http://www.rssboard.org/rss-specification 720 https://escholarship.org/uc/uciem_cpcem/rss Recent eScholarship items from Clinical Practice and Cases in Emergency Medicine Thu, 17 Sep 2026 23:28:28 +0000 https://escholarship.org/uc/item/884004wt <p><strong>Introduction:</strong> Luxatio erecta is a rare glenohumeral dislocation. The standard treatment is reduction under procedural sedation; however, decision-making becomes more nuanced in patients with comorbidities. This report describes a hyperglycemic patient with type 1 diabetes with luxatio erecta.</p> <p><strong>Case Report:</strong> An 18-year-old man resented with a traumatic inferior shoulder dislocation. Laboratory tests indicated severe hyperglycemia without diabetic ketoacidosis. The emergency department team performed a risk-benefit assessment before proceeding with procedural sedation. Closed reduction was successful, and hyperglycemia was managed with intravenous fluids.</p> <p><strong>Conclusion:</strong> Inferior shoulder dislocations are rare; severe hyperglycemia in diabetics is not an absolute contraindication to procedural sedation, but the patient may need individualized risk-benefit assessment.</p> https://escholarship.org/uc/item/884004wt Tue, 8 Sep 2026 00:00:00 +0000 Daniel, Mitch Deutsch, Aaron B. Greenberg, Marna R. https://escholarship.org/uc/item/81m7799m <p><strong>Case Presentation:</strong> A 16-year-old girl presented to the emergency department after being struck in the right eye by another player’s elbow during a basketball game. She had only minimal periorbital swelling but developed persistent nausea, repeated vomiting, and diplopia with upward gaze. Visual acuity, visual fields, and pupillary light reflexes were normal. Extraocular movement testing showed mild limitation of upward gaze of the right eye, and upward gaze reproducibly provoked diplopia, marked nausea, and vomiting. Computed tomography (CT) showed no intracranial hemorrhage, and orbital CT was initially interpreted as showing no obvious orbital floor fracture or extraocular muscle entrapment. Given the discrepancy between the mild external appearance and the severe ocular symptoms, white-eyed blowout fracture with trapdoor-type entrapment and an oculocardiac reflex was suspected. She underwent emergent surgery, after which her vomiting, diplopia, and ocular... https://escholarship.org/uc/item/81m7799m Tue, 8 Sep 2026 00:00:00 +0000 Yamada, Naoki https://orcid.org/0000-0001-8556-9009 Kato, Yukinori https://escholarship.org/uc/item/6vm7k9kd <p><strong>Case Presentation: </strong>A 26-year-old man with past medical history of prolactinoma presented two weeks status post endoscopic transsphenoid prolactinoma excision with a positional headache and cerebrospinal fluid rhinorrhea; he was found to have diffuse subarachnoid air.</p> <p><strong>Discussion: </strong>There are few reports of subarachnoid pneumocephalus in the emergency medicine literature. Pneumocephalus, particularly tension pneumocephalus, typically occurs in the setting of traumatic skull fractures. However, emergency physicians should be aware of subarachnoid pneumocephalus in the setting of endoscopic skull base surgeries.</p> https://escholarship.org/uc/item/6vm7k9kd Tue, 8 Sep 2026 00:00:00 +0000 Dong, Willie Rothenberg, Roger https://escholarship.org/uc/item/6sh2t32p <p><strong>Introduction:</strong> Shoulder dislocations comprise approximately half of all major joint dislocations evaluated in the emergency department. Despite often being considered a simple injury, diagnosing a dislocation can be difficult, especially when accompanied by a fracture associated with unusual mechanism, or when the physical examination is limited. Missed and delayed diagnoses can result in poor patient outcomes and legal risks for clinicians, necessitating a high level of vigilance.&nbsp;</p> <p><strong>Case Series: </strong>We review three medical malpractice cases centered on the failure to recognize shoulder dislocations. Key issues included missed diagnosis, limited physical examination documentation, and inadequate discharge instructions.&nbsp;</p> <p><strong>Conclusion:</strong> Shoulder dislocations can be challenging to identify, and missed diagnoses give rise to subsequent clinical and legal risks. Emergency physicians must maintain a high index of suspicion... https://escholarship.org/uc/item/6sh2t32p Tue, 8 Sep 2026 00:00:00 +0000 Billings, Clara Thomas, Aaron Bardwell, Abigail Lindor, Rachel https://orcid.org/0000-0003-3099-8388 https://escholarship.org/uc/item/57d6r7k9 <p><strong>Introduction:</strong> A Bezold abscess is a neck abscess characterized by inflammation and infection of the mastoid process that can invade deep into local anatomical musculature and vasculature.</p> <p>&nbsp;</p> <p><strong>Case Report:</strong> We highlight the case of a 62-year-old man who presented with ongoing left-sided neck pain, headache, and tinnitus that started two weeks prior to arriving at the emergency department. Physical examination showed tenderness to the left trapezius muscle, left-sided mastoid tenderness, and pearly tympanic membranes bilaterally. A computed tomography angiogram of the head and neck was performed due to concerns of vertebral dissection, which eventually led to a diagnosis of Bezold abscess.</p> <p>&nbsp;</p> <p><strong>Conclusion:</strong> Although Bezold abscess has been described in the medical literature, it is rarely encountered in modern clinical practice because the widespread use of antibiotic therapy prevents acute mastoiditis... https://escholarship.org/uc/item/57d6r7k9 Tue, 8 Sep 2026 00:00:00 +0000 Wahhab, John Oganesyan, Ani Pham, Peter Jackson, Evan https://escholarship.org/uc/item/2c63h6vn <p><strong>Introduction: </strong>Electrical storm is an emergent medical condition in which a patient experiences recurrent episodes of ventricular tachycardia or ventricular fibrillation. Traditional management includes intravenous antiarrhythmics and/or electrical cardioversion. However, in some cases, cardiac arrhythmias may persist despite these interventions. In rare circumstances, traditional therapies in the emergency department (ED) may prove to be futile. In such cases, a stellate ganglion nerve block (SGNB) can be considered.</p> <p><strong>Case Report: </strong>We present a novel case in which a SGNB was performed in the ED on an awake patient experiencing recurrent cardioversions from his implantable cardioverter defibrillator shocks for ventricular tachycardia.&nbsp;</p> <p><strong>Conclusion:</strong> In the setting of refractory ventricular dysrhythmias, sympathetic blockade of the left stellate ganglion can be a useful adjunct to conventional management in the ED.</p> https://escholarship.org/uc/item/2c63h6vn Tue, 8 Sep 2026 00:00:00 +0000 Smith, Allison https://orcid.org/0000-0002-1978-3370 Weindruch, Louisa Mayo, Rebecca Brewer, Jonathan https://orcid.org/0000-0001-9300-3670 https://escholarship.org/uc/item/1xj6c2dd <p><strong>Introduction:</strong> Vertebral augmentation procedures, including vertebroplasty and kyphoplasty, can result in cement extravasation, which is often clinically silent. Less commonly, cement may migrate intravascularly into the inferior vena cava (IVC) and pulmonary arterial circulation, resulting in pulmonary cement embolism, a potentially life-threatening complication. Early recognition in the emergency department (ED) is essential to guide appropriate imaging, specialty consultation, and timely management.</p> <p><strong>Case Report:</strong> A 76-year-old woman with recent third lumbar vertebral augmentation presented to the ED with acute worsening low back pain and burning bilateral radicular symptoms approximately one week after the procedure. Computed tomography (CT) of the abdomen and pelvis with intravenous contrast demonstrated linear hyperdense material extending from the treated vertebral body into the IVC, concerning for intravascular cement migration.... https://escholarship.org/uc/item/1xj6c2dd Tue, 8 Sep 2026 00:00:00 +0000 Sneed, Christina Sneed Adnan, Syed https://escholarship.org/uc/item/7vx7j3nh <p><strong>Introduction: </strong>Rib fractures in older adults carry high morbidity and mortality, leading many hospitals to admit patients based on age alone. The Rib Injury Guidelines (RIG) offer a triage system; under RIG 2, patients are typically admitted to inpatient care.&nbsp;</p> <p><strong>Case Series: </strong>This study evaluated whether older adults categorized as RIG 2 solely due to age could be safely managed in an emergency department observation unit. We conducted a 14-month case series at an academic trauma center, reviewing 23 patients 60 years and older with rib fractures. Twenty met RIG 2 criteria, including those later admitted for nontrauma reasons. The mean observation stay was 26.6 hours, and the total hospital stay was 1.8 days. Seventeen patients (85%) were discharged directly from observation, three (15%) were admitted to medicine, and none returned within 72 hours.&nbsp;</p> <p><strong>Conclusion: </strong>Carefully selected older adults with rib fractures... https://escholarship.org/uc/item/7vx7j3nh Mon, 31 Aug 2026 00:00:00 +0000 Jenkins, Phillip D Crawford Rowe, Elizabeth K Gershon, Colin Cook, Mackenzie Marshall, John https://escholarship.org/uc/item/72j8r9s4 <p><strong>Introduction:</strong> Heat stroke is a time-sensitive condition that requires early intervention to prevent morbidity and mortality. Heat-related deaths are also increasing. Multiple studies have evaluated various cooling methods and assessed their effectiveness, safety, and practicality across diverse settings and populations. Earlier and faster cooling leads to improved patient outcomes. The National Association of Emergency Medical Services Physicians recommends initiating prehospital cold-water immersion before emergency medical services (EMS) transport.&nbsp;</p> <p><strong>Case Series: </strong>This case series evaluated the feasibility and effectiveness of prehospital cold-water immersion initiated before and continued during EMS transportation from the scene to emergency department arrival in this critically ill patient population.&nbsp;</p> <p><strong>Conclusion:</strong> Rapid initiation and maintenance of prehospital cold-water immersion in undifferentiated... https://escholarship.org/uc/item/72j8r9s4 Mon, 31 Aug 2026 00:00:00 +0000 Lindow, David Everitt, Bryan Smith, Nick Wells, Michael Dickson, Robert Patrick, Casey https://escholarship.org/uc/item/72g5m4qp <p><strong>Introduction: </strong>Cardiac tamponade typically develops from the accumulation of blood and other fluids, although it can occur from pneumopericardium.</p> <p><strong>Case Report: </strong>A 62-year-old man presented to the emergency department with chest pain and was found to have a pneumopericardium on computed tomography. He developed signs of obstructive shock with hypotension refractory to intravenous fluids and vasopressors. The patient stabilized with bedside pericardiocentesis and pericardial drain placement.</p> <p><strong>Conclusion:</strong> Gastrointestinal-pericardial fistulae are a rare cause of pneumopericardium. Emergency physicians typically rely on cardiac point-of-care ultrasound to evaluate for tamponade and guide pericardiocentesis. However, air artifacts interfere with images, complicating diagnosis and procedures.&nbsp;</p> https://escholarship.org/uc/item/72g5m4qp Mon, 31 Aug 2026 00:00:00 +0000 Moscinski, Catherine Altheimer, Alyssa Driver, Lachlan Maryanov, Nikita Cunningham, Cassidy https://orcid.org/0000-0002-7357-7092 https://escholarship.org/uc/item/594347pw <p><strong>Introduction:</strong> Venous leg ulcers disproportionately affect people experiencing homelessness and contribute to recurrent emergency department (ED) use. Standard wound care protocols often require daily dressing changes and leg elevation, which are unrealistic in unstable housing environments.</p> <p><strong>Case Report:</strong> A 71-year-old male with a 10-year history of venous leg ulcers and 15 ED visits achieved complete wound epithelialization after four months of weekly Unna boot compression therapy, despite eviction during treatment. He has not returned to the ED for this condition.</p> <p><strong>Conclusion:</strong> Emergency department-initiated compression therapy with structured wound care referral may reduce recurrent ED use among unhoused patients with venous leg ulcers.</p> https://escholarship.org/uc/item/594347pw Mon, 31 Aug 2026 00:00:00 +0000 Coba Clementel, Ariana https://orcid.org/0009-0001-4708-4649 Ross, Frank https://escholarship.org/uc/item/57x0j0hk <p>Amphetamine-induced Reverse Takotsubo Syndrome: Further Implications</p> https://escholarship.org/uc/item/57x0j0hk Mon, 31 Aug 2026 00:00:00 +0000 Yalta, Kenan Gok, Murat https://escholarship.org/uc/item/41m7s14z <p><strong>Case presentation:</strong> A 57-year-old man with a history of obesity-hypoventilation syndrome, diabetes mellitus, and chronic renal insufficiency was intubated with an 8.0-mm endotracheal tube under video laryngoscopy in the emergency department due to respiratory failure. After successful intubation, bloody secretions were noted in the patient’s mouth. Subsequent examination revealed that the endotracheal tube had caused a through-and-through perforation at the junction of the soft palate and the anterior tonsillar pillar. Because the intubation had been successful, the endotracheal tube was not removed, and the soft palate was transected to free the tube. The patient made an uneventful recovery.