J Emerg Med
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Unenhanced computed tomography (CT) is a frequently used imaging method in patients who are evaluated in the emergency department with suspected cerebral vein thrombosis (CVT). ⋯ Hyperattenuation in the dural sinuses and the HU/Htc ratio in unenhanced brain CT scans have high diagnostic value in detecting CVT.
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Case Reports
Detection of a Urethral Foreign Body in a Pediatric Patient: Another Useful Application of Point-of-Care Ultrasound.
Urethral foreign bodies (UFBs) are rare in pediatric emergency care, but require immediate diagnosis and intervention when they occur. Although radiography, computed tomography, and cystography are available for diagnosing UFBs, these modalities are undesirable because they involve radiation exposure. Point-of-care ultrasound (POCUS) is used as an alternative imaging modality for UFB detection in adult patients, but reports of its use in pediatric emergency departments are still scarce. We report a pediatric case of a UFB detected by POCUS. ⋯ A 10-year-old boy with a history of a learning disorder presented to our pediatric emergency department with a paper clip in his penis, which he had intentionally inserted during play. He denied any symptoms, such as abdominal pain, vomiting, and hematuria. Physical examination failed to reveal the tip of the FB, but showed a palpable mass in the penile urethra accompanied by mild tenderness in the area. POCUS demonstrated a hyperechoic structure with reverberation artifact extending to the bulbar urethra. Endoscopic removal was planned, but the tip of the FB emerged from the external urethral meatus with postural change. Manual removal was successfully performed, after which the hyperechoic structure in the urethra was no longer visible on ultrasonography. The patient was discharged on the same day of the procedure. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: POCUS is a noninvasive procedure that can be useful for detecting UFBs in children.
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Case Reports
Severe Chemosis: Initial Misdiagnosis of an Emergent Complication of Acute Rhinosinusitis.
Orbital findings such as cellulitis, ophthalmoplegia, and proptosis are possible complications of sinusitis. Acute sinusitis can also cause a conjunctival cyst-like lesion induced by severe chemosis; however, it is an uncommon complication. ⋯ We report the case of a 53-year-old man who presented to our facility's emergency department. The patient complained of orbital discomfort resulting from an inability to close both eyes, and orbital discharge, accompanied by general weakness. On physical examination, cyst-like-appearing lesions with erythema of the eyelids were identified bilaterally and initially misdiagnosed as inflammatory lesions of the orbital area. However, orbital pathology was excluded by the ophthalmologist, and it was found that the patient had bilateral pansinusitis on the imaging studies. It was suspected that the sinusitis was responsible for the ocular symptoms. The patient was treated with emergent endoscopic sinus surgery, and the symptoms were promptly relieved. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although it is well known that orbital complications of sinusitis can occur, a conjunctival cyst-like-appearing lesion induced by severe chemosis is uncommon and is difficult to diagnose at first sight. Emergent surgical drainage is needed to prevent permanent orbital damage and other sinusitis-related complications. Therefore, recognizing the unique clinical presentation of a conjunctival cyst-like lesion resulting from severe chemosis is the key to appropriate diagnosis and management.
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Commercial large-bore suction catheters and makeshift large-bore suction catheters with an endotracheal tube (ETT) attached to a meconium aspirator have been shown to have superior suction rates compared with a standard Yankauer. ⋯ The commercial large-bore suction catheter had faster suction rates than the makeshift ETTMA combination when compared with the standard Yankauer.
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Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of assisted reproductive technology. Severe OHSS may be accompanied by thromboembolic events, such as pulmonary thromboembolism or acute respiratory distress syndrome. Ischemic stroke may occur in rare cases. ⋯ We report a 32-year-old woman with a recent medical history of OHSS who presented to the emergency department (ED) with acute onset of impaired consciousness. Her initial Glasgow Coma Scale score was 10 (E3V3M4). History taking and a thorough physical examination were impossible because of the patient's mental status. Additional medical history was obtained with the assistance of the patient's husband. Ischemic stroke was confirmed on diffusion-weighted magnetic resonance imaging performed after a basic examination and confirmation of normal findings on a noncontrast brain computed tomography scan. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although the incidence of cerebral infarction is low in younger patients, emergency physicians treating young women in the ED who have recently undergone fertility treatment or have been diagnosed with OHSS should be aware of the possibility of complications caused by OHSS. Specifically, if these patients complain of traditional or nontraditional neurologic symptoms during an ED visit, stroke should be strongly suspected.. This awareness will reduce the incidence of sequelae through prompt examination and treatment.