Emergency Medicine Commons^™

Takotsubo Cardiomyopathy In A 55-Year-Old Female With Atypical Chest Pain And A History Of Autoimmune Disease, Carrie Greene, Dana Mathew

Florida Journal of Emergency Medicine (FJEM)

A 55-year-old woman with rheumatoid arthritis and supraventricular tachycardia presented with acute chest pain radiating to the back/left shoulder, with nausea and lightheadedness. Initial ECG showed inferior–lateral ST-segment elevation with reciprocal depressions; within 90 minutes the STE resolved with new incomplete RBBB and diffuse low voltage. High-sensitivity troponin rose (delta ~270 ng/L). Point-of-care and formal echocardiography revealed LV wall-motion abnormalities. Emergent catheterization showed no obstructive CAD (<30% distal OM) with apical ballooning and EF 40–45%, consistent with Takotsubo cardiomyopathy; cardiac MRI confirmed myocardial edema. She was managed with anticoagulation initially, telemetry, and supportive care, and recovered uneventfully with normalization of function on follow-up.

ED Takeaways

• TTC can mimic STEMI with transient STE and conduction changes.

• Troponin rise + non-obstructive coronaries should prompt consideration of TTC.

• Consider TTC in post-menopausal women and those with autoimmune disease; use …

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Meningococcemia In Boy With Dense Deposit Disease Receiving C5 Complement Inhibitor Ravulizumab, Andrew Gonedes, Alexandra Martinez, Allan M. Greissman, Hanan Atia, Eric Boccio

Florida Journal of Emergency Medicine (FJEM)

No abstract provided.

Complete Atrioventricular Block In A Heart Transplant Recipient, Jalyn Joseph, Morgan Reel, Eric Boccio

Florida Journal of Emergency Medicine (FJEM)

Complete atrioventricular (AV) block, though uncommon in heart transplant recipients, is a potentially life-threatening condition that demands rapid diagnosis and management in the acute care setting. During complete AV block, there is a failure of electrical conduction from the atria to the ventricles resulting in the independent and dyssynchronous contraction of the heart chambers. Due to the resultant decrease in cardiac output, patients may experience lightheadedness, fatigue, shortness of breath, syncope and near syncope, and, in severe cases, cardiogenic shock may develop. A 58-year-old female with past medical history including hypertension, diabetes, chronic kidney disease, and congestive heart failure and …

Distinguishing Acute Cardiac Events From Chronic Troponin Elevation: Integrating High-Sensitivity Troponin Trends With Objective Ischemic Evidence Under The 4th Udmi Across Diverse Renal Function Profiles, Aidan Fernandez, Amanda Green, Silvija Milanovic, Eric Han, Asia Elbooz, Michael Petrauskis, Justin Nippert, Michael Marchick, Nicholas Maldonado, Mohammed Ruzieh, Elizabeth Warren, Matthew Shaw, Lars Beattie, Brandon Allen

Florida Journal of Emergency Medicine (FJEM)

The Fourth (4th) Universal Definition of Myocardial Infarction (UDMI) provides a standardized framework to enhance diagnostic accuracy and clinical decision-making. However, challenges can arise due to the use of subjective clinical assessment in diagnostic criteria or in the presence of impaired renal clearance. This study modifies the 4th UDMI by requiring objective ischemic evidence to improve consistency in myocardial infarction (MI) classification and applies it across diverse patient populations.

In this retrospective study, patients who presented to the emergency department (ED) with 99th percentile high sensitivity cardiac troponin (hs-cTn) values were classified using the modified 4th UDMI into the categories …

Unexpected Companions: Appendicitis And Bilateral Testicular Torsion, Jc Alvarenga, Melissa Kirk, Michelle Osorio-Rodriguez

Florida Journal of Emergency Medicine (FJEM)

Abdominal pain is a frequent chief complaint in the emergency department (ED), responsible for 5% of all visits yearly. Despite emergency room work ups, 25% of these cases go undiagnosed. In the pediatric population, abdominal pain can be even harder to differentiate with causes ranging from low acuity constipation to emergent surgical emergencies like torsion or appendicitis. During these visits, the likelihood of two emergent surgical diagnoses occurring concurrently is a rare and often overlooked occurrence.

