Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons^™

Case Report: Overdrive Pacing In Refractory Ventricular Tachycardia, Alyssa A. Baldini, Kishan Patel

Rowan-Virtua Research Day

We report a case of a 67-year-old male who presented to the emergency department (ED) for palpitations and complaint of his automated implantable cardioverter defibrillator (AICD) firing at home who had multiple episodes of persistent ventricular tachycardia (VT) during his course of stay in the ED. Patients with pacemakers and AICDs can present an additional layer of complexity when treating these conditions. Temporary overdrive pacing (TOP) should be considered as a treatment to correct refractory ventricular tachycardia in patients with implanted pacemakers and AICDs presenting to the ED.

A Case Of Esophagogastric Junction Outflow Obstruction Resulting To Megaesophagus In A 37-Year-Old Male, Dean Esma, Robin Lahr, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Esophagogastric junction outflow obstruction (EGJOO) is a major motility disorder characterized by an increase of > 15 mmHg in the integrated relaxation pressure (IRP) with or without problems in esophageal motility. This presents as dysphagia, chest pain, regurgitation, heartburn, cough, and a globus sensation, with dysphagia. Severe cases may lead to a megaesophagus causing compression of mediastinal structures.6 Its similarity to other esophageal disorders urge an investigation to improve its identification and treatment. This report presents a case of EGJOO in a 37-year-old cachectic male patient with dysphagia and vomiting, eventually determined to be EGJOO with diagnostic manometry.

Case Report: Wellens Syndrome In 28-Year-Old With Pleuritic Chest Pain, Tucker A. Ledo

Rowan-Virtua Research Day

We report a case of a 28-year-old male with months of diffuse, pleuritic, intermittent, non-exertional chest pain. He had an elevated troponin and ECG showing Wellens’ syndrome and was found to have 80% LAD coronary artery occlusion and 100% apical occlusion. Identification and proper management of Wellens’ syndrome relies on being familiar with its ECG patterns. Other information such as age, cardiac risk factors, chest pain with exertion and at rest, and elevated troponin, are all helpful supplemental information, but as demonstrated in the following case report, presentations may vary or even cause as distractors to the diagnosis.

Case Report: An Emergency Department Presentation Of An Ovarian Teratoma, David Marconi, Zamron Masih

Rowan-Virtua Research Day

A teratoma (from the Greek terato for “monster” and onkoma for “mass” or “swelling”) is a type of neoplasm composed of tissues from two or three germ layers. Mature cystic teratomas (MCTs) constitute 70% of all ovarian neoplasms. They typically present with nonspecific symptoms such as pain and nausea. They account for approximately 2% of all primary ovarian malignant cancers and are predominately diagnosed via ultrasound. Computed tomography may be necessary if malignancy is suspected. Larger size warrants a higher suspicion of malignancy. Management is symptom control and ultimately, surgical removal. Prognosis is generally excellent, provided there is no malignant …

Complications Following Hemivertebrectomy For Congenital Scoliosis, Sanjana Davuluri, Taemin Oh, Kyrillos Akhnoukh, Zachary Weingrad, Michael Lesgart, Terrence Ishmael, Joshua Pahys, Amer Samdani, Steven Hwang

Rowan-Virtua Research Day

Introduction:

Hemivertebrae are rare congenital anomalies that can cause severe scoliosis requiring surgical correction. We aimed to determine whether severity of deformities is associated with more long-term surgical complications following surgical correction.

Methods:

We performed a retrospective, single-institution review on patients who underwent hemivertebrectomy and spinal fusion for congenital scoliosis between 2008-2020. We extracted pertinent data on demographics, radiographic parameters, operative details, and complication rates. Subgroup analyses were also done by complication severity, deformity complexity, and construct length.

Results:

In our series, 30 patients underwent hemivertebrectomy and fusion. Mean age was 9±4.2 years and there was 2:1 male preponderance, with …

Case Report: Hidden Posterior Dislocation Of The Clavicular Head, David F. Koziel

Rowan-Virtua Research Day

Reported is a case of a 24-year-old male who presented with left shoulder pain and decreased range of motion of the same shoulder upon awakening, diagnosed with a posterior dislocation of the proximal clavicle, with the clavicular head residing in the mediastinum. In the conscious, ambulatory, young adult it is arguably much more common for major bony trauma involving the upper extremity and shoulder to present with pain, deformity, and a known mechanism. This is an example that lacks all three of these characteristics and highlights the importance of details in the physical examination as well as clinical gestalt.

Case Report: A Case Of Ttp In The Ed, Brian F. Lim, Andrew Caravello, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 54-year-old female who presented with mild shortness of breath, lower chest discomfort, fatigue, and weakness ongoing for several days and was diagnosed with thrombotic thrombocytopenic purpura (TTP). TTP is characterized by microangiopathic hemolytic anemia and thrombocytopenia due to either an inherited or immune-mediated reduction in von Willebrand Factor (VWF) cleaving protease ADAMTS13.

