Measurement of Optic Nerve Sheath Diameter by Bedside Ultrasound in Patients With Traumatic Brain Injury Presenting to Emergency Department: A Review.

The aim of this review article is to outline the effectiveness of using bedside ultrasound to measure the optic nerve sheath diameter (ONSD) in order to identify variations in intracranial pressure (ICP) and subsequently avoid the complication of secondary brain injury in patients with traumatic brain injury (TBI), who are admitted to an emergency department (ED). Reputable publications and numerous studies demonstrate the problem's exponential rampancy and pervasiveness. In a TBI patient, the emergence of secondary brain damage has been recognized as a serious emergency. It is believed that secondary brain damage is caused by an abnormally high ICP. High levels of ICP can be measured using both invasive and non-invasive approaches. ONSD measurement via bedside ultrasound has been identified as a quick, useful technique to be used in the ED to avoid potential morbidity and mortality owing to secondary brain injury.

Cerebral Venous Sinus Thrombosis (CVST): A Clinically Significant Neurological Condition.

Cerebral venous sinus thrombosis (CVST), a rare but deadly disorder, causes papilledema as well as a number of frequent clinical symptoms, including excruciating headaches, focal seizures, and paralysis on one or both sides of the body. In this intriguing case study, we present the clinical narrative of a 45-year-old man who sought medical attention due to severe headaches persisting for two days. Concurrently, he experienced an abrupt onset of tingling and numbness in his left upper arm. Remarkably, magnetic resonance venography (MRV) revealed an absence of the sigmoid sinus, left transverse sinus, left jugular vein, and superior sagittal sinus, adding complexity to the diagnostic puzzle. Despite this anomaly, conventional brain MRI findings appeared normal. The patient reported a significant reduction in headache intensity following treatment, which included a year-long course of anticoagulant therapy. Subsequently, he gradually regained his health, underscoring the importance of multidisciplinary approaches in managing such challenging cases. This example emphasizes the significance of considering CVST while developing a differential diagnosis of various neurological disorders. Given the vast spectrum of clinical symptoms associated with CVST, it should be taken into account as a potential causative factor in a number of neurological illnesses, in order for patients to experience the best outcomes, quick diagnosis, and quality care.

Methemoglobinemia Following Indoxacarb Ingestion: A Unique Toxicological Presentation.

Indoxacarb, an oxadiazine insecticide, is known for its selective lethality by blocking neuronal voltage-dependent sodium channels. While primarily developed to target insect populations resistant to other pesticides, its toxicity in humans remains poorly understood. We present a case of methemoglobinemia resulting from indoxacarb ingestion, a rare manifestation of its toxic effects. A 38-year-old farmer attempted suicide by ingesting the insecticide, leading to cyanosis, hypoxemia, and characteristic arterial blood gas findings indicative of methemoglobinemia. Prompt diagnosis was challenging due to the absence of specific tests, necessitating clinical suspicion. Treatment with methylene blue and supportive therapy resulted in significant clinical improvement, highlighting the importance of early intervention in managing indoxacarb poisoning. This case underscores the need for increased awareness among healthcare providers regarding the potential toxic effects of indoxacarb. It emphasizes the importance of prompt recognition and treatment of methemoglobinemia in pesticide-related poisonings. Further research is warranted to elucidate the mechanisms underlying indoxacarb toxicity in humans and to optimize treatment strategies for affected individuals.

Delayed Manifestation of Massive Bilateral Sub-acute Subdural Hemorrhage.

