J Emerg Med
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Review Case Reports
Acute cerebellar ataxia in a toddler: case report and literature review.
Acute cerebellar ataxia (ACA) is an inflammatory CNS disease that is characterized by rapid onset of ataxia in a child under 6 years of age. Symptoms typically occur in association with a relatively benign viral illness and have been reported after vaccination as well. ⋯ The emergency approach should be focused on excluding more significant illnesses, such as meningitis or an intracranial mass lesion. Here we present a case of a young girl with ACA and review the relevant literature.
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A 54-year-old man presented with a deep zone II neck injury accompanied by profuse bleeding secondary to attempting suicide by slashing his anterior neck with a knife. Blind passage of the endotracheal tube (ETT) into the glottis through the open anterior neck was unsuccessful. ⋯ The patient underwent operative repair and tracheostomy, and he left the hospital 2 days later with his baseline mental status. The use and the benefits of the GEB are reviewed.
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Infarction of the posterior cerebral artery may present only with signs of agitated delirium and an acute confusional state. In the absence of other prominent neurological deficits, this can be easily mistaken for toxic-metabolic encephalopathy, head trauma, post-ictal confusion, or a psychiatric disorder. Appropriate head imaging studies are important to detect an illness that might otherwise be missed and left untreated.
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Thrombocytopenia is a common occurrence in moderate to severe crotaline envenomation. The exact mechanism by which rattlesnake venom leads to thrombocytopenia is unclear, but aggressive treatment with crotaline-specific antivenom often leads to resolution of this disorder. Crotalinae Polyvalent Immune Fab (CroFab(TM), Protherics Inc., Nashville, TN) (crotaline Fab) is now available for the treatment of symptomatic rattlesnake envenomation. ⋯ We report a case of severe crotaline envenomation that appears to have exhibited two separate episodes of thrombocytopenia, only one of which responded to antivenom. The second, later phase was refractory to both crotaline Fab as well as traditional Antivenin (Crotalinae) Polyvalent (Wyeth-Ayerst Pharmaceuticals, Philadelphia, PA) (ACP). By reviewing the literature regarding venom-induced thrombocytopenia, we attempt to explain this "biphasic" phenomenon and the inability of crotaline Fab to reverse this toxic effect.
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Numerous studies have described the pathophysiology, clinical manifestations, and treatment of the many forms of congenital heart disease (CHD), but none has specifically addressed the reasons CHD patients present to the Emergency Department (ED). The objective of this study was to provide a descriptive analysis of the ED presentations of acute and seriously ill pediatric CHD patients. We intended to capture a subset of acutely ill CHD patients who had presenting signs and symptoms that were potentially attributable to their underlying CHD. ⋯ Patients with complex CHD are often very difficult to correctly diagnose and manage in the ED. They often require extensive inpatient observation and evaluation. A low threshold for inpatient management of these high-risk patients is warranted.