Kissing choroidal sign: A case report.

Choroidal detachment (CD) is a rare and potentially vision-threatening complication of glaucoma surgery. Inflammation and prolonged ocular hypotony can promote fluid accumulation between the choroid and sclera. Risk factors include trauma, advanced age, use of anticoagulant medications, systemic hypertension, atherosclerosis, and diabetes. CD ultrasound findings will show 2 layers, detaching as far anteriorly as the ciliary bodies, that protrude convexly into the vitreous without extending to the optic disc, often described as the appositional or kissing choroidal sign. In contrast, retinal detachments will show a distinct "V" shape due to the retina's fixation to the optic nerve head posteriorly. In the case of hemorrhagic CD, therapy should be targeted at reducing intraocular pressure. In this case, the patient was started on atropine and prednisolone drops and discontinued on all glaucoma medications in the left eye. While serous choroidal detachments are usually benign, persistent choroidal effusions may cause significant morbidity with hemorrhagic CD having a worse prognosis. Point of care ultrasound can help emergency physicians quickly distinguish between choroidal and retinal detachments and thus guide management in a safe and timely manner.

Severe Heat Stroke Resuscitation Using a Body Bag in a Community Emergency Department.

Heat stroke can lead to severe complications such as end-organ damage and death. The primary treatment modality for heat stroke is rapid cold-water immersion to lower the patient's body temperature. This typically requires a large bath to place the patient in, which may not be available in small or community emergency departments. Although rarely present in the literature, a body bag for cold-water immersion can be used if a bath is not available. Here, we present a case of a 63-year-old male who presented to the emergency department unresponsive with hyperthermia after a heat wave warning was issued. After a thorough workup and imaging, the patient was given IV saline and naloxone, which did not improve his condition. Therefore, the patient was placed in a body bag filled with cold water and ice until his body temperature reduced to 100°F, after which he was removed and closely monitored. The patient was safely discharged and only required repeat lab work three days after discharge. This case highlights a unique technique that emergency physicians can utilize in scenarios where a typical cold-water immersion setup and execution are not possible.

A non-traumatic, rapid-onset headache that is as dangerous as subarachnoid hemorrhage (SAH) seen in the emergency department.

A 36yo male with multiple non-traumatic, rapid-onset headaches had Emergency Department visits on days 3 and 10 after onset of symptoms. He is a social smoker and drinker. CT head imaging was negative. An MRI/MRA was obtained. The image represents multiple foci of vasoconstriction and dilation in medium and large cerebral vessels consistent with Reversible Cerebral Vasoconstriction Syndrome (RCVS). Multiple rapid-onset headaches and "string of beads" on MRA imaging are pathognomonic for RCVS, which has a 4:1 female to male ratio. Manifestations include the pure cephalic form, characterized by a headache; subarachnoid hemorrhage and cerebral infarction have also been reported. Vasoactive drugs and the post-partum period are recognized as common inciting events. Symptoms usually resolve in 3-6 months. Treatment with nimodipine, 1-2mg/kg/hr IV and/or 30-60mg PO QID orally over 4-8 weeks, has been reported to be effective.