scholarly journals Skull Base Osteomyelitis in the Emergency Department: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Mustafa Burak Sayhan ◽  
Cemil Kavalci ◽  
Ozgur Sogüt ◽  
Eylem Sezenler
Keyword(s):  
Emergency Department ◽  
Skull Base ◽  
Vital Signs ◽  
Morbidity And Mortality ◽  
Cranial Computed Tomography ◽  
Lytic Lesion ◽  
High Morbidity ◽  
Skull Base Osteomyelitis ◽  
Normal Limits ◽  
History Of

Skull base osteomyelitis (SBO) is a rare clinical presentation and usually occurs as a complication of trauma or sinusitis. A 5-year-old child presented to the emergency department with a three-week history of fever associated with drowsiness and left parietal headache, and a week's history of swelling on the left frontoparietal soft tissue. He had suffered a penetrating scalp injury four month ago. On physical examination, there was a tender swelling with purulent stream on the lateral half of his scalp. His vital signs are within normal limits. Plain X-ray of the skull showed a lytic lesion on the left frontoparietal bone. A cranial computed tomography (CT) scan demonstrated a large subgaleal abscess at the left frontoparietal region. SBO possesses a high morbidity and mortality; therefore, prompt diagnosis and appropriate treatment are mandatory to prevent further complications and to reduce morbidity and mortality significantly.

scholarly journals The Role of Acetyl Cysteine in Cocaethylene (Non-Acetaminophen) Acute Liver Failure

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Getaw Worku Hassen ◽  
Amaninder Dhaliwal ◽  
Catherine Ann Jenninigs ◽  
Hossein Kalantari
Keyword(s):  
Emergency Department ◽  
Substance Abuse ◽  
Liver Failure ◽  
Liver Transplant ◽  
Acute Liver Failure ◽  
Active Substance ◽  
Vital Signs ◽  
Normal Limits ◽  
History Of ◽  
Acetyl Cysteine

Background.Acute liver failure can result from acetaminophen overdose, viral infection, toxins, and other disease conditions. Liver transplant is available in limited fashion and the criteria are strict as to who should get an available liver. N- Acetyl Cysteine (NAC) has been used in non-acetaminophen induced liver failure with success. Here we report a case of acute liver failure from cocaethylene that was reversed with NAC along with other medical therapy.Case Presentation.A 50-year-old female patient presented to the Emergency Department (ED) with a two-day history of coffee ground vomiting and hematemesis. She reported occasional substance abuse and heavy alcoholism. She reported shortness of breath and chest pain from the recurrent forceful vomiting. The rest of the review of systems was unremarkable except a fall from intoxication. Physical examination revealed anicteric conjunctiva and nontender abdomen and her vital signs were within normal limits. Initial blood work revealed acute liver and renal failure. The patient was started with general medical management and liver transplant service rejected the case due to active substance abuse. She underwent brief hemodialysis and was started on NAC. Over the course of her hospital stay her liver function and kidney function improved significantly and patient was discharged to home.Conclusion.In cases where liver transplant is not an option for various reasons including active substance abuse, a trial of N-Acetyl Cysteine may be beneficial and should be considered in the Emergency Department.

A Rare Case of Bilateral Incarcerated Obturator Hernias and a Right-Side Femoral Hernia

2020 ◽  
pp. 1-3
Author(s):  
Jinping Xu ◽  
Jinping Xu ◽  
Ruth Wei ◽  
Salieha Zaheer
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Femoral Hernia ◽  
Rare Case ◽  
Hernia Recurrence ◽  
High Morbidity ◽  
Diagnostic Challenge ◽  
Abdominal Ct ◽  
Abdominal Ct Scan ◽  
History Of

Obturator hernias are rare but pose a diagnostic challenge with relatively high morbidity and mortality. Our patient is an elderly, thin female with an initial evaluation concerning for gastroenteritis, and further evaluation revealed bilateral incarcerated obturator hernias, which confirmed postoperatively as well as a right femoral hernia. An 83-year-old female presented to the outpatient office initially with one-day history of diarrhea and one-week history of episodic colicky abdominal pain. She returned 4 weeks later with diarrhea resolved but worsening abdominal pain and left inner thigh pain while ambulating, without changes in appetite or nausea and vomiting. Abdominal CT scan then revealed bilateral obturator hernias. Patient then presented to the emergency department (ED) due to worsening pain, and subsequently underwent hernia repair. Intraoperatively, it was revealed that the patient had bilateral incarcerated obturator hernias and a right femoral hernia. All three hernias were repaired, and patient was discharged two days later. Patient remained well postoperatively, and 15-month CT of abdomen showed no hernia recurrence.