</p> <p><strong>Discussion:</strong> Soft palate perforation is an uncommon injury that has been reported more frequently with video laryngoscopy than direct laryngoscopy. To prevent this injury and ensure its rapid recognition, it is recommended that the clinician sequentially... https://escholarship.org/uc/item/41m7s14z Mon, 31 Aug 2026 00:00:00 +0000 Thomas, Samuel J. https://orcid.org/0009-0004-1644-7074 Zimmer, David I. https://orcid.org/0000-0001-8656-2175 Langford, Jack H. Brenner, Toby J. https://orcid.org/0000-0002-5970-9730 Kelly, Kate M. Zimmer, Donald F. https://escholarship.org/uc/item/2bn8g84j <p><strong>Introduction: </strong>Group A streptococcus (GAS, Streptococcus pyogenes) is commonly associated with pharyngitis and skin and soft tissue infections, but invasive infection can occur. Primary bacterial peritonitis due to GAS is rare, especially in healthy children without nephrotic syndrome or immunocompromise.</p> <p><strong>Case Report:</strong> We present a 21-month-old previously healthy male with four days of fever, irritability, and refusal to walk. Examination revealed abdominal distention and peritonitis. Computed tomography showed ascites and a normal appendix. Diagnostic laparoscopy revealed copious purulent peritoneal fluid; both peritoneal fluid and blood cultures were positive for GAS. He was treated with ampicillin-sulbactam followed by oral amoxicillin-clavulanate with complete recovery.</p> <p><strong>Conclusion: </strong>This case highlights a rare presentation of invasive GAS as primary peritonitis in a healthy child. Clinicians should consider this... https://escholarship.org/uc/item/2bn8g84j Mon, 31 Aug 2026 00:00:00 +0000 Drinnan, Alex Naprawa, James Kim, Sunghoon Mansour, Karim https://escholarship.org/uc/item/0gd6z5hd <p><strong>Introduction:&nbsp;</strong>Spontaneous pneumomediastinum is a rare condition characterized by the presence of air in the mediastinum without preceding trauma. It is often triggered by minor events such as coughing, physical exertion, or traditional therapies.&nbsp;</p> <p><strong>Case Report: </strong>A 52-year-old male with a history of pulmonary tuberculosis developed sudden left-sided chest pain and swelling following traditional chest massage therapy. Examination revealed subcutaneous emphysema with palpable crepitus. Imaging showed characteristic signs of pneumomediastinum with bilateral lung opacities. As a complication of pneumomediastinum the patient developed mediastinitis and a mediastinal abscess, requiring open thoracotomy and drainage. He recovered with multidisciplinary care.&nbsp;</p> <p><strong>Conclusion:</strong> Early recognition of spontaneous pneumomediastinum in emergency settings is crucial, especially when chest pain is accompanied by subcutaneous... https://escholarship.org/uc/item/0gd6z5hd Mon, 31 Aug 2026 00:00:00 +0000 H, Naveed Ul Hassan https://orcid.org/0009-0002-3920-0758 B G, Kowsthubha https://orcid.org/0009-0006-7909-7248 Uthayakumar, Amaravathi https://escholarship.org/uc/item/5jw302zf <p><strong>Introduction:</strong> Purulent pericarditis is a rare subset of pericarditis that can result in serious morbidity and mortality. Presenting symptoms are often nonspecific, and a high index of suspicion must be maintained to reach an early diagnosis. Point-of-care ultrasound can be pivotal in the emergency department evaluation of purulent pericarditis, providing key information including characteristics of the effusion and a sonographic assessment for signs of tamponade. We present a case of purulent pericarditis first detected using point-of-care ultrasound in the emergency department.&nbsp;</p> <p><strong>Case Report</strong>: A 55-year-old male presented with chest pain and dyspnea and was found to have cardiac tamponade secondary to purulent pericarditis.</p> <p><strong>Conclusion:</strong> Cases of purulent pericarditis are rare but should be recognized by emergency clinicians. Point-of-care ultrasound is a powerful tool to assist in early diagnosis of pericardial... https://escholarship.org/uc/item/5jw302zf Mon, 24 Aug 2026 00:00:00 +0000 Baquet, Daniel Blevins, Aaron Casey, Dillon Glass, Casey Seaback, Jordan Schoeneck, Jacob https://escholarship.org/uc/item/9fq820rz <p><strong>Introduction:</strong> Retrograde intubation is a seldom used but valuable technique in managing difficult airways, especially in resource‑limited settings when advanced equipment is unavailable or ineffective.</p> <p><strong>Case Report:</strong> We report the case of a 64‑year‑old male with advanced ankylosing spondylitis and severe cervicothoracolumbar kyphosis who presented with altered mental status and respiratory distress. Extreme fixed cervical flexion, markedly restricted mouth opening, and an inaccessible anterior neck rendered direct laryngoscopy, video laryngoscopy, fiberoptic intubation, and surgical airway approaches unfeasible. Retrograde nasotracheal intubation was successfully performed, resulting in airway stabilization and hemodynamic improvement.</p> <p><strong>Conclusion:</strong> This case highlights retrograde intubation as a lifesaving low‑technology technique in complex anatomic and physiologic airways, demonstrating its continued relevance... https://escholarship.org/uc/item/9fq820rz Wed, 12 Aug 2026 00:00:00 +0000 Joshi, Shrirang Shriram https://orcid.org/0000-0002-0913-852X Nayak, Shreesha Chakraborty, Shoubhik Kaur, Hardeep Siddiqua, Naazia Bhoi, Sanjeev https://escholarship.org/uc/item/99b4z9x7 <p><strong>Introduction</strong>: Lemierre syndrome is a rare but potentially severe thrombophlebitis of the internal jugular vein. It most often presents after oropharyngeal infection, likely stemming from anaerobic&nbsp;bacteria, commonly&nbsp;<em>Fusobacterium necrophorum</em>. The potential severity of this condition&nbsp;underscores the importance of early and accurate diagnosis. The gold standard diagnosis relies on&nbsp;computed tomography and blood cultures; however, point-of-care ultrasound offers a rapid and cost-effective tool.</p> <p><strong>Case Report:&nbsp;</strong>A 58-year-old woman with chronic obstructive pulmonary disease, migraines, and&nbsp;recent dental extractions presented with two days of worsening right-sided neck pain and swelling.&nbsp;She denied fever, chills, or recent upper respiratory symptoms. Examination revealed a tender&nbsp;anterior neck mass without airway compromise. Point-of-care ultrasound demonstrated a 1.22 x&nbsp;1.80 centimeters hyperechoic... https://escholarship.org/uc/item/99b4z9x7 Wed, 12 Aug 2026 00:00:00 +0000 Hotton, Maxx F Roth, Kevin R Schultz, Kristine L https://escholarship.org/uc/item/92c6n3wt <p><strong>Introduction</strong>:&nbsp;Hyperkalemia is a common and potentially life-threatening complication of end-&nbsp;stage renal disease, often producing nonspecific symptoms but profound cardiac effects. While&nbsp;nonadherence and dietary indiscretion are typical precipitants, clinicians must also consider the adequacy and effectiveness of dialysis.</p> <p><strong>Case Report</strong>:&nbsp;We report a patient with end-stage renal disease on thrice-weekly hemodialysis who&nbsp;presented with significant bradycardia and altered mental status. Initial prehospital electrocardiogram&nbsp;(ECG) was suspicious for acute coronary syndrome after automated ECG interpretation suggested&nbsp;anterior ST-segment elevation. In the emergency department, the patient was in a junctional&nbsp;escape rhythm with diffuse peaked T-waves. Serum potassium was 7.8 millimoles per liter with&nbsp;concomitant uremia. Despite administration of potassium-shifting therapies bradycardia persisted,&nbsp;and... https://escholarship.org/uc/item/92c6n3wt Wed, 12 Aug 2026 00:00:00 +0000 Kim, Joseph Lim https://orcid.org/0009-0000-4922-8514 Glazer, Joshua Achufusi, Amaka E. https://orcid.org/0000-0002-4628-2993 Tsuchida, Ryan Ellis https://escholarship.org/uc/item/8j7267dj <p><strong>Introduction:</strong> The use of antipsychotic drugs can prolong the corrected QT (QTc) interval of the electrocardiogram and cause a life-threatening ventricular arrhythmia. There is no consensus as to what is considered normal or what cutoff indicates QTc prolongation. However, recent literature has described the biological variation of the QTc interval from healthy subjects, with researchers concluding that the best approach at establishing a normal range is to determine an individual baseline interval during health.&nbsp;</p> <p><strong>Case Report:</strong> A baseline QTc interval (460 milliseconds) had been determined for a 42-year-old female with a history of schizophrenia and depression who was prescribed antipsychotic drugs including escitalopram, olanzapine, haloperidol, clonazepam and divalproex over the course of four years. Over that time frame, she was admitted on 20 occasions with chest pain, but her QTc interval was at or above her baseline level. Acute... https://escholarship.org/uc/item/8j7267dj Wed, 12 Aug 2026 00:00:00 +0000 Wu, Alan H.B. Alamillo, Melissa Kendrick, Kayla https://escholarship.org/uc/item/8bg1w4xd Clinical Practice and Cases in Emergency Medicine Volume 10 Issue 3 https://escholarship.org/uc/item/8bg1w4xd Wed, 12 Aug 2026 00:00:00 +0000 CPC-EM, Clinical Practice and Cases in Emergency Medicine Saucedo, Cassandra Haghkhah, Omid https://escholarship.org/uc/item/74x388s6 <p><strong>Introduction: </strong>Wolff-Parkinson-White syndrome is a congenital conduction disorder involving an accessory pathway that predisposes patients to reentrant tachyarrhythmias and, in rare cases, sudden cardiac death. While often asymptomatic, it may predispose patients to serious tachyarrhythmias, particularly under conditions that enhance atrioventricular (AV) conduction. Risk stratification using noninvasive and invasive tools such as electrophysiologic studies is critical&nbsp;to identifying high-risk individuals and guiding treatment decisions such as catheter ablation.&nbsp;Pharmacologic agents that alter autonomic tone may unmask latent pre-excitation. Dicyclomine, an&nbsp;anticholinergic agent used for gastrointestinal disorders, is not an&nbsp;AV-nodal blocking drug but exerts&nbsp;vagolytic effects that can increase sinus rate and AV nodal conduction. Dicyclomine’s vagolytic&nbsp;effects and potential for interaction with other proarrhythmic drugs warrant... https://escholarship.org/uc/item/74x388s6 Wed, 12 Aug 2026 00:00:00 +0000 Wahhab, John Loveridge, Natalie Margaret Siaj, Manar https://escholarship.org/uc/item/6x79r7pf <p><strong>Case Presentation: </strong>A 62-year-old male presented to the emergency department with a three-day history of right knee, calf, and foot pain following a bout of prolonged crouching while gardening. The physical examination revealed a cold and pale foot with absent pulses. A point-of-care ultrasound (POCUS) performed at bedside revealed a thrombosed popliteal artery aneurysm. A heparin infusion was initiated, and vascular surgery was consulted. Subsequent imaging confirmed the diagnosis of a thrombosed popliteal artery aneurysm with thrombus extension into the superficial femoral artery. The patient underwent a femoropopliteal bypass, resulting in successful revascularization of the limb.</p> <p><strong>Discussion: </strong>While POCUS is a well-established imaging modality for the diagnosis of deep vein thrombosis, its utility in diagnosing acute peripheral arterial pathologies is less well-known. This case demonstrates how prompt bedside POCUS evaluation can circumvent... https://escholarship.org/uc/item/6x79r7pf Wed, 12 Aug 2026 00:00:00 +0000 Gonedes, Andrew Kohen, Brian Diallo, Alfa McKenna, Mark Farrow II, Robert Boccio, Eric https://escholarship.org/uc/item/6rz50010 <p><strong>Introduction: </strong>Globe injuries constitute true ophthalmologic emergencies and require prompt surgical intervention. When direct physical examination is limited, due to trauma or swelling, point-of-care ultrasound (POCUS) can serve as a valuable adjunct in evaluating globe integrity.&nbsp;</p> <p><strong>Case Report:</strong> We report the case of a 31-year-old male who presented to the emergency department with a barbed fishing hook embedded in his right eyelid. The patient reported pain localized to the eyelid but denied any visual disturbances or direct eye involvement. On examination, a large fishing hook embedded in the right upper eyelid was visualized. His eye was swollen, and he was unable to fully open it, limiting direct assessment of the globe. Given the limited exam, POCUS of the right eye revealed a foreign body traversing the anterior chamber toward the lens, raising concern for globe injury. Ophthalmology was consulted, and computed tomography of... https://escholarship.org/uc/item/6rz50010 Wed, 12 Aug 2026 00:00:00 +0000 Carter, Jeremy Zatarain, John Robert Zatarain, Mia Koscumb, Paul Paul, Krishna Jehle, Dietrich https://orcid.org/0009-0002-6006-3903 https://escholarship.org/uc/item/6rh5n8kv <p><strong>Introduction:</strong> Aortoesophageal fistula is a rare but life-threatening hemorrhagic complication of thoracic endovascular aortic repair. Without intervention, mortality approaches 100%. Our case highlights the utility of using an esophageal-gastric balloon tamponade device for hemostasis.</p> <p><strong>Case Report:</strong> We report the case of a 70-year-old man who presented after a sentinel episode of hematemesis six days after thoracic endovascular aortic repair. Shortly after admission, the patient developed massive hematemesis and hemorrhagic shock from an aortoesophageal fistula. Hemorrhage was temporarily controlled via bedside placement of a Minnesota tube, a type of balloon tamponade device, by two emergency medicine and critical care physicians, allowing for hemostasis, resuscitation, and definitive diagnosis with esophagogastroduodenoscopy. The device successfully bridged the patient to the operating room, where he underwent definitive endovascular... https://escholarship.org/uc/item/6rh5n8kv Wed, 12 Aug 2026 00:00:00 +0000 Burton, Erich https://orcid.org/0009-0000-9299-4767 Wray, Trenton https://escholarship.org/uc/item/6dc9d00z <p><strong>Introduction</strong>:&nbsp;Cardiac arrest in the setting of cocaine use portends high morbidity and mortality&nbsp;secondary to its powerful sodium channel blockade effects. Intravenous (IV) lipid emulsion has long&nbsp;been used as a rescue therapy in lipophilic toxicities.