Isolated Interrupted Aortic Arch: A Case Report and Review of the Literature

An 18-years-old male presented to emergency department after a car accident with the diagnosis of femoral bone fracture. Arterial blood pressure was 160/90 mmHg in both arms. Bilateral femoral and popliteal pulses were extremely weak and there was systolic ejection murmur on the left second intercostals area. Chest X-ray showed rib notching with normal cardiac silhouette. Transthoracic echocardiography showed the aortic interruption just below the left subclavian artery. Aortography showed a complete interruption of the aortic arch (IAA) just distal to the origin of the left subclavian artery. Femoral bone fracture was treated by conservative strategy. A gadolinium contrast-enhanced magnetic resonance angiogram (1.5 T scanners) clearly reaffirmed a complete interruption of the descending aorta, 3.6 cm from the left subclavian artery with extensive collateralizations. Mild degree hypertension was controlled by a long acting calcium channel blocker. Later the patient has been scheduled for elective surgical repair. We aimed to discuss the diagnostic and treatment options of the interrupted aortic arch as being a rare anomaly.     

Racial and Socioeconomic Disparities in the Presence of Acute Type A Aortic Dissections

Nonadherence to hypertensive medications is the most common predisposing factor associated with acute aortic dissections. Acute dissections are more likely to occur in African Americans due to higher rates of uncontrolled hypertension. Through a patient case study, the effects of racial and socioeconomic disparities will be illustrated. Through discussing the case of a 39-year-old African American man who presented with hypertensive crisis and nonadherence to hypertension treatment resulting in the diagnosis of an acute aortic dissection. His case exemplifies the effect of health disparities on postoperative outcomes, morbidity, and mortality in the African American population diagnosed with aortic dissections.     

Overwhelming Post-Splenectomy Infection (OPSI): A Case Report and Review of the Literature

Background

Overwhelming post-splenectomy infection (OPSI) is a serious disease that can progress from a mild flu-like illness to fulminant sepsis in a short time period. Although relatively rare, it has a high mortality rate with delayed or inadequate treatment, and therefore, it is important for Emergency Physicians to be familiar with it. Patients who are asplenic or hyposplenic are at an increased risk for infection and death from encapsulated organisms and other dangerous pathogens.

Objectives

There is an abundance of literature discussing OPSI from the perspective of hematologists and infectious disease specialists, but an Emergency Medicine perspective is necessary to truly understand the acute nature of the disease. The objective of this article is to present a careful examination of the literature with a focus on early diagnosis and management to provide Emergency Physicians with the ability to positively affect outcomes of this deadly disease.

Case Report

We present the case of a well-appearing 5-month-old girl with congenital asplenia who presented to the Emergency Department with fever, and rapidly progressed to septic shock as a result of OPSI. Aggressive resuscitation was initiated, including empiric antibiotics, and after a prolonged hospital course in the pediatric intensive care unit, the child recovered.

Conclusion

Rapid identification of patients at risk for OPSI, followed by administration of intravenous antibiotics, usually vancomycin and ceftriaxone, combined with early goal-directed therapy, are the keys to successful treatment. If initiated early in the patient's course, the 70% mortality rate can be reduced to the 10–40% range.     

Acute Respiratory Failure during Routine Blood Transfusion: A Case Report and Review of the Literature

Background

Transfusion medicine is a common practice in the emergency department (ED) and other outpatient settings, and may be complicated by a low rate of potentially fatal transfusion-related reactions.

Objectives

This article presents a case of transfusion-related acute lung injury (TRALI) diagnosed and treated in the ED and reviews the differential diagnosis of acute transfusion reactions.

Case Report

A 74-year-old woman presented to the ED from the hospital's transfusion center with fever and respiratory distress immediately after the start of her second unit of red blood cell transfusion. Chest radiograph demonstrated a pattern consistent with acute respiratory distress syndrome (ARDS). After 48 h of respiratory support and antibiotic therapy, the patient's condition improved.

