Traumatic spinal epidural hematoma: an alarming and diagnostic challenge in the ED

Traumatic spinal epidural hematoma (TSEH) is a neurosurgical emergency which is considered as one of the rare causes of back pain. The onset of symptoms presentation can vary especially following a trauma. Here, we report a case where a young girl had a trivial fall and presented symptoms of back pain three days later. She developed abrupt onset of lower limb weakness during her stay in the emergency department (ED). X-ray and computed tomography (CT) imaging of the spine did not show any obvious abnormality whereas, Magnetic resonance imaging (MRI) imaging revealed hyper-intense lesions in the thoracic spinal segment which led to the diagnosis of TSEH. Our case highlights the importance of the atypical and varied nature of presentation and the choice of investigation which would help in the early diagnosis of this entity

Etiologic diagnosis of acute shortness of breath in the emergency department

Background-Dyspnea is the term applied to sensation of breathlessness and the patient’s reaction to that sensation, In the BLUE (Bedside Lung Ultrasound in Emergency) protocol, lung profiles have been designed for the main etiologies of dyspnea (acute pulmonary edema, COPD, pulmonary embolism, pneumothorax, pneumonia) with an accuracy of >90%. Objectives-•To investigate if BLUE protocol will improve diagnostic accuracy of patients with acute dyspnea •To compare the diagnostic accuracy of BLUE protocol findings alone with final diagnosis in patients with acute dyspnea. Methods-This study was a cross-sectional, hospital-based, follow-up observational study conducted in 130 patients who presented to the Emergency Department of Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala during January 2020 to August 2020, with complains of dyspnea of acute onset. It was done by incorporating the Bedside Lung Ultrasound in Emergency (BLUE) protocol for diagnosing the etiology of dyspnea. Epiinfo 7 was used for analysis. Results-the study sample included 130 subjects who fulfilled the inclusion criteria.Amongthestudypopulation,76(58.5%)weremalesand54(41.5%) were females. The mean age of the study population was 66.6 with a standard deviation of 14.1. The minimum age included in the study was 32 years and the maximum age was 91years.&nbsp