ABSTRACT
Aortic intramural hematoma (IMH) is characterized by blood spilling through the intimal layer of the aortic wall without any tear within the aortic wall. The condition has been troublesome to analyze until of late. A 55-year-old gentleman with hypertension presented with epigastric pain radiating to the back, he later developed back pain as well as bilateral lower limb numbness and was found to have IMH when a CT angiogram was conducted. Due to the severity of the illness, the patient expired on the 10th day of the admission. It is important for physicians to be aware of atypical presentations of this life-threatening aortic disease.
ABSTRACT
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Subject(s)
Calcium Channel Blockers , Drug Overdose , Adrenergic beta-Antagonists/therapeutic use , Calcium Channel Blockers/therapeutic use , HumansABSTRACT
Emergency medicine has evolved as a speciality but airway management is still a challenge. Traditionally, direct laryngoscopy (DL) is used for intubation with maneuvers to directly visualize the vocal cords. Most tracheal intubations in the emergency department (ED) are done on an emergent basis and enhancing the technicalities of intubation can be life-saving. Video laryngoscopy (VL) is available in the emrgenyc department and can help reduce the intubation failure rate; hence, it has been recommended for maintaining airways in obese patients.
ABSTRACT
Extensively drug-resistant (XDR) salmonella typhi is a gram-negative bacillus, transmitted by feco-oral route. Its systemic manifestations are protean. Untreated enteric fever carries high morbidity and mortality. Life-threatening complications are mainly extra-intestinal, and include involvement of central nervous system, lungs, liver, and genitourinary system. We report a case of a young girl presenting to a hospital in Karachi with a 1-week history of fever, rigors, abdominal pain, watery diarrhea, nausea, and anorexia. She developed toxic myocarditis, pulmonary edema, septic shock, and coagulopathy. Multi-drug-resistant (MDR) salmonella typhi was isolated from blood cultures. Her symptoms resolved after intravenous antibiotics and she completely recovered. Key Words: Myocarditis, Salmonella typhi, Coagulopathy.
Subject(s)
Myocarditis , Typhoid Fever , Anti-Bacterial Agents/therapeutic use , Blood Culture , Female , Humans , Salmonella typhi , Typhoid Fever/complications , Typhoid Fever/diagnosis , Typhoid Fever/drug therapyABSTRACT
Cryptococcal meningitis (CM) is an uncommon opportunistic infection in immunocompetent hosts; and causes significant mortality and long-term morbidity. Cryptococci primarily cause disease in immunocompromised hosts, but rarely can lead to severe disease in immunocompetent individuals. A 64-year man, with no known immunosuppressive illnesses, presented in the Emergency Department with gait disturbances and lethargy for one year, which got worsened recently. After further deliberation on elevated intracranial pressure (ICP), a CT brain was performed, which showed hydrocephalus; and thus lumbar puncture (LP) was done. Fungal cultures grew cryptococcus neoformans. The patient was treated with anti-fungal medications. It is highly essential for emergency physicians and other clinicians to think of atypical neurological manifestations of meningitis in immunocompetent individuals. Key Words: Cryptococcus, Immunocompetent, Antifungal treatment, Meningitis.
Subject(s)
Cryptococcus neoformans , Hydrocephalus , Meningitis, Cryptococcal , Meningoencephalitis , Antifungal Agents/therapeutic use , Humans , Male , Meningitis, Cryptococcal/diagnosis , Meningitis, Cryptococcal/drug therapy , Meningitis, Cryptococcal/microbiology , Meningoencephalitis/diagnosis , Meningoencephalitis/drug therapy , Meningoencephalitis/microbiologyABSTRACT
Acute urinary retention (AUR) is a fairly common presentation in the elderly; but interesting to be noted in a healthy young individual as a manifestation of acute appendicitis. We present a case of a 32-year gentleman with decreased urine output with mild tenderness at the supra-pubic region; which was later on, shifted to the right iliac fossa. Computed tomography of the abdomen showed acute appendicitis. Emergency physicians are challenged to recognize the uncommon presentation of acute appendicitis and need to be reminded of this common complaint as a rare presentation of it. This case also stresses on the repeated abdominal examinations to seek diagnostic clarity. Key Words: Appendicitis, Acute urinary retention, Repeat abdominal examination.
Subject(s)
Appendicitis , Urinary Retention , Acute Disease , Aged , Appendicitis/diagnosis , Appendicitis/diagnostic imaging , Humans , Physical Examination , Tomography, X-Ray Computed , Urinary Retention/diagnosis , Urinary Retention/etiologySubject(s)
COVID-19 , COVID-19 Testing , Diagnostic Tests, Routine , Humans , Nasopharynx , SARS-CoV-2 , Specimen HandlingSubject(s)
COVID-19 , Sinus Thrombosis, Intracranial , Thrombocytopenia , Anticoagulants/adverse effects , COVID-19 Vaccines , Heparin , Humans , SARS-CoV-2 , Sinus Thrombosis, Intracranial/diagnostic imaging , Sinus Thrombosis, Intracranial/drug therapy , Sinus Thrombosis, Intracranial/etiology , Thrombocytopenia/chemically induced , VaccinationABSTRACT
Acute rhabdomyolysis and elevated transaminases during streptococcal pharyngitis are rare presentations. The proposed pathophysiological mechanisms include direct bacterial invasion and toxin generation. Physicians should be aware of the association between these infections and the above-mentioned complications to facilitate optimal treatment of these patients. We present the case of a 18-years-old gentleman with ß-haemolytic streptococcal pharyngitis complicated by rhabdomyolysis and elevated liver function tests. Such high levels of creatine phosphokinase of 111856 IU/L and elevated liver function tests with aspartate aminotransferase (AST) of 1862 U/L and alanine aminotransferase (ALT) of 1003 U/L in streptococcal pharyngitis is rare to find in the literature. He was treated with aggressive intravenous hydration, antibiotics and hemodialysis. Key Words: Rhabdomyolysis, ß-haemolytic Streptococci, Creatine phosphokinase, Liver function tests.
Subject(s)
Pharyngitis , Streptococcal Infections , Adolescent , Anti-Bacterial Agents/therapeutic use , Humans , Male , Pharynx , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Streptococcus pyogenesSubject(s)
Electronic Nicotine Delivery Systems , Lung Injury , Vaping , Humans , Lung Injury/etiology , Public Health , Vaping/adverse effectsABSTRACT
Hypoxemia is the most common cause for hospitalization in COVID-19 patients. Acute hypoxemic respiratory failure or acute respiratory distress syndrome (ARDS) is the most common complication in COVID-19 patients. Close monitoring of respiratory decompensation is essential. Supplemental oxygen, high flow nasal canula, non-invasive ventilation and endotracheal intubation are the most commonly suggested methods to improve oxygenation. Early intubation with pre-oxygenation, modified rapid sequence intubation and intubation using a video laryngoscope has been advised as a strategy including lung protective ventilation, prone position ventilation, adequate sedation and extracorporeal membrane oxygenation. Strict personal precautions and challenges related to airway management has been currently studied. The authors summarize here the issues of mechanical ventilation and some strategies to resolve them. Key Words: Mechanical ventilation, COVID-19, Hypoxemia.
