an-approach-to-point-care-ultrasound-evaluation-abdominal

An Approach to Point-Of-Care Ultrasound Evaluation of the Abdominal Aorta

Disorders of the abdominal aorta, including aneurysms and dissection, have potentially high rates of morbidity and mortality. While computed tomography ...

The case of a 24-year-old athlete who presented with a syncopal episode after having run 25 miles in a marathon is reported. The patient was subsequently found to have significant elevations of troponin I, which remained detectable for 3 days. The patient remained asymptomatic during his 8-day hospitalization without other evidence of cardiac ischemia: studies included echocardiography and multiple gated acquisition (MUGA) scan. The current knowledge about elevation of troponin I unrelated to cardiac injury in endurance athletes is discussed.

Elevation of troponin I in athletes: a case report in a marathon runner.

The term supraventricular tachycardia (SVT) is used to describe tachydysrhythmias that require atrial or atrioventricular nodal tissue for their initiation and maintenance. SVT can be used to describe atrioventricular nodal reentry tachycardia, atrioventricular reentry tachycardia, and atrial tachycardia (AT). AT is the least common of these SVT subtypes, accounting for only 10% of cases. Although the suggested initial management of each SVT subtype is different, they all can present with similar symptoms and electrocardiographic findings.

Atrial tachycardia mimicking atrioventricular nodal reentry tachycardia.

Lemierre's syndrome is a condition characterized by thrombophlebitis of the internal jugular vein and bacteremia caused by primarily anaerobic organisms, following a recent oropharyngeal infection. This has been an uncommon illness in the era of antibiotic therapy, though it has been reported with increasing frequency in the past 15 years. Lemierre's syndrome should be suspected in young healthy patients with prolonged symptoms of pharyngitis followed by symptoms of septicemia or pneumonia, or an atypical lateral neck pain. Diagnosis is often confirmed by identification of thrombophlebitis of the internal jugular vein and growth of anaerobic bacteria on blood culture. Treatment involves prolonged antibiotic therapy occasionally combined with anticoagulation. We review the literature and a case of a child with Lemierre's syndrome.

Lemierre's syndrome.

Thiazide diuretics are commonly used as first-line antihypertensive agents. Hyponatremia is a reported, though uncommon, complication of thiazide use. Although the exact mechanism of thiazide-induced hyponatremia (TIH) is unclear, it can be a significant cause of morbidity and mortality.

Severe hyponatremia associated with thiazide diuretic use.

Intracranial subdural hematoma occurring as a result of a procedure that causes a puncture of the spinal dura mater is extremely rare, with less than 100 cases reported. Often, this condition is initially misdiagnosed and treated as a post dural puncture headache.

Intracranial subdural hematoma after epidural anesthesia: a case report and review of the literature.

The sodium-glucose cotransporter-2 (SGLT2) inhibitors are the newest class of anti-hyperglycemic medications used in the treatment of diabetes mellitus. Their increasing use has been driven by their apparent cardiovascular and renal benefits. They have been associated with a small but significantly increased risk of diabetic ketoacidosis (DKA). Many of the cases of DKA associated with SGLT2 inhibitor use present with normal or minimally elevated serum glucose levels, often delaying the diagnosis.

Euglycemic diabetic ketoacidosis associated with sodium-glucose cotransporter-2 inhibitor use: a case report and review of the literature.

Paroxysmal supraventricular tachycardia (PSVT) is one of the more common arrhythmias requiring treatment in the emergency department. Intravenous adenosine is recommended as the initial medication of choice for treatment of PSVT, given in escalating doses up to a maximum of 12 mg. With a serum half-life of less than 10 s, adenosine must be given rapidly to allow for adequate time for it to reach the heart via venous return. In over 10% of adult patients, PSVT will not be terminated with maximum doses of adenosine. We report a case of a patient requiring a higher-than recommended dose of adenosine for termination of PSVT. The patient had a history of pulmonary hypertension with resultant right heart failure at the time of presentation. We believe the higher dose of adenosine was necessary in this patient because of the impaired venous return to her right heart. This case indicates that patients with impaired venous return to the right heart may require higher-than-recommended doses of adenosine for effective termination of PSVT.

