http://www.rssboard.org/rss-specification 720 https://escholarship.org/uc/uciem_cpcem/rss Recent eScholarship items from Clinical Practice and Cases in Emergency Medicine Fri, 15 May 2026 22:25:08 +0000 https://escholarship.org/uc/item/99b4z9x7 <p><strong>Introduction</strong>: Lemierre syndrome is a rare but potentially severe thrombophlebitis of the internal jugular vein. It most often presents after oropharyngeal infection, likely stemming from anaerobic&nbsp;bacteria, commonly&nbsp;<em>Fusobacterium necrophorum</em>. The potential severity of this condition&nbsp;underscores the importance of early and accurate diagnosis. The gold standard diagnosis relies on&nbsp;computed tomography and blood cultures; however, point-of-care ultrasound offers a rapid and cost-effective tool.</p> <p><strong>Case Report:&nbsp;</strong>A 58-year-old woman with chronic obstructive pulmonary disease, migraines, and&nbsp;recent dental extractions presented with two days of worsening right-sided neck pain and swelling.&nbsp;She denied fever, chills, or recent upper respiratory symptoms. Examination revealed a tender&nbsp;anterior neck mass without airway compromise. Point-of-care ultrasound demonstrated a 1.22 x&nbsp;1.80 centimeters hyperechoic... https://escholarship.org/uc/item/99b4z9x7 Wed, 29 Apr 2026 00:00:00 +0000 Hotton, Maxx F Roth, Kevin R Schultz, Kristine L https://escholarship.org/uc/item/4v42s2gq <p><strong>Introduction</strong>:&nbsp;Oropharyngeal myxedema is a rare presenting symptom of decompensated&nbsp;hypothyroidism that can mimic more common causes of sore throat.</p> <p><strong>Case Report: </strong>We describe a case of an older woman who presented with throat pain and dysphagia,&nbsp;found to have soft palate edema on exam and imaging. Laboratory testing confirmed severe&nbsp;hypothyroidism, and her symptoms eventually resolved with thyroid hormone replacement therapy.</p> <p><strong>Conclusion</strong>:&nbsp;This case highlights a rare and under-recognized presentation of a common&nbsp;endocrine disorder. Consider myxedema from severe hypothyroidism in patients with subacute&nbsp;oropharyngeal pain and swelling. Without early recognition and treatment, the patient is at risk for&nbsp;two life-threatening conditions: airway compromise from soft palate myxedema and progression of&nbsp;hypothyroidism to myxedema coma.</p> https://escholarship.org/uc/item/4v42s2gq Wed, 29 Apr 2026 00:00:00 +0000 Miller, Gabriella Myers, Bennett A https://orcid.org/0009-0004-1863-3620 https://escholarship.org/uc/item/2w7697n7 <p><strong>Introduction</strong>: Shoulder pain is a common emergency department (ED) presentation. Scapular&nbsp;winging is a rare condition often associated with long thoracic nerve injury.&nbsp;This case report&nbsp;describes an even rarer case of dorsal scapular nerve injury caused by a nontraumatic first rib&nbsp;fracture in a young weightlifter, an injury mechanism not previously reported in the literature.</p> <p><strong>Case Report: </strong>A 17-year-old male presented to the ED with left shoulder pain following weightlifting.&nbsp;Physical examination demonstrated scapular winging, and a clinical diagnosis of dorsal scapular&nbsp;neuropraxia was made. Imaging revealed a nontraumatic first rib fracture.&nbsp;The patient was treated&nbsp;conservatively with nonsteroidal anti-inflammatory drugs and rest, resulting in complete resolution of&nbsp;symptoms within two weeks at clinic follow-up.</p> <p><strong>Conclusion</strong>:&nbsp;To our knowledge, this is the first case... https://escholarship.org/uc/item/2w7697n7 Wed, 29 Apr 2026 00:00:00 +0000 Remy, Jessica Prendergast, Nicole https://escholarship.org/uc/item/13x391fq <p><strong>Introduction</strong>:&nbsp;Primary spontaneous pneumothorax generally presents with symptoms of chest pain&nbsp;and shortness of breath. Progression to a tension pneumothorax results in a medical emergency.