Sub-acute subdural hematoma (SASDH) in the elderly is a challenging diagnosis given its insidious onset and nonspecific presentation, particularly following minor head trauma. This case report highlights the clinical features, diagnostic challenges, and management of SASDH in an elderly patient. A 72-year-old male presented with a five-day history of giddiness, headache, and balance issues, which began suddenly without a significant triggering event. His medical history was notable only for a minor fall approximately one month before presentation, after which he experienced no immediate or significant symptoms. An MRI at an outside hospital revealed bilateral frontoparietotemporal SASDHs with diffuse cerebral edema. The patient underwent a bilateral mini craniotomy for hematoma evacuation and was managed postoperatively with anti-seizure medications and supportive care, resulting in a satisfactory outcome. The diagnosis of SASDH requires a high index of suspicion, especially in the elderly, who may present with vague and progressive symptoms following minor head trauma. Early and accurate diagnosis via imaging, particularly MRI, is crucial for effective management. Surgical intervention, typically involving hematoma evacuation, significantly improves outcomes in patients with SASDH, underscoring the importance of timely surgical referral and treatment. Elderly patients presenting with unexplained neurological symptoms following even minor trauma should be evaluated for SASDH. Early recognition and intervention are crucial to prevent long-term morbidity and mortality in this vulnerable population.

Acute Presentation of Extra-Pulmonary Tuberculosis in the Emergency Department: A Case Report.

Pericardial effusion is a rare manifestation of tuberculosis (TB) that can present as a life-threatening emergency. It poses a diagnostic challenge, as its clinical presentation may mimic other more common causes of acute cardiac emergencies. Emergency physicians should maintain a high index of suspicion for tuberculosis, particularly in regions where the prevalence of the disease is high. This case report is about a 17-year-old girl who presented to the emergency room with dyspnea, chest discomfort, and hemodynamic instability consistent with cardiac tamponade. Urgent diagnostic procedures, including point-of-care ultrasound (POCUS) and pericardiocentesis, were crucial to the successful management of this patient.

When Venom Meets the Heart: A Rare Case of Scorpion Sting-Induced Acute Myocardial Infarction.

Scorpion sting cases are everyday encounters in the Emergency Department (ED). However, scorpion sting-induced systemic manifestations are rarely seen. Signs and symptoms of envenomation involve the central nervous system, stimulation of the autonomic nervous system and rarely respiratory and heart failure leading to death. Cardiovascular manifestations are particularly prominent following stings by the Indian red scorpion. This case report is of an 18-year-old male patient who presented to ED with complaints of scorpion sting. Twelve lead electrocardiography (ECG) done was suggestive of acute inferior wall myocardial infarction with raised cardiac markers. He also had autonomic dysfunction in the form of hypertension, hypothermia and priapism. He was treated with an alpha-blocker, dual antiplatelets and analgesics. ECG changes reverted to normal the next day, and he was discharged. So, the anticipation of life-threatening complications of scorpion stings plays a vital role in the treatment and prognosis of patients presenting to ED.

A Rare Phenomenon of Pulseless Body Movements Induced During Prolonged Cardiopulmonary Resuscitation.

Patients receiving cardiopulmonary resuscitation (CPR) may rarely experience cardiopulmonary resuscitation-induced consciousness (CPRIC), manifesting as body movements, eye-opening, or even awareness. We present a case report of a 55-year-old male patient who experienced CPRIC but did not survive despite resuscitative measures. The patient suffered a sudden cardiac arrest and received early initiation of CPR. However, CPRIC posed a treatment dilemma for our resuscitation team as the patient displayed body movements, requiring careful management to avoid interruptions in CPR. The challenge of differentiating CPRIC from the return of spontaneous circulation (ROSC) highlights the need for further research and evidence-based guidelines. Effective management strategies for CPRIC are necessary to guide resuscitation teams in making informed decisions. Understanding and addressing CPRIC can improve the quality of CPR and post-resuscitation care, supporting the well-being of both patients and healthcare providers. Further investigation is essential to developing comprehensive approaches to managing CPRIC and improving patient outcomes.

Myocardial Infarction in Young Individuals: A Review Article.

