The American journal of emergency medicine
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Hiccups (singultus) is often a benign, common and self- limited condition. A case of profound electrolyte disturbances presenting with chief complaint of hiccups is presented in which chlorpromazine was not administered and could have been problematic had it been given. For those who present to the ED with chief complaint of hiccups, it is critical to consider a life threatening etiology as the cause of their symptom. This case presents a potential pitfall in the management of singultus.
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Case Reports
Repeat acute abdomen and hemoperitoneum during the same pregnancy due to a ruptured ectopic treated by salpingostomy.
A leading cause of maternal mortality in the first trimester is hemorrhage due to a ruptured ectopic pregnancy. With the advent of tube salvage surgery, ectopic pregnancies can be removed while ensuring hemostasis and preserving the integrity of the fallopian tube. A major drawback of tube salvage surgery is the significant risk of persistent trophoblastic tissue being left behind. ⋯ Surgical intervention confirmed a ruptured ectopic pregnancy in the same site as previous, and salpingectomy was performed, after which the patient recovered without complications. The increased risk of persistent trophoblastic tissue associated with tube salvage surgery can lead to subsequent reoperation for tubal rupture. Patients undergoing these procedures should be closely monitored in the following weeks and undergo serial β-hCG testing in order to confirm successful removal of the ectopic.
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Hashimoto's Encephalopathy (HE) is a rare form of autoimmune encephalopathy associated with Hashimoto's thyroiditis in which patients experience cognitive impairment and various neurologic symptoms. We present a case of a young female that presented to the emergency department with urinary retention, and was ultimately diagnosed with HE. Examination was significant for direction-changing and vertical nystagmus (direction-changing nystagmus describes a phenomenon where the fast beat changes with the direction of gaze), hyperreflexia, clonus, and Babinski and Hoffman's reflexes (all upper motor neuron (UMN) signs). ⋯ To our knowledge, urinary retention in the presence of other UMN signs has not been reported in association with HE; nor has this patient's type of nystagmus. Emergency physicians should be aware of this condition and can play an important role by considering it when neurologic findings are not explained by infectious, toxic, metabolic, or structural etiologies. Although relatively rare, if detected and treated early HE can have a good prognosis.
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Case Reports
The de Winter electrocardiographic pattern of proximal left anterior descending occlusion.
Prompt recognition of electrocardiographic signs of acute left anterior descending (LAD) occlusion is essential for timely restoration of flow. However, some patients may present with atypical electrocardiographic signs, and early diagnosis of these patients may constitute a clinical challenge. ⋯ These cases highlight the importance of recognizing the de Winter electrocardiogram pattern in cases of suspected acute myocardial infarction (AMI). An emergency percutaneous coronary intervention (PCI) should be performed in suspected AMI patients as early as possible.
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Case Reports
Spontaneous coronary artery dissection in a young woman with polycystic ovarian syndrome.
Polycystic ovarian syndrome (PCOS) affects 4% to 12% of women in reproductive age, representing a clinical condition that could predispose to cardiovascular diseases. We report a case of a 34-year-old woman with PCOS, presenting with chest pain, onset two days before, and ST segment-elevation myocardial infarction. ⋯ The patient was discharged in medical therapy after 5days. This is the first observation of spontaneous coronary artery dissection occurring in a PCOS patient.