&nbsp;Rare presentations with abdominal pain are possible and must be considered to expedite&nbsp;appropriate treatment of pneumothorax.</p> <p><strong>Case Report: </strong>We report a case of a 21-year-old male with primary spontaneous pneumothorax&nbsp;who initially presented to the emergency department with right lower quadrant abdominal pain.&nbsp;History and physical exam were suggestive of acute appendicitis. A large right pneumothorax was incidentally found on computed tomography.</p> <p><strong>Conclusion</strong>:&nbsp;This case highlights unusual presentations of pneumothorax. Emergency physicians&nbsp;should consider atypical presentations of chest pathology such as pneumothorax in patients&nbsp;presenting with symptoms consistent with an acute abdomen.</p> https://escholarship.org/uc/item/13x391fq Wed, 29 Apr 2026 00:00:00 +0000 Crowe, Timothy Cheatle, Patrick https://escholarship.org/uc/item/1120q3v9 <p><strong>Introduction</strong>:&nbsp;Brugada syndrome is an important differential diagnosis for unexplained sudden&nbsp;cardiac arrest, particularly in younger patients. The electrocardiographic (ECG) pattern characteristic&nbsp;of Brugada syndrome can be provoked by fever and may vary with changes in body temperature.&nbsp;Therefore, targeted temperature management following cardiac arrest may obscure the distinctive&nbsp;morphology, increasing the risk of misdiagnosis.</p> <p><strong>Case Report:</strong> We report the case of a 44-year-old man who experienced out-of-hospital cardiac arrest due to ventricular fibrillation following influenza B infection. Initial evaluation revealed transient ST-segment elevation in leads V1-V3, while coronary angiography and echocardiographic findings were normal. Although Brugada syndrome was suspected, the diagnosis was deferred because the ECG findings normalized during targeted temperature management at 36°Celsius. However, after completion... https://escholarship.org/uc/item/1120q3v9 Wed, 29 Apr 2026 00:00:00 +0000 Kondo, Yuki https://orcid.org/0000-0003-1270-8308 Tanaka, Atsuhito Okazaki, Tomoya https://escholarship.org/uc/item/9r8461ds <p><strong>Introduction</strong>: Sternutation is a physiological reflex that clears the upper respiratory tract through forceful air expulsion. Although it is typically considered benign, sternutation can generate&nbsp;substantial pressure and airflow that can result in barotrauma, including pneumocephalus.</p> <p><strong>Case Report: </strong>A 67-year-old female presented with shortness of breath, rhinorrhea, and a headache&nbsp;following sneezing. Physical exam revealed no signs of trauma or neurological deficits but did note&nbsp;clear rhinorrhea bilaterally. Computed tomography (CT) of the head revealed extensive extra-axial&nbsp;intracranial gas bilaterally, and the patient was admitted for further management. While admitted,&nbsp;otolaryngology was consulted and surgically corrected a right cribriform meningoencephalocele with&nbsp;an active cerebrospinal fluid leak. At follow-up the patient had no residual rhinorrhea symptoms or&nbsp;focal neurological findings.</p> <p><strong>Conclusion</strong>:&nbsp;One... https://escholarship.org/uc/item/9r8461ds Fri, 24 Apr 2026 00:00:00 +0000 Tejpal, Tushar Ashurst, John Barnett-Trapp, Danielle https://escholarship.org/uc/item/9r43b2xz <p><strong>Introduction</strong>:&nbsp;Kratom (<em>Mitragyna speciosa</em>) is an unregulated herbal supplement increasingly&nbsp;associated with severe toxicity. Concentrated liquid formulations pose risks, with emerging reports of&nbsp;seizures, hepatotoxicity, and arrhythmias.