The American journal of emergency medicine
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Brucellosis is a zoonotic infectious disease that is common around the world. Its clinical course demonstrates great diversity as it can affect all organs and systems. However, the central nervous system is rarely affected in the pediatric population. ⋯ In this article, we present the case of a 9-year-old girl who developed unilateral nerve paralysis as a secondary complication of neurobrucellosis and recovered without sequel after treatment. This case is notable because it is a very rare, the first within the pediatric population. Our article emphasizes that neurobrucellosis should be considered among the distinguishing diagnoses in every case that is admitted for nerve paralysis in regions where Brucella infection is endemic.
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The goal of this study is to identify clinical variables associated with bacteremia. Such data could provide a rational basis for blood culture testing in emergency department (ED) patients with suspected infection. ⋯ This study identified several clinical factors associated with bacteremia as well as MRSA and Gram-negative subtypes, but the magnitude of their associations is limited. Combining these covariates into a multivariable model moderately increases their predictive value.
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Thirty-year-old woman with history of AIDS and anxiety presented with palpitations. Although clinically euvolemic, she was aggressively fluid resuscitated in lieu of sinus tachycardia. ⋯ Given her normal cardiac, renal, and liver status, she spontaneously cleared the extra fluid, and the pulmonary edema resolved. This case highlights the importance of recognizing transient unilateral pulmonary edema and need for early radiographs to document clearance and prevent unnecessary testing.
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A 69-year-old man presented to the emergency department with hematemesis, hypotension, tachycardia, and hypothermia. The emergency physician performed a bedside ultrasound of the chest, heart, and abdomen. The heart was unable to be visualized in the parasternal, apical, or subxiphoid windows, and free fluid and particulate matter were visualized in the chest and abdomen. ⋯ The presence of air in the pericardial sac results in nonvisualization of the heart on ultrasound. Fluid in the chest and abdomen may be visualized in the posterior upper abdominal windows. Although these ultrasound findings alone are not entirely specific for esophageal perforation, when coupled with a high index of suspicion due to the patient presentation, ultrasound can be one of the most portable, readily available, low-cost, and minimally invasive techniques to make the diagnosis of esophageal perforation.
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Pregabalin, a synthetic derivate of the inhibitory neurotransmitter γ-aminobutyric acid, shows antiepileptic, analgesic, anticonvulsant, anxiolytic, and sleep-modulating activities. The major advantage of pregabalin is its relative reliability, easy use, high tolerance, and lack of negative interaction with other drugs. A 65-year-old woman with medical histories of diabetes mellitus, lumbar spondylosis, diabetic nephropathy, chronic renal failure, and anemia of chronic disease was admitted with the complaint of dizziness and syncope. ⋯ To our knowledge, this is the first case of complete AV block associated with pregabalin. We believe that AV block occurred as a result of pregabalin's effect on L-type Ca++ channels in the heart. Pregabalin's different effects on electrocardiogram and on the heart in different individuals may have an association with the patterns of distribution of the L-type calcium channels in myocardium.