patients and their companions in order to use it correctly.
Emergency medicine
Parvin Aَbbaslou; Maryam Ahmadipour
Volume 6, Issue 2 , July 2020, , Pages 118-120
Abstract
Objective: Foreign body swallowing is a common pediatric problem. A foreign body in the pharynx is a medical emergency that requires urgent intervention. Evaluation and treatment of pharyngeal foreign bodies is much more difficult in children than in adults and sometimes requires hospitalization and ...
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Objective: Foreign body swallowing is a common pediatric problem. A foreign body in the pharynx is a medical emergency that requires urgent intervention. Evaluation and treatment of pharyngeal foreign bodies is much more difficult in children than in adults and sometimes requires hospitalization and removal of the foreign bodies under general anesthesia due to children’s lack of cooperation. Fish and chicken bones are the most common swallowed foreign bodies, but an interesting case of a piece of dishwashing steel wool stuck in a child’s pharynx is reported in this article.Case Presentation: A 10-year old boy was presented with a history of dysphagia from five weeks ago. Oral examination did not reveal anything significant. In lateral neck radiographs of the patient, a metal wire was observed in the hypopharyngeal region opposite the 4th and 5th cervical vertebrae. Endoscopic attempts to remove the foreign body were not successful. Therefore, the foreign body was removed from the patient’s pharynx in the operating room under general anesthesia. No complications were observed.Conclusion: Despite the prevalence of swallowing foreign bodies in children, ingestion of a piece of dishwashing steel wool not diagnosed for three weeks was considered interesting to report. Pharyngeal foreign bodies are medical emergencies; therefore, it is particularly important to suspect the presence of a foreign body and perform diagnostic procedures.
Emergency medicine
Mustafa Mahmood Eid
Volume 7, Issue 1 , January 2021, , Pages 77-79
Abstract
Objective: Epidural anesthesia is one of the famous, generally safe, and most requestedpain relief measures in labor. Nevertheless, it can have some complications thoughpneumocephalus and subdural effusion are very rare complications.Case Presentation: A 32-year-old woman presented with a severe persistent ...
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Objective: Epidural anesthesia is one of the famous, generally safe, and most requestedpain relief measures in labor. Nevertheless, it can have some complications thoughpneumocephalus and subdural effusion are very rare complications.Case Presentation: A 32-year-old woman presented with a severe persistent headacheafter a vaginal delivery, where epidural anesthesia was used for pain control. Her braincomputerized tomography (CT) scan confirmed pneumocephalus and subdural effusionas a complication of the procedure.Conclusion: Although headache can be present in many women post-delivery,investigations should run in susceptible women with alerting signs.
Clinical Toxicology
Jyoti Aggarwal; Zainab Mehdi; Baldeep Kaur; Yuvraj Singh Cheema; Monica Gupta
Volume 8, Issue 1 , January 2022, , Pages 69-73
Abstract
Objective: Lithium is a principal drug used in the treatment of bipolar disorder (BPD). Due to its narrow therapeutic index, serum levels need to be monitored regularly. In elderly patients with renal dysfunction lithium toxicity can develop paradoxically within the therapeutic range. This can lead to ...
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Objective: Lithium is a principal drug used in the treatment of bipolar disorder (BPD). Due to its narrow therapeutic index, serum levels need to be monitored regularly. In elderly patients with renal dysfunction lithium toxicity can develop paradoxically within the therapeutic range. This can lead to erroneous diagnosis and delayed treatment resulting in irreversible neurological sequelae as is described in our case.Case Presentation: A 65-year-old hypertensive female, with a 7-year history of BPD presented with decreased oral intake since 5-7 days, followed by altered sensorium. Neurological examination revealed coarse tremors in bilateral upper and lower limbs with spasticity, hyperreflexia, bilateral knee clonus. Twenty-five days earlier, she was prescribed Lithium carbonate. On evaluation she was found to have chronic kidney disease. Serum lithium levels came out to be 1.18 mg/dL (borderline high). After ruling out other differentials, a diagnosis of lithium toxicity was considered and she underwent two sessions of hemodialysis (HD) leading to significant improvement in sensorium; however, the patient had persistent dysarthria, difficulty in walking and proximal myopathy predominantly in the lower limbs. Nerve conduction studies confirmed the presence of axonal neuropathy. These findings of peripheral neuropathy (both sensory and motor) were suggestive of SILENT (syndrome of irreversible lithium-effectuated neurotoxicity).Conclusion: Unintended lithium toxicity can occur even at therapeutic levels especially in the elderlies owing to its narrow therapeutic window, complex pharmacokinetics and numerous drug interactions. Lithium can result in irreversible neurotoxicity including SILENT; therefore, a high level of suspicion is required to prevent such permanent disability.
