J Emerg Med
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Dehydration is a primary cause of visits to pediatric emergency departments (PED). ⋯ In this PED cohort, we found no predictors for RV to the PED. However, HCO3 ≤16 mmol/L, physician-estimated dehydration >5%, ≥1 IV fluid bolus, and PED antibiotics were associated with increase hospital admission. If replicated, these findings can help clinicians make faster disposition decisions when caring for dehydrated pediatric patients.
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Case Reports
Neuro-Behcet's Masquerading as Status Epilepticus and Meningoencephalitis in the Emergency Department.
Behcet disease (BD) is a rare small vessel vasculitis that commonly manifests as recurrent painful oral or genital ulcerations, uveitis, and skin lesions. Some patients with BD develop neurological symptoms termed neuro-Behcet's disease. In the emergency department setting, these symptoms can be mistaken for other common acute issues including stroke, infection, epilepsy, multiple sclerosis, toxin ingestion, or psychiatric conditions. ⋯ We present a case of a 28-year-old male with neuro-BD mimicking status epilepticus and meningoencephalitis. He was actively seizing on arrival and febrile at 103.8 F. The patient also had a history of vasculitis, uveitis, and genital lesions which raised suspicion for a rheumatological process. Cerebrospinal fluid samples were obtained and computed tomography of the head revealed no acute findings. The patient was started on treatment for seizure and meningoencephalitis and admitted to neurology for continuous electroencephalogram monitoring with additional consults placed for rheumatology, ophthalmology, and infectious disease. The patient was ultimately diagnosed with neuro-Behcet's disease and treated appropriately. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In a patient presenting with neurological symptoms and signs of rheumatological disease providers should consider neuro-Behcet's disease as a differential diagnosis. This case exemplifies the vital role of reviewing past medical history to expand differential diagnoses and early coordination with specialists so treatment can be initiated early to prevent morbidity and mortality. The case will also review different presentations of this unfamiliar diagnosis for a more comprehensive understanding.
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Case Reports
Ultrasound-Guided Erector Spinae Plane Nerve Block for Relief of Acute Cholecystitis Pain.
Acute cholecystitis is a common surgical emergency and a painful condition that often requires frequent intravenous opioid analgesia. Sometimes, pain control of patients with acute cholecystitis is challenging. In this case, we present a potential alternative to managing acute cholecystitis pain. ⋯ A 40-year-old female presented to the emergency department (ED) with right upper quadrant pain. While awaiting testing and ultrasound, she received multiple doses of opioid analgesia. A point-of-care ultrasound of the right upper quadrant was performed and demonstrated findings of acute cholecystitis. Given that her pain was challenging to manage, even with intravenous opioids, an ultrasound-guided erector spinae plane (ESP) nerve block was discussed and subsequently performed at the T7 level. Thirty minutes after the procedure, the patient reported significant relief of her pain and did not require any opioid analgesia until ten hours later on the inpatient floor. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: ESP nerve blocks can potentially offer an alternative analgesic in the management of acute cholecystitis, subsequently reducing the use of opioids in the ED. ESP nerve blocks can potentially offer patients longer-lasting analgesia. ESP nerve blocks can potentially manage visceral pain in the ED.