</p> <p><strong>Case Report: </strong>We report a case in which IV lipid emulsion was used to successfully stabilize a&nbsp;patient who suffered cocaine-associated, out-of-hospital cardiac arrest.</p> <p><strong>Conclusion</strong>:&nbsp;Intravenous lipid emulsion was used in the successful resuscitation of a cocaine&nbsp;overdose and could be considered for use in patients with cocaine-associated cardiac arrest.</p> <p></p> https://escholarship.org/uc/item/6dc9d00z Wed, 12 Aug 2026 00:00:00 +0000 Offman, Ryan Baribeau, Sarah K https://escholarship.org/uc/item/68g1v3hg <p><strong>Case Presentation: </strong>An 83-year-old man with a history of left corneal transplant presented to the emergency department with several days of left eye pain, redness, and tearing. Visual acuity was 20/50 in the right eye and bare light perception in the left eye. Intraocular pressure was 15 millimeters fo mercury in the right eye and unobtainable in the left. The left conjunctiva and sclera were injected, and slit-lamp examination revealed a full-thickness corneal perforation with corneal haze in the transplanted cornea. We placed a rigid eye shield, provided systemic analgesia, kept the patient nil per os, and obtained urgent ophthalmology consultation.</p> <p><strong>Discussion:</strong> Corneal perforation is a full-thickness corneal defect that disrupts globe integrity and allows aqueous leakage. It may result from infection, ocular surface disease, autoimmune disorders, trauma, or prior keratoplasty, with graft–host junction instability representing a key... https://escholarship.org/uc/item/68g1v3hg Wed, 12 Aug 2026 00:00:00 +0000 Dahdal, Diala Nama, Ahmad Deng, Wenyu Hahn, Barry https://orcid.org/0000-0001-9035-5603 https://escholarship.org/uc/item/67t9g0sh <p><strong>Introduction:</strong> Subungual myiasis is an infection under the fingernail or toenail caused by an infestation of fly larvae. It is rarely reported internationally, with only one previously reported case in the United States.</p> <p><strong>Case Report:&nbsp;</strong>An 80-year-old female with a history of polyneuropathy, peripheral artery disease, peripheral venous insufficiency, and chronic bilateral lower extremity edema presented to the emergency department (ED) after staff at her skilled nursing facility noted what appeared to be several whitish-colored maggots moving under the nail of the patient’s left great toe. Thorough examination was consistent with subungual myiasis with associated onycholysis without evidence of associated cellulitis or soft tissue infection. Manual extraction of six larvae was performed, and the patient’s foot was soaked in chlorhexidine. She was discharged back to her facility with a plan for daily chlorhexidine soaks and prompt follow-up... https://escholarship.org/uc/item/67t9g0sh Wed, 12 Aug 2026 00:00:00 +0000 Marquis, Taylor Sheng, Alexander Y https://escholarship.org/uc/item/67n326s9 <p><strong>Introduction:</strong> Tension hydrocele is a rare but serious complication that can threaten testicular viability. This case report describes how testicular point-of-care ultrasound (POCUS) enabled timely recognition of a large hydrocele compromising testicular perfusion and guided management.<br>Case Report: A 57-year-old male presented to the emergency department (ED) with painful right scrotal swelling. Testicular POCUS demonstrated a large hydrocele with reduced intratesticular blood flow. A scrotal centesis performed by the emergency physician led to symptom resolution and restoration of normal flow.</p> <p><strong>Conclusion:</strong> Testicular POCUS can rapidly identify impaired perfusion and guide scrotal centesis in the ED, a temporary yet potentially testis-saving intervention.</p> https://escholarship.org/uc/item/67n326s9 Wed, 12 Aug 2026 00:00:00 +0000 Potalivo, Sophia Fornbacher, Sophia Abadilla, Joey Goubert, Ron Tovar Hirashima, Eva https://escholarship.org/uc/item/6785283v <p><strong>Case Presentation: </strong>A 28-year-old woman was brought to the emergency department after being found collapsed at home. Because she was unable to provide a history, contextual bedside clues were important during the initial assessment. Bright yellow granular material with a medicinal odor was noted adherent to her hair. This unusual finding raised suspicion of overdose with an acetaminophen-containing over-the-counter (OTC) cold medication. Her serum acetaminophen concentration was elevated at 135 micrograms per milliliter, and N-acetylcysteine was promptly administered. She did not develop hepatic injury and was discharged after recovery.</p> <p><strong>D</strong><strong>iscussion:</strong> This case highlights the diagnostic value of visible bedside clues when history is initially unavailable. The yellow residue was not pathognomonic, and no chemical analysis of the material was performed. However, in the context of the increasing incidence of overdoses involving... https://escholarship.org/uc/item/6785283v Wed, 12 Aug 2026 00:00:00 +0000 Sakamoto, So https://orcid.org/0000-0002-0921-7375 https://escholarship.org/uc/item/5xk417k4 <p><strong>Introduction:</strong> Adult ileocolic intussusception is rare and typically associated with a pathological lead point. Diagnosis can be challenging in the emergency department (ED), particularly when initial vital signs and laboratory studies are reassuring. Point-of-care ultrasound (POCUS) may allow for earlier recognition and expedited management.</p> <p><strong>Case Report: </strong>A woman with ulcerative colitis presented to the ED with abrupt, severe, waxing-and-waning abdominal pain. Initial vital signs and lab studies were normal. Bedside POCUS performed at the point of maximal tenderness revealed a target sign in the right mid-abdomen, prompting concern for intussusception. This finding was used to advocate for urgent surgical evaluation and expedited computed tomography of the abdomen and pelvis, which confirmed ileocolic intussusception with early distal small-bowel obstruction and no identifiable mass. Despite reassuring objective data, the patient’s persistent... https://escholarship.org/uc/item/5xk417k4 Wed, 12 Aug 2026 00:00:00 +0000 Parambath, Andrew Patel, Bobby Batchelor, Timothy J. Ashenburg, Nicholas Geoffrey Ahern, Terence Lee https://escholarship.org/uc/item/5xj64561 <p><strong>Introduction:</strong> Acquired idiopathic laryngomalacia causing dynamic airway collapse is rare in adolescents and may be overlooked because it mimics more common causes of acute dyspnoea and stridor in the emergency department (ED). Airway point-of-care ultrasound (POCUS) provides a rapid, non-invasive means to visualize dynamic supraglottic obstruction when laryngoscopy is not immediately feasible or tolerated.​</p> <p><strong>Case Report:&nbsp;</strong>A 13-year-old boy presented with sudden-onset respiratory distress and dyspnoea that worsened on lying flat and improved when sitting upright, without history of fever, trauma, allergy, or foreign body aspiration, and with similar prior self-limiting episodes. He was anxious with nasal flaring, subcostal retractions, tachypnoea, tachycardia, distended neck veins, and a squeaky tracheal inspiratory sound, yet he maintained normal oxygen saturation with equal air entry on auscultation. Airway POCUS showed abnormal... https://escholarship.org/uc/item/5xj64561 Wed, 12 Aug 2026 00:00:00 +0000 Jain, Arihant https://orcid.org/0000-0003-3729-8608 Mohammed Muthanikkatt, Anas https://orcid.org/0000-0003-2325-4719 Ayyan, S. Manu https://escholarship.org/uc/item/5rw263cs <p><strong>Introduction: </strong>High-risk pulmonary embolism (PE) is an uncommon but potentially reversible cause of out-of-hospital cardiac arrest, frequently presenting as pulseless electrical activity (PEA). Early identification and multidisciplinary intervention are critical, yet confirmatory imaging is often delayed. Current guidelines recommend consideration of venoarterial extracorporeal membrane oxygenation (VA-ECMO) support in specialized centers when high-risk PE is suspected and the patient presents with cardiogenic shock or cardiac arrest.&nbsp;</p> <p><strong>Case Report:</strong> We describe a 50-year-old woman with a remote history of deep vein thrombosis who arrested after acute-onset dyspnea. Emergency medical services documented PEA arrest and initiated advanced cardiac life support. On arrival to the emergency department (ED), the patient remained in PEA arrest without cardiac motion on point-of-care ultrasound. Pulmonary embolism was strongly suspected but... https://escholarship.org/uc/item/5rw263cs Wed, 12 Aug 2026 00:00:00 +0000 Chopra, Tananshi Dahlke, Lea Salinas, Nancy Shabbir, Moizza Gunn, Tyler Torbati, Sam https://escholarship.org/uc/item/5jf8p2sx <p><strong>Introduction: </strong>Lidocaine toxicity is a rare but potentially dangerous consequence of a frequently used medication. Most commonly, it has generalized neurologic and cardiac effects. Discontinuation of lidocaine is sufficient with less severe symptoms. With more severe symptoms, such as seizures and arrhythmia, intravenous (IV) lipid emulsion therapy can be used. To date, lidocaine toxicity presenting as focal neurologic deficits has rarely been documented in the literature. In the case reported here, the patient was receiving lidocaine injections when she developed palpitations and left arm and facial weakness and numbness, which resolved after IV lipid emulsion therapy.&nbsp;</p> <p><strong>Case Report:</strong> A 52-year-old female with a past medical history of migraines, cholecystectomy, nephrolithiasis, and hypothyroidism presented to the emergency department (ED) via ambulance from her dental office with acute neurologic symptoms. While receiving an injection... https://escholarship.org/uc/item/5jf8p2sx Wed, 12 Aug 2026 00:00:00 +0000 Yeung, Timothy Estrada, Isaac Phan, Tammy H. Samones, Emmelyn J. Kalam, Sharmin https://escholarship.org/uc/item/5g5672bk <p><strong>Introduction: </strong>Nontraumatic subarachnoid hemorrhage (SAH) is a life-threatening neurological emergency, accounting for 5-10% of strokes. While most cases result from aneurysm rupture, perimesencephalic nonaneurysmal SAH is a distinct subtype characterized by blood localized to the midbrain cisterns and a venous pathophysiology. Perimesencephalic nonaneurysmal SAH is often associated with activities increasing intracranial venous pressure. Reports linking it to low-impact exercise such as yoga are rare.</p> <p><strong>Case Report: </strong>A 45-year-old female with no significant medical history presented with acute onset of severe headache and subjective unilateral hearing loss. Symptoms began immediately after a sudden, startled hyperextension movement during a yoga session. Noncontrast computed tomography of the brain revealed hemorrhage localized to the perimesencephalic and basal cisterns (modified Fisher Grade 4). Magnetic resonance imaging confirmed hemorrhage... https://escholarship.org/uc/item/5g5672bk Wed, 12 Aug 2026 00:00:00 +0000 Vierra, Andrew Sinha, Mrinal Jamal, Leena Khan, Nadir Liebert, Taylor Bokhari, Abdullah https://escholarship.org/uc/item/5cf0r1x8 <p><strong>Introduction: </strong>Spinal cord infarction is a rare but critical cause of acute neuromuscular paralysis, accounting for approximately 1.2% of all strokes. Timely diagnosis is essential but challenging due to its clinical overlap with more common etiologies. Failure to promptly identify spinal cord infarction can result in irreversible neurological deficits and missed opportunities for secondary prevention.&nbsp;</p> <p><strong>Case Report:</strong> A 66-year-old female presented to the emergency department with progressive bilateral limb weakness, numbness, and urinary incontinence. The examination revealed symmetric weakness, impaired coordination, and diffuse sensory loss. She was admitted and empirically treated with intravenous immunoglobulin for suspected atypical acute inflammatory demyelinating polyneuropathy. Despite mild improvement, worsening hyperreflexia and spasticity raised concern for a central process. Cervical magnetic resonance imaging revealed... https://escholarship.org/uc/item/5cf0r1x8 Wed, 12 Aug 2026 00:00:00 +0000 Golder, Jack Tjiattas-Saleski, Lindsay https://escholarship.org/uc/item/5383h1hh <p><strong>Introduction: </strong>Magnet ingestions are a growing pediatric emergency due to the use of widely available stronger magnets in toys. A legislative ban briefly reduced injuries, but cases rose after its reversal in federal court. Magnet ingestions are resulting in increasing morbidity and mortality, specifically due to bowel obstruction and perforation.&nbsp;</p> <p><strong>Case Report:</strong> We present a complex case involving a child with global developmental delay presenting to the emergency department for evaluation of abdominal pain. While the initial evaluation focused on working up appendicitis, which he was found to have, he was also found to have ingested multiple magnets causing small bowel obstruction and perforation.