This case describes a 15-year-old male with a chief complaint of nausea and vomiting starting several hours prior to arrival. In the ED, history, …

Acquired Methemoglobinemia Secondary To Oral Ingestion Of Alkyl Nitrite, Larissa L. Tavares, David Neff, Christopher Didonato, Atul Sofat, Eric Boccio

Florida Journal of Emergency Medicine (FJEM)

Methemoglobinemia is a potentially life-threatening condition in which the ferric state of hemoglobin impairs oxygen transport, leading to refractory hypoxia. While most cases are acquired through exposure to oxidizing agents, this report details a rare case of acquired methemoglobinemia complicated by severe hypotension and pulmonary edema secondary to the oral ingestion of alkyl nitrite, colloquially known as a “popper.”

A 54-year-old male presented to the emergency department after orally ingesting an alkyl nitrite product, believing it would be more effective than inhalation. Shortly after, he developed dizziness, dyspnea, and dusky skin, and was found to be hypotensive and hypoxic. Initial …

Disaster Exercise: Evaluating Mci Triage Training, Michael J. Steflovich Jr, Jodie Stobierski, Alexis Davis, Natasha Pavlinetz, Nela Isic, Nicole Roberson, Earl Best Md

Florida Journal of Emergency Medicine (FJEM)

Abstract

Study Objectives

The primary objective of this study was to evaluate the effectiveness of a didactic lecture-based training on mass casualty incident (MCI) triage performance among first- and second-year medical students. Specifically, the study aimed to measure improvements in overall triage accuracy, as well as reductions in over-triage and under-triage rates for both adult and pediatric patients.

Methods

This study employed a pre-test/post-test design involving 31 participants. Participants completed an electronic pre-test consisting of 30 patient scenarios (20 adult and 10 pediatric) before attending a 40-minute didactic lecture on MCI triage principles. The lecture covered the identification of MCI …

Point Of Care Ultrasound For Rapid Identification Of Central Retinal Artery Occlusion And Subsequent Vision Rescue Utilizing Intravenous Alteplase, Joseph Pepe, Karl Kasischke, Calen Hart

Florida Journal of Emergency Medicine (FJEM)

Central retinal artery occlusion (CRAO) is a rare but critical diagnosis to make in patients with acute vision loss. Cases of central retinal artery occlusion historically have a poor prognosis due to delayed presentation, lack of early identification, and limited effective treatment options. Due to these challenges, patients are often left with permanent loss of vision.

We present a case of a male patient in his late 70s with sudden onset of loss of vision to the right eye. Identification of CRAO was made utilizing point of care ultrasound (POCUS). After discussion with neurology, the patient was treated with alteplase …

Hemiballismus Secondary To Acute Cerebrovascular Accident, Benjamin Duppstadt, Andres Vega, Jonathan Hill, David Arbona

Florida Journal of Emergency Medicine (FJEM)

Hemiballismus is a rare hyperkinetic movement disorder characterized by involuntary, large amplitude flinging movements. We present the case of a 61-year-old male with multiple comorbidities who arrived at the emergency department with acute-onset hemiballismus of the left upper extremity, ultimately found to be secondary to a right middle cerebral artery (MCA) infarct. This case underscores the importance of considering stroke in the differential for new-onset movement disorders, even in patients with seemingly psychiatric features and a nondiagnostic initial computed tomography (CT) scan.

Ultrasound-Guided Needle Aspiration Of A Peritonsillar Abscess In The Emergency Department, Elizabeth Piwowarski, Kenith Dsouza, Taryn Hoffman

Florida Journal of Emergency Medicine (FJEM)

Background

Peritonsillar abscess (PTA) is a relatively common diagnosis to encounter in the emergency department (ED). If untreated, PTA can lead to serious outcomes such as airway compromise, deep space infections and septicemia. Point of care ultrasound (POCUS) can be used by the emergency physician to confirm the suspected diagnosis, evaluate the size and depth of the abscess, and be used as a guide during needle aspiration.