Although myocardial infarction (MI) primarily affects patients over the age of 45, it can also affect young women and men. Still, when it occurs at an early age, it has severe morbidity and psychological and financial burdens for the patient and his or her relatives. Four classes can be used to categorize the causes of MI in individuals below the age of 45. These are drug abuse-related MI, hyper-coagulable conditions, atheromatous coronary artery disease (CAD), and non-atheromatous CAD. There is a significant overlap between each category. Elevated blood pressure, smoking, diabetes, obesity, high cholesterol, inactivity, an unbalanced diet, binge drinking alcohol, and related substances are all risk factors. The primary mechanism of an MI is typically the total obstruction of a vessel caused by breaking an atheromatous plaque. This article covers the research and focuses on the practical concerns related to young adults with MI.

Deltamethrin Poisoning Mimicking Organophosphate Poisoning: A Case Report.

Deltamethrin is a newer class of insecticide used on crops, pets, and livestock, in home pest control, and malaria vector control belonging to the synthetic pyrethroid group, which is being promoted in the place of organophosphate compounds due to the harmful and persistent effects of the latter. Unfortunately, as its usage increased, so has the number of poisoning cases associated with deltamethrin. Fortunately, the mortality in deltamethrin poisoning cases is low. However, deltamethrin poisoning causes signs and symptoms similar to the clinical features of organophosphate poisoning. This case report is of a 20-year-old man who consumed an unknown substance in a suicidal attempt and presented with clinical signs of organophosphate toxicity. Later the compound was identified as deltamethrin. This case report adds to the medical literature on deltamethrin poisoning. It showed that apart from the similarity in their clinical features in toxicity, deltamethrin can even give a positive result on atropine challenge tests like organophosphate and that the fasciculations induced by deltamethrin may be temporary. This case report will also benefit the clinician in unknown compound poisoning cases as it shows that the clinician can suspect deltamethrin toxicity alongside organophosphate toxicity in the differential diagnosis when the atropine challenge test gives a positive result.

Posterior Circulation Stroke Secondary to Basilar Artery Thrombosis With a Fatal Outcome.

Stroke is a regularly encountered emergency by emergency physicians, categorized based on the culprit artery and diagnosed based on non-contrast computerized tomography (CT) brain, which is supported by clinical examination that can be treated intravenously by thrombolytic agents or mechanical thrombectomy. Here we present one such case, which was brought to the emergency room with symptoms of posterior circulation stroke within 8 hours and underwent mechanical thrombectomy.

Surprising Diagnosis of Myxedema Crisis In-Patient Who Presented With Altered Sensorium.

Hypothyroidism, a disorder of decreased thyroid hormone secretion diagnosed by increased thyroid stimulating hormone (TSH) and low free triiodothyronine (FT3) and free thyroxine (FT4) levels, is classified as primary and secondary hypothyroidism, depending on the pathology. Raised TSH levels are associated with primary hypothyroidism, while decreased levels of TSH are seen in secondary hypothyroidism. With the easy availability of diagnostic tests, hypothyroidism can be detected and managed early but can be life-threatening if not treated within time. Manifestations of hypothyroidism are dry skin, hoarseness of voice, weight gain, constipation, cold intolerance, fatigue, and lethargy; however, the clinical presentation can differ as per age and sex and person to person. Here, we present one such case, which was brought to the emergency room with a history of altered sensorium, hypotension, and swelling over the bilateral lower limbs and face, with a surprise diagnosis of myxedema crisis. The uniqueness of this case is the omnipresent availability of early diagnosis and treatment in this era. still got a female patient with altered sensorium who was diagnosed to be a myxedema crisis which was given a lesser thought in our provisional diagnosis.

Diabetic Ketoacidosis and COVID-19: A Retrospective Observational Study.

