Posterior Reversible Encephalopathy Syndrome and Eclampsia in the Setting of Magnesium Toxicity: A Case Report.

Posterior reversible encephalopathy syndrome (PRES) is a rare neurologic condition and a feared complication of eclampsia. It is evidenced by acute neurologic dysfunction secondary to cerebral edema and is typically reversible in nature. Although it is a relatively new diagnosis, an increasing amount of literature has described its occurrence, including an association with hypomagnesemia. We present a case wherein a 24-year-old parturient developed PRES and eclampsia in the setting of symptomatic hypermagnesemia, requiring management with lorazepam after seizures developed. Here we detail her clinical course, including the unique challenges of treating eclampsia and PRES in the setting of magnesium toxicity.

Point-of-care Ultrasound Evaluation of Tibial Avulsion Fractures.

It can be difficult to diagnose a tibial avulsion fracture based on physical examination alone as findings are often non-specific. Emergency physicians will usually opt for radiography as their initial imaging modality, which has several disadvantages in evaluating tibial avulsion fractures. The objective of this case series is to describe the utility of point-of-care ultrasound (POCUS) in the evaluation of tibial avulsion injuries. A 15-year-old male presented to the emergency department (ED) after sustaining a left knee injury while playing soccer. The clinician had a high suspicion for patellar tendon involvement. A POCUS exam revealed a cortical irregularity and interruption of the left proximal tibia. The patellar tendon was found attached to an avulsed bony portion. Findings were consistent with a tibial tuberosity avulsion fracture. The patient was admitted and scheduled for surgery the following day. Our second case is a 31-year-old male who presented to the ED with a complaint of left knee pain after a 10-foot fall from a ladder. A POCUS exam revealed a bony avulsion over the anterior tibia that was not noted on the initial radiography read by radiology. His patellar tendon showed no evidence of rupture. This led to prompt consultation with orthopedics who evaluated the patient in the ED. Radiographs were reviewed again and it appeared that there was a missed anterior tibial spine fracture. The patient was placed in a knee immobilizer and discharged with instructions to follow up with orthopedics for outpatient surgery. The use of POCUS in the evaluation of these patients led to prompt diagnosis of tibial avulsion injuries, which led to early consultation and appropriate patient management. POCUS allows for expedited diagnosis and appropriate management of patients with tibial avulsion injuries.

Point of Care Ultrasound Diagnosis of Upper Gastrointestinal Bleeding.

A 28-year-old male was brought to the emergency department by the Emergency medical services (EMS) after being found unconscious and unresponsive. Upon arrival, he was hypotensive, intubated with a Glasgow Coma Scale (GCS) 3T, without the signs of trauma or the evidence of bleeding. A focused assessment with sonography in trauma (FAST), point-of-care ultrasound (POCUS) was performed, obscuring part of the spleen from the distended stomach, which was filled with the heterogeneous contents, with the internal movement being identified. This was found to be blood after orogastric (OG) tube was placed for suction. The bedside endoscopy confirmed active variceal bleeding. This case illustrates the potential utility of the ultrasound in detecting the upper gastrointestinal bleeding.