Conclusion

TRALI is a clinical diagnosis with presentation similar to that of ARDS. Prompt differentiation from other transfusion reactions and initiation of appropriate treatment is crucial in minimizing the morbidity and mortality associated with this syndrome.     

Immediate aortic dissection after transcatheter aortic valve replacement: A case report and review of the literature

‐Aortic dissection of descending aorta was detected by intraoperative TEE in a case of 67‐year‐old man with symptomatic severe aortic stenosis after TAVR.‐Transesophageal echocardiogram after TAVR procedure is helpful to detect this rare complication.     

Acute Spontaneous Subdural Hematoma in a Middle-Aged Adult: Case Report and Review of the Literature

Background

Acute spontaneous subdural hematomas (ASSDH) occur by a variety of pathological processes and are less common than trauma-related acute subdural hematomas (SDH). Both types are usually seen in the elderly, and only 22 cases of ASSDH in patients aged < 40 years have been reported in the medical literature. Objectives: We report a rare case of ASSDH in a middle-aged male with no previous history of head trauma. A literature review comparing the clinical presentations, etiologies, incidence, mortality rates, and prognostic factors of ASSDH in various age groups is discussed.

Case Report

A 37-year-old man presented to the Emergency Department with headaches, myalgias, and vomiting. Noncontrast computed tomography revealed a unilateral ASSDH with 9 mm of midline shift, despite a normal neurological examination. Upon admission, the patient developed an abducens palsy suggesting increased intracranial pressure and underwent an urgent hemicraniectomy. Pathological sampling revealed large atypical cells indicative of a hematopoietic neoplasm, but various advanced imaging modalities failed to identify signs of cerebral tumor, vascular malformation, or arterial extravasation.

Conclusion

Given the rarity of SDH in nonelderly patients, this case suggests a broader differential diagnosis for nontraumatic headaches to include arterial and even neoplastic origins. Our literature review confirms the paucity of reported incidences of ASSDH, yet reminds medical providers to closely monitor for developing neurological symptoms and initiate prompt medical intervention when necessary.     

Screening,Brief Intervention,and Referral to Treatment by Emergency Nurses: A Review of the Literature

Introduction

Emergency nurses could assume a unique role in the screening process and provide patient education regarding the consequences of harmful alcohol use. Screening, brief intervention, and referral to treatment is an evidence-based method used to identify drinking behaviors that may have a negative impact on people's lives and reduce abuse or dependence on alcohol.

氟达拉宾治疗慢性淋巴细胞白血病诱发嗜酸细胞增多症1例报告并文献复习

目的:探讨氟达拉宾治疗慢性淋巴细胞白血病(CLL)诱发嗜酸细胞增多症的临床特点、诊断及治疗方法,减少误诊误治的发生。方法:总结1例诊断及治疗经过,结合文献对临床特点进行复习。结果:此病多发生在用药后2.4个疗程,大多无症状,少数患者发生皮损,皮损重者可应用激素及抗组胺药治疗。结论:氟达拉宾及2-氯脱氧腺苷(2-CdA)治疗淋巴增殖性疾病可诱发嗜酸细胞增多症,用药期间监测血象有助于早期诊断。     

Use of an Impedance Threshold Device to Treat Severe Hypotension in a Pregnant Woman: Case Report and Review of the Literature

Background

Impedance threshold device technology harnesses the patient's normal physiological mechanisms to increase circulation during hypotensive crises. We report the first clinical use of one version of this device on a spontaneously breathing hypotensive pregnant woman.

Objective

The objective of our study was to report this case to help Emergency Medical Service rescue personnel to noninvasively treat hypotensive but conscious spontaneously breathing patients.

