The Case Files: An Incarcerated Richter's Inguinal Hernia
Hourizadeh, Joshua B. DO; Kelly, Joseph VM MD, MBA
An 81-year-old man presented to the emergency department complaining of acute onset abdominal pain, vomiting for one day, and subjective fever and chills. The patient had had non-bloody bowel movements, and was able to pass flatus. The patient said the pain started suddenly the day before, and that it was accompanied by two episodes of bilious non-bloody vomiting.
The patient had a surgical history, including bilateral inguinal hernia repair in 1974, a repeat left inguinal hernia repair in 1996, and lip cancer surgery in 2009. His vitals were normal except for a rect...
Source: The Case Files - August 26, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: An Incarcerated Richter's Inguinal Hernia
Hourizadeh, Joshua B. DO; Kelly, Joseph VM MD, MBA
An 81-year-old man presented to the emergency department complaining of acute onset abdominal pain, vomiting for one day, and subjective fever and chills. The patient had had non-bloody bowel movements, and was able to pass flatus. The patient said the pain started suddenly the day before, and that it was accompanied by two episodes of bilious non-bloody vomiting.
The patient had a surgical history, including bilateral inguinal hernia repair in 1974, a repeat left inguinal hernia repair in 1996, and lip cancer surgery in 2009. His vitals were normal except for a rectal ...
Source: The Case Files - August 26, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: A Diagnostic Pitfall: Stump Appendicitis
Irvine, Scott D. MD; Neltner, Kurt A. MD; Shellman-White, Sondra A. MD; Zimmer, Brandi L. MD
Acute abdomen is one of the most common surgical emergencies encountered by emergency physicians, and appendicitis is the most common cause requiring emergent surgical consultation and surgery. Stump appendicitis is a rare complication occurring after an incomplete appendectomy, and can be defined as an acute inflammation of the residual remnant of the appendix. Many physicians are unaware that stump appendicitis is a real entity, but it is so rare that they may not include it in their differential diagnosis, leading to possible d...
Source: The Case Files - August 26, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: A Diagnostic Pitfall: Stump Appendicitis
Irvine, Scott D. MD; Neltner, Kurt A. MD; Shellman-White, Sondra A. MD; Zimmer, Brandi L. MD
Acute abdomen is one of the most common surgical emergencies encountered by emergency physicians, and appendicitis is the most common cause requiring emergent surgical consultation and surgery. Stump appendicitis is a rare complication occurring after an incomplete appendectomy, and can be defined as an acute inflammation of the residual remnant of the appendix. Many physicians are unaware that stump appendicitis is a real entity, but it is so rare that they may not include it in their differential diagnosis, leading to possible de...
Source: The Case Files - August 26, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: ‘It Whistles When I Pee’
Price, James; Bachmann, Daniel MD; Neltner, Kurt MD; Dick, Mike MD
A 65-year-old man presented to the emergency department with a chief complaint of “it whistles when I pee.” The patient complained of a two-day history of gross hematuria and dysuria but denied flank, back, and abdominal pain. He described a two-week history of air coming from the urethral meatus at the end of urination.
He also reported that he had been treated with ciprofloxacin for two weeks for a urinary tract infection, which he finished one week prior to presentation. The patient had been seen five months previously with diverticulitis and perfo...
Source: The Case Files - August 26, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: ‘It Whistles When I Pee’
Price, James; Bachmann, Daniel MD; Neltner, Kurt MD; Dick, Mike MD
A 65-year-old man presented to the emergency department with a chief complaint of “it whistles when I pee.” The patient complained of a two-day history of gross hematuria and dysuria but denied flank, back, and abdominal pain. He described a two-week history of air coming from the urethral meatus at the end of urination.
He also reported that he had been treated with ciprofloxacin for two weeks for a urinary tract infection, which he finished one week prior to presentation. The patient had been seen five months previously with diverticulitis and perfora...
Source: The Case Files - August 26, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: One in a Million: A Rare Cause of Altered Mental Status
By Ringhauser, Holly DO; Glantz, Sanford MD; Havasy, Stephen P. MD
A 74-year-old woman presented to the emergency department with altered mental status for one week. The patient's husband said the patient had been in her usual state of health until seven days earlier, when she got lost on the way home from a restaurant that she had frequented for several decades. She had become increasingly confused and unable to care for herself, and was now unable to finish a sentence or ambulate without assistance. The patient had been seen by her primary physician and a neurologist. She had blood work, a CT scan, and an MRI performed,...
Source: The Case Files - July 8, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: One in a Million: A Rare Cause of Altered Mental Status
By Ringhauser, Holly DO; Glantz, Sanford MD; Havasy, Stephen P. MD
A 74-year-old woman presented to the emergency department with altered mental status for one week. The patient's husband said the patient had been in her usual state of health until seven days earlier, when she got lost on the way home from a restaurant that she had frequented for several decades. She had become increasingly confused and unable to care for herself, and was now unable to finish a sentence or ambulate without assistance. The patient had been seen by her primary physician and a neurologist. She had blood work, a CT scan, and an MRI performed, ...