scholarly journals A Rare Case of Vault Angiofibroma

2021 ◽  
Vol 10 (16) ◽  
pp. 1177-1178
Author(s):  
Jayanthi R. ◽  
Iysverya G.T ◽  
Nishanthi Chandru
Keyword(s):  
Female Patient ◽  
Rare Case ◽  
Vital Signs ◽  
Vaginal Vault ◽  
Vaginal Examination ◽  
Speculum Examination ◽  
Normal Limits ◽  
Surgical Menopause ◽  
History Of ◽  
Foul Smell

A 52-year-old female patient, para 2 live 2, who attained surgical menopause 10 years back, presented to the outpatient department (OPD) with complaints of white discharge per vagina for 6 months, which was watery in consistency and was not associated with foul smell or itching vulva. She had history of hysterectomy done for fibroid uterus 10 years back. On examination, she was afebrile and vital signs were within normal limits. Per abdomen examination, was normal, while, per speculum examination revealed a watery discharge per vaginum. The per vaginal examination revealed a firm, non-tender, globular mass felt arising from the vaginal vault and the mass did not bleed on touch. A globular mass of size 3 x 4 cms, pinkish white in colour, was seen occupying the whole of the vaginal vault with curdy white precipitates in the vaginal rugosities as well as over the mass.

Acute stroke management and late referrals-Clinician and community unawareness, A one month case series from Tumbi regional referral hospital Pwani, Tanzania

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Adam M Gembe ◽  
◽  
Erhad Bilaro ◽  
Keyword(s):  
Emergency Department ◽  
Acute Stroke ◽  
Developing World ◽  
Case Series ◽  
Referral Hospital ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Stroke Management ◽  
Regional Referral Hospital ◽  
The Common

Stroke is among the common emergency department presentations in Tanzania at large. In the developing world, still there are challenges in diagnosis, management and monitoring of these cases hence high morbidity and mortality. A one month case series is presented here, from Pwani region Tanzania, to demonstrate the encountered challenges. Keywords: Acute stroke management clinician; Community unawareness.

scholarly journals Invasive Cryptococcal Meningitis Presenting as a Skull Base Mass in An Immunocompetent Host: A Case Report

2019 ◽  
Vol 80 (03) ◽  
pp. e31-e35
Author(s):  
Joshua Prickett ◽  
Juan Altafulla ◽  
Anna Knisely ◽  
Zachary Litvack
Keyword(s):  
Skull Base ◽  
Amphotericin B ◽  
Treatment Guidelines ◽  
External Ventricular Drain ◽  
Treatment Algorithm ◽  
Morbidity And Mortality ◽  
Intrathecal Therapy ◽  
High Morbidity ◽  
Fungal Sinusitis ◽  
Immune Systems