<br><br><strong>Case Report:</strong>A previously healthy 24-year-old woman ingested a highly concentrated kratom&nbsp;extract and developed seizure-like activity followed by pulseless monomorphic ventricular&nbsp;tachycardia. She underwent approximately 45 minutes of resuscitation, including multiple&nbsp;defibrillations, dual-sequential shocks, amiodarone, lidocaine, magnesium, calcium, sodium&nbsp;bicarbonate, potassium repletion, epinephrine, and esmolol. Persistent instability prompted&nbsp;consultation with cardiology and cardiothoracic surgery, and she was cannulated for venoarterial&nbsp;extracorporeal membrane oxygenation (ECMO) in the emergency department. Lab studies showed&nbsp;profound hypokalemia,... https://escholarship.org/uc/item/9r43b2xz Fri, 24 Apr 2026 00:00:00 +0000 Mclin-Evans, Megan Tiscareno, Jennerfer Beneke, Laura Lee https://escholarship.org/uc/item/9h01z918 <p><strong>Introduction</strong>:&nbsp;Drowning is a significant cause of death in Nepal, especially in rural areas. Identifying&nbsp;pulmonary edema is important for management of cases of non-fatal drowning, and while radiograph&nbsp;is the standard of care, point-of-care ultrasound (POCUS) offers a rapid, accessible alternative.</p> <p><strong>Case Report: </strong>A 40-year-old woman presented to the emergency department after non-fatal&nbsp;drowning with respiratory distress and hypoxia. Chest radiograph was unavailable. Point-of-care&nbsp;ultrasound revealed diffuse B-lines consistent with pulmonary edema. She was stabilized and&nbsp;transported to a hospital with intensive care-level management.</p> <p><strong>Conclusion</strong>:&nbsp;Point-of-care ultrasound enabled rapid identification of pulmonary edema and guided&nbsp;timely referral. In resource-limited settings, POCUS is a valuable tool for managing drowning victims&nbsp;when other diagnostics are unavailable.</p> https://escholarship.org/uc/item/9h01z918 Fri, 24 Apr 2026 00:00:00 +0000 Kansakar, Rochak Katz, Elijah J Zhao, Justin Weldon, Evan https://escholarship.org/uc/item/85z10556 <p><strong>Introduction</strong>:&nbsp;Dense deposit disease, also known as C3 glomerulopathy, is a rare renal disorder&nbsp;caused by abnormal complement deposition in the glomerular basement membrane. Patients often&nbsp;require long-term immunosuppressive therapy and, in some cases, complement inhibitors such as&nbsp;ravulizumab. While effective at limiting renal damage, complement blockade significantly increases&nbsp;susceptibility to invasive infections from encapsulated bacteria, particularly&nbsp;<em>Neisseria meningitidis</em>.&nbsp;Despite immunization and antimicrobial prophylaxis, these patients remain incompletely protected.&nbsp;We describe a case of meningococcemia in a fully vaccinated adolescent with dense deposit&nbsp;disease on ravulizumab therapy.</p> <p><strong>Case Report: </strong>A 17-year-old male with a history of dense deposit disease on mycophenolate mofetil and ravulizumab presented to the pediatric emergency department with fever, vomiting, altered... https://escholarship.org/uc/item/85z10556 Fri, 24 Apr 2026 00:00:00 +0000 Gonedes, Andrew Martinez, Alexandra Greissman, Allan M. Atia, Hanan Boccio, Eric https://escholarship.org/uc/item/82w848j0 <p><strong>Introduction</strong>:&nbsp;Reversible cerebral vasoconstriction syndrome is a recently defined disease entity&nbsp;classically presenting with recurrent thunderclap headache. The pathology involves triggered cerebral&nbsp;arterial vasoconstriction, which can lead to complications including seizure, ischemic stroke, and&nbsp;intracranial hemorrhage. Diagnosis requires angiography, and treatment consists of vasodilatory therapy.</p> <p><strong>Case Report: </strong>We describe a case of reversible cerebral vasoconstriction syndrome following&nbsp;glucocorticoid burst therapy in a patient on multiple vasoactive medications, suggesting the&nbsp;possibility of compounding risk factors and triggers. As is common with this syndrome, the patient in&nbsp;our case required multiple hospital visits for diagnosis but ultimately experienced a positive outcome&nbsp;upon treatment.