Recent uciem_cpcem items

Focal Hepatic Hot Spot Sign Mimicking Active Extravasation on CT Angiography in Superior Vena Cava Syndrome: A Case Report

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Caused by portosystemic venous shunting, the focal hepatic hot spot sign (or hot quadrate sign) is a radiologic finding most commonly associated with superior vena cava (SVC) obstruction. On contrast-enhanced imaging, this finding may mimic active hepatic extravasation or focal hepatic pathology, posing a diagnostic challenge in the emergency department (ED).

Case Report: We report a case of a 70-year-old man with progressive cognitive decline and hypoxemic respiratory failure requiring intubation. Computed tomography (CT) angiography of the chest demonstrated a focal area of intense contrast enhancement in the left hepatic lobe, initially concerning for active extravasation. Further review of the imaging revealed a right upper lobe lung mass and a large mediastinal mass causing high-grade SVC stenosis. The hepatic finding was subsequently identified by the reading radiologist as a focal hepatic hot spot sign representing...

Atypical Emergency Department Presentation of Acute Motor and Sensory Axonal Neuropathy: A Case Report

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Acute motor and sensory axonal neuropathy is a rare, severe axonal variant of Guillain–Barré syndrome characterized by rapidly progressive motor and sensory dysfunction. Early recognition in the emergency department (ED) is challenging because patients may initially present with subtle neurologic findings, preserved reflexes, and normal cerebrospinal fluid (CSF) studies.

Case Report: A 29-year-old woman with a history of generalized anxiety disorder presented to the ED with progressive distal numbness and mild weakness, with weakness being her chief complaint. Neurologic examination demonstrated preserved reflexes without focal deficits, and she was noted to be anxious. Given the reassuring examination, the patient was discharged with strict return precautions, including instructions to seek immediate reevaluation for worsening weakness, numbness, or progression of neurologic symptoms. She returned 48 hours later...

Spontaneous Spinal Epidural Hematoma as a Manifestation of Hypertensive Emergency: A Case Report

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Uncontrolled hypertension is frequently evaluated in the emergency department (ED), with the goal of identifying those patients with hypertensive emergencies. Spontaneous spinal epidural hematoma is rare and not considered a typical manifestation of hypertensive emergency.

Case Report: A 31-year-old man presenting to the ED with chest pain and hypertension subsequently developed lower extremity neurologic deficits and was diagnosed with a spontaneous spinal epidural hematoma. After thorough testing, no other risk factors for this medical condition were identified, and the hemorrhage was attributed to hypertensive emergency.

Conclusion: Spontaneous spinal epidural hematoma is a rare complication of hypertensive emergency and should be considered when evaluating patients with hypertension, back pain, and neurologic deficits.

Partial Segmental Thrombosis of the Corpus Cavernosum Following Valsalva Maneuver: A Case Report

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Partial segmental thrombosis of the corpus cavernosum is a rare vascular condition that may present with nonspecific groin or pelvic pain and mimic more common surgical or urologic emergencies.

Case Report: A 33-year-old man presented to the emergency department with acute left-sided groin and pelvic pain after straining during defecation. Initial history and evaluation raised concern for incarcerated inguinal hernia, epididymo-orchitis, renal colic, lymphadenopathy, and soft tissue infection. Computed tomography demonstrated asymmetric enlargement of the left corpus cavernosum, while penile ultrasound showed diminished cavernosal flow. Magnetic resonance imaging confirmed segmental thrombosis of the left corpus cavernosum. The patient was treated conservatively with rivaroxaban and analgesia, resulting in symptomatic improvement.

Conclusion: Partial segmental thrombosis of the corpus cavernosum...

Behavioral Trigger Identification in Recurrent Postpartum Chest Pain After Negative Cardiopulmonary Evaluation: A Case Report

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Recurrent chest pain in postpartum patients frequently results in repeated emergency department (ED) visits despite negative cardiopulmonary investigations, creating diagnostic uncertainty and increasing healthcare resource utilization. We report a case highlighting the value of a structured postexclusion assessment to identify clinically relevant behavioral triggers after life-threatening causes have been excluded.

