The American journal of emergency medicine
-
Although trauma-induced simple pubic ramus fracture is common in the emergency department (ED), it can result in life-threatening hemorrhagic shock. We describe a 58-year-old woman with closed minimally displaced simple pubic ramus fracture. ⋯ She was successfully treated with transarterial embolization and discharged uneventfully 10 days later. Literature review showed involvement of the superior pubic ramus in all reported cases probably because of hemorrhage from “corona mortis” with delay in shock presentation mostly within 6 hours, suggesting at least an equivalent observation period for these patients, particularly those at high risk for hemorrhage.
-
Case Reports
Acute confusion in headache with neurologic deficits and cerebrospinal fluid lymphocytosis syndrome.
Abrupt headaches with focal neurologic deficits usually indicate medical emergencies that require advanced investigations and prompt treatment. The distinct syndrome of “headache with neurologic deficits and cerebrospinal fluid lymphocytosis” (HaNDL) is infrequent and considered a benign, self-limited disorder. ⋯ The diagnosis was made carefully by exclusion of other likely entities. It is important for clinical physicians to differentiate HaNDL from other potentially fatal.
-
Case Reports
Neurogenic stunned myocardium as a manifestation of encephalitis involving cerebellar tonsils.
Neurogenic stunned myocardium is defined as a myocardial injury or dysfunction after neurological insults. It is most commonly reported in patients with subarachnoid hemorrhage, and the presenting symptoms may mimic an acute myocardial infarction or myocarditis. In severe cases, cardiogenic shock and acute pulmonary edema may occur and lead to a devastating event. ⋯ We herein report the case of a 25-year-old woman who presented to our hospital with the symptoms of acute pulmonary edema, shock, and consciousness disturbance. The diagnosis of encephalitis of cerebellar tonsils complicated with acute hydrocephalus and neurogenic stunned myocardium was made. Detailed neurologic examinations, neuroimaging studies, and characteristic echocardiographic changes expedite the correct diagnosis and treatment.
-
A 23-month-old boy was brought to the emergency department of an adult and pediatric tertiary care center 1 hour after an inadvertent “double dose” of 120 mg flecainide (9.2 mg/kg). His electrocardiogram revealed sinus rhythm with a terminal R wave in aVR greater than 7 mm, a bifascicular block, and prolonged QRS and QTc intervals. ⋯ This case demonstrates that flecainide can cause significant cardiac conduction disturbances in doses much lower than previously described. All supratherapeutic ingestions should be assessed in hospital.