Clinical Toxicology
Mehran Shahi; Seyed Hamid Moosavy; Hossein Sanaei-Zadeh
Volume 6, Issue 2 , July 2020, , Pages 121-125
Abstract
Objective: Scorpion stings are common in tropical regions of Iran. Hemiscorpius enischnochela are distributed in southern part of Iran. The venom of this scorpion causes severe hemolysis, hemoglobinuria, and occasionally death.Case Presentation: This report describes the clinical manifestations of envenomation ...
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Objective: Scorpion stings are common in tropical regions of Iran. Hemiscorpius enischnochela are distributed in southern part of Iran. The venom of this scorpion causes severe hemolysis, hemoglobinuria, and occasionally death.Case Presentation: This report describes the clinical manifestations of envenomation by H. enischnochela in a 3-year-old boy from Ruydar city in south of Iran.Conclusion: Special attention should be paid to the painless stings of yellow scorpions and more studies are needed to set out a protocol for the management of these cases in areas with this envenomation to be a common one.
Emergency medicine
Chui King Wong; Glen Chiang Hong Tan; Mohd Johar Jaafar
Volume 8, Issue 1 , January 2022, , Pages 74-76
Abstract
Objective: ST-elevations in electrocardiogram (ECG) secondary to an acute myocarditis may mimic ST-elevation myocardial infarction (STEMI). It is vital to distinguish between the two entities to avoid inappropriate clinical management and complications.Case Presentation: A previously well 19-year-old ...
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Objective: ST-elevations in electrocardiogram (ECG) secondary to an acute myocarditis may mimic ST-elevation myocardial infarction (STEMI). It is vital to distinguish between the two entities to avoid inappropriate clinical management and complications.Case Presentation: A previously well 19-year-old male presented with two episodes of central chest pain which were resolved spontaneously. His presentation was preceded by multiple episodes of vomiting, diarrhoea and abdominal pain. Physical examination was unremarkable except for a low-grade temperature of 37.7°C. The first ECG revealed ST-segment elevations in anterior leads without reciprocal changes. Serial ECGs showed increasing ST elevations and his cardiac markers were significantly raised. As the initial clinical presentation was potentially an acute coronary syndrome, he was instinctively treated with anti-platelets. Fortunately, this patient was not given thrombolysis as there were clinical suspicions of an acute myocarditis due to his young age, presence of viral symptoms, and absence of cardiac risk factors. Subsequent cardiac MRI confirmed the diagnosis of an acute myocarditis.Conclusion: An acute myocarditis is well known but less common presentation of viral infections. ST-segment elevations in ECG of any young patients with chest pain but without risk factors for acute coronary syndrome should always raise the suspicion of acute myocarditis especially in the presence of viral symptoms. Investigations such as cardiac magnetic resonance imaging (MRI) should be carried out emergently to distinguish both conditions.
Emergency medicine
Garima Sharma; Sanya Vermani; Anjum Syed
Volume 8, Issue 1 , January 2022, , Pages 77-79
Abstract
Objective: The presence of air within the mediastinal compartment and retro-peritoneal compartment, in the setting of trauma, can be because of visceral and skeletal injuries. However, in absence of a local site injury, an approach based on anatomical communication between various body compartments should ...