Case Report

A 28-year-old woman who was 21 weeks pregnant developed frank syncope at home but recovered spontaneously. When Emergency Medical Service paramedics arrived, her initial blood pressure and heart rate were 115/80 mm Hg and 125 beats/min, respectively. She suddenly complained of feeling anxious and developed profound bradycardia and hypotension, followed by 20 s of asystole. An impedance threshold device (ResQGARD^TM) with −7 cmH₂O resistance to inspiration was rapidly applied using a facemask. After four spontaneous breaths, blood pressure increased from 62/40 mm Hg to 106/66 mm Hg. She was hemodynamically stable thereafter.

Conclusions

In this case report, the multiple physiological effects of inspiration through −7 cmH₂O resistance helped this pregnant hypotensive patient to rapidly and noninvasively restore adequate perfusion and reduced the duration of her hypotensive episode. To our knowledge, this is the first report of this technology in a pregnant hypotensive but spontaneously breathing patient.     

Recurrent Pulmonary Emboli Secondary to Right Atrial Thrombus Around a Permanent Pacing Catheter: A Case Report and Review of the Literature

This report describes the management of a woman with multiple pulmonary emboli secondary to a large right atrial clot which had formed around her permanent transvenous pacemaker. She continued to have pulmonary emboli despite adequate anticoagulation. Removal of the catheter and pacing required right atriotomy under cover of cardiopulmonary bypass. Additionally, eight English language case reports of symptomatic pericatheter thromboses are reviewed. In these cases, pericatheter clot resulted either in right-sided inlet obstruction or pulmonary emboli. The mortality rate was 75%. Although the cause for our patent's thromboembolic events is uncertain, congestive heart failure was a predisposing factor in 75% of the other reported cases. We suggest that pacemaker patients in congestive heart failure might benefit greatly from chronic anticoagulation.     

Effects of the Dietary Approaches to Stop Hypertension (DASH) on Pregnancy/Neonatal Outcomes and Maternal Glycemic Control: A Systematic Review and Meta-analysis of Randomized Clinical Trials

Background & objectiveNo systematic review to date has appraised the impact of the Dietary Approaches to Stop Hypertension (DASH) eating plan on maternal glycemic control and pregnancy outcomes. Thus, we conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) to ascertain whether the DASH diet in pregnant women ameliorates their glycemic control and neonatal outcomes when compared to standard diets.MethodsWe performed a comprehensive systematic review and meta-analysis of RCTs on PubMed/MEDLINE, Web of Science, SCOPUS, and Embase from the inception until October 2019.ResultsSix studies met the eligibility criteria and were included in the quantitative meta-analysis. The pregnant women had cardiometabolic disorders such as gestational diabetes, obesity, and hypertension. The meta-analysis suggested a significant effect of DASH diet on fasting plasma levels of glucose (WMD = -6.239 mg/dl; 95% CI: -11.915, -0.563, p = 0.031), but not for the homeostasis model assessment of insulin resistance (WMD = -1.038; 95% CI: -2.704, 0.627, p = 0.22). Following the DASH diet during pregnancy decreased the risk of gestational preeclampsia (RR = 0.667; 95% CI: 0.451, 0.987, p = 0.043), macrosomia (birth weight >4000 g) (RR = 0.294; 95% CI: 0.120, 0.721, p = 0.043), and large for gestational age (RR = 0.452; 95% CI: 0.211, 0.969, p = 0.041). Consuming DASH diet during pregnancy neither increased nor decreased the risk of cesarean section, polyhydramnios, preterm birth (<37 weeks), and small for gestational age. The mean newborn head circumference (cm) (WMD = -0.807; 95% CI: -1.283, -0.331, p = 0.001) and ponderal index (kg/m³) (RR = -0.396; 95% CI: -0.441, -0.350, p = 0.000) in the group receiving the DASH diet were lower than in the control group.ConclusionThe adherence of pregnant women with cardiometabolic disorders to DASH eating pattern has a significant effect on decreasing fasting plasma glucose levels, ponderal index, incidence of preeclampsia, fetal macrosomia, large for gestational age, and newborn head circumference.