The fatal rupture of an Aspergillus aneurysm of the cerebral artery that presented as a flu-like syndrome

AbstractFever and headache are common problems encountered by emergency physicians. The diagnostic etiologies can range from benign conditions to life-threatening conditions. Subarachnoid hemorrhage from a ruptured intracranial aneurysm that was caused by an Aspergillus infection is a rare event with a high mortality rate. The central nervous system (CNS) Aspergillus infection should be considered as a differential diagnosis when an immunocompromised patient presents with fever and headache. We reported a 61-year-old male with the above presentations collapsed unexpectedly shortly after been seen by emergency physicians without any imminent signs. He was eventually diagnosed as having an Aspergillus infection of the central nervous system. The clinical manifestations of intracranial Aspergillus infection are subtle and highly variable in term of severity, onset and progression. Early detection is often difficult and even aggressive treatment often results in a drastic medical outcome, which has legal implications for the treating physicians. This case typifies the high stakes associated with the diagnostic challenges that are encountered by emergency physicians when evaluating immunocompromised patients who are experiencing flu-like symptoms

Sternoclavicular Septic Arthritis Caused by Acupuncture over the Posterior Neck

Acupuncture has been used therapeutically for thousands of years and is considered a relatively safe procedure. Sternoclavicular joint (SCJ) arthritis is a rare joint infection and has never been reported as an adverse event of acupuncture. We report the case of a 50-year-old woman who presented with progressive left neck, shoulder and upper chest pain after acupuncture. A computerized tomography (CT) scan revealed septic arthritis over the left sternoclavicular joint (SCJ) and methicillin-sensitive Staphylococcus aureus bacteraemia was noted. The patient was discharged uneventfully after intravenous antibiotic treatment. SCJ septic arthritis should be considered if unilateral neck and upper chest pain occurs after acupuncture

A 52-Year-Old Woman with a Palpable Abdominal Mass

A 52-year-old woman presented with a history of diabetes mellitus under medical treatment and a surgical history of a cesarean section 20 years ago. The patient was referred to our emergency department because of a 2-week hypermenorrhea and unspecific abdominal pain without nausea and vomiting, fever, or other symptoms. She did not complain of weight loss

Age as a predisposing factor of respiratory alkalosis in accidental carbon monoxide poisoning

AbstractAimsThe purpose of this study was to determine the frequency of and identify the predisposing factors for respiratory alkalosis in patients with accidental carbon monoxide (CO) poisoning.MethodsPatients presenting to the emergency department with accidental CO poisoning were retrospectively identified and divided into Group A (no respiratory alkalosis) and Group B (respiratory alkalosis). Charts were reviewed for neurologic status, various demographic factors, and laboratory data.ResultsA total 96 patients, 37 (38.5%) men and 59 (61.5%) women, were identified. Of these, the 58 (60.4%) patients without respiratory alkalosis were placed in Group A and the 38 (39.6%) patients with respiratory alkalosis were placed in Group B. Independent multivariate predictors of CO poisoning presenting with respiratory alkalosis were age [odds ratio (OR), 1.04; 95% confidence interval (CI), 1.01–1.08] and respiratory rate (OR, 1.16; 95% CI, 1.01–1.33). The rates of respiratory alkalosis in patients younger than 15 years, 15–29 years, 30–44 years, 45–59 years, and older than 59 years were 17.4%, 32.4%, 51.9%, 75%, and 75%, respectively (p<0.01).ConclusionsRespiratory alkalosis in the patients with CO poisoning is not an uncommon finding, and as age increases, the percentage becomes higher. When emergency physicians are faced with patients presenting with respiratory alkalosis of undetermined cause, CO poisoning should be taken into consideration, especially in the elderly

Onion-induced anaphylactic shock rapidly evolving to allergic right ventricular myocardial infarction and subsequent cardiogenic shock

AbstractThe type II variant of Kounis syndrome is defined as a rare allergic myocardial angina or infarction event in patients with preexisting quiescent coronary artery disease. Various causative factors have been implicated in the etiology of Kounis syndrome. However, reports highlighting the importance of recognizing a decreased preload caused by allergic right ventricular (RV) myocardial infarction and subsequent cardiogenic shock from ongoing anaphylactic shock are rare. Here we report the case of a 54-year-old male who initially presented with anaphylactic shock after ingesting onions. His condition silently progressed to RV infarction and cardiogenic shock within 2 hours of symptom onset. Under such instances, it is crucial to promptly identify RV infarction and cardiogenic shock by repeatedly performing electrocardiography at frequent intervals