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Objective: The presence of air within the mediastinal compartment and retro-peritoneal compartment, in the setting of trauma, can be because of visceral and skeletal injuries. However, in absence of a local site injury, an approach based on anatomical communication between various body compartments should be utilized and all potential sites of injuries must be reviewed.Case Presentation: We present a case of a 40-year-old male patient with a history of trauma (fall from height), presenting to the emergency department with loss of consciousness and ear bleed. Chest radiographs showed pneumomediastinum. On cross-sectional imaging, pneumomediastinum and pneumoretroperitoneum were seen, however no esophageal, tracheal and skeletal injuries could be identified. On careful evaluation, fractures involving the base of skull were identified as a source of ectopic air.Conclusion: This case represents a situation where the fascial connections between various compartments of the body were utilized to find the site of injury and hence the source of ectopic air. Base of skull fractures are important to be identified since these require surgical attention at an early stage.
Emergency medicine
Luis Miguel Castro; Rui Manuel Mendes; Coelho Fátima Borges; Capella Vanessa; Ávila Leonor
Volume 8, Issue 1 , January 2022, , Pages 80-82
Abstract
Objective: A Perforation of hollow viscus is the most common cause of pneumoperitoneumafter a blunt thoracoabdominal trauma and demands prompt surgical exploration.Alternative routes into the peritoneal cavity, such as the presence of a diaphragmaticlaceration associated with pneumothorax, although rare, ...
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Objective: A Perforation of hollow viscus is the most common cause of pneumoperitoneumafter a blunt thoracoabdominal trauma and demands prompt surgical exploration.Alternative routes into the peritoneal cavity, such as the presence of a diaphragmaticlaceration associated with pneumothorax, although rare, should be considered whenapproaching these patients.Case Presentation: We present the case of a 78-year-old male admitted to the emergencydepartment after being ran over by a car resulting in right thoracoabdominal trauma,presenting with dyspnea and signs of peritoneal irritation. CT scan identified rightpneumothorax, pneumoperitoneum and free abdominal fluid. The pneumothoraxwas drained and posteriorly he underwent exploratory laparotomy where a traumaticlaceration of the diaphragm was identified as the cause of pneumoperitoneum.Conclusion: Alternative causes of pneumoperitoneum should be considered in bluntthoracoabdominal trauma with possibility of conservative management in the absenceof peritoneal irritation signs. Pneumothorax drainage is mandatory before intubation toavoid creation of a tension pneumothorax.
Clinical Toxicology
Rouhullah Dehghani; Kobra Taji; Amrollah Mahmoudi; Masoomeh Varzandeh
Volume 8, Issue 1 , January 2022, , Pages 83-85
Abstract
Objective: A Scorpion sting is one of the most important health and medical problems in most parts of Iran.Case Presentation: This case report occurred in Chaharmahal Bakhtiari province of Bazoft city. The injured person was a 48-year-old woman, weighing about 69 kg. Two documentary filmmakers were on ...
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Objective: A Scorpion sting is one of the most important health and medical problems in most parts of Iran.Case Presentation: This case report occurred in Chaharmahal Bakhtiari province of Bazoft city. The injured person was a 48-year-old woman, weighing about 69 kg. Two documentary filmmakers were on their way to work and suddenly one of them felt pain caused by a sting in the thigh area of her lower limb. The patient was referred to the medical center with the ‘scorpion’ sample, where she was examined by a doctor. The doctor prescribed some medicine for the patient. The pain from the sting lasted for about three hours. The patient recovered after taking the medication and received counseling three days after the sting. A photo of the dorsal and ventral surface of the scorpion specimen was sent to the animal identification specialist along with the size and color record. Scorpion specimen with a size of 4 cm was identified as Compsobuthus matthiesseni.Conclusion: According to the findings of this report, the clinical signs of C. matthiesseni sting are mild in the injured person and comparable to the stings of yellow bees Vespa germania. There is local pain two to three hours after the sting. Other systemic clinical manifestations can improve after a maximum of 2 to 3 days.