The Case Files This is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.

Otitis Media Leads to Brain Abscess Presenting as Stroke
By Mikhail Elfond, DO; Esi Quayson, MD; & Joseph V.M. Kelly, MD, MBA A 65-year-old man presented to the ED via EMS with symptoms of stroke. The paramedics stated his right-sided weakness and speech difficulty started 40 minutes prior to presentation in the ED. En route to the hospital, paramedics observed four episodes of facial twitching. Vitals signs were significant for a rectal temperature of 100.2°F and a fingerstick blood sugar of 220 mg/dL. History of present illness was significant for a diagnosis of left otitis media treated with Augmentin and Vicodin at an urgent care center ...
Source: The Case Files - January 20, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Otitis Media Leads to Brain Abscess Presenting as Stroke
By Mikhail Elfond, DO; Esi Quayson, MD; & Joseph V.M. Kelly, MD, MBA A 65-year-old man presented to the ED via EMS with symptoms of stroke. The paramedics stated his right-sided weakness and speech difficulty started 40 minutes prior to presentation in the ED. En route to the hospital, paramedics observed four episodes of facial twitching. Vitals signs were significant for a rectal temperature of 100.2°F and a fingerstick blood sugar of 220 mg/dL. History of present illness was significant for a diagnosis of left otitis media treated with Augmentin and Vicodin at an urgent care center one day prior to prese...
Source: The Case Files - January 20, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: research

A Rare Cause of Necrotizing Fasciitis
By Mikhail Elfond, DO, & Joseph V.M. Kelly, MD, MBA A 63-year-old woman presented to the ED via ambulance with complaint of a draining abscess from her groin that had worsened over the past day. She also reported subjective fever and chills. The patient said she first noticed the abscess two days earlier. The patient had had an appendectomy in 1994 and a hysterectomy in 2000, and she had type II diabetes, hypercholesterolemia, and hypertension. The patient was not compliant with her medications, and was not sure what they were. Her body mass index was 33.2, respiration rate was 18 bpm, oral temperatur...
Source: The Case Files - January 7, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: research

A Rare Cause of Necrotizing Fasciitis
By Mikhail Elfond, DO, & Joseph V.M. Kelly, MD, MBA A 63-year-old woman presented to the ED via ambulance with complaint of a draining abscess from her groin that had worsened over the past day. She also reported subjective fever and chills. The patient said she first noticed the abscess two days earlier. The patient had had an appendectomy in 1994 and a hysterectomy in 2000, and she had type II diabetes, hypercholesterolemia, and hypertension. The patient was not compliant with her medications, and was not sure what they were. Her body mass index was 33.2, respiration rate was 18 bpm, oral temperature was 100.5�...
Source: The Case Files - January 7, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Prostatic Abscess in a Diabetic Patient
By Tamara Halaweh, MD, & Ashish Panchal, MD A 53-year-old man with fair control of his diabetes presented with three-and-a-half weeks of scrotal pain. He reported difficulty sitting, and complained of significant dysuria and inability to initiate a urine stream. He was also constipated, but had no fevers or chills. A rectal exam was consistent with an exquisitely tender and boggy prostate and significant perineal tenderness. His labs were consistent with a leukocytosis of 20,000. A CT scan with rectal contrast displayed a prostate abscess measuring 5.6 x 6.2 x 6.1 cm in maximum dimensions with extensi...
Source: The Case Files - January 7, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Prostatic Abscess in a Diabetic Patient
By Tamara Halaweh, MD, & Ashish Panchal, MD A 53-year-old man with fair control of his diabetes presented with three-and-a-half weeks of scrotal pain. He reported difficulty sitting, and complained of significant dysuria and inability to initiate a urine stream. He was also constipated, but had no fevers or chills. A rectal exam was consistent with an exquisitely tender and boggy prostate and significant perineal tenderness. His labs were consistent with a leukocytosis of 20,000. A CT scan with rectal contrast displayed a prostate abscess measuring 5.6 x 6.2 x 6.1 cm in maximum dimensions with extension into the ...
Source: The Case Files - January 7, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: research

The Case Files: A Necrotizing Soft Tissue Infection
By Brian Ichwan, MD & Andrew King, MD A 35-year-old woman with a history of congenital hydrocephalus with bilateral ventriculoperitoneal (VP) shunts, morbid obesity, and a ventral hernia after multiple abdominal surgeries presented to the ED with three weeks of abdominal pain and distention that had acutely worsened over the previous two days. Her vital signs revealed a temperature of 100.4°F, blood pressure of 107/60 mm Hg, pulse rate of 118 bpm, and oxygen saturation at 95%. Her exam was significant for a large ventral hernia with a large exquisitely tender area of erythema and necrosis with bulla formation. (Fi...
Source: The Case Files - December 9, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research