</p> <p><strong>Conclusion: </strong>The presentation of reversible cerebral vasoconstriction syndrome... https://escholarship.org/uc/item/82w848j0 Fri, 24 Apr 2026 00:00:00 +0000 Lenning, Jacob Halfill, Caleb Rountree, Justin https://escholarship.org/uc/item/7p89z6dp <p><strong>Introduction</strong>: Diclofenac sodium is a widely used medication for its analgesic and anti-inflammatory properties. Although the adverse effects of diclofenac are well described, diclofenac-associated new-onset atrial fibrillation in a young, healthy adult has not been previously reported.</p> <p><strong>Case Report</strong>: A 22-year-old man with severe pain following an ankle injury used diclofenac sodium&nbsp;at a dose of 50 mg orally three times daily for one week. At the end of the week, he presented to the&nbsp;emergency department (ED) complaining of palpitations for a few hours. The patient had no past&nbsp;medical history. His physical examination revealed no pathologic signs except for tachycardia and&nbsp;an irregularly irregular pulse rate. An electrocardiogram showed an irregularly irregular rhythm with&nbsp;a ventricular rate of 128 beats per minute (bpm) (rapid ventricular response) and absent P waves,&nbsp;consistent with atrial fibrillation. The... https://escholarship.org/uc/item/7p89z6dp Fri, 24 Apr 2026 00:00:00 +0000 Çağlar, Sabri Onur Çağlar, Hilal Hira, Serdar https://escholarship.org/uc/item/7mb8k87q <p>Pediatric seizures are an alarming presentation to the emergency department (ED) that can be&nbsp;caused by a multitude of etiologies. It is important to differentiate life-threatening conditions from&nbsp;more benign causes. A 19-month-old girl presented to the ED after a witnessed seizure. This case&nbsp;offers a differential diagnosis for pediatric seizures and uses history, exam, laboratory findings, and&nbsp;imaging to hone the differential in the ED setting. The surprising final diagnosis and case outcome<br>are then revealed and discussed.</p> https://escholarship.org/uc/item/7mb8k87q Fri, 24 Apr 2026 00:00:00 +0000 Kurek, Julie Falat, Cheyenne Bontempo, Laura J Gatz, John David https://orcid.org/0000-0002-3380-2419 https://escholarship.org/uc/item/6j41d4bw <p><strong>Introduction</strong>: Hyponatremia is a common and often vexing electrolyte abnormality seen in&nbsp;the emergency setting. The severity of a patient’s symptoms is often dictated by the acuity of&nbsp;hyponatremia development and degree of serum sodium deficit, with patients typically demonstrating&nbsp;more severe neurological symptoms in acute-onset severe hyponatremia. Patients prescribed&nbsp;chlorthalidone are at particular risk of developing hyponatremia, especially in the setting of a&nbsp;secondary insult.</p> <p><strong>Case Report</strong>: We describe two patients presenting to the emergency department with severe&nbsp;hyponatremia who were taking chlorthalidone. Both patients had clinical symptoms that were mild&nbsp;given the degree of their hyponatremia. Additionally, each patient had a secondary insult affecting&nbsp;their volume status that was an important contributing factor in the development of hyponatremia.</p> <p><strong>Conclusion</strong>: Thiazide... https://escholarship.org/uc/item/6j41d4bw Fri, 24 Apr 2026 00:00:00 +0000 Richardson, Jordan Wood, Luke Raukar, Neha https://escholarship.org/uc/item/5wv73358 <p><strong>Introduction</strong>:&nbsp;Central retinal artery occlusion (CRAO) is a neurological and ophthalmologic&nbsp;emergency that presents as sudden, painless, monocular vision loss. Central retinal artery occlusioncan be classified as arteritic or non-arteritic. Most cases of non-arteritic CRAO are due to embolism,&nbsp;commonly from atherosclerosis of the ipsilateral carotid artery. More proximal sources of embolism&nbsp;are uncommon but can occur. Prompt recognition of CRAO is critical for vision preservation therapy&nbsp;and initiation of ischemic stroke diagnosis protocols.