Background Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus (DM), mainly type 1 DM. DM is one of the comorbidities recognized as the predictor of the severity in COVID-19-positive patients. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) illness (COVID-19) has a bidirectional association with DM. DM is a state of chronic inflammatory condition and hyperglycemia that predisposes one to acquire an exaggerated form of COVID-19 infection. Moreover, in recent literature, it has been established that SARS-CoV-2 is capable of directly damaging beta cells of the pancreas, thereby inducing new-onset diabetes in previously non-diabetics. Hence, new-onset diabetes and severe metabolic consequences of pre-existing diabetes, such as DKA, are seen in COVID-19-positive patients. DKA in patients with COVID-19 may increase the risk of mortality and lead to poor prognosis. Methods This retrospective observational study includes 25 patients who presented to our hospital with DKA secondary to COVID-19 infection as a triggering factor. Demographic parameters, medical history, physical examination, laboratory tests including reverse transcriptase polymerase chain reaction test (RT-PCR), chest X-ray, treatment administered, clinical course, and outcomes were recorded. All data were computed and analyzed using SPSS Version 22.0 (IBM Corp., Armonk, NY, USA). Results Of the 25 cases, 14 were females, and a statistically significant difference was seen in the values of blood sugar (367 mg/dL), D-dimer, ferritin, blood urea nitrogen (BUN), and anion gap among males and females (p < 0.050). The males had higher mean values of blood sugar (367 mg/dL), BUN (60.63 mg/dL), D-dimer (1.09 mcg/mL), and ferritin (821.23 mcg/mL) than females, whereas females had a higher anion gap (20.85) than males. A negative correlation was seen between D-dimer and the following biochemical investigations in COVID-19 patients: serum bicarbonate, anion gap, chloride, BUN, creatinine, sodium, potassium, magnesium, and phosphorous. COVID-19 can present with atypical symptoms in patients with high blood sugar levels. Diabetics are more likely to experience effects on multiple organs compared to non-diabetic patients who mainly have lung involvement. Hence, a high degree of suspicion is essential to diagnose DKA early in COVID-19 patients. Conclusion These cases show that DKA can be precipitated by COVID-19 in a significant number of patients and that the presence of diabetes can also exaggerate the underlying COVID-19 infection, a bidirectional relationship. All cases were COVID-19-positive presenting with features characteristic of DKA. SARS-CoV-2 was precipitating factor of DKA. Patients with newly diagnosed diabetes or pre-existing diabetes were equally susceptible to DKA. Due to the high prevalence of both illnesses (DM and COVID-19) in our country, a high level of suspicion is required to detect DKA early and improve the outcome of COVID-19-related life-threatening hyperglycemic consequences.

Intraoperative surprise evidence of bronchial rent during lung surgery: a case report.

Among multiple causes of tracheobronchial rent, most common is iatrogenic factor. Whenever there is surprise evidence of bronchial wall tear while doing lung surgery, tracheal tube extubation and postoperative management pose a challenge. We report a 16-year-old girl, weighing 27kg, a case of pulmonary Koch's who presented with hydropneumothorax on left side. She had a prolonged course on mechanical ventilation, was gradually weaned off and extubated in intensive care unit (ICU) with implantable cardioverter defibrillator (ICD) in-situ. However, chest X-ray continued to show loss of bronchovascular markings and high-resolution computed tomography (HRCT) thorax revealed multiple cavitatory lesions, hydropneumothorax from upper to lower lobe, ground glass opacities on left side and mediastinal shift towards right side. Hence, she was posted for left lung decortication. Decortication was done using one lung ventilation protocol with 28 Fr left sided double-lumen endobronchial tube (DLT). While checking for leaks before closure, it was noted that exhaled tidal volume was unacceptably low and a rent on left main bronchus of around 2x2 cm with scarred borders was detected. The rent was repaired with tissue patch suturing by the surgeons. After the procedure, DLT was exchanged with endotracheal tube (ETT) no 6. Patient was managed with elective ventilation post-operatively in ICU for 48 hours and extubated uneventfully. A vigilant monitoring of vital parameters and close communication with surgeons is important for detecting and managing any perioperative complication during lung surgery. Elective ventilation could play a significant role for healing a big rent in trachea-bronchial area.