&nbsp;</p> <p><strong>Conclusion:&nbsp;</strong>This case highlights the need for emergency physicians to maintain a high level of suspicion when evaluating pediatric patients with abdominal pain, especially those with developmental delay.... https://escholarship.org/uc/item/5383h1hh Wed, 12 Aug 2026 00:00:00 +0000 Ball, Seth Wierzbicki, Marissa https://escholarship.org/uc/item/5262n1mr <p>A seven-year-old girl presented to the pediatric emergency department with three days of nonbloody, nonbilious vomiting, nonbloody diarrhea, and decreased oral intake. She also had weight loss and fatigue over the preceding month. The examination showed persistent tachycardia despite antipyretics and fluids. This presentation addresses the many causes of persistent tachycardia in a child with a diagnostic test sent from the emergency department revealing the ultimate diagnosis.&nbsp;</p> https://escholarship.org/uc/item/5262n1mr Wed, 12 Aug 2026 00:00:00 +0000 Girgis, Mary Stephanos, Kathleen Bontempo, Laura J. Windsor, T. Andrew https://orcid.org/0000-0001-6307-7177 https://escholarship.org/uc/item/51d876jf <p><strong>Introduction:</strong> Penetrating neck injury is rare in children, but it can have devastating consequences due to the vital structures in the neck. Having a high index of suspicion is crucial for detection and management of such injuries. Superficial-appearing wounds can mask underlying injury. In this case report, we present a case of penetrating neck injury in a patient who presented with what appeared to be a simple laceration to his neck.</p> <p><strong>Case Report:</strong> A three-year-old male presented with a laceration to his neck caused by a piece of shattered glass. On evaluation, he had normal vital signs and no hard or soft signs of penetrating neck injury. During bedside examination, a track was found extending beyond the platysma. The patient developed hoarseness in his voice, prompting computed tomography (CT). The CT revealed three foreign bodies lodged between the right common carotid artery and tracheal wall, abutting the wall. The patient underwent... https://escholarship.org/uc/item/51d876jf Wed, 12 Aug 2026 00:00:00 +0000 Davitt, Brian Quinn, Eric https://escholarship.org/uc/item/4v42s2gq <p><strong>Introduction</strong>:&nbsp;Oropharyngeal myxedema is a rare presenting symptom of decompensated&nbsp;hypothyroidism that can mimic more common causes of sore throat.</p> <p><strong>Case Report: </strong>We describe a case of an older woman who presented with throat pain and dysphagia,&nbsp;found to have soft palate edema on exam and imaging. Laboratory testing confirmed severe&nbsp;hypothyroidism, and her symptoms eventually resolved with thyroid hormone replacement therapy.</p> <p><strong>Conclusion</strong>:&nbsp;This case highlights a rare and under-recognized presentation of a common&nbsp;endocrine disorder. Consider myxedema from severe hypothyroidism in patients with subacute&nbsp;oropharyngeal pain and swelling. Without early recognition and treatment, the patient is at risk for&nbsp;two life-threatening conditions: airway compromise from soft palate myxedema and progression of&nbsp;hypothyroidism to myxedema coma.</p> https://escholarship.org/uc/item/4v42s2gq Wed, 12 Aug 2026 00:00:00 +0000 Miller, Gabriella Myers, Bennett A https://orcid.org/0009-0004-1863-3620 https://escholarship.org/uc/item/4r85p7bq <p><strong>Introduction: </strong>Blunt thoracic aortic injury is a rare but potentially fatal consequence of motor vehicle collisions. While commonly associated with hemodynamic instability, some cases present with normal vital signs, delaying diagnosis and treatment. We present the case of a 42-year-old unrestrained backseat passenger who sustained a blunt thoracic aortic injury following a motor vehicle collision and underwent emergent endovascular repair. This case emphasizes the critical role of early imaging and multidisciplinary coordination in the management of high-risk trauma patients.</p> <p><strong>Case Report:&nbsp;</strong>A 42-year-old female presented to the emergency department (ED) following a high-risk motor vehicle collision. She was an unbelted passenger in a vehicle traveling at approximately 35 miles per hour that collided with a telephone pole. The patient was unconscious at the scene but regained consciousness en route. Upon arrival at the ED she was alert,... https://escholarship.org/uc/item/4r85p7bq Wed, 12 Aug 2026 00:00:00 +0000 Knudsen, Joseph Lucas, Stephen Mangano, James https://escholarship.org/uc/item/4ft5016k <p><strong>Introduction:</strong> Natural supplements are readily available without a prescription and are not regulated by the United States Food and Drug Administration. The popularity of berberine, a bioactive compound used for centuries in traditional Chinese medicine, has surged due to its proposed benefits in glycemic control and cardiovascular health. However, use of berberine may lead to possible negative electrophysiologic changes.</p> <p><strong>Case Report:</strong> A 92-year-old male presented to the emergency department (ED) with chief complaints of tremors, urinary incontinence, and brief syncopal episodes that began approximately two weeks after starting berberine. In the ED he had multiple episodes of polymorphic ventricular tachycardia with pulselessness requiring immediate cardioversion, with a rapid return of spontaneous circulation between episodes. Amiodarone was started; however, despite this, he continued to have persistent episodes. Finally, the episodes... https://escholarship.org/uc/item/4ft5016k Wed, 12 Aug 2026 00:00:00 +0000 Mesmin, Melson P Tweet, Marit S Kim, Sharon H https://orcid.org/0000-0002-8996-9752 Fulks, Tyler J https://escholarship.org/uc/item/4fc1v72d <p><strong>Introduction: </strong>Hernias are a common presenting complaint in the emergency department. If they are not promptly identified and reduced, patients may need urgent surgery, which entails an increase in morbidity and mortality. The diagnosis and reduction of hernias can be challenging due to a patient’s large body habitus. In this case, we demonstrate the utility of using point-of-care ultrasound (POCUS) to detect an abdominal wall defect and provide real-time guidance to reduce a hernia and avoid surgery in a patient who was a poor surgical candidate.&nbsp;</p> <p><strong>Case Report:&nbsp;</strong>A 48-year-old morbidly obese male with multiple comorbidities presented with abdominal pain at the location of a known ventral hernia. Computed tomography (CT) of the abdomen confirmed a ventral hernia; however, three different physicians attempted reduction and were unsuccessful. We then used POCUS to identify the ventral hernia and the abdominal wall defect and to guide... https://escholarship.org/uc/item/4fc1v72d Wed, 12 Aug 2026 00:00:00 +0000 Lochner, Arion Stovicek, Elizabeth Kman, Nicholas Petelinsek, Sarah https://orcid.org/0009-0005-9733-7674 Cotton, Jennifer https://escholarship.org/uc/item/4c5952n2 <p><strong>Introduction:</strong> Duloxetine, a serotonin-norepinephrine reuptake inhibitor, has been associated with extrapyramidal symptoms and tardive syndromes; however, such adverse reactions are rare and remain sparsely documented, particularly in the setting of non-psychiatric use.</p> <p><strong>Case Report:</strong> A young, healthy, active-duty military service member developed acute extrapyramidal symptoms—restlessness, dystonic movements, and acute dystonia—shortly after initiating duloxetine for postsurgical neuropathic pain.&nbsp;</p> <p><strong>Conclusion:</strong> This case highlights the need for vigilance regarding movement disorders in patients prescribed duloxetine, even in the absence of psychiatric comorbidity or antipsychotic exposure.</p> https://escholarship.org/uc/item/4c5952n2 Wed, 12 Aug 2026 00:00:00 +0000 Shulby, Michael W. Powell, Christina M. https://escholarship.org/uc/item/4632c8mb Recurrence of Guillain-Barré Syndrome Is not Uncommon, and a Relapse May Require More Aggressive Treatment than the Original Condition https://escholarship.org/uc/item/4632c8mb Wed, 12 Aug 2026 00:00:00 +0000 Finsterer, Josef https://escholarship.org/uc/item/3vg0r4z5 <p><strong>Case Presentation:</strong> A 78-year-old woman who presented to the emergency department with abdominal pain was found to have a tender, pulsatile abdominal mass on examination. Point-of-care ultrasound demonstrated an abdominal aortic aneurysm with findings concerning for active rupture. Emergent computed tomography angiography confirmed rupture with a large retroperitoneal hematoma.&nbsp;</p> <p><strong>Discussion: </strong>Ruptured abdominal aortic aneurysm is a catastrophic diagnosis associated with high mortality, particularly when recognition is delayed. Point-of-care ultrasound is well established for identifying aneurysmal dilation; however, direct visualization of active rupture is rarely described.&nbsp;</p> https://escholarship.org/uc/item/3vg0r4z5 Wed, 12 Aug 2026 00:00:00 +0000 Sherman, Michael https://escholarship.org/uc/item/3km0945p <p><strong>Introduction: </strong>The placement of central venous catheters (CVC) is a common procedure for the administration of chemotherapy. Adverse events include malposition or displacement; there are limited reports of misplaced implanted CVCs.</p> <p><strong>Case Report:</strong> A 59-year-old female with a history of recently diagnosed metastatic small cell lung cancer, hypertension, former tobacco use of over 60 pack-years, and chronic obstructive pulmonary disease without chronic hypoxemic respiratory failure presented to the emergency department following the first outpatient infusion of chemotherapy. She developed acute onset dyspnea, moderate respiratory distress, and hypoxemia. She was found to have a malpositioned subclavian implanted (ie, “port”) CVC that was placed under fluoroscopy the week prior with placement confirmed by chest radiograph. The evaluation revealed a large right pleural effusion secondary to unintentional intrapleural infusion of chemotherapy.... https://escholarship.org/uc/item/3km0945p Wed, 12 Aug 2026 00:00:00 +0000 Miller, Hannah E. https://orcid.org/0000-0002-0541-1939 Lentz, Skyler https://escholarship.org/uc/item/3js6z7z5 <p><strong>Introduction: </strong>Hepatopulmonary syndrome is a rare but serious cause of pediatric hypoxemia.</p> <p><strong>Case Report:</strong> A 10-year-old obese male with obstructive sleep apnea and asthma presented to the emergency department with low baseline oxygen saturations and exertional hypoxia, despite normal physical exam and outpatient pulmonary function testing. Workup revealed liver cirrhosis, hepatosplenomegaly, gastroesophageal varices, and an elevated alveolar-arterial gradient, raising concern for hepatopulmonary syndrome. He was diagnosed with this disease at a tertiary hepatology center and underwent liver transplantation.</p> <p><strong>Conclusion:&nbsp;</strong>Emergency physicians should consider hepatopulmonary syndrome in children with unexplained hypoxia and liver disease, especially in a child with a normal lung exam and no bronchodilator response.</p> https://escholarship.org/uc/item/3js6z7z5 Wed, 12 Aug 2026 00:00:00 +0000 Haupt, Shawn A. Lalos, Demetra Muntean, Cornelia Vaysman, Dmitriy https://escholarship.org/uc/item/3607s65c <p><strong>Introduction:</strong> Duloxetine, a serotonin-norepinephrine reuptake inhibitor, is commonly prescribed for depression, anxiety, and neuropathic pain. Although rare, duloxetine has been associated with hepatotoxicity.&nbsp;</p> <p><strong>Case Report:</strong> We present the case of a 61-year-old male with multiple comorbidities who developed significant transaminitis two months after initiation of duloxetine therapy.</p> <p><strong>Conclusion:</strong> Emergency physicians should be cognizant of duloxetine-induced liver injury, particularly in patients with increased risk factors who present with unexplained liver injury.</p> https://escholarship.org/uc/item/3607s65c Wed, 12 Aug 2026 00:00:00 +0000 Galletta, Gayle Mehta, Savant Jancura, Daniel Ryan, Daminica Li, Irene https://escholarship.org/uc/item/34x717qk <p><strong>Introduction: </strong>Exfoliative dermatitis, also known as erythroderma, represents an infrequent clinical presentation in emergency departments (ED) and often contributes to considerable diagnostic uncertainty. The differential diagnosis is broad, and the condition may arise from a wide variety of etiologies. We report a case of severe exfoliative dermatitis characterized by gradual progression and resistance to multiple therapeutic interventions over several weeks, ultimately resulting in significant systemic complications and marked hematological abnormalities.</p> <p><strong>Case Report:</strong> A 57-year-old man presented to the ED with severe pain, pruritus, and widespread skin peeling involving more than 90% of his body surface area. The patient developed a rash following a trip to Korea about six months prior to presentation, which progressively worsened despite multiple prior diagnoses and treatments including corticosteroids, immunosuppressive therapy,... https://escholarship.org/uc/item/34x717qk Wed, 12 Aug 2026 00:00:00 +0000 Boukouris, Jennifer https://orcid.org/0009-0001-2349-7203 Elsherif, Sherif https://orcid.org/0009000834650032 https://escholarship.org/uc/item/2xb7r5tg <p><strong>Introduction: </strong>ST-elevation myocardial infarctions (STEMI) represent complete occlusion of a coronary artery. An electrocardiogram (ECG) is a method of diagnosis; however, on rare occasions clues of myocardial infarction are first noted on imaging. This is a case of myocardial infarction first noted on computed tomography (CT).</p> <p><strong>Case Report:&nbsp;</strong>A 62-year-old man was brought to the emergency department after being found unresponsive with multiple burns. An ECG performed on arrival did not show changes consistent with myocardial ischemia. Due to reported trauma, a CT incidentally found a heterogeneous low-attenuation area in the posterior wall of the left ventricle of the heart. A repeat ECG subsequently showed an inferior STEMI.