The American journal of emergency medicine
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The COVID-19 pandemic has profoundly affected the habits of patients, as well as its negative effects on human health. The aim of this study is to investigate the factors associated with discharge against medical advice (DAMA) from the emergency department (ED) during the COVID-19 pandemic. ⋯ During the COVID-19 pandemic period, it was observed that the rate of those with severe disease increased among DAMA cases. Necessary precautions should be taken for all patients, especially seriously ill patients, to feel safe in the hospital and to be treated, and the negative consequences that may develop should be prevented by addressing the concerns of the patients and their relatives.
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Interstitial pregnancies are a rare form of ectopic pregnancy that occur when there is implantation of a fetus into the interstitial portion of the uterus. These can be particularly challenging to diagnose and have a high risk of morbidity and mortality due to the relatively late presentation compared to other ectopic pregnancies. ⋯ This case demonstrates the importance of ultrasound as a critical tool in the diagnosis of interstitial pregnancy and the sonographic findings. It is essential for emergency clinicians to be aware of this rare diagnosis.
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Case Reports
Visual hallucination as presenting symptom for acute parieto-occipital cerebrovascular accident.
Visual hallucinations are visual perceptions that are not associated with a real object. Visual hallucinations are often associated with dementia, eye disease, visual pathway disease, psychiatric disorders, delirium, migraines, ictal phenomena, or medication effects. We report a case of a 74-year-old woman with a previous cerebrovascular accident(CVA) without residual deficit and no previous psychiatric history presenting for one week of worsening hallucinations progressing from shapes to cats to human figures in the left visual field. ⋯ She continues to have infrequent hallucinations of floating hands and fingers at follow-up appointment 2 weeks after the initial presentation to the Emergency Department. Posterior circulation CVAs can present with subtle or unusual symptoms. CVA should be included in the differential for new onset hallucinations, particularly in elderly patients.
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Case Reports
Pyometra: Atypical cause of pediatric abdominal pain following complicated appendicitis.
This case is significant to the practice of emergency medicine and describes a unique post-operative infection that to my knowledge has not been described in this age group or under this set of circumstances before. Pyometra is a rare disease that is classically seen in an older cohort, and not commonly on the differential for pediatric patients presenting to the ED with vaginal discharge and fever. While post operative complications such as abscesses may be common following a surgery, intrauterine infections in this context are rare and the treatment is unique. It is important for emergency physicians to have knowledge of pyometra to keep on their differential for abdominal pain and fever after surgery, as well as be familiar with its management and which consultants may need to get involved.