</p> <p><strong>Case Report</strong>: We present the case of a 66-year-old female who presented to the emergency department eight hours after sudden, painless, monocular vision loss. Her past medical history included type II diabetes, hypertension, and hyperlipidemia. She had previously undergone bilateral lens replacement for cataracts three years prior and had a history of intermittent floaters,... https://escholarship.org/uc/item/5wv73358 Fri, 24 Apr 2026 00:00:00 +0000 Kofman, Rochelle Smartt, Addison Myles, Reginald Jerome https://orcid.org/0009-0001-7731-832X Kishi, Patrick Rappaport, Douglas Drechsel, Kevin https://escholarship.org/uc/item/5m21n0nw <p><strong>Introduction: </strong>Intracranial arterial injury is typically associated with high-energy trauma. &nbsp;Early diagnosis and treatment are essential for improving patients' functional prognosis.&nbsp;</p> <p><strong>Case Presentation: </strong>A 76-year-old woman complained of pulsatile tinnitus on the 15th day after her traffic accident, in which she got injured only a bruise to her face, while severe injuries to her torso. On the 17th day, ptosis, conjunctival congestion, and an ocular motility disorder developed in her right eye. Magnetic resonance angiography showed a direct high-flow shunt from the internal carotid artery to the cavernous sinus. On the 20th day, the same symptoms developed in her left eye. On the 23rd day, coil embolization to the fistula reduced symptoms in the left eye, but not the right eye.</p> <p><strong>Discussion: </strong>This complication rarely occurs in patients with head trauma. Our case indicates that this can occur even in patients... https://escholarship.org/uc/item/5m21n0nw Fri, 24 Apr 2026 00:00:00 +0000 Miyake, Yoshihiro Abe, Tomohiro https://orcid.org/0000-0001-5585-6381 Kubo, Keisuke Nagoshi, Hideki Ochiai, Hidenobu https://escholarship.org/uc/item/51n9m25c <p><strong>Introduction</strong>:&nbsp;Paradoxical coronary embolism is a rare cause of myocardial infarction.</p> <p><strong>Case Report: </strong>A 57-year-old man presented with acute chest pain after a recent non-ST elevation&nbsp;myocardial infarction, during which a patent foramen ovale was identified. On readmission, the&nbsp;electrocardiogram showed an inferior ST-elevation myocardial infarction, and angiography revealed&nbsp;a distal thrombotic occlusion in otherwise normal coronary arteries. No venous thromboembolism&nbsp;was found, but thrombophilia testing revealed heterozygous factor V Leiden. He was managed&nbsp;conservatively and underwent successful patent foramen ovale closure.</p> <p><strong>Conclusion</strong>: This case highlights paradoxical embolism as a diagnostic consideration in acute myocardial infarction without coronary artery disease.</p> <p></p> <p></p> https://escholarship.org/uc/item/51n9m25c Fri, 24 Apr 2026 00:00:00 +0000 Berckmans, Dago https://escholarship.org/uc/item/4z69k3w1 <p><strong>Introduction</strong>:&nbsp;Trichobezoar is a rare gastrointestinal condition typically caused by ingestion of hair,&nbsp;which most often affects adolescent females. Its clinical presentation is frequently nonspecific, with&nbsp;symptoms such as abdominal pain, constipation, or early satiety, which can delay recognition until&nbsp;severe complications such as obstruction or perforation develop.</p> <p><strong>Case Report: </strong>We present the case of a 14-year-old girl who developed a massive trichobezoar&nbsp;resulting in gastric perforation and death. She had a three-month history of intermittent constipation&nbsp;and multiple healthcare visits without definitive diagnosis. On arrival to the emergency department,&nbsp;she was in cardiopulmonary arrest. Computed tomography revealed a large intragastric mass&nbsp;with associated pneumoperitoneum. Emergency laparotomy confirmed a trichobezoar with gastric&nbsp;perforation and diffuse peritonitis. Despite prompt surgical... https://escholarship.org/uc/item/4z69k3w1 Fri, 24 Apr 2026 00:00:00 +0000 Gültekin, Mert https://orcid.org/0009-0001-1285-5490 Erinmez, Ayça https://orcid.org/0009-0003-0653-0053 Karpuz, Yunus Emre https://orcid.org/0009-0008-7163-3784 https://escholarship.org/uc/item/4xm6x30x <p>Manuscript: A Case Report of Delayed, Severe, Paroxysmal Muscle Cramping after Chilean Rose Tarantula (Grammostola rosea) Envenomation&nbsp;</p> https://escholarship.org/uc/item/4xm6x30x Fri, 24 Apr 2026 00:00:00 +0000 Cole, Jon Gooley, Brian Thomas Hughes, Kirk Gooley, Mark Keyler, Daniel Vetter, Richard https://escholarship.org/uc/item/4ns2d0kx <p><strong>Introduction</strong>: Radial collateral ligament injuries of the thumb are rare, especially in adolescent athletes. We present a case of a 17-year-old female cheerleader who sustained a complete radial collateral ligament tear while basing during a cheerleading stunt.