&nbsp;</p> <p><strong>Conclusion:</strong> Computed tomography of the chest obtained in the evaluation of trauma may demonstrate evidence of myocardial ischemia. This case highlights the ability of CT to detect... https://escholarship.org/uc/item/2xb7r5tg Wed, 12 Aug 2026 00:00:00 +0000 Araujo, Maria Jose Sandhu, Eknoor https://orcid.org/0009-0001-9258-890X Romero, Angel Randhawa, Jugraj https://orcid.org/0009-0000-7235-8659 O’Donnell, Rachel https://escholarship.org/uc/item/2w7697n7 <p><strong>Introduction</strong>: Shoulder pain is a common emergency department (ED) presentation. Scapular&nbsp;winging is a rare condition often associated with long thoracic nerve injury.&nbsp;This case report&nbsp;describes an even rarer case of dorsal scapular nerve injury caused by a nontraumatic first rib&nbsp;fracture in a young weightlifter, an injury mechanism not previously reported in the literature.</p> <p><strong>Case Report: </strong>A 17-year-old male presented to the ED with left shoulder pain following weightlifting.&nbsp;Physical examination demonstrated scapular winging, and a clinical diagnosis of dorsal scapular&nbsp;neuropraxia was made. Imaging revealed a nontraumatic first rib fracture.&nbsp;The patient was treated&nbsp;conservatively with nonsteroidal anti-inflammatory drugs and rest, resulting in complete resolution of&nbsp;symptoms within two weeks at clinic follow-up.</p> <p><strong>Conclusion</strong>:&nbsp;To our knowledge, this is the first case... https://escholarship.org/uc/item/2w7697n7 Wed, 12 Aug 2026 00:00:00 +0000 Remy, Jessica Prendergast, Nicole https://escholarship.org/uc/item/2tc110vg <p><strong>Introduction</strong>:&nbsp;Carotid free-floating thrombus is a rare and potentially devastating cause of ischemic stroke. Diagnosis remains challenging due to the dynamic nature of the lesion.</p> <p><strong>Case Report</strong>:&nbsp;We report the case of a 46-year-old female presenting with neck pressure and gait&nbsp;instability, who was found to have a free-floating thrombus at the brachiocephalic-carotid junction.&nbsp;Despite early anticoagulation, she developed biparietal ischemic strokes.</p> <p><strong>Conclusion</strong>:&nbsp;This case highlights the challenges in management of carotid free-floating thrombus&nbsp;including appropriate anticoagulation, contraindications to thrombolysis, and the need for&nbsp;multidisciplinary involvement. Emergency physicians must maintain high suspicion for vascular&nbsp;pathology in atypical neurologic presentations and recognize that even optimal medical therapy does&nbsp;not eliminate stroke risk.</p> https://escholarship.org/uc/item/2tc110vg Wed, 12 Aug 2026 00:00:00 +0000 Droger, Ariel Torres-Castro, Rolando https://orcid.org/0009-0009-9976-672X Mahmood, Kashan Graf, Jason Serio, Sean Scumpia, Alexander John https://orcid.org/0000-0001-6862-6315 https://escholarship.org/uc/item/2bj3g0pr <p><strong>Introduction: </strong>Ocular ultrasound is highly effective for diagnosing traumatic eye injuries such as retinal detachment, vitreous hemorrhage, foreign bodies, and retrobulbar hematomas. However, it is contraindicated in cases of suspected globe rupture, as applying external pressure to the eye could cause further damage. When globe injury is clinically suspected, computed tomography is typically used to confirm the diagnosis. However, delays can occur if other life-threatening injuries require immediate attention or there are long wait times. We propose a novel method for performing ocular ultrasound in such cases—the modified water bath technique—which allows for the diagnosis of globe rupture upon the patient’s arrival in the emergency department.</p> <p><strong>Case Series:</strong> We present five cases where the modified water bath technique was used. A glove partially filled with saline is prepared and gently placed on the affected eye while the patient lies... https://escholarship.org/uc/item/2bj3g0pr Wed, 12 Aug 2026 00:00:00 +0000 Chawang, Hannah https://orcid.org/0000-0003-2158-2065 Bhoi, Sanjeev Chandran, Vineeth Chanda, Anmol Das, Anand Kumar https://escholarship.org/uc/item/28v7b6tn <p><strong>Introduction:</strong> Agitation in the emergency department (ED) poses a significant safety concern for staff and patients. Multidisciplinary responses, such as Code Violet activations, are common but resource-intensive. Early identification and intervention may reduce escalation, but ED-specific data are limited. The objective of the study was to evaluate the implementation of a novel agitated behavior score (ABS) and assess whether higher ABS scores are associated with increased risk of Code Violet activation.</p> <p><strong>Case Series:</strong> This prospective observational study included adult patients admitted to a behavioral health unit in a community teaching hospital ED. Trained staff administered a novel 25-point ABS incorporating altered mentation, verbal agitation, and motor agitation. The primary outcome was Code Violet activation; secondary outcomes included pharmacologic interventions and substance use. Among 83 patients, 27 (33%) experienced ≥ 1 Code... https://escholarship.org/uc/item/28v7b6tn Wed, 12 Aug 2026 00:00:00 +0000 Ceraolo, Negin Sandine, Julianna Crouse, Bethany Krizo, Jessica Simon, Erin L https://escholarship.org/uc/item/22j4p7w7 <p><strong>Case Presentation: </strong>Temporary transvenous pacemaker placement is frequently performed in&nbsp;the emergency department for the management of symptomatic bradyarrhythmias. We report the&nbsp;case of a 93-year-old male who presented with profound bradycardia, hypotension, and altered&nbsp;mental status requiring emergent pacing. Initial transcutaneous pacing achieved hemodynamic&nbsp;improvement but necessitated escalation to transvenous pacing due to patient discomfort and&nbsp;high current requirements. During attempted transvenous pacemaker placement, resistance&nbsp;was encountered and capture could not be achieved despite appropriate technique. Subsequent&nbsp;cardiology consultation and imaging revealed an undiagnosed tricuspid valve myxoma obstructing&nbsp;catheter advancement.</p> <p><strong>Discussion</strong>: This case highlights a rare mechanical complication of transvenous pacemaker&nbsp;placement caused by an intracardiac mass. Awareness of structural... https://escholarship.org/uc/item/22j4p7w7 Wed, 12 Aug 2026 00:00:00 +0000 Molyneux, Kevin Krejchi, Nicholas Fulton II, Matthew Robert Youssef, Mina https://escholarship.org/uc/item/1vr3s5k2 <p><strong>Introduction: </strong>Immunoglobulin A (IgA) vasculitis, formerly known as Henoch–Schönlein purpura, is a small-vessel leukocytoclastic vasculitis caused by IgA immune complex deposition. While it is the most common systemic vasculitis in children, adult cases can present with more severe systemic manifestations. The classic clinical tetrad includes palpable purpura, arthralgia, abdominal pain, and renal involvement. Gastrointestinal symptoms, occurring in approximately two-thirds of cases, result from inflammation of small bowel vessels resulting in bowel wall edema and hemorrhage, which may serve as lead points for intussusception.</p> <p><strong>Case Report:</strong> A 21-year-old male presented with two days of severe periumbilical abdominal pain, bilateral knee pain, and a nonblanching palpable purpuric rash on his lower extremities. Physical examination revealed a soft but tender abdomen. Lab results were remarkable for leukocytosis. Computed tomography (CT)... https://escholarship.org/uc/item/1vr3s5k2 Wed, 12 Aug 2026 00:00:00 +0000 Sawhney, Preet Frost, Patrick Stueve, Peter Boccio, Eric https://escholarship.org/uc/item/1vb4c5q0 <p><strong>Introduction:</strong> Acute aortic dissection is a life-threatening emergency with a wide spectrum of clinical presentations. Neurological deficits as the initial manifestation of aortic dissection are uncommon and may result in delayed or missed diagnosis. This case describes aortic dissection presenting primarily as acute paraplegia without persistent chest pain or other classic features.</p> <p><strong>Case Report:</strong> We report a 52-year-old male who presented with sudden-onset paraplegia. Neurological examination revealed flaccid paralysis of both lower limbs, with loss of pain and temperature sensation below the first lumbar dermatome and preserved dorsal column modalities. The patient was hypertensive on presentation. A clinical diagnosis of anterior spinal artery syndrome was made. Contrast-enhanced computed tomography of the chest and abdomen demonstrated a Stanford type A aortic dissection. The patient was counseled regarding the need for urgent surgical... https://escholarship.org/uc/item/1vb4c5q0 Wed, 12 Aug 2026 00:00:00 +0000 Nagarajan, Sindujaa Ganessane, Ezhilkugan https://orcid.org/0000-0001-8541-5675 B G, Kowsthubha https://orcid.org/0009-0006-7909-7248 Somasundaram, Anukarthika Balamurugan, Nathan https://escholarship.org/uc/item/1r6395bj <p><strong>Introduction:</strong> Entrectinib is a kinase inhibitor used in ROS1-positive non-small cell lung carcinoma. Cardiovascular toxicity is rare, with only one prior report of myocarditis related to entrectinib use. The triangular QRS-ST-T waveform electrocardiographic pattern is a ST-elevated myocardial infarction equivalent and is rarely associated with myocarditis.</p> <p><strong>Case Report:</strong> A 42-year-old male with metastatic non-small cell lung carcinoma presented with presyncope, palpitations, and dyspnea three days after initiating entrectinib. Electrocardiograph (ECG) revealed a “shark-fin” T-wave morphology with diffuse ST elevation, QTc prolongation, and elevated troponin. ST-elevated myocardial infarction protocol was initiated with tenecteplase, heparin, clopidogrel, and aspirin. Left heart catheterization was normal. The ECG showed an ejection fraction of 20–25% with global hypokinesis. Myocarditis with heart failure associated with entrectinib use... https://escholarship.org/uc/item/1r6395bj Wed, 12 Aug 2026 00:00:00 +0000 Dean, William Dean, James Lichaa, Hady Wilbert, Christopher David https://escholarship.org/uc/item/1mz494sf <p><strong>Introduction: </strong>Tetanus is a rare but life-threatening disease caused by Clostridium tetani, characterized by generalized muscle rigidity, autonomic instability, and respiratory compromise.&nbsp;</p> <p><strong>Case Report:</strong> We present a case of a 65-year-old male poultry hobbyist with type two diabetes who developed severe tetanus following a rooster-peck injury to his finger. The patient presented with progressive trismus and respiratory distress necessitating fiberoptic nasotracheal intubation and subsequent tracheostomy. Despite appropriate antimicrobial therapy, immunoglobulin administration, and sedation, the patient continued to exhibit spasms when sedation was reduced.&nbsp;</p> <p><strong>Conclusion:&nbsp;</strong>This case highlights the ongoing risk of tetanus in under-immunized agricultural populations, the challenges of airway management in severe trismus, and the importance of maintaining vaccination awareness even in developed healthcare... https://escholarship.org/uc/item/1mz494sf Wed, 12 Aug 2026 00:00:00 +0000 White, Robin https://orcid.org/0009-0008-0813-0850 Singh, Hardeep Craver, Kelsey Cranston, Rebecca Hodge, Kelsey Vandervort, Elizabeth https://escholarship.org/uc/item/1h69z68x <p><strong>Case Presentation:</strong> A 46-year-old woman presented to the emergency department after stepping on an object while playing in shallow seawater. Examination revealed a barbed foreign body protruding from the plantar aspect of the left foot. Plain radiography demonstrated that the retained stingray barb had fragmented into three pieces within the soft tissue. Because deeper extension was a concern, computed tomography was additionally obtained to better assess the depth and extent of penetration. The fragments were removed through staged incisions, and repeat radiography confirmed complete extraction. The wound was irrigated, a Penrose drain was placed, and levofloxacin was prescribed at discharge.</p> <p><strong>Discussion:</strong> Stingray injuries are among the most common marine vertebrate envenomations and should not be regarded as simple puncture wounds when retained foreign body is suspected. This case highlights that even when a stingray barb is externally... https://escholarship.org/uc/item/1h69z68x Wed, 12 Aug 2026 00:00:00 +0000 Sakamoto, So https://orcid.org/0000-0002-0921-7375 https://escholarship.org/uc/item/1dg7k0mw <p><strong>Introduction: </strong>Kounis syndrome describes anaphylaxis-induced coronary vasospasm and is often misdiagnosed as acute coronary syndrome. We report a similar phenomenon of cerebral vasospasm following anaphylaxis, a rare and under-recognized mimic of stroke.</p> <p><strong>Case Report:&nbsp;</strong>A previously healthy 45-year-old gentleman developed sudden right-sided hemiparesis and dysarthria while working outdoors, accompanied by generalized pruritus, rash, presyncope, dyspnea, palpitation, and abdominal pain. He received prompt intramuscular epinephrine and other anti-inflammatory agents, resulting in rapid symptom resolution and complete recovery in the emergency department. Computed tomography of the brain and other studies were unremarkable. This case underscores a rare neurological manifestation of anaphylaxis.