Case Report: A 33-year-old woman, six weeks postpartum, presented repeatedly with nocturnal chest pain, palpitations, and dyspnea. Serial electrocardiograms, cardiac biomarkers, chest imaging, and transthoracic echocardiography were consistently normal, excluding acute cardiopulmonary pathology. Careful reassessment of symptom chronology and behavioral history identified a reproducible temporal association between symptom onset and nocturnal binge-eating episodes. Following outpatient psychiatric and clinical...

Transient Electrocardiographic Changes in Anaphylaxis Mimicking Acute Coronary Syndrome: A Case Series

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Anaphylaxis is a life-threatening emergency that can involve significant cardiovascular manifestations. Transient electrocardiographic (ECG) changes during anaphylaxis and following epinephrine administration may closely mimic acute coronary syndrome, creating a diagnostic dilemma in the emergency department (ED). Failure to recognize these reversible patterns can result in delayed anaphylaxis treatment or unnecessary activation of invasive cardiac pathways.

Case Series: We report a case series of three adult patients presenting to the ED with anaphylaxis who developed alarming ECG changes, including ST-segment elevation, ST-segment depression, and hyperacute T waves. One patient demonstrated transient ECG changes temporally related to intramuscular epinephrine administration, while two patients exhibited features suggestive of hypersensitivity-associated coronary vasospasm or thrombosis manifesting as ECG changes. In all...

Bedside Sonography Brings the Weiss Ring into Focus: Rapid Diagnosis of Posterior Vitreous Detachment

Tue, 13 Oct 2026 00:00:00 +0000

Case Presentation: A 51-year-old woman presented to the emergency department with blurred vision and a large, dark floater in her right eye. Point-of-care ultrasound (POCUS) revealed a Weiss ring, strongly suggesting a diagnosis of a posterior vitreous detachment.

Discussion: Identifying a Weiss ring with POCUS may be a reasonable and easier alternative for emergency clinicians when used in conjunction with a slit-lamp examination and may aid in timely ophthalmologic management of posterior vitreous detachments.

Hemopericardium After Cardiopulmonary Resuscitation—Bedside Drainage with a Triple-Lumen Catheter: A Case Report

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Hemopericardium from chest compression-related cardiac injury is an underrecognized complication of cardiopulmonary resuscitation, with bleeding risk amplified in anticoagulated patients.

Case Report: A 66-year-old man on apixaban and hemodialysis presented in cardiac arrest. Post resuscitation ultrasound revealed pericardial tamponade. With no pericardiocentesis kit available, a seven French triple-lumen central venous catheter was placed under ultrasound guidance via a subxiphoid approach. Approximately one liter of bloody fluid was drained; the patient died within 24 hours.

Conclusion: Hemopericardium is an underrecognized complication of resuscitation in anticoagulated patients. A triple-lumen central venous catheter offers a familiar bedside drainage alternative when a commercial kit is unavailable.

Carotid Artery Dissection After Cervical Traction Device Use: A Case Report

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Internal carotid artery (ICA) dissection is a time-sensitive vascular emergency that may present with subtle findings, most notably painful Horner syndrome. Mechanical stress to the cervical vasculature is a recognized trigger for this condition.

Case Report: We report a 56-year-old man who developed ipsilateral ptosis, miosis, and head and neck pain after using a home cervical traction device. Computed tomography angiography showed focal critical stenosis of the distal cervical left ICA consistent with dissection, along with a contralateral pseudoaneurysm suggesting prior injury. He was treated with dual antiplatelet therapy.

Conclusion: This case highlights a potential association between cervical traction device use and carotid dissection and underscores the importance of recognizing painful Horner syndrome and bilateral carotid pathology, while prompting clinicians to specifically inquire about...

