Septic Cavernous Sinus Thrombosis Caused by Sinusitis
By Ichwan, Brian MD; Barrie, Michael MD; Neltner, Kurt MD
A 37-year-old man with no significant medical history presented to the emergency department with a headache. He described it as an insidious, constant severe pain that was initially localized occipital but progressed to a bitemporal distribution. His neurologic exam, extraocular movements, and visual acuity were all normal. The patient was given symptomatic treatment with compazine and Benadryl. He was responsive to therapy and discharged home after his headache symptoms resolved.
Seven days later, however, he presented to the emergency department with a worse...
Source: The Case Files - October 14, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
Painful Blistering on the Dorsal Hands
By Wold, Lindsey; Lampel, Heather P. MD, MPH
A 58-year-old man presented with an eight-month history of nail changes and painful blisters on the dorsal surface of his hands. He noticed these findings after working in his yard. He smokes three packs of cigarettes daily, and receives hemodialysis three times weekly for ESRD secondary to polycystic kidney disease. His medications included simvastatin, omeprazole, minoxidil, calcium, and a vitamin B complex.
The patient was well-appearing, had stable vitals, and wasn't in any acute distress. Skin examination revealed shallow, well-defined erosions, some with centra...
Source: The Case Files - October 14, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
Painful Blistering on the Dorsal Hands
By Wold, Lindsey; Lampel, Heather P. MD, MPH
A 58-year-old man presented with an eight-month history of nail changes and painful blisters on the dorsal surface of his hands. He noticed these findings after working in his yard. He smokes three packs of cigarettes daily, and receives hemodialysis three times weekly for ESRD secondary to polycystic kidney disease. His medications included simvastatin, omeprazole, minoxidil, calcium, and a vitamin B complex.
The patient was well-appearing, had stable vitals, and wasn't in any acute distress. Skin examination revealed shallow, well-defined erosions, some with central crus...
Source: The Case Files - October 14, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Aftermath of Cocaine-Induced Pneumothorax
By Joshua B. Hourizadeh, DO, & Joseph VM Kelly, MD, MBA
A 38-year-old African American man presented to the emergency department with severe left-sided inspiratory chest pain with no radiation for two days and increasing shortness of breath. The patient said he had recently broken up with his girlfriend, which lead him to smoke crack cocaine for three consecutive days.
The patient had no past medical or surgical history, but he had a past social history of illicit drug abuse, nicotine use, and social alcohol use. His heart rate was 96 bpm, blood pressure was 112/80 mm Hg, oxygen saturation was 86% on room air...
Source: The Case Files - September 18, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Aftermath of Cocaine-Induced Pneumothorax
By Joshua B. Hourizadeh, DO, & Joseph VM Kelly, MD, MBA
A 38-year-old African American man presented to the emergency department with severe left-sided inspiratory chest pain with no radiation for two days and increasing shortness of breath. The patient said he had recently broken up with his girlfriend, which lead him to smoke crack cocaine for three consecutive days.
The patient had no past medical or surgical history, but he had a past social history of illicit drug abuse, nicotine use, and social alcohol use. His heart rate was 96 bpm, blood pressure was 112/80 mm Hg, oxygen saturation was 86% on room air, hi...
Source: The Case Files - September 18, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
A Case of Spontaneous Mesenteric Hematoma
By Andrew Yocum, MD & Andrew King, MD
A 69-year-old woman with a past medical history of multiple sclerosis, hypertension, hyperlipidemia, remote cerebral vascular accident, and a known abdominal aortic aneurysm was brought to the emergency department by EMS complaining of abdominal pain. Her AA was stable on imaging four months prior to presentation with a measurement of 3.8 cm.
The patient had intermittent generalized abdominal pain over the previous four weeks that resolved without intervention. This episode began almost 24 hours prior to presentation after the patient finished eating. She had a constant, ...
Source: The Case Files - September 18, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
A Case of Spontaneous Mesenteric Hematoma
By Andrew Yocum, MD & Andrew King, MD
A 69-year-old woman with a past medical history of multiple sclerosis, hypertension, hyperlipidemia, remote cerebral vascular accident, and a known abdominal aortic aneurysm was brought to the emergency department by EMS complaining of abdominal pain. Her AA was stable on imaging four months prior to presentation with a measurement of 3.8 cm.
The patient had intermittent generalized abdominal pain over the previous four weeks that resolved without intervention. This episode began almost 24 hours prior to presentation after the patient finished eating. She had a constant, gene...
Source: The Case Files - September 18, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: Culling through Diagnoses to Get to Rat Bite Fever
By Dyer, Alexandra; Berg, Kenneth MD; King, Andrew MD
Rat bite fever (RBF) is a fairly rare illness caused by Streptobacillus moniliformis or Spirillum minus. It can be a devastating and even fatal illness if left undiagnosed or untreated. Despite its name, RBF is not only transmitted by rat bites but also by contact with rat feces, ingestion of rat-contaminated food and water, or simply through direct contact with rats. (Clin Microbiol Rev 2007;20[1]:13; Vet Microbiol 2009;133[3]:211; BMJ Case Rep 2009; Epub Dec 17.)