A 5-Month-Old Infant with Right Scrotum Swelling

Case presentation:A five-month-old male infant (gestational age 28 weeks, birthweight 1020 gm) with posthemorrhagic hydrocephalus subsequent to prematurity had a left sided ventriculoperitoneal shunt 3 months after birth. Frontal radiography of the chest and abdomen check-up after operation are shown in figure 1. He was referred to our emergency department with a history of right scrotal swelling for several days. Physical examination, he appeared malnourished. He was afebrile. The right scrotum was found to be distended. Bilateral testicles were palpable on both sides. There were no features of shunt malfunction. A complete blood cell count showed the following: leukocyte count, 7900/mm3; segmented neutrophils, 65%; hemoglobin level of 9.3 mg/dL; hematocrit, 25.9%; and platelet, 190000/uL. Other laboratory studies included: glucose, 92 mg/dL; serum urea nitrogen, 10 mg/dL; serum creatinine, 0.2 mg/dL; sodium, 140 mEq/L; potassium, 3.9 mEq/L; C-reactive protein, 2.9mg/L; and prothrombin time with an international normalized ratio of 1.2. His abdomen x-ray is shown in figure 2. 

Unusual case of spontaneous uterine rupture in a single gestational primipara

AbstractSpontaneous rupture of the primiparous uterus is a rare but catastrophic obstetrical emergency. It is usually associated with prior uterine surgery, trauma, or placental abnormality. To remind physicians to include this condition in their differential diagnosis of acute abdominal pain in pregnant patients, we describe an interesting case of spontaneous uterine rupture that clinically mimicked bowel perforation. A 27-year-old single primiparous pregnant woman presented with sudden onset of severe abdominal pain and peritoneal signs, with absence of vaginal bleeding at 26 weeks’ gestation. The usual risk factors for uterine rupture, such as advanced maternal age, scarred uterus due to mode of previous delivery, or unusual pregnancy, were not present in our patient. Based on clinical examination, abdominal sonography and magnetic resonance imaging, uterine rupture was suspected and eventually confirmed at exploratory laparotomy. No uterine pathological abnormality was noted on the microscopic examination The preterm newborn expired after surgery. Since surgical intervention is the only definitive treatment, emergency physicians should be aware of this rare complication. Emergency physicians should be aware of spontaneous uterine rupture in pregnant patients, even in the absence of risk factors

A 33-year-old Man with Abdominal Pain

A 33-year-old man presented to the emergency department ED) with complaint of 2-day history of abdominal pain. His pain developed with gradual onset prominently in epigastric area after eating dried mushrooms. The pain was diffuse, persistent, radiating to the back and aggravated by meal. He had been tolerating only liquids and had complaints of nausea and vomiting. He had no history of diabetes mellitus, hypertension, alcohol consumption, malignancy, or prior surgery. On arrival his blood pressure was 128/72 mmHg, with a heart rate of 101 beats/minute and a respiratory rate of 20 breaths/minute. He was afebrile. Physical examination revealed diffuse abdominal distention, hyper-pitched bowel sounds, and tenderness more marked over the umbilicus with no guarding or rebound tenderness. A complete blood cell count showed the following: leukocyte count 12600 /mm3; segmented neutrophils 90%; hemoglobin level of 14 mg/dl; hematocrit 30%; and platelet 420000/µL. Other laboratory studies included: glucose 101 mg/dL; serum urea nitrogen 45 mg/dL; serum creatinine 2.0 mg/dL; sodium 148 mEq/L; potassium 3.1 mEq/L; serum glutamic oxaloacetic transaminase (SGOT) 38 U/L and lipase 30 U/L. Figure 1 shows patient’s plain upright abdominal X-ray as well as coronal and axial cuts of abdominal CT scan

A 78-Year-Old Woman with Fecaloid Vaginal Discharge

A 78-year-old woman with a history of colon cancer with metastasis to the liver was presented to our emergency department because of bilateral groin pain and difficulty in walking, which had gradually increased during the previous 5 days. The pain was of sudden onset, radiating to the back, without aggravating or relieving factors. It was associated with constipation, dysuria and vaginal discharge. She reported passing fecal matter from the vagina one month ago. On physical examination, she appeared malnourished. Her blood pressure was 98/65 mmHg, with a 108 beats/min heart rate and 28 breaths/min respiratory rate. She was afebrile. Physical examinations were unremarkable, except for pale conjunctiva, abdominal distention, and diffuse tenderness especially over the umbilicus with guarding tenderness. Bowel sounds were decreased. Pelvic examination showed a yellowish odorous vaginal discharge from the external orifice of uterus. A complete blood cell count showed the following: leukocyte count, 34,200/mm3; segmented neutrophils, 87.5%; hemoglobin level of 7.4 mg/dl; hematocrit, 18.8%; and platelet, 180000/uL. Other laboratory studies included: glucose, 86 mg/dL; serum urea nitrogen, 28 mg/dL; serum creatinine, 0.87 mg/dL; sodium, 142 mEq/L; potassium, 4.8 mEq/L; albumin, 2.5g/dL; a carbohydrate antigen 19-9 level of 3,244 U/ml, and a carcinoembryonic antigen (CEA) level of 64.6 ng/ml. Coronal and axial cuts of patient’s abdominopelvic computed Tomography (CT) are shown in figures 1 and 2

2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research