Case

A 26-year-old male presented to the ED with a sore throat and was found to have a peritonsillar abscess on exam, which was confirmed using computerized tomography (CT) imaging. Providers were unable …

When Clotting And Bleeding Collide: A Case Of Bilateral Pe And Concurrent Upper Gi Hemorrhage, Tabitha D. Baca, David Rayburn, Daniel Castro, Jessica Aird

Florida Journal of Emergency Medicine (FJEM)

Introduction

Concurrent episodes of pulmonary emboli and gastrointestinal bleeding in one patient are not commonly seen. When a patient presents with both, it presents a challenge to manage as they are opposite ends of the same disease spectrum associated with the coagulation system.

Case Report

We present the case of a 65-year-old male who presented to our hospital via EMS with unknown prior history after a witnessed cardiac arrest, who on evaluation also had a concurrent bilateral pulmonary emboli with right heart strain.

Why should an emergency physician be aware of this?

While there is extensive research on the management …

Maximizing Relief: The Benefits Of Combining Lateral Femoral Cutaneous Nerve Block With Sciatic Nerve Block In The Emergency Department, Courtney Smith, Taryn Hoffman

Florida Journal of Emergency Medicine (FJEM)

Low back pain accounts for more than 2.6 million emergency department (ED) visits annually, with 40% of Americans experiencing sciatica at some point in their lives. Our case report describes a patient presenting with atraumatic right-sided low back pain and paresthesias in her right leg. We utilized a combination of a transgluteal sciatic nerve block and a lateral femoral cutaneous nerve block to achieve improved pain relief after an initial isolated transgluteal sciatic nerve block left her with persistent anterolateral thigh pain.

We detail the technique for performing this procedure under ultrasound guidance. Our patient experienced significant pain improvement and …

"Star Sign" Of Subarachnoid Hemorrhage, Shivani Ruf

Florida Journal of Emergency Medicine (FJEM)

A 60-year-old female who was brought to the emergency department after a syncopal episode. She was found to have a subarachnoid hemorrhage (SAH) from a ruptured anterior communicating artery aneurysm. Her CT showed the classic "star sign" of SAH.

Elderly Woman With Bilateral Finger Pain, Eric Boccio, Claudia Risi

Florida Journal of Emergency Medicine (FJEM)

N/A

Paroxysmal, Severe, And Unilateral Facial Pain In Adult Male, Eric Boccio, Joshua Mcfarlane, Jeannine Bobadilla

Florida Journal of Emergency Medicine (FJEM)

No abstract provided.

Factors Contributing To The Negative And Unhealthy Psychological Conditions In The Ed Rn, Ariana M. Nieves

Honors Undergraduate Theses

The emergency department is a stressful environment. Emergency department registered nurses (ED RNs) are at an increased risk of development of negative and unhealthy psychological conditions due to their frequent exposure to stress and traumatic events. These conditions include post-traumatic stress disorder, compassion fatigue, and burnout syndrome, which are already known to be common in the emergency department registered nurse population. It is important to understand the factors that influence the development of these psychological conditions in order to provide better education to nurses regarding prevention of the development of these psychological conditions. This literature review aimed to identify articles …

The Effectiveness Of Interventions And Bundles For Central Line-Associated Bloodstream Infections In The Neonatal Intensive Care Unit, Mohamad Alhamwi

Honors Undergraduate Theses

Introduction: Central Line-Associated Bloodstream Infections (CLABSIs) are a major cause of increased mortality, morbidity and healthcare costs in neonatal intensive care units (NICUs) patients. Despite CDC's efforts to reduce infection rates, patients often suffer consequences. The objective of this study is to perform a systematic review of strategies utilized in the neonatal population and evaluate them with the current CDC's guidelines to assess the effectiveness of bundles in preventing CLABSI in NICUs.

Methods: A systematic literature search was conducted using CINAHL Plus with Text, Cochrane Database of Systematic Reviews and MEDLINE from January 2008 up to 2018. There were multiple …

Protocol Based Screening Tools To Identify Sepsis Patients Transported By Emergency Medical Services, Isaiah Moser

Honors Undergraduate Theses

Sepsis is a complicated disorder in which an infection has reached the bloodstream and caused a cascade of events that in time will lead to death. Interventions aimed at identifying sepsis early in its progression are imperative to stopping the process. The purpose of this study is to examine the current state of the literature regarding sepsis screening tools utilized by emergency medical services. A literature review exploring the various tools in place was conducted to see their value in predicting sepsis and secondary what the initiation of a sepsis alert has on the patients’ outcome. Results found included that …