Clinical Practice and Cases in Emergency Medicine

Introduction: The use of telemedicine and ultrasound is emerging and novel in the ﬁeld of community paramedicine. However, there is a paucity of data supporting its use and even less evidence that shows a morbidity and mortality beneﬁt. This case highlights a unique way to diagnose a common medical emergency, which can lead to a good outcome. Case Report: We describe the use of lung point-of-care ultrasound by a trained community paramedic that led to the identiﬁcation of a pneumothorax in an 86-year-old male at a scheduled home visit. The images were interpreted over telehealth in real-time by an emergency physician, and the patient was transported to the emergency department where the diagnosis was conﬁrmed by chest radiography. He underwent chest tube placement and was discharged ﬁve days later after returning to his baseline. Conclusion: Despite minimal data to support or refute the use of paramedic tele-ultrasound, this case highlights a unique opportunity to expand the use of telemedicine and ultrasound in community paramedicine to improve patient outcomes.

Shriman Balasubramanian

Michael Defilippo

Michael Stone

Gabriela Galli

Matthew McCarty

Brock Daniels

Pneumothorax Identified by a Remote Physician Using Paramedic-obtained Tele-ultrasound: Case Report

远程医生使用急救人员获得的远程超声诊断气胸：病例报告

Case Presentation: A 33 year old female with a history of antiphospholipid syndrome presented with exertional chest pain and ST-elevation in aVR with diffuse ST-depression. An emergent catheterization was performed which showed an isolated 99% stenosis in the left main coronary artery. The remaining coronary arteries were without any stenosis. Successful stent placement was performed, and the patient was discharged without complications. Discussion: Previous guidelines suggested that ST-elevation with diffuse ST-depression should be treated as a STEMI-equivalent involving the left-main or proximal left anterior descending coronary artery. However recent data suggests that the majority of these cases may not involve that territory. Regardless, this ECG finding should still be concern for acute coronary syndrome with the need for urgent catheterization.

Bruce M Lo

Megyn K Christensen

Katherine Schaffer

Theodore J Tzavaras

ST-elevation in aVR with Diffuse ST-segment Depression: Need for Urgent Catheterization?

aVR导联ST段抬高伴广泛ST段压低：是否需要紧急导管介入？

Introduction: Obstructive shock results from reduced cardiac output due to physical blockage of blood flow, such as cardiac tamponade. Cardiac tamponade compresses cardiac chambers, particularly the left atrium, causing decreased end-diastolic volume and cardiac output. Rapid fluid accumulation within the pericardial sac is the usual cause. Transesophageal echocardiography provides clearer visualization of these structures than transthoracic ultrasound. This case underlines the impact of esophageal pathology on cardiac output and highlights ultrasound’s dynamic diagnostic utility alongside computed tomography. Case Report: A 64-year-old female with a history of colon cancer and peritoneal metastases status post colostomy presented with altered mental status and urinary symptoms. Laboratory evaluation was notable for leukopenia, hypoglycemia, elevated ammonia, and an abnormal urinalysis that was positive for urinary tract infection. She was initially admitted to the internal medicine service for sepsis secondary to urine as the source of infection. During her hospital stay, she developed hypotension, tachypnea, tachycardia, and complained of chest pressure. Point-of-care echocardiogram revealed compression of the left atrium by distended gastric and esophageal contents. A nasogastric tube was placed and suctioned partially digested food and liquid with improvement of her condition. Follow-up ultrasound showed improvement of compression and cardiac function. Conclusion: In evaluation of acute shock, multiple etiologies must be considered. In this case, the cause of reduced cardiac output was direct compression of the left atrium from an adjacent structure. Even with direct visualization and imaging, immediate history and patient-centered approach are still useful to complete the clinical picture and treat the reversible cause of undifferentiated shock.