High-dose adenosine for treatment of refractory paroxysmal supraventricular tachycardia.

Ruptured abdominal aortic aneurysm (AAA) is a highly lethal condition which requires rapid identification and treatment to improve the chance of survival. Computed tomography is the diagnostic modality of choice for ruptured AAA though it is time-consuming and often requires movement of the patient out of the emergency department (ED). Point-of-care ultrasound in the ED has excellent sensitivity and specificity for the detection of AAA, though less is known about its use to diagnose AAA rupture. We report a case of ruptured AAA identified on ultrasound performed at the bedside in the ED.

Ruptured abdominal aortic aneurysm identified on point-of-care ultrasound in the emergency department.

Dermal sinus tracts (DSTs) are rare congenital defects occurring along the cranial spinal axis. They may extend from the skin into the deeper structures of the central nervous system. While most DSTs remain clinically occult, they can provide a route of entry for skin pathogens to cause intracranial infection. We report a child with a recent history of fever of unknown etiology who presented to our emergency department with a subcutaneous occipital mass. She was ultimately diagnosed with an infected intracranial dermal sinus tract. In this report, we provide a review of the literature on the diagnosis and management of this unique entity.

Infected intracranial dermal sinus tract in a child.

Mycoplasma pneumoniae-induced rash and mucositis (MIRM) is a recently defined clinical entity characterized by pneumonia caused by M. pneumoniae with associated mucositis and frequent cutaneous lesions of a characteristic pattern. Although often similar in presentation, MIRM has distinct clinical and histologic features that are different from erythema multiforme and Stevens-Johnson syndrome/toxic epidermal necrolysis. We report a case of MIRM in a nine-year-old boy.

Mycoplasma pneumoniae-induced rash and mucositis.

Thrombotic microangiopathies are a diverse group of clinical syndromes characterized by microangiographic hemolytic anemia, thrombocytopenia, and organ dysfunction. We report a unique case of thrombotic microangiopathy in an adult caused by vitamin B12 deficiency that presented with stroke-like symptoms.

Thrombotic microangiopathy presenting with stroke-like symptoms.

Copper deficiency is an uncommon condition primarily affecting the hematologic and neurologic systems. We report a unique case of severe anemia in a patient with copper deficiency caused by zinc supplement use.

Article	Year
Elevation of troponin I in athletes: a case report in a marathon runner. The Journal of emergency medicine\| PubMed ID: 17976796	2008
Atrial tachycardia mimicking atrioventricular nodal reentry tachycardia. The Journal of emergency medicine\| PubMed ID: 23466023	2013
Lemierre's syndrome. International journal of emergency medicine\| PubMed ID: 24152679	2013
Severe hyponatremia associated with thiazide diuretic use. The Journal of emergency medicine\| PubMed ID: 25499401	2015
Intracranial subdural hematoma after epidural anesthesia: a case report and review of the literature. International journal of emergency medicine\| PubMed ID: 31179908	2018
Euglycemic diabetic ketoacidosis associated with sodium-glucose cotransporter-2 inhibitor use: a case report and review of the literature. International journal of emergency medicine\| PubMed ID: 31488052	2019
High-dose adenosine for treatment of refractory paroxysmal supraventricular tachycardia. The American journal of emergency medicine\| PubMed ID: 32278568	2020
Ruptured abdominal aortic aneurysm identified on point-of-care ultrasound in the emergency department. International journal of emergency medicine\| PubMed ID: 32410576	2020
Infected intracranial dermal sinus tract in a child. The American journal of emergency medicine\| PubMed ID: 34144262	2021
Mycoplasma pneumoniae-induced rash and mucositis. The American journal of emergency medicine\| PubMed ID: 34642080	2022
Thrombotic microangiopathy presenting with stroke-like symptoms. The American journal of emergency medicine\| PubMed ID: 35094883	2022
Severe copper deficiency anemia caused by zinc supplement use. The American journal of emergency medicine\| PubMed ID: 37640593	2023

Wesley Eilbert

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