Recent uciem_cpcem items

Incidental Diagnosis of ST-Elevation Myocardial Infarction on Computed Tomography in a Burn Patient: A Case Report

Wed, 29 Jul 2026 00:00:00 +0000

Introduction: 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).

Case Report: 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.

Conclusion: 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...

Elderly Male with a Painful Red Eye

Tue, 28 Jul 2026 00:00:00 +0000

Case Presentation: 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.

Discussion: 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...

Case Report: Lidocaine Toxicity Presenting with Focal Neurologic Findings

Tue, 28 Jul 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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...

Magnetic Mishaps—Small Bowel Obstruction Caused by Ingested Magnets Complicated by Appendicitis: A Case Report

Tue, 28 Jul 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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.

Conclusion: 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....

Persistent and Progressive Exfoliative Dermatitis: A Case Report

Tue, 28 Jul 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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,...

Tension Hydrocele—How Point-of-care Ultrasound Helps in the Emergency Department: A Case Report

Mon, 20 Jul 2026 00:00:00 +0000

Introduction: 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.
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.

Conclusion: Testicular POCUS can rapidly identify impaired perfusion and guide scrotal centesis in the ED, a temporary yet potentially testis-saving intervention.

Yellow Granular Material in Hair: A Bedside Clue to Overdose from Cold Medication Containing Acetaminophen

Mon, 20 Jul 2026 00:00:00 +0000

Case Presentation: 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.

Discussion: 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...

VenoArterial Extracorporeal Membrane Oxygenation in Cardiac Arrest Suspected due to Massive Pulmonary Embolism: A Case Report

Mon, 20 Jul 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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...

Blunt Thoracic Aortic Injury Presenting as Hemodynamically Stable: A Case Report

Mon, 20 Jul 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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,...

Ultrasound-guided Hernia Reduction—Preventing Surgery for an Incarcerated Ventral Hernia: A Case Report

Mon, 20 Jul 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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...

Stridor and Dysphagia Unmasking an Aberrant Right Subclavian Artery in a Toddler

Mon, 20 Jul 2026 00:00:00 +0000

Case Presentation: 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...

Fishing Hook Globe Injury Diagnosed with Point-of- care Ultrasound: A Case Report

Fri, 10 Jul 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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...

Adult Intussusception and Ischemic Bowel Potentially Associated with CurQD Supplementation: A Case Report of A Diagnosis Driven by Point-of-care Ultrasound

Fri, 10 Jul 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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...

Emergency Department Presentation of Duloxetine-induced Acute Extrapyramidal Symptoms: A Case Report

Fri, 10 Jul 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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.

Conclusion: This case highlights the need for vigilance regarding movement disorders in patients prescribed duloxetine, even in the absence of psychiatric comorbidity or antipsychotic exposure.

Recurrence of Guillain-Barré Syndrome Is not Uncommon, and a Relapse May Require More Aggressive Treatment than the Original Condition

Fri, 10 Jul 2026 00:00:00 +0000

Recurrence of Guillain-Barré Syndrome Is not Uncommon, and a Relapse May Require More Aggressive Treatment than the Original Condition

Unmasking the Silent Liver-Lung Connection: A Pediatric Hepatopulmonary Syndrome Case Report

Fri, 10 Jul 2026 00:00:00 +0000

Introduction: Hepatopulmonary syndrome is a rare but serious cause of pediatric hypoxemia.

Case Report: 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.

Conclusion: 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.

Subungual Myiasis Presenting to the Emergency Department: A Case Report

Mon, 29 Jun 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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...

Dynamic Supraglottic Airway Collapse Diagnosed Using Airway Point-of-care Ultrasound: A Case Report

Mon, 29 Jun 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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...

Ruptured Abdominal Aortic Aneurysm Identified on Point-of-Care Ultrasound

Mon, 29 Jun 2026 00:00:00 +0000

Case Presentation: 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.

Discussion: 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.

Severe Tetanus Following a Rooster-Peck Injury Requiring Nasotracheal Intubation: A Case Report

Mon, 29 Jun 2026 00:00:00 +0000

Introduction: Tetanus is a rare but life-threatening disease caused by Clostridium tetani, characterized by generalized muscle rigidity, autonomic instability, and respiratory compromise.

Case Report: 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.

Conclusion: 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...

Keeping An Eye Out for Stroke—Herpes Zoster Ophthalmicus Leading to Acute Ischemic Stroke

Mon, 29 Jun 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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.

Conclusion: 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...

Stretching the Limits: A Rare Case Report of Perimesencephalic Subarachnoid Hemorrhage During Yoga

Sun, 28 Jun 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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...

Differentiating Weakness—an Atypical Presentation of Acute Neuromuscular Paralysis: A Case Report

Sat, 27 Jun 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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...