</p> <p><strong>Case Report: </strong>The patient presented to the emergency department with pain in the right thumb after&nbsp;catching a falling flyer. Examination of the first metacarpophalangeal joint of the right thumb revealed&nbsp;tenderness and laxity. Radiographic imaging showed no fracture. Magnetic resonance imaging&nbsp;confirmed a complete radial collateral ligament tear. She underwent surgical repair with full recovery.</p> <p><strong>Conclusion</strong>: This case highlights an uncommon thumb ligament injury in a non-traditional&nbsp;mechanism. Emergency physicians should consider radial collateral ligament tears in&nbsp;patients with metacarpophalangeal joint tenderness, even when radiographs... https://escholarship.org/uc/item/4ns2d0kx Fri, 24 Apr 2026 00:00:00 +0000 Baker, Russell Andrew https://escholarship.org/uc/item/4m59j13s <p><strong>Introduction</strong>:&nbsp;Foreign body-induced pancreatitis is rare and diagnostically challenging, often&nbsp;presenting with non-specific symptoms and no clear history, unlike typical causes.</p> <p><strong>Case Report: </strong>A 70-year-old man presented with vomiting and abdominal tenderness. Imaging&nbsp;revealed a 4-cm sharp foreign body near the pancreatic head causing inflammation. Endoscopy and&nbsp;endoscopic ultrasound failed to locate the object. Surgical exploration with intraoperative ultrasound&nbsp;identified and removed the foreign body at the pylorus-duodenal junction.&nbsp;The patient recovered&nbsp;without complications.</p> <p><strong>Conclusion: </strong>Early diagnosis, multimodal imaging, and surgical collaboration are essential for optimal&nbsp;management of foreign body-induced pancreatitis.</p> https://escholarship.org/uc/item/4m59j13s Fri, 24 Apr 2026 00:00:00 +0000 Vaghela, Nital Abou Chaar, Mohamad K. https://orcid.org/0000-0002-9584-2184 Mahnke, Steven Colak, Ceylan Stephens, Daniel Kummer, Tobias https://escholarship.org/uc/item/4bg1t7pq <p><strong>Case Presentation: </strong>A 52-year-old man involved in a high-speed car crash presented with hypotension, abdominal and back pain, and seatbelt bruising. Imaging revealed a mesenteric bucket-handle injury with active bleeding. He received resuscitation and was taken emergently to the&nbsp;operating room for a sigmoid colectomy with primary anastomosis.</p> <p><strong>Discussion</strong>:&nbsp;In patients with blunt abdominal trauma, 1-6% are diagnosed with mesenteric or&nbsp;hollow visceral injuries; the bucket handle injury is a subtype of these injuries. These injuries often&nbsp;present subtly and may be missed on initial evaluation, particularly when the extended focused&nbsp;assessment with sonography for trauma is negative. Unexplained hemodynamic instability should&nbsp;prompt further investigation, as delayed diagnosis can lead to bowel ischemia or infarction. Early&nbsp;recognition and surgical intervention are critical to reducing morbidity and mortality... https://escholarship.org/uc/item/4bg1t7pq Fri, 24 Apr 2026 00:00:00 +0000 Gottam, Bhargavesh McCoy, Christopher Eric https://escholarship.org/uc/item/3wk9474r <p><strong>Introduction: </strong>Metformin, a first-line type two diabetes medication, is generally considered safe and&nbsp;effective. However, it is rarely associated with life-threatening lactic acidosis. This generally presents&nbsp;in patients with gastrointestinal upset as a primary complaint. It is most common in patients with&nbsp;underlying chronic kidney disease. Prevention of associated mortality requires early diagnosis and&nbsp;intervention with fluids, bicarbonate, vasopressors, and hemodialysis.