Introduction Encephalitis due to Cryptococcus neoformans has been seen almost exclusively in patients with severe compromise of their immune systems, such as acquired immune deficiency syndrome (AIDS). Fungal sinusitis with frank invasion through the cranial base and subsequent seeding of the central nervous system is rare, but should be considered in the differential of patients presenting with meningitis and sinus/skull base lesions even without obvious immune compromise. Improvements in diagnostic testing has increased the ability to correctly identify and new antimicrobials have allowed a condition that once carried a high morbidity and mortality to be managed with better outcomes. We present our treatment algorithm for successful management of an immunocompetent patient with extensive fungal encephalitis due to erosion through the skull base. Case Description The patient is a 59-year-old male presenting unresponsive with sphenoid mass erosive of the skull base and symptoms of meningitis and encephalitis due to C. neoformans. Magnetic resonance imaging (MRI) at presentation demonstrated extensive diencephalic invasion, and a sphenoid mass with erosion of the skull base. Lumbar puncture (LP) confirmed elevated opening pressure of 45 cm H2O, and cultures confirmed infection with C. neoformans. He underwent operative sinonasal debridement followed by placement of an external ventricular drain for management of hydrocephalus. He was treated aggressively with a combination of both intravenous (IV) amphotericin B daily and intrathecal amphotericin B via the ventriculostomy thrice weekly. By the 2nd week of treatment, patient regained consciousness. After 4 weeks of therapy, cerebrospinal fluid (CSF) cultures turned negative, and the external ventricular drain (EVD) was converted to a ventriculoperitoneal shunt (VPS) to manage chronic postinfectious hydrocephalus. We also placed a contralateral Ommaya reservoir to permit continued weekly intrathecal amphotericin B without violation of the shunt valve. With each instillation, the shunt was set to its highest setting to minimize CSF egress for 6 hours then reset to its “drainage” setting. After an additional 6 weeks of outpatient therapy, intrathecal therapy was discontinued. We continued CSF surveillance via Ommaya sampling monthly. At 9-month follow-up, he has remained clinically stable without evidence of recurrent infection. He has residual mild cognitive deficits, but is living semiindependently with his brother. Conclusions Fungal sinusitis is uncommon, especially in those without significantly compromised immune systems. Invasive fungal meningitis resulting in meningitis and encephalitis is even rarer. The condition carries high morbidity and mortality that can only be mitigated with a multidisciplinary effort by neurosurgery, otolaryngology, and infectious disease specialists. While there are no clear treatment guidelines, we present an approach that may permit longer term independent survival.

Risk factors of vitamin K antagonist overcoagulation

2008 ◽  
Vol 100 (10) ◽  
pp. 685-692 ◽  
Author(s):  
Gwenaëlle Cadiou ◽  
Rémi Varin ◽  
Hervé Levesque ◽  
Vanessa Grassi ◽  
Jacques Benichou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Medical History ◽  
Vitamin K ◽  
Female Gender ◽  
Vitamin K Antagonist ◽  
High Morbidity ◽  
Duration Of Hospitalization ◽  
History Of ◽  
Previous Medical History

SummaryThe aims of this case-control study were to identify in vitamin K antagonist (VKA)-treated unselected patients, factors associated with international normalised ratio (INR) values: (i) greater than 6.0.;and (ii) ranging from 4.0 to 6.0 complicated with bleeding. We also assessed VKA-related morbidity in these patients. During a two-month period, 4,188 consecutive and unselected patients were referred to our Emergency Department. At admission, the medical records of each patient and two age- and sex-matched controls were reviewed for: both duration and indication of VKA therapy, previous medical history of VKA-related haemorrhage, underlying co-morbidities, concomitant medications other than VKA, duration of hospitalization and deaths’ causes. Of these 4,188 subjects,50 case-patients (1.19%) were identified; both case-patients and controls did not differ as regards indications and patterns of VKA therapy. Interestingly, two-thirds of case-patients were women, suggesting that female gender may be a risk factor of VKA over-coagulation onset. We identified the following risk factors of VKA over-coagulation: previous medical history of INR levels over therapeutic range, therapy with antibiotics, amiodarone and proton pump inhibitors, as well as fever. A total of 88% of case-patients were hospitalized; mean duration of patients’ hospitalization was seven days [range:1–56 days];no patient died from major bleeding. Our study underscores that it is of utmost importance to consider the strength of indication before starting VKA therapy, as this therapy has been responsible for as high as 1.19% of admissions in unselected subjects referred to an Emergency Department. Our data therefore suggest that internists should be aware of VKA-related high morbidity, particularly in situations at risk of VKA over-coagulation.

scholarly journals Use of Emergency Department Extracorporeal Membrane Oxygenation for Treatment of Acute Necrotizing Myocarditis

2019 ◽  
Vol 3 (1) ◽  
pp. 47-50
Author(s):  
Carly Loner ◽  
Peter Crane
Keyword(s):  
Emergency Department ◽  
Extracorporeal Membrane Oxygenation ◽  
Rare Complication ◽  
High Morbidity ◽  
Membrane Oxygenation ◽  
Acute Necrotizing ◽  
History Of ◽  
Eosinophilic Myocarditis ◽  
Systemic Symptoms