Cerebral Kounis Syndrome—A Rare Case Report of Cerebral Vasospasm Following Anaphylaxis

Sat, 27 Jun 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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.

Conclusion: Cerebral vasospasm is an unusual sequela of anaphylaxis that may lead to a diagnostic dilemma. Prompt...

Retrograde Intubation in a Severe Fixed Spinal Deformity: A Case Report

Fri, 26 Jun 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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.

Conclusion: This case highlights retrograde intubation as a lifesaving low‑technology technique in complex anatomic and physiologic airways, demonstrating its continued relevance...

Penetrating Neck Injury in a Child Presenting as a Simple Laceration: A Case Report

Fri, 26 Jun 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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...

Novel Technique in Performing Ocular Ultrasound in Trauma: A Case Series

Thu, 25 Jun 2026 00:00:00 +0000

Introduction: 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.

Case Series: 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...

Unusual Etiology and Presentation for Hyperkalemia - Dialysis Access Recirculation: A Case Report

Mon, 25 May 2026 00:00:00 +0000

Introduction: Hyperkalemia is a common and potentially life-threatening complication of end- stage renal disease, often producing nonspecific symptoms but profound cardiac effects. While nonadherence and dietary indiscretion are typical precipitants, clinicians must also consider the adequacy and effectiveness of dialysis.

Case Report: We report a patient with end-stage renal disease on thrice-weekly hemodialysis who presented with significant bradycardia and altered mental status. Initial prehospital electrocardiogram (ECG) was suspicious for acute coronary syndrome after automated ECG interpretation suggested anterior ST-segment elevation. In the emergency department, the patient was in a junctional escape rhythm with diffuse peaked T-waves. Serum potassium was 7.8 millimoles per liter with concomitant uremia. Despite administration of potassium-shifting therapies bradycardia persisted, and...

Incidental Wolff-Parkinson-White Syndrome Discovered Following Dicyclomine Use: A Case Report

Sat, 23 May 2026 00:00:00 +0000

Introduction: 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 to identifying high-risk individuals and guiding treatment decisions such as catheter ablation. Pharmacologic agents that alter autonomic tone may unmask latent pre-excitation. Dicyclomine, an anticholinergic agent used for gastrointestinal disorders, is not an AV-nodal blocking drug but exerts vagolytic effects that can increase sinus rate and AV nodal conduction. Dicyclomine’s vagolytic effects and potential for interaction with other proarrhythmic drugs warrant...

Clinical Application of Intravenous Lipid Emulsion Therapy in Cocaine-associated Cardiac Arrest: A Case Report

Sat, 23 May 2026 00:00:00 +0000

Introduction: Cardiac arrest in the setting of cocaine use portends high morbidity and mortality secondary to its powerful sodium channel blockade effects. Intravenous (IV) lipid emulsion has long been used as a rescue therapy in lipophilic toxicities.

Case Report: We report a case in which IV lipid emulsion was used to successfully stabilize a patient who suffered cocaine-associated, out-of-hospital cardiac arrest.

Conclusion: Intravenous lipid emulsion was used in the successful resuscitation of a cocaine overdose and could be considered for use in patients with cocaine-associated cardiac arrest.

The Floating Threat: A Rare Case Report of Carotid Saddle Thrombus in a Healthy Adult

Sat, 23 May 2026 00:00:00 +0000

Introduction: 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.

Case Report: We report the case of a 46-year-old female presenting with neck pressure and gait instability, who was found to have a free-floating thrombus at the brachiocephalic-carotid junction. Despite early anticoagulation, she developed biparietal ischemic strokes.

Conclusion: This case highlights the challenges in management of carotid free-floating thrombus including appropriate anticoagulation, contraindications to thrombolysis, and the need for multidisciplinary involvement. Emergency physicians must maintain high suspicion for vascular pathology in atypical neurologic presentations and recognize that even optimal medical therapy does not eliminate stroke risk.

Emergency Department Transvenous Pacemaker Placement Complicated by Tricuspid Mass

Sat, 23 May 2026 00:00:00 +0000

Case Presentation: Temporary transvenous pacemaker placement is frequently performed in the emergency department for the management of symptomatic bradyarrhythmias. We report the case of a 93-year-old male who presented with profound bradycardia, hypotension, and altered mental status requiring emergent pacing. Initial transcutaneous pacing achieved hemodynamic improvement but necessitated escalation to transvenous pacing due to patient discomfort and high current requirements. During attempted transvenous pacemaker placement, resistance was encountered and capture could not be achieved despite appropriate technique. Subsequent cardiology consultation and imaging revealed an undiagnosed tricuspid valve myxoma obstructing catheter advancement.

Discussion: This case highlights a rare mechanical complication of transvenous pacemaker placement caused by an intracardiac mass. Awareness of structural...