A Rare Presentation of Pneumococcal Meningitis with Acute Bilateral Vision Loss: A Case Report

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Bacterial meningitis affects about 1.2 million people worldwide each year. Streptococcus pneumoniae is responsible for the majority of cases of bacterial meningitis in the United States and Europe, with visual impairment seen in 6.3% of patients. The etiology of acute vision loss in the setting of bacterial meningitis remains wide-ranging, most often occurring in the setting of endogenous endophthalmitis, optic neuropathy, and cortical blindness. Retinal necrosis is rare, and typically associated with viral meningitis, but has not been reported in bacterial meningitis.

Case report: A 66-year-old man with headache, malaise, and intermittent blurry vision, initially diagnosed with viral upper respiratory infection and presumed trigeminal neuralgia, presented to the emergency department with altered mental status, meningismus, and progressive bilateral vision loss. He was diagnosed with bacterial meningitis, and subsequent...

Cauda Equina Syndrome Secondary to Seizure-Induced Spinal Fracture During Hyperbaric Oxygen Therapy: A Case Report

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Hyperbaric oxygen therapy carries a risk of central nervous system oxygen toxicity, which can result in seizures. Seizure-induced spinal fractures are uncommon complications that occur during generalized convulsive activity. While often benign, lumbar vertebral body burst fractures may result in cauda equina syndrome. Additionally, patients with beta-thalassemia may have decreased bone mineral density due to ineffective erythropoiesis and bone marrow expansion increasing the risk for pathologic and traumatic fractures.

Case Report: A 35-year-old man with beta-thalassemia major presented to the emergency department after a witnessed, first-time generalized tonic-clonic seizure during hyperbaric oxygen therapy for chronic venous ulcers. Initial evaluation revealed severe low back pain and midline lumbar tenderness. Computed tomography revealed an acute third lumbar vertebra (L3) burst fracture with retropulsion. The patient...

Type I Choledochal Cyst in a Three-Year-Old with Recurrent Vomiting and Pancreatitis: A Case Report

Wed, 7 Oct 2026 00:00:00 +0000

Introduction: Choledochal cysts are rare congenital dilatations of the biliary tree that may present with nonspecific gastrointestinal symptoms in children, posing diagnostic challenges.

Case Report: We report a 3-year-old girl who presented with recurrent vomiting and abdominal pain. Initial laboratory testing revealed a mildly elevated lipase. An abdominal ultrasound demonstrated a pancreatic cyst; the patient was discharged with outpatient follow-up. She returned with worsening symptoms and a markedly elevated lipase of 2,247 U/L (reference range, < 160 U/L). Computed tomography subsequently revealed a type I choledochal cyst. She underwent operative resection with an uncomplicated postoperative course.

Conclusion: Persistent gastrointestinal symptoms with uptrending lipase in children should prompt consideration of hepatobiliary etiologies. Choledochal cysts may be missed on initial presentation as...

Status Epilepticus in a Patient Prescribed Theophylline: A Case Report

Tue, 6 Oct 2026 00:00:00 +0000

Introduction: Seizures are a frequent reason for emergency department (ED) evaluation, and new-onset events carry a wide differential in which medication toxicity can be overlooked. Toxicity from seldomly prescribed drugs, such as theophylline, can be particularly challenging to recognize because they can cause nonspecific adverse effects, including palpitations, nausea, vomiting, and seizures. Although theophylline use was widespread in the 1980s, current prescribing patterns are unknown. Nevertheless, theophylline toxicity continues to result in ED visits and poison center calls. Because adverse effects may be acute or chronic, identifying theophylline toxicity remains difficult.

Case Report: A 74-year-old woman presented to the ED with status epilepticus. After thorough history and extensive medical work-up, medication toxicity was suspected as the cause of her seizures. Upon further investigation, the patient was found...