The first documented outbreak in Haverhill, MA, in 1926 was believed to be caused by a pathogen named Ha...
Source: The Case Files - September 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: Culling through Diagnoses to Get to Rat Bite Fever
By Dyer, Alexandra; Berg, Kenneth MD; King, Andrew MD
Rat bite fever (RBF) is a fairly rare illness caused by Streptobacillus moniliformis or Spirillum minus. It can be a devastating and even fatal illness if left undiagnosed or untreated. Despite its name, RBF is not only transmitted by rat bites but also by contact with rat feces, ingestion of rat-contaminated food and water, or simply through direct contact with rats. (Clin Microbiol Rev 2007;20[1]:13; Vet Microbiol 2009;133[3]:211; BMJ Case Rep 2009; Epub Dec 17.)
The first documented outbreak in Haverhill, MA, in 1926 was believed to be caused by a pathogen named Have...
Source: The Case Files - September 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: When a Spade is Not a Spade
Turrin, Danielle DO; Sattler, Steven DO; Amodeo, Dana DO
A 25-year-old Hispanic man presented to the emergency department with a complaint of three days of left-sided precordial chest pain. He described the pain as a constant 6/10 with pressure-like discomfort radiating to his left arm and the left side of his neck. He also experienced nausea, but denied any provocative or palliative factors. He said he had not experienced anything similar to this before.
He had no family history of heart disease, acute myocardial infarction, or sudden cardiac death. He admitted to a 1.5 pack-per-day smoking history and social alcohol us...
Source: The Case Files - August 26, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: When a Spade is Not a Spade
Turrin, Danielle DO; Sattler, Steven DO; Amodeo, Dana DO
A 25-year-old Hispanic man presented to the emergency department with a complaint of three days of left-sided precordial chest pain. He described the pain as a constant 6/10 with pressure-like discomfort radiating to his left arm and the left side of his neck. He also experienced nausea, but denied any provocative or palliative factors. He said he had not experienced anything similar to this before.
He had no family history of heart disease, acute myocardial infarction, or sudden cardiac death. He admitted to a 1.5 pack-per-day smoking history and social alcohol use,...
Source: The Case Files - August 26, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: The Undifferentiated Bradycardic Patient
Robbins, Shari MD; King, Andrew MD
Delineating a specific cause when evaluating patients with bradycardia in the emergency department can often be difficult. Unlike tachycardia, which often accompanies sepsis, fever, dehydration, and other common presentations, bradycardia is less frequently encountered, and can provide a challenge for the emergency practitioner.
Physicians must re-examine the potential causes when a patient is refractory to initial treatments, and ensure accurate vital signs to rule out a commonly missed but easily reversible cause. Bradycardia is initially overlooked because many patients present in st...
Source: The Case Files - August 26, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: The Undifferentiated Bradycardic Patient
Robbins, Shari MD; King, Andrew MD
Delineating a specific cause when evaluating patients with bradycardia in the emergency department can often be difficult. Unlike tachycardia, which often accompanies sepsis, fever, dehydration, and other common presentations, bradycardia is less frequently encountered, and can provide a challenge for the emergency practitioner.
Physicians must re-examine the potential causes when a patient is refractory to initial treatments, and ensure accurate vital signs to rule out a commonly missed but easily reversible cause. Bradycardia is initially overlooked because many patients present in stab...
Source: The Case Files - August 26, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: Sigmoid Volvulus in an Adolescent
Volpe, Michael DO; Golden, Jonathan MD; Amodeo, Dana DO
A 17-year-old Caucasian man with no significant past medical history or hospitalization presented to the ED complaining of abdominal pain, bloating, and diarrhea for five days. The patient said his pain was located in his upper abdomen; it was cramping, constant, and worse when he laid down, with a 7/10 intensity.
He reported more than 10 episodes of watery, brown, non-bloody diarrhea daily since the onset of his symptoms. He said he had nausea and had one episode of non-bloody and non-bilious vomiting prior to arrival. He denied fever, chills, headache, sore throat...
Source: The Case Files - August 26, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: Sigmoid Volvulus in an Adolescent
Volpe, Michael DO; Golden, Jonathan MD; Amodeo, Dana DO
A 17-year-old Caucasian man with no significant past medical history or hospitalization presented to the ED complaining of abdominal pain, bloating, and diarrhea for five days. The patient said his pain was located in his upper abdomen; it was cramping, constant, and worse when he laid down, with a 7/10 intensity.
He reported more than 10 episodes of watery, brown, non-bloody diarrhea daily since the onset of his symptoms. He said he had nausea and had one episode of non-bloody and non-bilious vomiting prior to arrival. He denied fever, chills, headache, sore throat, ...
Source: The Case Files - August 26, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