The Case Files: A Necrotizing Soft Tissue Infection
By Brian Ichwan, MD & Andrew King, MD A 35-year-old woman with a history of congenital hydrocephalus with bilateral ventriculoperitoneal (VP) shunts, morbid obesity, and a ventral hernia after multiple abdominal surgeries presented to the ED with three weeks of abdominal pain and distention that had acutely worsened over the previous two days. Her vital signs revealed a temperature of 100.4°F, blood pressure of 107/60 mm Hg, pulse rate of 118 bpm, and oxygen saturation at 95%. Her exam was significant for a large ventral hernia with a large exquisitely tender area of erythema and necrosis with bulla formation. (Figu...
Source: The Case Files - December 9, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research

The Case Files: The Effects of an Epidural Steroid Injection
This study showed that the duration of absorption of 50 ml of air decreased from 5.8 to 1.9 weeks by 40% FiO2 from 1.9 to 0.6 weeks on room air and 100% FiO2, respectively. (Anesthesiology 1996;84[2]:442.) Several diagnoses should be added to the headache differential diagnosis in the case of a patient receiving recent epidural spinal injections. Post-procedural headache or low-pressure headache, as well as pneumocephalus, should be added to the differential. The patient can be easily placed on a face mask to expedite air resorption, and can be provided symptom control as needed. This patient was successfully ma...
Source: The Case Files - November 21, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research

The Case Files: The Effects of an Epidural Steroid Injection
This study showed that the duration of absorption of 50 ml of air decreased from 5.8 to 1.9 weeks by 40% FiO2 from 1.9 to 0.6 weeks on room air and 100% FiO2, respectively. (Anesthesiology 1996;84[2]:442.) Several diagnoses should be added to the headache differential diagnosis in the case of a patient receiving recent epidural spinal injections. Post-procedural headache or low-pressure headache, as well as pneumocephalus, should be added to the differential. The patient can be easily placed on a face mask to expedite air resorption, and can be provided symptom control as needed. This patient was successfully manag...
Source: The Case Files - November 21, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research

The Case Files: An Atypical Quarter Ingestion
By Brian Ault, DO; Rudolph Baldeo, MD; Martin Winick, MD; Ronald Dvorkin, MD; David Levy, DO A 5-year-old boy presented to the ED with three days of progressive abdominal pain. He had been afebrile with nonbloody, nonbilious vomiting, decreased oral intake, and resultant decreased urination. He was not taking any prescribed medications, nor was he given any medications for his symptoms. His initial vital signs were blood pressure 102/70 mm Hg; heart rate 130 beats per minute; SpO2 100% on room air; respiratory rate 22 breaths per minute; temperature 36.8°C orally. He looked well and was interactive, pla...
Source: The Case Files - November 21, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research

The Case Files: An Atypical Quarter Ingestion
By Brian Ault, DO; Rudolph Baldeo, MD; Martin Winick, MD; Ronald Dvorkin, MD; David Levy, DO A 5-year-old boy presented to the ED with three days of progressive abdominal pain. He had been afebrile with nonbloody, nonbilious vomiting, decreased oral intake, and resultant decreased urination. He was not taking any prescribed medications, nor was he given any medications for his symptoms. His initial vital signs were blood pressure 102/70 mm Hg; heart rate 130 beats per minute; SpO2 100% on room air; respiratory rate 22 breaths per minute; temperature 36.8°C orally. He looked well and was interactive, playful, ...
Source: The Case Files - November 21, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Hidden Trauma in Tramadol Intoxication
A 24-year-old man was brought to the ED with lethargy and confusion. His relatives found him lying flat in his room near a strip of tramadol tablets with 10 empty blisters, which meant he ingested 1,000 mg of the drug. They revealed that he had been taking tramadol illegally for five months. The patient received supportive care and cardiac monitoring. The next day, the patient became alert and complained of pain and discomfort in his upper teeth. He did not remember the seizure, but admitted tramadol abuse. His teeth seemed to be normal but were tender on pressure without evident buccal mucosa ecchymosis or laceration. The...
Source: The Case Files - November 10, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research

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...
Source: The Case Files - October 14, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research