Intracardiac Placement of Needle Thoracostomy Catheter by Paramedics Due to Anatomic Variation: A Case Report

Tue, 6 Oct 2026 00:00:00 +0000

Introduction: Needle thoracostomy is the only procedure in the United States for paramedic treatment of suspected tension pneumothorax within the most recent emergency medical services (EMS) national scope of practice model. We present a rare complication of an out-of-hospital left needle thoracostomy performed by paramedics after intracardiac placement of the catheter. The patient’s imaging studies in the receiving emergency department (ED) confirmed that the needle thoracostomy insertion location was correct, but the catheter entered the heart due to the patient’s existing atypical anatomy.

Case Report: A 64-year-old unrestrained male driver in a roll-over motor vehicle accident was found in respiratory distress with difficulty auscultating left-sided lung sounds, left chest wall pain on palpation, and confusion. The first-arriving paramedics performed a left needle thoracostomy for suspected tension pneumothorax in advance of...

Case Report of Orthopedic Screw Migration Presenting as Abdominal Pain in the Emergency Department

Tue, 6 Oct 2026 00:00:00 +0000

Introduction: Hip fractures are a concern in older adults, with incidence expected to rise as the population ages. Despite advances in surgical technique and hardware design, complications remain, influenced by patient factors and surgical choices. Rarely, hardware migration into the pelvis occurs, which poses serious risks. In the emergency setting, abdominal pain is a common complaint, and when evaluating patients with complex histories or prior orthopedic surgeries, clinicians must maintain a broad differential. This case details the discovery of a medially displaced hip screw into the pelvis as the cause of abdominal pain in a patient in the emergency department (ED).

Case Report: A 44-year-old female with end stage renal disease on hemodialysis, anemia, and osteoporosis presented to the ED with sudden-onset, bilateral lower quadrant abdominal pain, vomiting, and diarrhea. The patient reported undergoing left hip open reduction and...

Polysubstance-Induced Vasoplegia Managed with Venoarterial Extracorporeal Membrane Oxygenation: A Case Report

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: While the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) becomes increasingly commonplace in overdose, questions about its role in various shock states remain. The application of VA-ECMO with impaired myocardial function is well established, and use in cardiogenic shock precipitated by poisoning has continued to increase. In poison-induced vasoplegia with preserved myocardial function, the role of VA-ECMO remains undefined. Many atypical antipsychotic and antidepressant agents are known to cause mild hypotension via alpha-1 adrenergic blockade. Intravenous fluids and vasopressors alone are generally effective for single-substance ingestions. In the setting of polysubstance intoxication, synergism leading to bradycardia and refractory vasoplegia refractory to conventional therapies may result, prompting consideration for extracorporeal support.

Case Report: A 71-year-old woman presented to the emergency...

Idiopathic Left Anterior Fascicular Ventricular Tachycardia in the Emergency Department: A Case Report

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Idiopathic fascicular ventricular tachycardia is a rare form of ventricular tachycardia that is commonly seen in young, otherwise healthy individuals without structural heart disease. This rhythm can be difficult to distinguish from other forms of tachyarrhythmia, including supraventricular tachycardia, yet acute pharmacologic management of this condition varies significantly from more common forms.

Case Report: We describe a 42-year-old woman with no cardiac history who presented with palpitations and lightheadedness. She was found to be in a hemodynamically stable, wide-complex tachycardia. Given no prior cardiac history, supraventricular tachycardia with aberrancy was initially considered as a leading diagnosis; however, a trial of adenosine and lidocaine was ineffective. Her electrocardiogram revealed a regular wide complex tachycardia at 262 beats per minute with a right bundle branch block morphology and right axis...

Mechanical Small Bowel Obstruction Secondary to Deflated and Migrated Intragastric Balloon

Sat, 26 Sep 2026 00:00:00 +0000

Case presentation: A 29-year-old woman presented to the emergency department three months after intragastric balloon placement with nausea, vomiting, constipation, and abdominal pain. Computed tomography (CT) demonstrated spontaneous deflation and migration of the device into the small bowel with resultant mechanical small bowel obstruction. The patient was managed conservatively with bowel rest, intravenous fluids, electrolyte repletion, and nasogastric decompression. Repeat CT on hospital day 2 confirmed distal migration of the balloon into the descending colon with interval decompression of the small bowel. On hospital day 3, the patient reported spontaneous passage of the balloon per rectum with complete resolution of symptoms.