Sharmin Kalam

Sergio Marquez

Emmelyn Samones

Tammy Phan

Vi Dinh

A Case Report of Obstructive Shock from an Esophageal Bolus Leading to Left Atrial Compression

食管异物导致左心房受压引发阻塞性休克的病例报告

Introduction: A pericapsular nerve group (PENG) block is unique compared to other regional anesthetic techniques (femoral nerve and fascia iliaca blocks) because it is a motor-sparing block. It also provides anesthesia to more nerves that innervate the anterior capsule of the femoroacetabular joint when compared to the femoral nerve and fascia iliaca blocks. Additionally, regional anesthesia carries fewer risks and requires less resources when compared with procedural sedation, which is the typical method for reducing a dislocated femoroacetabular joint. Case Report: We describe a novel case in which a PENG block was used in the emergency department (ED) to reduce a prosthetic hip dislocation. Conclusion: The PENG block is a safe and effective method of achieving sufficient analgesia to reduce prosthetic hips in the ED.

Rebecca Thomas

Matthew Carr

Janae Fry

Taryn Hoffman

Pericapsular Nerve Group Block for Prosthetic Hip Reduction in the Emergency Department: Case Report

急诊科假体髋关节复位术中的囊周神经丛阻滞：病例报告

Case Presentation: We describe a case of persistent odynophagia due to a retained foreign body 27 days after emergent intubation. Discussion: Dentures constitute a potential esophageal foreign body and warrant special consideration during airway management. Odynophagia, dysphagia, and changes in phonation should prompt consideration of retained esophageal foreign bodies, especially in the post-intubation setting.

Richard White

Kaitlyn Mander

Christian Koziatek

Sanjay Mohan

Persistent Odynophagia 27 Days After Emergent Intubation

紧急插管后27天持续性吞咽困难

Introduction: Penile pain in children and adolescents is an uncommon presenting symptom in the emergency department (ED). The differential diagnosis includes trauma, priapism, urethral stone, infection, Mondor disease, Peyronie disease, and thrombosis. Case Report: A 15-year-old male with a high-risk, B-cell acute lymphocytic leukemia and recent pegaspargase administration presented to the ED with new-onset penile pain. After the administration of opioid analgesics, he developed hypoxia prompting an urgent computed tomography pulmonary angiogram that revealed bilateral segmental acute pulmonary embolism (PE). Ultrasound of the penis revealed findings consistent with superficial dorsal vein thrombosis of the penis. Conclusion: To our knowledge, this is the first case report of an adolescent with superficial dorsal vein thrombosis of the penis and a coexisting PE. Doppler ultrasound can provide a prompt assessment of penile induration and differentiate venous thrombosis from other causes.

Tomas Leng

Jason H. Homme

Jana Anderson

Superficial Dorsal Vein Thrombosis of the Penis and Pulmonary Embolism in a 15-year-old Boy: A Case Report

15岁男孩阴茎浅表背静脉血栓形成及肺栓塞病例报告

Publication Information	Publisher: University of California, Irvine - Department of Emergency Medicine，Publishing cycle: ，Journal Type: journal，Open Access Journals: Yes
Basic data	Year of publication: 2021，Proportion of original research papers: 0.00%，Self Citation Rate:N.A.， Gold OA Rate: 0.00%
Journal Fees	$500Details
Average review cycle	网友分享经验：21 Weeks

Clinical Practice and Cases in Emergency Medicine

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Pneumothorax Identified by a Remote Physician Using Paramedic-obtained Tele-ultrasound: Case Report

ST-elevation in aVR with Diffuse ST-segment Depression: Need for Urgent Catheterization?

A Case Report of Obstructive Shock from an Esophageal Bolus Leading to Left Atrial Compression

Pericapsular Nerve Group Block for Prosthetic Hip Reduction in the Emergency Department: Case Report

Persistent Odynophagia 27 Days After Emergent Intubation

ST-elevation in aVR with Diffuse ST-segment Depression: Need for Urgent Catheterization?

Pericapsular Nerve Group Block for Prosthetic Hip Reduction in the Emergency Department: Case Report

Persistent Odynophagia 27 Days After Emergent Intubation

A Case Report of Obstructive Shock from an Esophageal Bolus Leading to Left Atrial Compression

Superficial Dorsal Vein Thrombosis of the Penis and Pulmonary Embolism in a 15-year-old Boy: A Case Report

ISSN	2474-252X
h-index	7