The American journal of emergency medicine
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Capivasertib is a new targeted therapy for the treatment of select cases of hormone receptor positive, HER2 negative advanced breast cancer. Hyperglycemia is a known adverse effect of capivasertib with a 16 % incidence rate, however life-threatening hyperglycemia occurs rarely (incidence 0.3 %). We describe a case of severe hyperglycemic hyperosmolar syndrome with serum blood glucose of 1558 mg/dL in an 86 year old female patient presenting to the emergency department 16 days after starting oral capivasertib. ⋯ Her initial presentation was complicated by altered mental status, hypothermia, hypotension, and bradycardia, and she required over a week of intensive care. This case highlights the need for awareness of acute, severe hyperglycemia as a potential adverse effect of capivasertib and similar oncologic agents. Clinicians should ensure at least twice weekly blood glucose monitoring for any degree of capivasertib-induced hyperglycemia, and have high suspicion for this contributing factor in cases of severe hyperglycemia.
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Gastroduodenal intussusception is a rare but important cause of gastric outlet obstruction, particularly in elderly patients. We present the case of an 81-year-old female who arrived at the emergency department with complaints of epigastric pain, nausea, and vomiting. A CT scan revealed gastroduodenal intussusception, while subsequent endoscopy identified a submucosal mass, raising suspicion for either a gastrointestinal stromal tumor (GIST) or pancreatic rest. This case report highlights the diagnostic process, therapeutic considerations, and clinical outcomes, with a review of the relevant literature.
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Fentanyl use has been linked with an increasing number of opioid-related deaths. The emergency department (ED) is a critical contact point for patients with opioid use disorder (OUD) to access basic healthcare. Little information is known about buprenorphine precipitated opioid withdrawal (BPOW). This study sought to examine the rates of BPOW in patients who used fentanyl and received buprenorphine in the ED. ⋯ We demonstrate that the prevalence of BPOW is low in a cohort of patients who use fentanyl. When precipitated withdrawal does occur, however, it can be severe and require intensive treatment, ICU admission, and prolonged hospital stay.
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Skin and soft tissue infections (SSTIs) are common and contribute significantly to morbidity and healthcare costs in emergency departments (EDs). The rise of antimicrobial resistance, particularly due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA), complicates treatment decisions. Objective physical examination findings suggesting need for empiric MRSA coverage are sometimes ignored. Improving initial antimicrobial selection in the ED, especially regarding MRSA, could enhance antimicrobial stewardship. ⋯ Several factors, not always aligned with clinical guidelines, influenced the decision to initiate MRSA coverage in the ED. Understanding these determinants may improve antimicrobial stewardship and reduce costs. Future research should focus on patient outcomes based on methicillin-sensitive S. aureus (MSSA) versus MRSA coverage decisions and educational initiatives to improve guideline compliance.
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Multiple myeloma (MM) and its complications carry a high rate of morbidity and mortality. ⋯ An understanding of the complications of MM can assist emergency clinicians in diagnosing and managing this potentially deadly disease.