Discussion: Spontaneous deflation and distal migration of an intragastric balloon causing small bowel obstruction is a rare but potentially life-threatening complication. Most reported cases require surgical...

A Case Report of Meningitis due to Borrelia Species in Arizona

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Lyme disease is most prevalent in the Northeast and Midwest regions of the United States, as well as northern California; however, cases have been reported in nonendemic areas, including the Southwestern United States. Atypical presentations or underreporting can cause delay in diagnosis.

Case Report: We present the case of a 22-year-old previously healthy man, who presented to our emergency department in metropolitan Phoenix with five days of headache, fever, meningismus, and photophobia, and later developed focal neurologic deficits consistent with Lyme meningitis. Cerebrospinal fluid was notable for lymphocytic pleocytosis, and Western blot for Borrelia burgdorferi Immunoglobulin-M antibodies was positive, which led us to Lyme meningitis as the unifying diagnosis. He was treated with intravenous ceftriaxone and his symptoms resolved.

Conclusion: This case highlights the importance...

Atypical Presentation of Extensive Stanford Type A Aortic Dissection Initially Misattributed to Aspiration Pneumonia: A Case Report

Sun, 20 Sep 2026 00:00:00 +0000

Introduction: Acute aortic dissection is a life-threatening emergency that may present with nonspecific symptoms, particularly in older adults, leading clinicians to anchor on more common diagnoses.

Case Report: An 85-year-old man presented with four days of cough, weakness, and constipation after a recent emergency department (ED) visit due to food impaction after he choked on a carrot. A chest radiograph obtained the day before admission showed left basal consolidation, prompting referral for suspected aspiration pneumonia. In the ED, he appeared comfortable with no complaints of chest pain. Physical examination noted mild tachycardia and wheezes bilaterally and treatment was initiated with antibiotics and bronchodilators. A low-voltage electrocardiogram led to immediate point-of-care echocardiography, which demonstrated a large circumferential pericardial effusion, a markedly dilated aortic root, and right ventricular collapse. Computed...

Exercise-Induced Diaphragmatic Rupture with Intrathoracic Gastric Herniation: A Case Report

Sun, 20 Sep 2026 00:00:00 +0000

Introduction: While abdominal pain is a common complaint in the emergency department (ED), it is key to obtain a diligent history and maintain a broad differential diagnosis. The development of exercise-induced diaphragmatic hernia is rare but can result in a high risk of morbidity and mortality.

Case Report: This is a case of a 24-year-old man who presented to the ED with acute-onset epigastric abdominal pain that began while performing “burpee” (squat thrust) exercises. Computed tomography of the abdomen and pelvis revealed diaphragmatic rupture with gastric herniation into the left hemithorax. The patient underwent emergent surgical intervention to reduce the intra-abdominal contents and repair the diaphragmatic defect.

Conclusion: There are no prior reports of diaphragmatic hernia due to burpee exercises in the emergency medicine literature. Consideration of exercise-induced diaphragmatic hernia is necessary...

Prehospital Ultrasound to Identify Endotracheal Tube Dislodgment in an Infant: A Case Report

Sun, 20 Sep 2026 00:00:00 +0000

Introduction: Point-of-care ultrasound (POCUS) is well established as a useful adjunct for airway management in both adult and pediatric patients, including confirmation of successful endotracheal intubation. While suprasternal ultrasound of the trachea is the most described method for confirming endotracheal tube (ETT) placement, a focused lung exam can be used to rapidly identify appropriate ventilation in otherwise apneic patients.

Case Report: This case involves a one-month-old male infant who experienced an out-of-hospital cardiac arrest secondary to suspected sudden infant death syndrome. During resuscitation, an accidental extubation occurred after an attempt at securing the ETT with a commercial pediatric tube holder. Loss of end-tidal carbon dioxide (ETCO2) waveform was recognized immediately; however, emergency medical services clinicians questioned the device’s accuracy due to earlier failures of the ETCO2 monitor and the...