A Split from Traditional Orbital Compartment Syndrome Intervention: Case Report of Vision-saving Vertical Lid Split Procedure

Sat, 23 May 2026 00:00:00 +0000

Introduction: 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 permanent vision loss. This procedure is notoriously difficult and rare, but a recently proposed alternative—the vertical lid split—may be simpler and more effective.

Case Report: We report the case of a 35-year-old woman with motor vehicle collision-related orbital trauma who presented to a community emergency department. Initially, she had intact vision and extraocular movements. Imaging showed a comminuted inferior orbital blowout fracture with retrobulbar hemorrhage, and the transfer process was initiated. However, after coughing she developed vision loss and elevated intraocular pressure. Lateral canthotomy and cantholysis was performed for suspected orbital compartment syndrome but did not fully address the...

It’s A Pain in The Neck: Case Report of Bedside Diagnosis of Unilateral Neck Swelling

Wed, 29 Apr 2026 00:00:00 +0000

Introduction: 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 bacteria, commonly Fusobacterium necrophorum. The potential severity of this condition underscores the importance of early and accurate diagnosis. The gold standard diagnosis relies on computed tomography and blood cultures; however, point-of-care ultrasound offers a rapid and cost-effective tool.

Case Report: A 58-year-old woman with chronic obstructive pulmonary disease, migraines, and recent dental extractions presented with two days of worsening right-sided neck pain and swelling. She denied fever, chills, or recent upper respiratory symptoms. Examination revealed a tender anterior neck mass without airway compromise. Point-of-care ultrasound demonstrated a 1.22 x 1.80 centimeters hyperechoic...

Sorely Mistaken—Soft Palatal Myxedema in Decompensated Hypothyroidism Presenting as a Sore Throat: Case Report

Wed, 29 Apr 2026 00:00:00 +0000

Introduction: Oropharyngeal myxedema is a rare presenting symptom of decompensated hypothyroidism that can mimic more common causes of sore throat.

Case Report: We describe a case of an older woman who presented with throat pain and dysphagia, found to have soft palate edema on exam and imaging. Laboratory testing confirmed severe hypothyroidism, and her symptoms eventually resolved with thyroid hormone replacement therapy.

Conclusion: This case highlights a rare and under-recognized presentation of a common endocrine disorder. Consider myxedema from severe hypothyroidism in patients with subacute oropharyngeal pain and swelling. Without early recognition and treatment, the patient is at risk for two life-threatening conditions: airway compromise from soft palate myxedema and progression of hypothyroidism to myxedema coma.

Non-traumatic First Rib Fracture in a Young Weightlifter Resulting in Winged Scapula: A Case Report

Wed, 29 Apr 2026 00:00:00 +0000

Introduction: Shoulder pain is a common emergency department (ED) presentation. Scapular winging is a rare condition often associated with long thoracic nerve injury. This case report describes an even rarer case of dorsal scapular nerve injury caused by a nontraumatic first rib fracture in a young weightlifter, an injury mechanism not previously reported in the literature.

Case Report: A 17-year-old male presented to the ED with left shoulder pain following weightlifting. Physical examination demonstrated scapular winging, and a clinical diagnosis of dorsal scapular neuropraxia was made. Imaging revealed a nontraumatic first rib fracture. The patient was treated conservatively with nonsteroidal anti-inflammatory drugs and rest, resulting in complete resolution of symptoms within two weeks at clinic follow-up.

Conclusion: To our knowledge, this is the first case...

An Unusual Case of Spontaneous Pneumothorax Presenting as Right Lower Quadrant Pain: A Case Report

Wed, 29 Apr 2026 00:00:00 +0000

Introduction: Primary spontaneous pneumothorax generally presents with symptoms of chest pain and shortness of breath. Progression to a tension pneumothorax results in a medical emergency. Rare presentations with abdominal pain are possible and must be considered to expedite appropriate treatment of pneumothorax.

Case Report: We report a case of a 21-year-old male with primary spontaneous pneumothorax who initially presented to the emergency department with right lower quadrant abdominal pain. History and physical exam were suggestive of acute appendicitis. A large right pneumothorax was incidentally found on computed tomography.

Conclusion: This case highlights unusual presentations of pneumothorax. Emergency physicians should consider atypical presentations of chest pathology such as pneumothorax in patients presenting with symptoms consistent with an acute abdomen.

Electrocardiographic Changes Related to Targeted Temperature Management in Brugada Syndrome: A Case Report

Wed, 29 Apr 2026 00:00:00 +0000

Introduction: Brugada syndrome is an important differential diagnosis for unexplained sudden cardiac arrest, particularly in younger patients. The electrocardiographic (ECG) pattern characteristic of Brugada syndrome can be provoked by fever and may vary with changes in body temperature. Therefore, targeted temperature management following cardiac arrest may obscure the distinctive morphology, increasing the risk of misdiagnosis.

Case Report: 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...

Pneumocephalus Secondary to Sternutation: A Case Report