The American journal of emergency medicine
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Case Reports
Posterior reversible encephalopathy syndrome associated with Henoch Schonlein Purpura in a pediatric patient.
Henoch Schonlein Purpura is a rare hypersensitivity vasculitis that is commonly associated with pediatric patients. It typically presents with purpuric rash to the lower extremities, abdominal pain and microscopic hematuria; however, it may also be associated with intussusception, glomerulonephritis and hypertension. ⋯ Typically characterized by headaches, seizures, and visual changes, which is presumed to be associated with rapid increases in blood pressure. We present the case of a 6-year-old female who developed Posterior Reversible Encephalopathy Syndrome as a complication from Henoch Schonlein Purpura.
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Septic arthritis is an important but difficult to make diagnosis that leads to significant morbidity and mortality. Joint effusion is generally accepted to be a highly sensitive finding in septic arthritis; however, final diagnosis requires synovial fluid studies. Without a significant joint effusion, it is difficult to obtain synovial fluid. ⋯ Subsequent joint washout revealed purulent synovial fluid that grew out the same bacteria. This case emphasizes the importance of obtaining synovial fluid to evaluate for septic arthritis, even when joint effusion is absent. Ultrasound guidance can facilitate this.
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The 2019 novel coronavirus disease (COVID-19) has become a global pandemic that has struck the United States particularly hard. While it has disproportionately caused severe illness in the elderly and older adult population, many children have also been infected with the virus and some have become critically ill. It is important to recognize COVID-19 may present differently in children; specifically, those under twelve months of age. We report a case of COVID-19 infection in an infant characterized by a bulging anterior fontanelle without any additional symptoms.
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Meta Analysis
Intubation rate of patients with hypoxia due to COVID-19 treated with awake proning: A meta-analysis.
Awake prone positioning (PP), or proning, is used to avoid intubations in hypoxic patients with COVID-19, but because of the disease's novelty and constant evolution of treatment strategies, the efficacy of awake PP is unclear. We conducted a meta-analysis of the literature to assess the intubation rate among patients with COVID-19 requiring oxygen or noninvasive ventilatory support who underwent awake PP. ⋯ Our study demonstrated an intubation rate of 28% among hypoxic patients with COVID-19 who underwent awake PP. Awake PP in COVID-19 is feasible and practical, and more rigorous research is needed to confirm this promising intervention.
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Meta Analysis
Topical capsaicin for the treatment of cannabinoid hyperemesis syndrome, a systematic review and meta-analysis.
Cannabinoid hyperemesis syndrome (CHS) is a condition that is being recognized and treated more frequently in emergency departments (EDs) across the United States. Currently, ED providers rely on antiemetics, antipsychotics and benzodiazepines to alleviate the symptoms. Topical capsaicin, a transient receptor potential vanilloid 1 (TRPV1) agonist, has been proposed in recent years as a low-cost and effective alternative to the traditional antiemetic regimen when treating CHS. The aim of this systematic review and meta-analysis is to demonstrate the reliability and the gaps of what is known about this treatment modality. ⋯ With acceptable time to resolution of symptoms after topical administration and ED LOS, capsaicin appears to be an effective treatment option for symptomatic relief of CHS. Further randomized controlled trials should be conducted to examine if it is the more efficacious and efficient treatment for CHS across various care settings.