&nbsp;</p> <p><strong>Conclusion:&nbsp;</strong>Cerebral vasospasm is an unusual sequela of anaphylaxis that may lead to a diagnostic dilemma. Prompt... https://escholarship.org/uc/item/1dg7k0mw Wed, 12 Aug 2026 00:00:00 +0000 Ismail, Mohd Helmie https://orcid.org/0000-0002-1890-5233 Muniandy, Sadesvaran Azmi, Muhammad Shafiq https://escholarship.org/uc/item/1ct7231h <p><strong>Case Presentation:</strong> A one-year-old girl presented with acute-onset dyspnea persistent for two days and recurrent choking episodes. Physical examination revealed stridor and sub-costal retractions. Despite initial treatment with inhaled nebulized epinephrine, stridor persisted. Lateral chest radiography finding indicated tracheal stenosis. Contrast-enhanced neck and chest computed tomography (CT) showed an aberrant right subclavian artery compressing the esophagus posteriorly, causing esophageal stenosis with associated food residue accumulation. The proximally dilated portion of the esophagus caused mass effect with compression of the trachea, resulting in tracheal stenosis. Despite medical management, the patient experienced recurrent stridor and could only swallow liquids. Therefore, surgical translocation of the right subclavian artery to the right common carotid artery was performed. Postoperatively, the patient swallowed age-appropriate food, and the stridor... https://escholarship.org/uc/item/1ct7231h Wed, 12 Aug 2026 00:00:00 +0000 Yasuda, Masato Ito, Tomoya https://escholarship.org/uc/item/13x391fq <p><strong>Introduction</strong>:&nbsp;Primary spontaneous pneumothorax generally presents with symptoms of chest pain&nbsp;and shortness of breath. Progression to a tension pneumothorax results in a medical emergency.&nbsp;Rare presentations with abdominal pain are possible and must be considered to expedite&nbsp;appropriate treatment of pneumothorax.</p> <p><strong>Case Report: </strong>We report a case of a 21-year-old male with primary spontaneous pneumothorax&nbsp;who initially presented to the emergency department with right lower quadrant abdominal pain.&nbsp;History and physical exam were suggestive of acute appendicitis. A large right pneumothorax was incidentally found on computed tomography.</p> <p><strong>Conclusion</strong>:&nbsp;This case highlights unusual presentations of pneumothorax. Emergency physicians&nbsp;should consider atypical presentations of chest pathology such as pneumothorax in patients&nbsp;presenting with symptoms consistent with an acute abdomen.</p> https://escholarship.org/uc/item/13x391fq Wed, 12 Aug 2026 00:00:00 +0000 Crowe, Timothy Cheatle, Patrick https://escholarship.org/uc/item/12r398jz <p><strong>Introduction: </strong>Many emergency physicians will never perform a lateral canthotomy and cantholysis, and one-third of those who try will be unsuccessful at relieving the pressure that threatens&nbsp; permanent vision loss. This procedure is notoriously difficult and rare, but a recently proposed&nbsp;alternative—the vertical lid split—may be simpler and more effective.</p> <p><strong>Case Report: </strong>We report the case of a 35-year-old woman with motor vehicle collision-related orbital trauma&nbsp;who presented to a community emergency department. Initially, she had intact vision and extraocular&nbsp;movements. Imaging showed a comminuted inferior orbital blowout fracture with retrobulbar hemorrhage,&nbsp;and the transfer process was initiated. However, after coughing she developed vision loss and elevated&nbsp;intraocular pressure. Lateral canthotomy and cantholysis was performed for suspected orbital compartment&nbsp;syndrome but did not fully address the... https://escholarship.org/uc/item/12r398jz Wed, 12 Aug 2026 00:00:00 +0000 Chason, Hannah https://orcid.org/0000-0003-1771-9479 Zimmerman, Barret Jenzer, Andrew Fay, David Elpers, Julia https://escholarship.org/uc/item/1120q3v9 <p><strong>Introduction</strong>:&nbsp;Brugada syndrome is an important differential diagnosis for unexplained sudden&nbsp;cardiac arrest, particularly in younger patients. The electrocardiographic (ECG) pattern characteristic&nbsp;of Brugada syndrome can be provoked by fever and may vary with changes in body temperature.&nbsp;Therefore, targeted temperature management following cardiac arrest may obscure the distinctive&nbsp;morphology, increasing the risk of misdiagnosis.</p> <p><strong>Case Report:</strong> We report the case of a 44-year-old man who experienced out-of-hospital cardiac arrest due to ventricular fibrillation following influenza B infection. Initial evaluation revealed transient ST-segment elevation in leads V1-V3, while coronary angiography and echocardiographic findings were normal. Although Brugada syndrome was suspected, the diagnosis was deferred because the ECG findings normalized during targeted temperature management at 36°Celsius. However, after completion... https://escholarship.org/uc/item/1120q3v9 Wed, 12 Aug 2026 00:00:00 +0000 Kondo, Yuki https://orcid.org/0000-0003-1270-8308 Tanaka, Atsuhito Okazaki, Tomoya https://escholarship.org/uc/item/0vc4j8xs <p><strong>Introduction:</strong> Herpes zoster ophthalmicus, a reactivation of varicella-zoster virus involving the ophthalmic branch of the trigeminal nerve, is a known but under-recognized risk factor for acute cerebrovascular and cardiovascular events.&nbsp;</p> <p><strong>Case Report:</strong> We report the case of an 84-year-old female with herpes zoster ophthalmicus who suffered a fatal ischemic stroke and bilateral submassive pulmonary emboli within days of diagnosis. Despite early identification and appropriate antiviral treatment, the patient experienced rapid neurological decline and ultimately succumbed to complications.&nbsp;</p> <p><strong>Conclusion:</strong> This case underscores the critical association between herpes zoster ophthalmicus and increased risk of stroke and myocardial infarction, as supported by growing epidemiologic evidence. Physicians should be aware of these severe complications, consider close monitoring and cardiovascular risk stratification... https://escholarship.org/uc/item/0vc4j8xs Wed, 12 Aug 2026 00:00:00 +0000 Burke, Summer Armbruster, Mary Le, Jacqueline https://escholarship.org/uc/item/0ph2q8vz <p><strong>Case Presentation:</strong> A 60-year-old male from the country of Jordan presented to the emergency department with swelling, pain, black lesions on his fingertips and thumb, and a red streak up his arm. The patient had been trimming sheep wool and goat skin two weeks prior to onset of symptoms and cut his left thumb with trimming shears.&nbsp;</p> <p><strong>Discussion: </strong>Cutaneous anthrax is caused by Bacillus anthracis, a Gram-positive, spore-forming rod found naturally in the soil. Populations at greatest risk include those who consume undercooked meat with contaminated spores or who live and work in rural/agricultural areas. Occupations considered to be at a higher risk include farmers, wool sorters, and veterinarians. Although cutaneous anthrax is rare in the United States (U.S.), there have been cases reported since the bioterrorism attacks in 2001 when mail laced with anthrax was sent via the U.S. Postal Service. Human infection occurs in countries where... https://escholarship.org/uc/item/0ph2q8vz Wed, 12 Aug 2026 00:00:00 +0000 Christos, Steve C. Mazouni, Abdelhamid https://escholarship.org/uc/item/0h6287fs <p><strong>Introduction:</strong> The “lucky nut” is the seed of the yellow oleander plant, often sold as a medicinal supplement in unregulated markets and known to contain cardiac glycosides, which may cause life- threatening bradycardias and Digoxin-like toxicity upon ingestion. Diagnosis is typically clinical, with treatment including Digoxin immune Fab with supportive intensive cardiac care.&nbsp;</p> <p><strong>Case Report: </strong>A 70-year-old male presented to the emergency department after ingesting one-fourth of a Peruvian nut he found at a local market to reduce his nocturnal polyuria. The patient brought a part of the Peruvian nut with him, which was identified as a seed of the yellow oleander. His clinical presentation was consistent with a digoxin-like toxicity, requiring multiple vials of Digoxin immune Fab and admission to the cardiac intensive care unit.&nbsp;</p> <p><strong>Conclusion: </strong>Yellow oleander can cause a cardiac glycoside-related cardiotoxicity... https://escholarship.org/uc/item/0h6287fs Wed, 12 Aug 2026 00:00:00 +0000 Long, Samantha Grim, Allison Bhandari, Salil K. Zaidi, Hashim Q. https://escholarship.org/uc/item/0626q542 <p><strong>Introduction: </strong>Infective endocarditis (IE) is associated with high mortality (30%). Patients with structural cardiac disease or implanted hardware have higher risk for IE (23-47%). Diagnosis per the 2023 Duke–International Society for Cardiovascular Infectious Diseases criteria is by pathological confirmation or the major/minor criteria. Major criteria include ≥ 2 positive blood culture sets, echocardiography or computed tomography vegetation visualization, and surgical visualization. Septic emboli symptoms (which complicate 25% of IE cases) include neurological deficits or shortness of breath. Early intravenous antimicrobial therapy within one hour for patients who meet sepsis criteria is recommended per Infectious Diseases Society of America guidelines.</p> <p><strong>Case report: </strong>A middle-aged male with recent IE and aortic valve prosthesis presented to the emergency department with altered mental status and hypoglycemia. He had right basilar lung... https://escholarship.org/uc/item/0626q542 Wed, 12 Aug 2026 00:00:00 +0000 Theophanous, Andrew G https://orcid.org/0009-0004-9376-9317 Theophanous, Rebecca G https://orcid.org/0000-0003-0697-3703 https://escholarship.org/uc/item/4xf5w364 <p><strong>Introduction:</strong> Acute abdomen is a common emergency presentation, and gastrointestinal perforation can be rapidly fatal if not promptly identified. Point-of-care ultrasound (POCUS) offers a rapid bedside alternative when advanced imaging is delayed or unavailable.&nbsp;</p> <p><strong>Case Report:</strong> We report a 40-year-old man presenting in cardiac arrest, resuscitated after ten minutes, with subsequent findings of abdominal distension and prior epigastric pain. Point-of-care ultrasound demonstrated classic signs of pneumoperitoneum, and intestinal perforation was confirmed by the drainage of feculent fluid. Despite intervention, the patient expired.&nbsp;</p> <p><strong>Conclusion:</strong> This case underscores the value of POCUS in diagnosing perforation in unstable patients, guiding emergent decisions when transfer or definitive imaging is not feasible.</p> https://escholarship.org/uc/item/4xf5w364 Tue, 11 Aug 2026 00:00:00 +0000 Nair, Archana https://orcid.org/0000-0001-6409-6038 Chakraborty, Soubhik Sinha, Tej Prakash Bhoi, Sanjeev https://escholarship.org/uc/item/9r8461ds <p><strong>Introduction</strong>: Sternutation is a physiological reflex that clears the upper respiratory tract through forceful air expulsion. Although it is typically considered benign, sternutation can generate&nbsp;substantial pressure and airflow that can result in barotrauma, including pneumocephalus.</p> <p><strong>Case Report: </strong>A 67-year-old female presented with shortness of breath, rhinorrhea, and a headache&nbsp;following sneezing. Physical exam revealed no signs of trauma or neurological deficits but did note&nbsp;clear rhinorrhea bilaterally. Computed tomography (CT) of the head revealed extensive extra-axial&nbsp;intracranial gas bilaterally, and the patient was admitted for further management. While admitted,&nbsp;otolaryngology was consulted and surgically corrected a right cribriform meningoencephalocele with&nbsp;an active cerebrospinal fluid leak. At follow-up the patient had no residual rhinorrhea symptoms or&nbsp;focal neurological findings.</p> <p><strong>Conclusion</strong>:&nbsp;One... https://escholarship.org/uc/item/9r8461ds Fri, 24 Apr 2026 00:00:00 +0000 Tejpal, Tushar Ashurst, John Barnett-Trapp, Danielle https://escholarship.org/uc/item/9r43b2xz <p><strong>Introduction</strong>:&nbsp;Kratom (<em>Mitragyna speciosa</em>) is an unregulated herbal supplement increasingly&nbsp;associated with severe toxicity. Concentrated liquid formulations pose risks, with emerging reports of&nbsp;seizures, hepatotoxicity, and arrhythmias.<br><br><strong>Case Report:</strong>A previously healthy 24-year-old woman ingested a highly concentrated kratom&nbsp;extract and developed seizure-like activity followed by pulseless monomorphic ventricular&nbsp;tachycardia. She underwent approximately 45 minutes of resuscitation, including multiple&nbsp;defibrillations, dual-sequential shocks, amiodarone, lidocaine, magnesium, calcium, sodium&nbsp;bicarbonate, potassium repletion, epinephrine, and esmolol. Persistent instability prompted&nbsp;consultation with cardiology and cardiothoracic surgery, and she was cannulated for venoarterial&nbsp;extracorporeal membrane oxygenation (ECMO) in the emergency department. Lab studies showed&nbsp;profound hypokalemia,... https://escholarship.org/uc/item/9r43b2xz Fri, 24 Apr 2026 00:00:00 +0000 Mclin-Evans, Megan Tiscareno, Jennerfer Beneke, Laura Lee https://escholarship.org/uc/item/9h01z918 <p><strong>Introduction</strong>:&nbsp;Drowning is a significant cause of death in Nepal, especially in rural areas. Identifying&nbsp;pulmonary edema is important for management of cases of non-fatal drowning, and while radiograph&nbsp;is the standard of care, point-of-care ultrasound (POCUS) offers a rapid, accessible alternative.</p> <p><strong>Case Report: </strong>A 40-year-old woman presented to the emergency department after non-fatal&nbsp;drowning with respiratory distress and hypoxia. Chest radiograph was unavailable. Point-of-care&nbsp;ultrasound revealed diffuse B-lines consistent with pulmonary edema. She was stabilized and&nbsp;transported to a hospital with intensive care-level management.</p> <p><strong>Conclusion</strong>:&nbsp;Point-of-care ultrasound enabled rapid identification of pulmonary edema and guided&nbsp;timely referral. In resource-limited settings, POCUS is a valuable tool for managing drowning victims&nbsp;when other diagnostics are unavailable.