The American journal of emergency medicine
-
Reactive arthritis is an inflammatory condition with multiorgan system disease potential. Because the standard constellation of symptoms in Reiter syndrome (arthritis, conjunctivitis, and urethritis) is not typically present in all patients, the disease can be easily overlooked if clinical suspicion is not high upon presentation. To highlight the importance of recognizing the potential of this disease in patients with a history of either gastrointestinal or genitourinary illnesses, we present the case of a young healthy male presented on multiple occasions later diagnosed with Reiter syndrome in the setting of a recent diagnosis of prostatitis. ⋯ He was treated with nonsteroidal anti-inflammatory drugs during a brief hospital stay and did well. Although reactive arthritis is an easily managed disease, it is easily missed particularly in young otherwise healthy patients who may not present with classic symptoms. Vigilance with regard to patients with vague seemingly unrelated complaints particularly with a history of gastrointestinal- or genitourinary-related illnesses deserves consideration for this disease process.
-
Case Reports
A patient with demyelination, laminar cortical necrosis, and rhabdomyolysis associated with hypernatremia.
A 60-year-old man with renal failure and intraabdominal abscess formation probably due to perforation of the colon underwent laparotomy on the sixth hospital day. He developed respiratory infection, deterioration of renal failure, and heart failure resulting in severe respiratory insufficiency after laparotomy. He was placed on mechanical ventilation using sedatives and muscle relaxant and was treated with antibiotics, steroids, and a diuretic. ⋯ He remained unconscious for 6 months. This is the first case that demonstrated demyelination, laminar cortical necrosis, and rhabdomyolysis associated with hypernatremia. Rhabdomyolysis after rapid occurrence of hypernatremia might be a laboratory sign of concomitant demyelination.
-
Extracorporeal membrane oxygenation (ECMO) is a form of a mechanical cardiopulmonary life-support system and an adjunct to prolonged cardiac resuscitation. The ECMO results in good outcomes for patients with in-hospital cardiac arrest. ⋯ Cardiac arrest with ventricular fibrillation was refractory to conventional cardiopulmonary resuscitation. In this case, the ECMO–cardiopulmonary resuscitation provided cardiopulmonary life support for out-of-hospital cardiac arrest, achieving a sustained return of spontaneous circulation that allowed prompt percutaneous coronary intervention and a good recovery.
-
Emergency medicine dogma traditionally teaches that aortic dissection presents as tearing chest pain, radiating to the back. This case report describes a 55-year-old woman presenting with a left homonymous hemianopsia and resultant gait disturbance. ⋯ This report provides further evidence for atypical, painless presentations of aortic dissection. Given recent literature on the increasing prevalence of painless dissection, the disease entity should be included in the differential diagnosis for stroke, and a simple portable chest x-ray should always be obtained before administering thrombolytics.
-
Therapeutic hypothermia is now regarded as the only effective treatment of global ischemic injury after cardiac arrest. Numerous studies of the neuroprotective effects of 17β-estradiol have yielded conflicting results depending on administration route and dose. Herein, we investigated the neuroprotective effect of postischemic 17β-estradiol administration combined with therapeutic hypothermia. ⋯ Postischemic administration of low-dose 17β-estradiol appears to be neuroprotective after transient global ischemia, and its effect is potentiated by therapeutic hypothermia.