Source: The Case Files - July 8, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: CrossFit-Induced Carotid Artery Dissection
By Fox, Alex MD; King, Andrew MD
CrossFit has become a workout phenomenon with more than 5,500 gyms and millions of staunch followers. Developed by Greg Glassman, CrossFit defines itself as “that which optimizes fitness, constantly varied functional movements performed at relatively high intensity.” The craze has been embraced by fitness enthusiasts and weekend warriors alike.
These intense workouts can be dangerous for those with less experience who do not have trainers to help ease them into the routine. A 2005 New York Times article, “Getting Fit, Even If It Kills You,” criticized CrossFit for placing ...
Source: The Case Files - July 8, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: CrossFit-Induced Carotid Artery Dissection
By Fox, Alex MD; King, Andrew MD
CrossFit has become a workout phenomenon with more than 5,500 gyms and millions of staunch followers. Developed by Greg Glassman, CrossFit defines itself as “that which optimizes fitness, constantly varied functional movements performed at relatively high intensity.” The craze has been embraced by fitness enthusiasts and weekend warriors alike.
These intense workouts can be dangerous for those with less experience who do not have trainers to help ease them into the routine. A 2005 New York Times article, “Getting Fit, Even If It Kills You,” criticized CrossFit for placing emph...
Source: The Case Files - July 8, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: Methanol Overdose by Ingestion of Windshield Wiper Fluid
By Libertin, Nicholas MD; Haynes, Ann MD; King, Andrew MD
Emergency physicians see toxicology cases every day, and the treatment for these cases is often just symptomatic care and stopping the offending agent. Certain cases, however, require specific antidotes to prevent significant morbidity and even mortality.
Toxicology cases are in many ways just as important as diagnosing sepsis or a ST-elevation myocardial infarction. Toxic alcohol cases fit into this “immediate treatment” category, like a patient we recently saw who drank windshield wiper fluid. She survived without any major morbidity or mortality thanks ...
Source: The Case Files - July 8, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: A Case of Hip Pain Masquerading a More Serious Problem
By Moises, Moreno DO; Glantz, Sanford DO
A 66-year-old woman with a history of osteoarthritis presented to the emergency department with progressively worsening left hip pain that had started five days prior to arrival. The pain was non-radiating and worse with movement, and it was associated with chills and anorexia. She had progressive difficulty walking because of pain. She had not had similar symptoms in the past, and attributed her pain to osteoarthritis. She denied recent trauma, back pain, leg swelling, numbness, and paresthesias. She also denied fever, abdominal pain and distention, nausea, vomiting, diarrhea, ...
Source: The Case Files - July 8, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: Foreign Body in Hoffa's Fat Pad
By Osgood, James Gale MD, MBA; Robison, Matthew MD; Siethel, Michelle PA
A 19-year-old woman presents with right knee pain and a laceration after a fall. She states that she was drinking alcohol at a local bar, and fell and cut her knee on broken glass on the bathroom floor. She denies loss of consciousness or other injuries. The patient is able to bear weight, but has increased pain when moving her knee. She denied distal numbness or weakness. The patient also denied other medical problems, and her last tetanus was four years earlier.
Physical exam revealed a stable knee with several lacerations and abrasions with m...
Source: The Case Files - June 23, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: The Absolutely Vital Need for Thorough Review of Systems and Physical Examination
By Ebeling, Brett MD; Rancour, Stephen MD; King, Andrew MD
A 19-year-old man presented with nausea, vomiting, and diarrhea for 24 hours. His vomitus was non-bloody and non-bilious, and his diarrhea contained neither blood nor mucus. His symptoms were associated with diffuse, cramping abdominal pain. He denied ill contacts, but stated that his symptoms started after eating at a fast food restaurant the day before.
He had no significant past medical history, but had emigrated from Saudi Arabia 18 months before presentation. He was a poor historian, and was unable to provide further details. Review of systems revealed s...
Source: The Case Files - June 20, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case Files: Niacin Overdose to Mask Marijuana Use
By Fox, Alex MD; Haynes, Ann MD; King, Andrew MD
Patients employ numerous ways to evade a positive urine drug screen, with most of the information on how to do this spread by word of mouth or the Internet. A simple Internet search leads to a bevy of options, including high-dose niacin. Drug testing has become a major topic recently with many reports from Major League Baseball, the Olympics, and, famously, Lance Armstrong documenting various masking agents used to evade testing.
Most Americans are conscious of the growing sensitivity of drug testing, and may look to find unique options that will remain undiscovered by...
Source: The Case Files - June 19, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research