</p> https://escholarship.org/uc/item/9h01z918 Fri, 24 Apr 2026 00:00:00 +0000 Kansakar, Rochak Katz, Elijah J Zhao, Justin Weldon, Evan https://escholarship.org/uc/item/85z10556 <p><strong>Introduction</strong>:&nbsp;Dense deposit disease, also known as C3 glomerulopathy, is a rare renal disorder&nbsp;caused by abnormal complement deposition in the glomerular basement membrane. Patients often&nbsp;require long-term immunosuppressive therapy and, in some cases, complement inhibitors such as&nbsp;ravulizumab. While effective at limiting renal damage, complement blockade significantly increases&nbsp;susceptibility to invasive infections from encapsulated bacteria, particularly&nbsp;<em>Neisseria meningitidis</em>.&nbsp;Despite immunization and antimicrobial prophylaxis, these patients remain incompletely protected.&nbsp;We describe a case of meningococcemia in a fully vaccinated adolescent with dense deposit&nbsp;disease on ravulizumab therapy.</p> <p><strong>Case Report: </strong>A 17-year-old male with a history of dense deposit disease on mycophenolate mofetil and ravulizumab presented to the pediatric emergency department with fever, vomiting, altered... https://escholarship.org/uc/item/85z10556 Fri, 24 Apr 2026 00:00:00 +0000 Gonedes, Andrew Martinez, Alexandra Greissman, Allan M. Atia, Hanan Boccio, Eric https://escholarship.org/uc/item/82w848j0 <p><strong>Introduction</strong>:&nbsp;Reversible cerebral vasoconstriction syndrome is a recently defined disease entity&nbsp;classically presenting with recurrent thunderclap headache. The pathology involves triggered cerebral&nbsp;arterial vasoconstriction, which can lead to complications including seizure, ischemic stroke, and&nbsp;intracranial hemorrhage. Diagnosis requires angiography, and treatment consists of vasodilatory therapy.</p> <p><strong>Case Report: </strong>We describe a case of reversible cerebral vasoconstriction syndrome following&nbsp;glucocorticoid burst therapy in a patient on multiple vasoactive medications, suggesting the&nbsp;possibility of compounding risk factors and triggers. As is common with this syndrome, the patient in&nbsp;our case required multiple hospital visits for diagnosis but ultimately experienced a positive outcome&nbsp;upon treatment.</p> <p><strong>Conclusion: </strong>The presentation of reversible cerebral vasoconstriction syndrome... https://escholarship.org/uc/item/82w848j0 Fri, 24 Apr 2026 00:00:00 +0000 Lenning, Jacob Halfill, Caleb Rountree, Justin https://escholarship.org/uc/item/7p89z6dp <p><strong>Introduction</strong>: Diclofenac sodium is a widely used medication for its analgesic and anti-inflammatory properties. Although the adverse effects of diclofenac are well described, diclofenac-associated new-onset atrial fibrillation in a young, healthy adult has not been previously reported.</p> <p><strong>Case Report</strong>: A 22-year-old man with severe pain following an ankle injury used diclofenac sodium&nbsp;at a dose of 50 mg orally three times daily for one week. At the end of the week, he presented to the&nbsp;emergency department (ED) complaining of palpitations for a few hours. The patient had no past&nbsp;medical history. His physical examination revealed no pathologic signs except for tachycardia and&nbsp;an irregularly irregular pulse rate. An electrocardiogram showed an irregularly irregular rhythm with&nbsp;a ventricular rate of 128 beats per minute (bpm) (rapid ventricular response) and absent P waves,&nbsp;consistent with atrial fibrillation. The... https://escholarship.org/uc/item/7p89z6dp Fri, 24 Apr 2026 00:00:00 +0000 Çağlar, Sabri Onur Çağlar, Hilal Hira, Serdar https://escholarship.org/uc/item/7mb8k87q <p>Pediatric seizures are an alarming presentation to the emergency department (ED) that can be&nbsp;caused by a multitude of etiologies. It is important to differentiate life-threatening conditions from&nbsp;more benign causes. A 19-month-old girl presented to the ED after a witnessed seizure. This case&nbsp;offers a differential diagnosis for pediatric seizures and uses history, exam, laboratory findings, and&nbsp;imaging to hone the differential in the ED setting. The surprising final diagnosis and case outcome<br>are then revealed and discussed.</p> https://escholarship.org/uc/item/7mb8k87q Fri, 24 Apr 2026 00:00:00 +0000 Kurek, Julie Falat, Cheyenne Bontempo, Laura J Gatz, John David https://orcid.org/0000-0002-3380-2419 https://escholarship.org/uc/item/6j41d4bw <p><strong>Introduction</strong>: Hyponatremia is a common and often vexing electrolyte abnormality seen in&nbsp;the emergency setting. The severity of a patient’s symptoms is often dictated by the acuity of&nbsp;hyponatremia development and degree of serum sodium deficit, with patients typically demonstrating&nbsp;more severe neurological symptoms in acute-onset severe hyponatremia. Patients prescribed&nbsp;chlorthalidone are at particular risk of developing hyponatremia, especially in the setting of a&nbsp;secondary insult.</p> <p><strong>Case Report</strong>: We describe two patients presenting to the emergency department with severe&nbsp;hyponatremia who were taking chlorthalidone. Both patients had clinical symptoms that were mild&nbsp;given the degree of their hyponatremia. Additionally, each patient had a secondary insult affecting&nbsp;their volume status that was an important contributing factor in the development of hyponatremia.</p> <p><strong>Conclusion</strong>: Thiazide... https://escholarship.org/uc/item/6j41d4bw Fri, 24 Apr 2026 00:00:00 +0000 Richardson, Jordan Wood, Luke Raukar, Neha https://escholarship.org/uc/item/5wv73358 <p><strong>Introduction</strong>:&nbsp;Central retinal artery occlusion (CRAO) is a neurological and ophthalmologic&nbsp;emergency that presents as sudden, painless, monocular vision loss. Central retinal artery occlusioncan be classified as arteritic or non-arteritic. Most cases of non-arteritic CRAO are due to embolism,&nbsp;commonly from atherosclerosis of the ipsilateral carotid artery. More proximal sources of embolism&nbsp;are uncommon but can occur. Prompt recognition of CRAO is critical for vision preservation therapy&nbsp;and initiation of ischemic stroke diagnosis protocols.</p> <p><strong>Case Report</strong>: We present the case of a 66-year-old female who presented to the emergency department eight hours after sudden, painless, monocular vision loss. Her past medical history included type II diabetes, hypertension, and hyperlipidemia. She had previously undergone bilateral lens replacement for cataracts three years prior and had a history of intermittent floaters,... https://escholarship.org/uc/item/5wv73358 Fri, 24 Apr 2026 00:00:00 +0000 Kofman, Rochelle Smartt, Addison Myles, Reginald Jerome https://orcid.org/0009-0001-7731-832X Kishi, Patrick Rappaport, Douglas Drechsel, Kevin https://escholarship.org/uc/item/5m21n0nw <p><strong>Introduction: </strong>Intracranial arterial injury is typically associated with high-energy trauma. &nbsp;Early diagnosis and treatment are essential for improving patients' functional prognosis.&nbsp;</p> <p><strong>Case Presentation: </strong>A 76-year-old woman complained of pulsatile tinnitus on the 15th day after her traffic accident, in which she got injured only a bruise to her face, while severe injuries to her torso. On the 17th day, ptosis, conjunctival congestion, and an ocular motility disorder developed in her right eye. Magnetic resonance angiography showed a direct high-flow shunt from the internal carotid artery to the cavernous sinus. On the 20th day, the same symptoms developed in her left eye. On the 23rd day, coil embolization to the fistula reduced symptoms in the left eye, but not the right eye.</p> <p><strong>Discussion: </strong>This complication rarely occurs in patients with head trauma. Our case indicates that this can occur even in patients... https://escholarship.org/uc/item/5m21n0nw Fri, 24 Apr 2026 00:00:00 +0000 Miyake, Yoshihiro Abe, Tomohiro https://orcid.org/0000-0001-5585-6381 Kubo, Keisuke Nagoshi, Hideki Ochiai, Hidenobu https://escholarship.org/uc/item/51n9m25c <p><strong>Introduction</strong>:&nbsp;Paradoxical coronary embolism is a rare cause of myocardial infarction.</p> <p><strong>Case Report: </strong>A 57-year-old man presented with acute chest pain after a recent non-ST elevation&nbsp;myocardial infarction, during which a patent foramen ovale was identified. On readmission, the&nbsp;electrocardiogram showed an inferior ST-elevation myocardial infarction, and angiography revealed&nbsp;a distal thrombotic occlusion in otherwise normal coronary arteries. No venous thromboembolism&nbsp;was found, but thrombophilia testing revealed heterozygous factor V Leiden. He was managed&nbsp;conservatively and underwent successful patent foramen ovale closure.</p> <p><strong>Conclusion</strong>: This case highlights paradoxical embolism as a diagnostic consideration in acute myocardial infarction without coronary artery disease.</p> <p></p> <p></p> https://escholarship.org/uc/item/51n9m25c Fri, 24 Apr 2026 00:00:00 +0000 Berckmans, Dago https://escholarship.org/uc/item/4z69k3w1 <p><strong>Introduction</strong>:&nbsp;Trichobezoar is a rare gastrointestinal condition typically caused by ingestion of hair,&nbsp;which most often affects adolescent females. Its clinical presentation is frequently nonspecific, with&nbsp;symptoms such as abdominal pain, constipation, or early satiety, which can delay recognition until&nbsp;severe complications such as obstruction or perforation develop.</p> <p><strong>Case Report: </strong>We present the case of a 14-year-old girl who developed a massive trichobezoar&nbsp;resulting in gastric perforation and death. She had a three-month history of intermittent constipation&nbsp;and multiple healthcare visits without definitive diagnosis. On arrival to the emergency department,&nbsp;she was in cardiopulmonary arrest. Computed tomography revealed a large intragastric mass&nbsp;with associated pneumoperitoneum. Emergency laparotomy confirmed a trichobezoar with gastric&nbsp;perforation and diffuse peritonitis. Despite prompt surgical... https://escholarship.org/uc/item/4z69k3w1 Fri, 24 Apr 2026 00:00:00 +0000 Gültekin, Mert https://orcid.org/0009-0001-1285-5490 Erinmez, Ayça https://orcid.org/0009-0003-0653-0053 Karpuz, Yunus Emre https://orcid.org/0009-0008-7163-3784 https://escholarship.org/uc/item/4xm6x30x <p>Manuscript: A Case Report of Delayed, Severe, Paroxysmal Muscle Cramping after Chilean Rose Tarantula (Grammostola rosea) Envenomation&nbsp;</p> https://escholarship.org/uc/item/4xm6x30x Fri, 24 Apr 2026 00:00:00 +0000 Cole, Jon Gooley, Brian Thomas Hughes, Kirk Gooley, Mark Keyler, Daniel Vetter, Richard https://escholarship.org/uc/item/4ns2d0kx <p><strong>Introduction</strong>: Radial collateral ligament injuries of the thumb are rare, especially in adolescent athletes. We present a case of a 17-year-old female cheerleader who sustained a complete radial collateral ligament tear while basing during a cheerleading stunt.</p> <p><strong>Case Report: </strong>The patient presented to the emergency department with pain in the right thumb after&nbsp;catching a falling flyer. Examination of the first metacarpophalangeal joint of the right thumb revealed&nbsp;tenderness and laxity. Radiographic imaging showed no fracture. Magnetic resonance imaging&nbsp;confirmed a complete radial collateral ligament tear. She underwent surgical repair with full recovery.</p> <p><strong>Conclusion</strong>: This case highlights an uncommon thumb ligament injury in a non-traditional&nbsp;mechanism. Emergency physicians should consider radial collateral ligament tears in&nbsp;patients with metacarpophalangeal joint tenderness, even when radiographs... https://escholarship.org/uc/item/4ns2d0kx Fri, 24 Apr 2026 00:00:00 +0000 Baker, Russell Andrew https://escholarship.org/uc/item/4m59j13s <p><strong>Introduction</strong>:&nbsp;Foreign body-induced pancreatitis is rare and diagnostically challenging, often&nbsp;presenting with non-specific symptoms and no clear history, unlike typical causes.</p> <p><strong>Case Report: </strong>A 70-year-old man presented with vomiting and abdominal tenderness. Imaging&nbsp;revealed a 4-cm sharp foreign body near the pancreatic head causing inflammation. Endoscopy and&nbsp;endoscopic ultrasound failed to locate the object. Surgical exploration with intraoperative ultrasound&nbsp;identified and removed the foreign body at the pylorus-duodenal junction.&nbsp;The patient recovered&nbsp;without complications.</p> <p><strong>Conclusion: </strong>Early diagnosis, multimodal imaging, and surgical collaboration are essential for optimal&nbsp;management of foreign body-induced pancreatitis.</p> https://escholarship.org/uc/item/4m59j13s Fri, 24 Apr 2026 00:00:00 +0000 Vaghela, Nital Abou Chaar, Mohamad K. https://orcid.org/0000-0002-9584-2184 Mahnke, Steven Colak, Ceylan Stephens, Daniel Kummer, Tobias https://escholarship.org/uc/item/4bg1t7pq <p><strong>Case Presentation: </strong>A 52-year-old man involved in a high-speed car crash presented with hypotension, abdominal and back pain, and seatbelt bruising. Imaging revealed a mesenteric bucket-handle injury with active bleeding. He received resuscitation and was taken emergently to the&nbsp;operating room for a sigmoid colectomy with primary anastomosis.