Patients presenting with non-specific symptoms is becoming increasingly common and initial bias could be to attribute symptoms to viral syndrome or upper respiratory tract infection. However, the differential for non-specific complaints is extensive and thorough review of labs and re-evaluations of patients …

Unmasking A Silent Threat: Early Detection Of Elevated Hbco Levels When The Story Doesn’T Add Up, Anna M. Delancy, Eric Maddock, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Carbon monoxide (CO) is difficult to detect in the surrounding environment due to its colorless, odorless, and tasteless properties. Patients acutely poisoned with CO can have a myriad of presentations including headache, dizziness, and critical illness— all with a mortality rate up to 3%. When concerned for CO poisoning, blood co-oximeter testing should be performed, with treatment surrounding the idea of providing supplemental oxygen The efficacy of hyperbaric oxygen (HBO) treatment remains unclear. Here we describe an atypical scenario of a patient ultimately found to have CO poisoning, and the importance of early identification and treatment of this elusive diagnosis …

Clinical Outcomes For Cardiac Ablation In Octogenarians, Nonagenarians, And Centenarians: A Retrospective Cohort Study, Tony Elias, Mena Elmalh, Kyrillos Girgis, Michael Valderrama, Rafail Beshai

Rowan-Virtua Research Day

Background

Cardiac ablation is a therapeutic intervention aimed at correcting abnormal heart rhythms by disrupting electrical pathways in the heart, using techniques such as radiofrequency or cryoablation. Despite its effectiveness, there is a scarcity of data regarding the outcomes of cardiac ablation specifically among elderly patients. Previous studies have highlighted the complexities and challenges associated with managing cardiac arrhythmias in the elderly population, emphasizing the need for further investigation into treatment outcomes in this demographic.1,2 Therefore, this study aimed to investigate in-hospital outcomes among elderly patients who underwent cardiac ablation using data from the National Inpatient Sample (NIS) Database.

Methods …

National Inpatient Sample Analysis: Examining Clinical Outcomes In Cardiac Ablation Patients With Hyperlipidemia, Tony Elias, Mena Elmalh, Kyrillos Girgis, Taha Syed, Rafail Beshai

Rowan-Virtua Research Day

Background Cardiac ablation, utilizing radiofrequency or cryoablation, is a therapeutic approach for correcting abnormal heart rhythms by disrupting specific electrical pathways within the heart. Despite the growing utilization of cardiac ablation, limited research exists on the impact of hyperlipidemia, a prevalent cardiovascular risk factor, on outcomes in patients undergoing this procedure. Previous studies underscore the importance of understanding how comorbid conditions, such as hyperlipidemia, influence the efficacy and safety of cardiac ablation.1,2 Consequently, this study aimed to leverage the national inpatient sample database to investigate in-hospital outcomes among cardiac ablation patients with hyperlipidemia.

Methods Data from the National Inpatient Sample …

Case Report: Monkeypox Diagnosed In The Ed, Richard M. Baluyot, Joseph Pagano, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Rashes are one of the most common chief complaints we see as emergency medicine physicians on a day-to-day basis. Most of them tend to be self-limited and require very little workup and can be discharged home; however, it is our job to try to identify rashes that may require isolation in order to prevent an outbreak in our communities. Here we present a case of one such rash that has gained major media attention as of late, Monkeypox.

The Effect Of Covid-19 Pandemic On Sanitation Practices And Anxiety In The General Population, Leah Cliatt, Joanna Petrides

Rowan-Virtua Research Day

Background: Illness anxiety and fear of contracting coronavirus increased considerably during the COVID-19 pandemic. The media, being in lockdown, and cyberchondria had the largest impact on the population’s anxiety surrounding illness. While this kind of reaction to illness is expected during the pandemic, there is limited data on post-pandemic illness anxiety levels in the general population. Patients’ perception of disease impacts medicine at every level; medical professionals need to understand the concerns and fears of their patients in order to treat the post-pandemic patient. We hypothesized that sanitation practices and anxiety surrounding illness have not returned to baseline pre-COVID-19 …

Back From Baclofen: A Case Report Of Baclofen Overdose, Alexis M. Dunn, Andrew M. Vasta, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 45-year-old female who presented with intentional Baclofen overdose. The patient was lethargic and then quickly unresponsive and hypotensive, intubated by EMS in the field. By the time the patient was admitted to the Intensive Care Unit (ICU), the patient was clinically brain dead. After several days of supportive care, patient slowly, and miraculously, regained full neurologic functioning and was admitted to the Psychiatric Unit.

