Spontaneously Conceived Ruptured Heterotopic Pregnancy Presenting with Chest Pain and Dyspnea: A Case Report.

Introduction: Heterotopic pregnancy, defined as simultaneous intrauterine and ectopic pregnancy, is a rare and potentially life-threatening condition. The incidence of heterotopic pregnancy has significantly increased in the modern era, primarily due to use of assisted reproductive technology. Heterotopic pregnancy in the absence of risk factors is uncommon. The symptoms of heterotopic pregnancy are similar to those of ectopic pregnancy, primarily abdominal pain and vaginal bleeding. Case Report: We report a case of heterotopic pregnancy occurring in the absence of risk factors and presenting with primary symptoms of chest pain and shortness of breath. Conclusion: While uncommon, heterotopic pregnancy may occur in patients without risk factors and may present with atypical symptoms such as chest pain and shortness of breath.

Out-of-Hospital Transesophageal Echocardiogram for Cardiac Arrest Resuscitation: The Initial Case.

Objective: The use of transesophageal echocardiogram (TEE) during cardiac arrest in the emergency department (ED) is a newer concept. TEE provides dynamic evaluation of chest compressions and rhythm analysis. Hand placement using external landmarks can result in maximal compression over the aorta, rather than the ventricles of the heart. Methods: We present the initial case of TEE performed in the out of hospital setting in an ambulance to facilitate cardiac arrest resuscitation using a disposable TEE probe. Results: This case is a proof of concept that TEE can be successfully performed and contribute to clinical care of cardiac arrest in the out of hospital setting. Conclusion: Further research needs to be performed to determine the clinical benefit, indications, and curriculum for emergency providers to successfully deliver this potentially valuable resource prior to widespread adoption.

Superficial Thrombosis of Pelvic Congestion Syndrome Mimicking Pelvic Abscess.

Pelvic congestion syndrome (PCS) is an uncommon illness that is typically diagnosed after chronic pelvic pain. We present a case of superficial thrombosis of pelvic veins from PCS that presented to the emergency department (ED) as a previous diagnosis of pelvic abscess with cellulitis. PCS was diagnosed in the ED by computed tomography after an abnormal point-of-care ultrasound. Here we describe this unusual presentation and our approach to the diagnosis.