</p> <p><strong>Discussion</strong>:&nbsp;In patients with blunt abdominal trauma, 1-6% are diagnosed with mesenteric or&nbsp;hollow visceral injuries; the bucket handle injury is a subtype of these injuries. These injuries often&nbsp;present subtly and may be missed on initial evaluation, particularly when the extended focused&nbsp;assessment with sonography for trauma is negative. Unexplained hemodynamic instability should&nbsp;prompt further investigation, as delayed diagnosis can lead to bowel ischemia or infarction. Early&nbsp;recognition and surgical intervention are critical to reducing morbidity and mortality... https://escholarship.org/uc/item/4bg1t7pq Fri, 24 Apr 2026 00:00:00 +0000 Gottam, Bhargavesh McCoy, Christopher Eric https://escholarship.org/uc/item/3wk9474r <p><strong>Introduction: </strong>Metformin, a first-line type two diabetes medication, is generally considered safe and&nbsp;effective. However, it is rarely associated with life-threatening lactic acidosis. This generally presents&nbsp;in patients with gastrointestinal upset as a primary complaint. It is most common in patients with&nbsp;underlying chronic kidney disease. Prevention of associated mortality requires early diagnosis and&nbsp;intervention with fluids, bicarbonate, vasopressors, and hemodialysis.</p> <p><strong>Case Report: </strong>This is a notable presentation of metformin toxicity, as the 68-year-old male patient&nbsp;presented with an atypical chief complaint of dyspnea and no history of kidney disease. Physical exam&nbsp;was notable for tachypnea and clear breath sounds. Labs revealed anion gap metabolic acidosis from&nbsp;an accumulation of lactic acid and acute renal failure. Other causes of lactic acid metabolic acidosis&nbsp;were considered and ruled out.... https://escholarship.org/uc/item/3wk9474r Fri, 24 Apr 2026 00:00:00 +0000 Welsch, Elizabeth https://orcid.org/0009-0005-3237-6111 Evans, Jerome https://orcid.org/0009-0006-7610-3809 Yoxall, Alexander https://orcid.org/0009-0004-5625-3311 Culhane, Anna https://orcid.org/0009-0006-5032-868X https://escholarship.org/uc/item/3t05q7rj <p><strong>Introduction</strong>: The vasovagal reaction can lead to benign, self-limiting syncope triggered by stimuli&nbsp;such as pain or emotional stress. However, in rare and severe cases it may result in cardiac&nbsp;asystole. Previous episodes of vasovagal reactions could be a risk factor for cardiac asystole.</p> <p><strong>Case Report: </strong>We present a 39-year-old male with a previous episode of vasovagal syncope who&nbsp;developed an unexpected 15-second episode of asystole during venipuncture, for which we performed&nbsp;immediate chest compressions. Further evaluations revealed no apparent underlying cause. The&nbsp;patient was subsequently diagnosed with transient asystole secondary to vasovagal reaction.</p> <p><strong>Conclusion</strong>: While venipuncture is a common procedure in clinical practice, clinicians should be&nbsp;aware of the potential risk for cardiac asystole. Detailed medical history of previous episodes of&nbsp;vasovagal reactions could be... https://escholarship.org/uc/item/3t05q7rj Fri, 24 Apr 2026 00:00:00 +0000 Nagano, Tomoki https://orcid.org/0009-0009-8455-5938 Sakuma, Ryo Horiguchi, Wataru Jeong, Soi Tanamoto, Takaki Yokota, Yumi Fowler, Matthew Kim, Jin https://escholarship.org/uc/item/3h40g6jv <p><strong>Case Presentation: </strong>An 88-year-old man was brought to our emergency department due to altered&nbsp;mental status and hemodynamic shock due to a urinary tract infection. Computed tomography&nbsp;showed an incarcerated ureter in the Petit triangle. Urology was consulted, and the hernia was&nbsp;reduced back into the retroperitoneal cavity.</p> <p><strong>Discussion</strong>:&nbsp;Petit hernia is rare; moreover, there is no literature to our knowledge discussing the&nbsp;ureter as the herniated structure. Interventional radiology can be considered as a reductive option.</p> https://escholarship.org/uc/item/3h40g6jv Fri, 24 Apr 2026 00:00:00 +0000 Tanaka, Atsuhito Kamitani, Yuka https://escholarship.org/uc/item/3g07934h <p><strong>Introduction</strong>:&nbsp;In this report we highlight the emerging role of pediatric cardiac point-of-care&nbsp;ultrasound (POCUS) in rapidly diagnosing infective endocarditis, using a clinical case as illustration.</p> <p><strong>Case Report</strong>:&nbsp;A six-year-old girl with a known ventricular septal defect presented with worsening&nbsp;respiratory symptoms, fevers, abdominal pain, and decreased oral intake. Initial POCUS, performed&nbsp;by an emergency physician, indicated a suspicious echogenic mass in the right atrium, prompting&nbsp;formal echocardiography. Further imaging and cultures confirmed infective endocarditis due to&nbsp;methicillin-sensitive&nbsp;<em>Staphylococcus aureus</em>.</p> <p><strong>Conclusion</strong>: This case underscores the utility of pediatric cardiac POCUS as a rapid bedside&nbsp;diagnostic tool for infective endocarditis in emergency settings, leading to early diagnosis and&nbsp;management. Although POCUS cannot replace comprehensive... https://escholarship.org/uc/item/3g07934h Fri, 24 Apr 2026 00:00:00 +0000 Dhillon, Reshvinder Mcmullin, Sarah https://escholarship.org/uc/item/2cd7n7dd <p><strong>Case Presentation: </strong>A 64-year-old Black female presented to the emergency department following a new-onset tonic-clonic seizure. The patient had been given 2 milligrams of lorazepam by emergency medical services with cessation of seizure activity. On physical exam she was lethargic and had&nbsp;clear discharge from the right nare. Computed tomography of the brain initially demonstrated&nbsp;findings consistent with sinusitis versus ethmoidal mass. Magnetic resonance imaging of the brain&nbsp;demonstrated a right frontal ethmoidal encephalocele.</p> <p><strong>Discussion</strong>:&nbsp;Basal encephaloceles occur due to a defect in the skull base. Location of the defect&nbsp;and extracranial herniation of brain tissue can cause neurologic sequelae. This case illustrates the&nbsp;importance of maintaining a broad differential diagnosis and for emergency physicians to obtain&nbsp;imaging when evaluating seizures and/or chronic rhinorrhea in adults.</p> https://escholarship.org/uc/item/2cd7n7dd Fri, 24 Apr 2026 00:00:00 +0000 Kim, Kiveum Craig, Taylor Delicio, Lucas Scumpia, Alexander John https://orcid.org/0000-0001-6862-6315 https://escholarship.org/uc/item/2c36p0r0 Letter to the Editor: A Case Report of Delayed, Severe, Paroxysmal Muscle&nbsp;Cramping After Chilean Rose Tarantula (<em>Grammostola rosea</em>)&nbsp;Envenomation https://escholarship.org/uc/item/2c36p0r0 Fri, 24 Apr 2026 00:00:00 +0000 Roque, Luis A https://orcid.org/0000-0003-1969-0315 https://escholarship.org/uc/item/1qn446rw <p><strong>Introduction</strong>: Amyand hernia is a rare condition in which the appendix is found within an inguinal hernia&nbsp;sac, often mimicking incarcerated or strangulated hernias. Diagnosis is typically made intraoperatively,&nbsp;but increasing use of point-of-care ultrasound (POCUS) is enhancing preoperative recognition.</p> <p><strong>Case Report: </strong>A 46-year-old male presented with a chronic, partially reducible inguinal hernia. Point-of-care ultrasound revealed a bowel-containing hernia with fluid. Computed tomography confirmed&nbsp;an inflamed appendix within the sac. Laparoscopic appendectomy and open hernia repair were&nbsp;performed without complications.</p> https://escholarship.org/uc/item/1qn446rw Fri, 24 Apr 2026 00:00:00 +0000 Wallace, Neil Hauger, Aila Suga https://escholarship.org/uc/item/1k44h5x9 <p><strong>Introduction</strong>: Lemierre syndrome is characterized by septic thrombophlebitis of the internal jugular&nbsp;vein, classically caused by&nbsp;<em>Fusobacterium necrophorum</em>. It is typically seen after an episode of&nbsp;pharyngitis where the palatine tonsils or peritonsillar mucosa is affected. It is thought to spread&nbsp;locally into the pharyngeal space toward the internal jugular vein.</p> <p><strong>Case Report: </strong>A 42-year-old male with progressively worsening, atraumatic right-sided neck pain&nbsp;was discovered to have methicillin-resistant <em>Staphylococcus aureus </em>(MRSA) bacteremia, septic thrombophlebitis of the right dural venous sinuses, skull base osteomyelitis, and otomastoiditis.</p> <p><strong>Conclusion</strong>:&nbsp;While septic thrombophlebitis of the dural venous sinuses and internal jugular&nbsp;vein is typically caused by <em>F necrophorum </em>and usually comes from local pharyngeal spread,&nbsp;community-acquired MRSA is... https://escholarship.org/uc/item/1k44h5x9 Fri, 24 Apr 2026 00:00:00 +0000 Kowalczyk, Daniel Ubiñas, George https://escholarship.org/uc/item/1gc895jz <p><strong>Introduction</strong>:&nbsp;Chalk-stick fractures are transverse spinal injuries seen in patients with ankylosing&nbsp;spondylitis due to chronic inflammation and spinal rigidity. These fractures may result from minor&nbsp;trauma and are associated with potentially fatal complications. While spinal fractures in ankylosing&nbsp;spondylitis are well recognized, thoracic chalk-stick fractures complicated by hemothorax from&nbsp;vascular injury remain exceedingly rare. We present a case of an elderly male with ankylosing&nbsp;spondylitis who sustained a thoracic chalk-stick fracture following a ground-level fall, complicated&nbsp;by hemothorax and hemorrhagic shock. This case highlights a rarely reported but life-threatening&nbsp;complication and emphasizes the importance of early imaging and high clinical suspicion in this high-risk population—even after minor trauma.</p> <p><strong>Case Report: </strong>A 90-year-old male with known history of ankylosing spondylitis presented... https://escholarship.org/uc/item/1gc895jz Fri, 24 Apr 2026 00:00:00 +0000 Dehkordi, Armin Akbarpur https://orcid.org/0000-0002-3492-4194 Aloise, Daniel Michael Scheppke, Eric Christodoulou, Mary Gigliotti, Grayson Zitek, Tony https://orcid.org/0000-0002-4357-6611 https://escholarship.org/uc/item/1fp5v5fw <p><strong>Case Presentation: </strong>A 20-year-old female with no past medical history presented to the emergency&nbsp;department (ED) after an episode of exertional syncope. Physical examination, vital signs, and&nbsp;electrocardiogram were unremarkable. Point-of-care ultrasound revealed abnormal invaginations&nbsp;in the interventricular septum. Laboratory evaluation was significant for markedly elevated troponin&nbsp;concerning for cardiac arrest. She was admitted to cardiology with suspicion for genetic cardiomyopathy.&nbsp;The patient underwent placement of an implantable cardioverter defibrillator after cardiac magnetic&nbsp;resonance imaging redemonstrated the septal invaginations known as myocardial crypts. Genetic&nbsp;studies later revealed sarcomere gene mutations associated with hypertrophic cardiomyopathy.</p> <p><strong>Discussion</strong>:&nbsp;Myocardial crypts, which are invaginations within the myocardium, are considered&nbsp;early morphological markers for... https://escholarship.org/uc/item/1fp5v5fw Fri, 24 Apr 2026 00:00:00 +0000 Allen, Christopher Wei Gubbels, Alexandra Duanmu, Youyou Vogel, Jody https://escholarship.org/uc/item/1f65799z <p><strong>Case Presentation: </strong>We present the case of a 53-year-old female with darting eye movements and difficulty walking who was found to have opsoclonus-myoclonus syndrome only after multiple&nbsp;presentations to emergency departments over five days.</p> <p><strong>Discussion</strong>:&nbsp;Adult-onset opsoclonus-myoclonus syndrome is a rare central nervous system&nbsp;disease typically associated with paraneoplastic or idiopathic etiologies. With non-specific symptom&nbsp;presentation, this condition is commonly misdiagnosed in adults, leading to diagnostic delays and&nbsp;long-term motor and cognitive sequelae.</p> https://escholarship.org/uc/item/1f65799z Fri, 24 Apr 2026 00:00:00 +0000 Stephens, Taylor O Imhoff, Bryan Patel, Janak https://escholarship.org/uc/item/1c1110m0 <p><strong>Introduction</strong>: Physician-in-triage (PIT) models have become increasingly common in emergency&nbsp;medicine. The goal is to facilitate rapid patient evaluation and improve key operational emergency&nbsp;department (ED) metrics. However, there is limited time for the PIT encounter, which often involves&nbsp;an abbreviated patient evaluation. Point-of-care ultrasound (POCUS) has been shown to improve&nbsp;patient care and speed diagnosis in a variety of scenarios. Although physicians working within a PIT&nbsp;model must remain mindful of time constraints, POCUS can help identify time-sensitive diagnoses&nbsp;and guide appropriate initial testing during certain encounters. Ocular POCUS can be particularly&nbsp;impactful on timely diagnosis and appropriate deployment of ED resources.</p> <p><strong>Case Series: </strong>We present three cases of acute monocular vision loss wherein the PIT physician&nbsp;used ocular POCUS to arrive at the correct initial diagnosis.... https://escholarship.org/uc/item/1c1110m0 Fri, 24 Apr 2026 00:00:00 +0000 Thom, Christopher https://orcid.org/0000-0003-1435-2712 Spirek, Benton Bhargava, Gitansh Moak, James https://escholarship.org/uc/item/1b33b9mh <p><strong>Introduction</strong>:&nbsp;Neurotoxic envenomation often presents with non-specific neurological symptoms and&nbsp;minimal local signs, which can delay appropriate diagnosis and treatment.&nbsp;This is the first reported&nbsp;case of a neurotoxic snakebite presenting with an atypical symptom of unilateral neck pain.</p> <p><strong>Case Report: </strong>A 12-year-old girl was referred to our emergency centre with neck weakness&nbsp;progressing to quadriplegia, attributed to a fall while playing.&nbsp;A diagnosis of acute flaccid paralysis&nbsp;secondary to cervical trauma was made and treated at the first hospital; however, she developed&nbsp;respiratory distress and was transferred to our centre. Clinical examination and computed&nbsp;tomography ruled out cervical cord injury. A diagnosis of neurotoxic envenomation was considered,&nbsp;given our centre’s high snakebite burden and the symptom of descending flaccid paralysis. Despite&nbsp;initiating antivenom and supportive... https://escholarship.org/uc/item/1b33b9mh Fri, 24 Apr 2026 00:00:00 +0000 T, Neithiya Nair, Jayan Jayapalan Chavali, Krishna Dutt