Sex Differences In Outcomes Among Patients Who Underwent Cardiac Ablation: A Retrospective Cohort Study, Tony Elias, Mena Elmalh, Kyrillos Girgis, Taha Syed, Rafail Beshai

Rowan-Virtua Research Day

Background Cardiac ablation, encompassing radiofrequency and cryoablation modalities, is a therapeutic intervention targeting abnormal heart rhythms by disrupting electrical pathways within the heart. Despite its widespread use, research focusing on sex-specific outcomes among patients undergoing cardiac ablation remains limited. Understanding potential sex differences in treatment response and outcomes is crucial for optimizing patient care and outcomes.1,2 Therefore, this retrospective cohort study aimed to analyze the national inpatient sample database to assess in-hospital outcomes among patients undergoing cardiac ablation, specifically focusing on sex disparities.

Methods Data from the National Inpatient Sample (NIS) Database for the years 2019 and 2020 were utilized …

Over The Counter Overdose: A Case Of Tylenol Toxicity, Swet M. Patel, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 51-year-old man presenting to the Emergency Department (ED) with suicidal ideations (SI) endorsing an intentional overdose of acetaminophen. Just as important is the clinical presentation; it is equally important to obtain a detailed history of patient's presentation leading to the ED visit when evaluating a suicide attempt. Tylenol (acetaminophen) is a common over the counter (OTC) medication available to the public. Management of Tylenol overdose follows a standard outline of things to observe and intervene on. In this case, we discuss how Tylenol overdose is managed in a clinical setting through a patient who …

Case Report: Diverticulitis Involving A Meckel’S Diverticulum, Samuel M. Thalathoti, Russell A. Mordecai

Rowan-Virtua Research Day

We report a case of a 65-year-old female who presented with abdominal pain and was diagnosed with diverticulitis involving a Meckel‘s Diverticulum. The differential diagnosis of abdominal pain is vast, in this age group includes, but is not limited to appendicitis, diverticulitis, cholecystitis, and small bowel obstruction. In the absence of complicated features, conservative management with oral antibiotics and close outpatient follow is advised. However, in the case of complicated diverticulitis and a rare manifestation such as a Meckel’s Diverticulum, careful management is indicated.

Case Report: Babesiosis Presenting To The Emergency Department, Daniel M. Zaayenga, Daniel A. Weeks

Rowan-Virtua Research Day

Babesiosis is a tick-borne illness caused by the parasitic protozoa Babesia transmitted by the Ixodes tick. Babesia infect the red blood cell of its host and requires the cell for its replication. It is a disease process that can range from asymptomatic infection to organ failure and death. This case presentation reviews a 68-year-old male who presented to the emergency department with flu like symptoms and was found to have babesiosis.

Wellen’S Syndrome: An Infamous Example Of Occlusive Myocardial Infarction (Omi), J. Maxell Piraneo, Joseph Pagano, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Wellen’s syndrome is a condition with characteristic ECG changes that can be highly specific for acute myocardial infarction involving the left anterior descending (LAD) artery. Acute myocardial infarctions are one of the leading causes of death in the developed world. Its estimated annual prevalence is nearly 3 million worldwide, with more than 1 million in the United States [1]. The importance of timely diagnosis cannot be understated. Here we describe a case of myocardial infarction secondary to LAD occlusion which presented with the atypical ECG pattern known as Wellen’s syndrome.

Pneumocephalus – Epidural Injection Nightmare, Mohammad A. Rattu, Frank A. Wheeler

Rowan-Virtua Research Day

Pneumocephalus (pneumatocele or intracranial aerocele) is defined as the presence of air in the intracranial space and most commonly occurs after a traumatic event (most commonly head or facial injury), epidural injection, cranial surgery, However, it may also be spontaneous. Classified into simple and tension types, the presentation varies based on severity and progression. Pneumocephalus with onset less than 72 hours prior to presentation is defined as acute, in contrast to a delayed presentation greater than the given timeframe. Symptoms vary based on the amount of air that is present as well as the exact location within the cranial cavity. …

A Case Of Hhv-6 Viral Meningitis, Mohammad A. Rattu, Wayne Tamaska

Rowan-Virtua Research Day

Meningitis is the inflammation of the meninges and associated with abnormal cell count in the cerebrospinal fluid (CSF). The lack of bacterial growth in cultures, most commonly referred to as aseptic meningitis, is frequently caused by viruses [2]. Viruses have become more common as the prevalence of bacterial meningitis has decreased secondary to vaccination use, with viral meningitis being the most common form among countries. Viral meningitis will present with fever, headache, photophobia, neck stiffness and nausea and vomiting. Younger children however may not show any signs of meningeal irritation. Viral meningitis is usually self-limiting and with good prognosis; however, …