Locked-In Syndrome from Delayed Vertebral Artery Dissection After Strangulation: A Case Report

Sun, 20 Sep 2026 00:00:00 +0000

Introduction: Vertebral artery dissection is a rare but life-threatening complication of strangulation. Symptoms are often nonspecific and may not manifest immediately, complicating diagnosis. If prior neck trauma is not elicited during assessment, clinicians may miss a mechanistic link to prompt vascular imaging, leaving patients at risk for irreversible outcomes, as illustrated in this case.

Case Report: A 24-year-old woman presented to a critical access emergency department (ED) with nonspecific neurological symptoms that had largely resolved upon arrival. Her only reported history was vague head and neck pain, which she attributed to stress after leaving an abusive relationship several weeks earlier. Hours later, while still in the ED, the patient experienced abrupt neurological deterioration. She was transferred to a regional medical center, where magnetic resonance imaging eventually revealed vertebral artery dissection...

Subacute Microperforation of Right Atrial Pacemaker Lead Presenting with Shock due to Cardiac Tamponade: A Case Report

Sun, 20 Sep 2026 00:00:00 +0000

Introduction: Delayed cardiac tamponade is a rare but life-threatening complication following permanent pacemaker placement and may present with non-specific symptoms.

Case Report: We report the case of a 66-year-old woman on oral anticoagulation who presented with generalized weakness, nausea, and profound hypotension four days after dual-chamber pacemaker placement. Initial evaluation demonstrated atrial fibrillation with rapid ventricular response, a normal chest radiographic findings, prerenal azotemia, and no evidence of device malfunction on interrogation. Point-of-care ultrasound (POCUS) performed in the emergency department revealed a large pericardial effusion with right atrial and right ventricular collapse and a plethoric inferior vena cava, consistent with cardiac tamponade. Emergent pericardiocentesis yielded 400 mL of sanguinous pericardial fluid with rapid hemodynamic improvement. Subsequent imaging revealed a 2-mm...

Acute Dystonia Following Ifosfamide Infusion in a Young Woman with Breast Angiosarcoma: A Case Report

Sun, 20 Sep 2026 00:00:00 +0000

Introduction: Ifosfamide is an alkylating chemotherapeutic agent commonly used in the treatment of sarcomas and other malignancies. Neurotoxicity is a recognized adverse effect, most often presenting as encephalopathy. Acute movement disorders such as dystonia are rare and may be underrecognized in the emergency department.

Case Report: We report a 22-year-old woman receiving combination chemotherapy with doxorubicin, ifosfamide, and mesna for breast angiosarcoma who developed acute right-sided neck spasms and involuntary movements within five minutes of initiating ifosfamide infusion. Vital signs were as follows: temperature, 98.0 degrees Fahrenheit; heart rate, 97 beats per minute; respiratory rate, 18 breaths per minute; blood pressure, 130/88 millimeters of mercury; and oxygen saturation, 99% on room air. Examination revealed sustained contraction of the right sternocleidomastoid and trapezius muscles with involuntary head deviation....

From Staple Removal to Startle—The Unexpected Discovery of a Scalp Pseudoaneurysm: A Case Report

Sun, 20 Sep 2026 00:00:00 +0000

Introduction: Point-of-care ultrasound (POCUS) allows emergency physicians to rapidly diagnose vascular abnormalities, including pseudoaneurysms. Although commonly identified following vascular catheterization, traumatic pseudoaneurysms of superficial scalp arteries are rare.

Case Report: An 85-year-old woman receiving anticoagulation presented to the emergency department (ED) for removal of a scalp staple placed during treatment of a previously bleeding scalp wound. Physical examination revealed a persistent scalp hematoma. Point-of-care ultrasound demonstrated a hypoechoic collection with Doppler flow consistent with a pseudoaneurysm. Computed tomography angiography confirmed the diagnosis. Ultrasound-guided compression attempted in the ED resulted only in transient thrombosis. The patient subsequently underwent elective percutaneous embolization.