We report a case of acute necrotizing eosinophilic myocarditis (ANEM) secondary to drug rash with eosinophilia and systemic symptoms (DRESS) related to administration of minocycline. Myocarditis is a rare complication of DRESS and can manifest as either a self-limited hypersensitivity myocarditis or as the frequently fatal ANEM. Due to the high morbidity and mortality caused by this disease, emergency physicians should be aware of the potential of ANEM in patients with history of DRESS and new-onset cardiac dysfunction. This case reviews the clinical presentation and management of ANEM and the potential role of extracorporeal membrane oxygenation use in the emergency department.

scholarly journals Unscheduled return visits by patients to a german emergency department are a high risk group for initial wrong diagnosis

2018 ◽  
Vol 17 (4) ◽  
pp. 178-181
Author(s):  
Felix Ludwig ◽  
◽  
Wilhelm Behringer ◽  
Steffen Herdtle ◽  
Christian Hohenstein ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Risk Group ◽  
Vital Signs ◽  
High Risk Group ◽  
Normal Limits ◽  
Wrong Diagnosis ◽  
Return Visits ◽  
Special Patient Population ◽  
Special Patient

The aim was to classify patients who returned unscheduled to an emergency department within 7 days. We categorized the patients’ cases arbitrarily according to the underlying cause of the return. The main causes for returning unscheduled were: “patient related” (24,2%), “illness related” (35,4%), “physician related” (18,3%), “system related” (3,8%) and “other” (21,7%). We also analyzed missed diagnoses, as the literature describes this special patient population as a high risk group. 15,4% of all return cases had a wrong diagnosis. No typical risk constellation/symptom could be found. Vital signs or blood values were within normal limits as well.

A case of Fournier’s gangrene diagnosed with POCUS

POCUS Journal ◽  
2019 ◽  
Vol 4 (1) ◽  
pp. 3
Author(s):  
Marco Badinella Martini, MD ◽  
Antonello Iacobucci, MD
Keyword(s):  
Type 2 Diabetes ◽  
Emergency Department ◽  
Alzheimer Disease ◽  
Physical Examination ◽  
Subcutaneous Emphysema ◽  
Vital Signs ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
History Of

An 87-year-old man with a history of type 2 diabetes and severe Alzheimer disease was admitted to the emergency department with a lesion of the perineum for two days. The patient appeared agitated and not collaborating on the visit. His vital signs were normal. Physical examination revealed an edematous, suppurative, and foul-smelling perineal-scrotal lesion, with possible subcutaneous emphysema.

Incidental diagnosis of situs inversus totalis: a perspective from an emergency department attendance

2021 ◽  
Vol 14 (4) ◽  
pp. e242337
Author(s):  
Umma-Kulthum Abdullahi Umar ◽  
Aysha Najim Alremeithi ◽  
Hasan Qayyum
Keyword(s):  
Emergency Department ◽  
Situs Inversus ◽  
Anatomical Variation ◽  
Vital Signs ◽  
Situs Inversus Totalis ◽  
Cardiac Complications ◽  
X Rays ◽  
Future Health ◽  
Normal Limits ◽  
Chest X Ray

A 30-year-old man of African origin presented to our emergency department (ED) with subjective fever and abdominal pain which started on the day of attendance. Vital signs and systemical examination were within normal limits. As part of his evaluation in ED, a 12-lead electrocardiogram was performed which showed features consistent with dextrocardia later confirmed on a chest X-ray as well. An ultrasound scan of the abdomen was performed which showed mirror imaging of the abdominal viscera, all of which were otherwise structurally normal. A diagnosis of situs inversus totalis was made. The patient’s symptoms resolved with analgesia and he was discharged with advice to follow-up in our hospital’s outpatient department. The diagnosis of situs inversus in the ED is a tricky one to make and most cases of this condition are discovered incidentally, as in our case. The mirror-imaged arrangement of viscera can have implications on the site of localised complaints, the physical examination, future health problems for the patient including anaesthesia risks, chronic lung conditions, cardiac complications and specialised trauma management. This anatomical variation can pose diagnostic challenges in such patients. Based on meticulous examination and readily accessible investigations including X-rays, 12-lead ECG and ultrasound, a timely diagnosis can be made.

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