Unusual case of seizures due to prolonged QT syndrome - A Case Report

Long QT syndrome (LQTS) is a cardiac electrical disorder. One of the rare symptoms of long QT caused by ventricular arrhythmia is seizure. Patients with LQTS may develop seizures due to an acute hypoxic-ischemic event associated with a ventricular arrhythmia. We present a case of a 47-year-old male who came to the Emergency Department (ED) with seizures and was diagnosed as LQTS. The cardiac cause of seizures was suspected because the patient was pulseless during the episode of seizures. The patient developed refractory ventricular tachycardia in the ED and was cardioverted (synchronized) multiple times. He was also put on amiodarone infusions. The patient was then urgently shifted to the Coronary Cath Lab for temporary pacemaker insertion with overdrive pacing. He was advised for an automated implantable cardioverter-defibrillator. This case illustrates that prolonged QT syndrome can masquerade as seizure. Therefore, a careful examination should be done in the patient presenting with the same and a cardiac cause should be excluded. Delays in recognition and treatment may expose the patient to a high risk of sudden cardiac death

ST elevation myocardial infarction in a healthy teenager with no risk factors

Myocardial infarction is not common in patients younger than 45 years. Young patients can experience a myocardial infarction in the presence or absence of atherosclerosis. We report a case of an 18-year-old male patient who presented with chest pain in the emergency department. There were neither any risk factors of coronary artery disease nor any co-morbidity. Investigations revealed an acute myocardial infarction with ST-segment elevation in ECG. On coronary angiography, mid 90% thrombus was seen in the left anterior descending artery, the cause of which remains unknown. Although rare, acute myocardial infarction should be considered in young adults or teenagers presenting with chest pain. Also, it can affect teenagers in the absence of traditional coronary risk factors or co-morbidities

Deodorant cap lodged in the rectum: A case report

Anorectal foreign bodies are rare but have shown a rising trend in recent times. Various kinds of a foreign object may be observed in the rectum, including sharp instruments which may pierce rectum, colon, or create visceral organ injuries. Most common presenting symptoms include abdominal, rectal pains and bleeding per rectum. Without proper history and examination, these foreign objects can easily be missed in the emergency department as these are still a matter of taboo especially in countries like India. We report a case of anelderly gentleman who presented to the emergency with bleeding per rectum and did not initially give a history of foreign body insertion

Elevated capillary blood glucose in the emergency department suggests a higher probability of underlying diabetes or prediabetes

Background: In the emergency department (ED), patients with no prior history of diabetes and with hyperglycemic capillary blood glucose (CBG) levels, an opportunity exists to detect undiagnosed diabetes. High glycosylated hemoglobin (HbA 1c ) levels in these patients could indicate underlying diabetes or prediabetes. Aim: To determine whether hyperglycemia in patients coming to ED without a history of diabetes is associated with elevated HbA 1c levels. Methods: A prospective correlational study of adults aged 18 years and more, presenting to ED with random CBG more than 140 mg/dL were enrolled. The patients with a history of diabetes were excluded. HbA 1c levels were checked in these patients and correlation was analyzed. Results: A total of 107 patients were enrolled and CBG levels were correlated with HbA 1c levels (r = 0.71, P < 0.0001). The median glucose and median HbA 1c levels were 201 mg/dL and 6.3%, respectively. The median time elapsed since last meal was 5 h (25-75% interquartile range, 4-9 h). Overall, 42.1% of the cases had elevated HbA 1c levels ≥6.5% while as 40.2% showed HbA 1c levels between 5.7% and 6.4%, which means 82.2% were either diabetic or prediabetic by HbA 1c criteria. Conclusion: CBG has a good correlation with HbA 1c . Therefore, in ED, HbA 1c should be considered in patients with CBG more than 140 mg/dL with no prior history of diabetes in order to uncover hidden diabetes/prediabetes and to exclude stress hyperglycemia

Unilateral traumatic adrenal hemorrhage with shock

Trauma to the adrenal glands is very rare. The variation in clinical manifestations is marked and markers for its diagnosis being limited, makes it tough to be diagnosed. Computed tomography remains the gold standard for detecting this injury. Prompt recognition and the potential for mortality with adrenal insufficiency can provide the best guidance for the treatment and care of the severely injured. We present a case of a 33-year-old trauma patient who was not responding to the management of his shock. He was finally found to have a right adrenal haemorrhage leading to adrenal crisis. The patient was resuscitated in the Emergency Department but succumbed 10 days post admission