Conclusion: Emergency physician–performed POCUS can rapidly identify...

Luxatio Erecta with Complex Medical Decision-Making Regarding Reduction: A Case Report

Tue, 8 Sep 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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.

Conclusion: 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.

Gaze-Evoked Vomiting After Minor Orbital Trauma: White-Eyed Blowout Fracture

Tue, 8 Sep 2026 00:00:00 +0000

Case Presentation: 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...

Subarachnoid Pneumocephalus Following Endoscopic Transsphenoidal Surgery

Tue, 8 Sep 2026 00:00:00 +0000

Case Presentation: 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.

Discussion: 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.

Medicolegal Pitfalls in Management of Shoulder Dislocations: A Case Series

Tue, 8 Sep 2026 00:00:00 +0000

Introduction: 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.

Case Series: 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.

Conclusion: 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...

Bezold Abscess: A Case Report

Tue, 8 Sep 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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.

Conclusion: 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...

The Stellate Ganglion Nerve Block—A Novel Use for Electrical Storm in the Emergency Department: A Case Report

Tue, 8 Sep 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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.

Conclusion: 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.

Inferior Vena Cava Cement Migration with Pulmonary Cement Embolism: A Case Report

Tue, 8 Sep 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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....

Observation Unit Management of Older Adults with Rib Fractures: A Case Series

Mon, 31 Aug 2026 00:00:00 +0000

Introduction: 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.

Case Series: 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.

Conclusion: Carefully selected older adults with rib fractures...

Prehospital Cold-Water Immersion for Undifferentiated Heat Stroke: A Case Series

Mon, 31 Aug 2026 00:00:00 +0000

Introduction: 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.

Case Series: 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.

Conclusion: Rapid initiation and maintenance of prehospital cold-water immersion in undifferentiated...

Tension Pneumopericardium from a Gastrojejunal-Pericardial Fistula Causing Tamponade: A Case Report

Mon, 31 Aug 2026 00:00:00 +0000

Introduction: Cardiac tamponade typically develops from the accumulation of blood and other fluids, although it can occur from pneumopericardium.

Case Report: 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.

Conclusion: 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.

Unna Boot Therapy Reduces Emergency Department Use in an Unhoused Patient: A Case Report

Mon, 31 Aug 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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.

Conclusion: Emergency department-initiated compression therapy with structured wound care referral may reduce recurrent ED use among unhoused patients with venous leg ulcers.

Amphetamine-induced Reverse Takotsubo Syndrome: Further Implications

Mon, 31 Aug 2026 00:00:00 +0000

Amphetamine-induced Reverse Takotsubo Syndrome: Further Implications

Soft Palate Perforation with Endotracheal Tube During Video Laryngoscopy

Mon, 31 Aug 2026 00:00:00 +0000

Case presentation: 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.

Discussion: 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...

Primary Group A Streptococcus Peritonitis in a Healthy Child: A Case Report

Mon, 31 Aug 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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.

Conclusion: This case highlights a rare presentation of invasive GAS as primary peritonitis in a healthy child. Clinicians should consider this...

A Case Report of Spontaneous Pneumomediastinum Following Chest Massage: A Rare Clinical Presentation

Mon, 31 Aug 2026 00:00:00 +0000

Introduction: 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.

Case Report: 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.

Conclusion: Early recognition of spontaneous pneumomediastinum in emergency settings is crucial, especially when chest pain is accompanied by subcutaneous...

Purulent Pericarditis Identified with Point-of-Care Echocardiography: A Case Report

Mon, 24 Aug 2026 00:00:00 +0000

Introduction: 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.

Case Report: A 55-year-old male presented with chest pain and dyspnea and was found to have cardiac tamponade secondary to purulent pericarditis.

Conclusion: 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...

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