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Case Reports in Emergency Medicine publishes case reports and case series related to prehospital care, disaster preparedness and response, acute medical and paediatric emergencies, critical care, sports medicine, wound care, and toxicology.
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ACE Inhibitor Induced Isolated Angioedema of the Small Bowel: A Rare Complication of a Common Medication
Angioedema is a subcutaneous or submucosal tissue swelling due to capillary leakage and transudation of fluid into the interstitial tissue. It can be localized or generalized as part of a widespread reaction known as anaphylaxis. Millions of people in United States and all over the world receive ACEI antihypertensive therapy. ACEI is known to cause angioedema with an incidence of 0.7 percent. We present a case of 40-year-old female who was started on lisinopril three days prior to presentation for newly diagnosed hypertension. She presented with nonspecific severe abdominal pain, nausea, and vomiting. She denied having difficulty breathing or swelling anywhere in the body. On exam, she did not have facial, lip, tongue, or throat swelling. Her abdomen was tender without guarding or rigidity. Laboratory examination was unrevealing except for mild leukocytosis. Computed tomography scan (CT scan) of the abdomen with oral and IV contrast revealed a moderate amount of ascites with diffuse wall thickening, hyperenhancement, and mucosal edema of the entire small bowel. In the absence of any other pathology, matching history, and imaging findings highly suggestive of angioedema, she was diagnosed with isolated small bowel angioedema as a result of ACEI therapy. She was managed conservatively, and lisinopril was discontinued. A week later on follow-up, all her symptoms had resolved, and repeat CT scan showed resolution of all findings.
A Case of Bedside Ultrasound in COVID-19 to Prognosticate Functional Lung Recovery
Introduction. The fight against COVID-19 poses questions as to the clinical presentation, course, diagnosis, and treatment of the condition. This case study presents a patient infected with COVID-19 and suggests with additional research, that bedside ultrasound may be used to diagnose severity of disease and potentially, prognosticate functional lung recovery without using unnecessary resources and exposing additional healthcare professionals to infection. Case Report. A 46-year-old male presented to the emergency department (ED) with cough, fever, and shortness of breath. Chest X-ray showed patchy airspace opacities bilaterally. Rapid testing resulted positive for SARS-CoV-2. Bedside ultrasound showed abnormal lung parenchyma, with diffuse comet tail artifacts, consistent with interstitial pulmonary edema. Following a prolonged intubation, patient’s abnormal lung ultrasound findings are resolved.
Failure of Nonoperative Management following Angioembolization for Blunt Splenic and Pancreatic Tail Injury
Background. Over several decades, standard management of blunt spleen injury (BSI) has been changed from operative intervention to the selective operative and nonoperative management (NOM). However, some patient needs laparotomy first. This article describes a case of a BSI patient who failed nonoperative management after angioembolization (AE). Case Presentation. A 58-year-old man fell from his motorcycle and was brought to our hospital. His vital sign was stable after extracellular fluid bolus. A contrast-enhanced computed tomography scan of the abdomen showed AAST grade V spleen injury. AE was performed for the splenic artery, but his systolic blood pressure suddenly dropped under 60 mmHg. The resuscitative endovascular balloon occlusion of the aorta was inserted, and immediate laparotomy was performed. A pancreatic tail injury was detected, and the splenic artery and vein were burst at the pancreatic tail and controlled by hemostatic suture. After splenectomy, a drain was placed at the pancreatic tail and the abdomen was temporally closed. The postoperative course was not remarkable except for abdominal abscess treated with antibiotics, and he was discharged on foot. Conclusion. Although NOM is becoming one of the choices for severe BSI, there will still be a patient who requires surgery. Surgeons should be aware of the mechanism of injury and the limitation of AE as an adjunct to NOM. Patient selection for initial NOM and timing to convert to laparotomy are important.
A Case of an 80-Year-Old Man with Empyema and Psoas Abscess
An 80-year-old man with flu symptoms collapsed at his house and had a backache worsened over time. His family called for an ambulance. On arrival, chest X-ray showed reduced permeability of the right lung field, and truncal computed tomography (CT) suggested right multilobular empyema and right iliopsoas abscess. A blood test showed an acute inflammatory response. The patient underwent right small thoracotomy for empyema and ultrasonic-guided drainage for the right iliopsoas abscess and started the administration of antibiotics. We started the administration of doripenem by intravenous drip and then deescalated to ampicillin based on the culture results. Streptococcus intermedius was cultured from all sites. Following these treatments for three months, his general condition improved. We herein report a unique case of complicated empyema and iliopsoas abscess in which a favorable outcome was obtained by an appropriate diagnosis and treatment. Reports of multiple abscesses have been increasing recently because of the growing geriatric population and aging-related complications. It is important to search the whole body to detect multiple abscesses in cases where an abscess is detected at a single site.
Run or Die: A Didactique Case Report of a Rare Cause of Lactic Acidosis in Emergency Medicine
Introduction. Acidosis with traumatic brain injury is a common and serious cause of consciousness disorders in emergency medicine. Extreme acidosis is significantly associated with high mortality (more than 67% if pH levels are under 7). Case Presentation. We describe the case of a 23-year-old man with unknown medical history who was found near the entrance of the emergency department sweat with a tachypnea (55 per minute), a lot of blood around him, and confused. The initial hypothesis was a hemorrhagic shock after a fight, but he did not have any hemodynamic trouble. The initial venous gazometry showed a major lactic acidosis (pH less than 6,8, HCO3 incalculable and lactate up to 20 mmol/L). A Focused Assessment with Sonography in Trauma-echography (FAST-echo) and secondly a body-tomodensitometry were conducted and did not reveal any anomaly. The team was now thinking that the patient situation was caused by an epileptic seizure (association of lactic acidosis and confusion), and the bleed was a consequence of the head trauma. The patient was treated only by NaCl 0,9%. One hour after his admission, the tachypnea began to decrease and he could speak and explain what was happen. He had to run as fast as possible to escape to a fight. The last gazometry, realized 2 hours after his admission, finds a normal pH at 7,35, HCO3 24,5 mmol/L and lactate 2,6 mmol/L. He was authorized to going home. Conclusion. We report here a rare case of major lactic acidosis in emergency medicine caused by a supramaximal effort.
Survival after Aluminum Phosphide Poisoning in Pregnancy
Intoxication and drug overdose as suicidal attempt are rare in pregnancy. We report here the case of aluminum phosphide poisoning in a pregnant lady through oral and intravaginal administration which was managed with aggressive supportive measures without resorting to extracorporeal life support.