Emergency Medicine Commons^™

Staphylococcal Scalded Skin Syndrome In Melanated Skin: A Pediatric Case Report, Aleah Lafrancis-Ream, Scott Gutovitz, Hannah Chotiner

HCA Healthcare Journal of Medicine

Background

Staphylococcal scalded skin syndrome (SSSS) is a dermatologic emergency that most commonly affects young children, requiring prompt recognition and treatment to avoid severe symptoms and fatal sequelae. It is characterized by a desquamation of the skin caused by exotoxins produced by the Staphylococcus aureus species and may present differently in melanated skin.

Case Presentation

Our case describes a 6-month-old Black infant girl who presented to the emergency department with SSSS that was unrecognized on 2 prior encounters. This delay in diagnosis and the misapplication of topical antibacterial agents and steroids may have contributed to the worsening of her symptoms …

Effect Of Implementing Safety Nursing Measures For Maintaining Fluid And Electrolyte Balance Among Critically Ill Patients With Acute Pancreatitis, Marwa Abdo

Nursing

Acute pancreatitis is a severe inflammatory condition that affects the pancreas and causes multiple organ failure. High rates of morbidity and mortality are caused by acute pancreatitis. Early fluid resuscitation, within the first 48 hrs., remains the hallmark for acute pancreatitis management. It lowers the incidence of pancreatic necrosis. Therefore, the foundation of treating acute pancreatitis in its early stages is safe fluid resuscitation. Aim: This study aims to evaluate the effect of implementing safety nursing measures for maintaining fluid and electrolyte balance among patients. Study design: A quasi-experimental research design was utilized in this study. Setting: This study was …

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 …

Improving Dka Protocol Adherence In The Emergency Department, Anjolaoluwa Lawani

Master's Projects and Capstones

Problem There was inconsistency in implementation of the DKA protocol by nurses in the emergency department at the Hospital A. Only 58% of the nurses reported feeling comfortable following the DK protocol, and 84% of the nurses described the DKA order set as confusing. Context Hospital A is a large magnet-recognition hospital system in the Bay Area. The emergency department at Hospital A averages about 12 DKA patients per quarter. Intervention Education sessions were held during pre-shift cuddles across day and night shifts to clarify the DKA protocol and answer any questions or nurses may have. Measures Baseline surveys and …

Advancing Anesthesia Provider Proficiency In Airway Assessment Using Point-Of-Care Ultrasound: An Osce-Based Educational Initiative, Austin Fike, Trevor Jordan, Sam Sherrill Iii

Doctoral Projects

Airway management is one of the fundamental pillars of anesthesia. Traditionally, tools such as the Mallampati classification and the thyromental distance are used for airway assessment in the perioperative area. However, often, these methods fail to reliably predict difficult intubations. The use of point-of-care ultrasound (POCUS) has emerged as a valuable adjunct in airway assessment. However, a knowledge deficit exists among anesthesia providers regarding its application in airway assessments for perioperative adult patients. This doctoral project addressed the knowledge deficit in POCUS airway assessment among Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs) through the development and …

Applying Entrustable Professional Activities Across Emergency Medicine Medical Education Fellowships: A Cross-Institutional Commentary, Carrie Maupin, Ambika Anand, Danielle Nesbit, Casey Morrone, Danielle Sultan

Department of Emergency Medicine Faculty Papers

No abstract provided.

Do Patient-Important Outcomes Differ By Care Setting? Findings From Semi-Structured Interviews With Individuals With Diabetes, Amy Cunningham, Alexzandra Gentsch, Pouya Arefi, Judd E. Hollander, Marianna D Lanoue, Amanda M. B. Doty, Geoffrey Mills, Brendan Carr, Kristin L. Rising

Department of Emergency Medicine Faculty Papers

Background: Patient-important outcomes (PIOs) reflect patient values and preferences. Prior studies have elicited a variety of PIOs for diabetes. However, no studies have examined whether, or how, PIOs differ across diabetes care settings. The purpose of this study was to compare the frequencies of PIOs derived from patients with diabetes in primary care (PC), acute care (emergency department (ED)), and post-acute care (post-hospital discharge (PHD)) settings within a large delivery system. Methods: This study was an analysis of 89 interviews with patients in PC, ED, and PHD settings. Participants had moderately to poorly controlled diabetes, defined as follows: presented to …

A Reversal In Fortunes: A Case Of Triumphant Retrograde Intubation., Vishal Tharani, Nickolas Meier

Ambulatory and Primary Care Articles

A 48-year-old male presented to the emergency department in respiratory distress, with a history of poorly controlled asthma and a remote history of pulmonary embolus. After failing a non-invasive ventilation trial and numerous treatments for presumed status asthmaticus, he was planned for intubation. During the procedure, a large supraglottic mass was visualized, obstructing the airway and preventing successful orotracheal intubation via video laryngoscopy. Securing the airway was complicated by cardiac arrest, likely hypoxia-driven. The patient underwent a successful retrograde intubation followed by post-cardiac arrest stabilization. This case highlights the technique and its role in difficult airway management.

Blistering Bulbs: The Hidden Dangers Of Garlic As A Home Remedy., Riley Bunstine, Christopher M Lloyd

Ambulatory and Primary Care Articles

We report a case of a 46-year-old male who developed a second-degree chemical burn after application of crushed raw garlic to his left wrist. When crushed, garlic activates the enzyme alliinase that converts alliin into allicin. In controlled concentrations, allicin has been shown to have a wide array of therapeutic benefits; however, its use as an unregulated home remedy carries a significant risk of toxicity. This patient applied crushed garlic to his left wrist and left this poultice in place for five hours, hoping to ease wrist pain from a previous car accident. Upon removal, he felt an intense burning …

A Model For Developing Subspecialty Clinical Practice Guidelines: The Geriatric Emergency Department Guidelines 20, Satheesh Gunaga, Christopher R Carpenter, Maura Kennedy, Lauren T Southerland, Alexander X Lo, Sangil Lee, Kirby Swan, Fabrice Mowbray, Rachel M Skains, Teresita M Hogan, Martin F Casey, Kei Ouchi, Naomi R George, Kerstin De Wit, Cameron J Gettel, Katherine Selman, Luna C Ragsdale, Anita N Chary, James D Van Oppen, Glenn Arendts, Charles L Maddow, Katherine M Hunold, Katren R Tyler, Danya Khoujah, Ula Hwang, Shan Liu

Faculty, Staff and Students Publications

The original consensus-based Geriatric Emergency Department (GED) Guidelines, published in 2014, established a framework of core principles for delivering high-quality, age-appropriate emergency care for older adults. In response to significant advances in geriatric emergency medicine research and evolving clinical priorities, we developed the GED Guidelines 2.0 to ensure continued relevance, clinical utility, and evidence-based rigor. This concept paper describes the systematic and iterative process undertaken to update the guidelines, including the formation of multidisciplinary working groups and the application of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Unlike the original GED Guidelines, our approach prioritized methodological transparency, …