</p> <p><strong>Case Report: </strong>This is a notable presentation of metformin toxicity, as the 68-year-old male patient&nbsp;presented with an atypical chief complaint of dyspnea and no history of kidney disease. Physical exam&nbsp;was notable for tachypnea and clear breath sounds. Labs revealed anion gap metabolic acidosis from&nbsp;an accumulation of lactic acid and acute renal failure. Other causes of lactic acid metabolic acidosis&nbsp;were considered and ruled out.... https://escholarship.org/uc/item/3wk9474r Fri, 24 Apr 2026 00:00:00 +0000 Welsch, Elizabeth https://orcid.org/0009-0005-3237-6111 Evans, Jerome https://orcid.org/0009-0006-7610-3809 Yoxall, Alexander https://orcid.org/0009-0004-5625-3311 Culhane, Anna https://orcid.org/0009-0006-5032-868X https://escholarship.org/uc/item/3t05q7rj <p><strong>Introduction</strong>: The vasovagal reaction can lead to benign, self-limiting syncope triggered by stimuli&nbsp;such as pain or emotional stress. However, in rare and severe cases it may result in cardiac&nbsp;asystole. Previous episodes of vasovagal reactions could be a risk factor for cardiac asystole.</p> <p><strong>Case Report: </strong>We present a 39-year-old male with a previous episode of vasovagal syncope who&nbsp;developed an unexpected 15-second episode of asystole during venipuncture, for which we performed&nbsp;immediate chest compressions. Further evaluations revealed no apparent underlying cause. The&nbsp;patient was subsequently diagnosed with transient asystole secondary to vasovagal reaction.</p> <p><strong>Conclusion</strong>: While venipuncture is a common procedure in clinical practice, clinicians should be&nbsp;aware of the potential risk for cardiac asystole. Detailed medical history of previous episodes of&nbsp;vasovagal reactions could be... https://escholarship.org/uc/item/3t05q7rj Fri, 24 Apr 2026 00:00:00 +0000 Nagano, Tomoki https://orcid.org/0009-0009-8455-5938 Sakuma, Ryo Horiguchi, Wataru Jeong, Soi Tanamoto, Takaki Yokota, Yumi Fowler, Matthew Kim, Jin https://escholarship.org/uc/item/3h40g6jv <p><strong>Case Presentation: </strong>An 88-year-old man was brought to our emergency department due to altered&nbsp;mental status and hemodynamic shock due to a urinary tract infection. Computed tomography&nbsp;showed an incarcerated ureter in the Petit triangle. Urology was consulted, and the hernia was&nbsp;reduced back into the retroperitoneal cavity.</p> <p><strong>Discussion</strong>:&nbsp;Petit hernia is rare; moreover, there is no literature to our knowledge discussing the&nbsp;ureter as the herniated structure. Interventional radiology can be considered as a reductive option.</p> https://escholarship.org/uc/item/3h40g6jv Fri, 24 Apr 2026 00:00:00 +0000 Tanaka, Atsuhito Kamitani, Yuka https://escholarship.org/uc/item/3g07934h <p><strong>Introduction</strong>:&nbsp;In this report we highlight the emerging role of pediatric cardiac point-of-care&nbsp;ultrasound (POCUS) in rapidly diagnosing infective endocarditis, using a clinical case as illustration.</p> <p><strong>Case Report</strong>:&nbsp;A six-year-old girl with a known ventricular septal defect presented with worsening&nbsp;respiratory symptoms, fevers, abdominal pain, and decreased oral intake. Initial POCUS, performed&nbsp;by an emergency physician, indicated a suspicious echogenic mass in the right atrium, prompting&nbsp;formal echocardiography. Further imaging and cultures confirmed infective endocarditis due to&nbsp;methicillin-sensitive&nbsp;<em>Staphylococcus aureus</em>.</p> <p><strong>Conclusion</strong>: This case underscores the utility of pediatric cardiac POCUS as a rapid bedside&nbsp;diagnostic tool for infective endocarditis in emergency settings, leading to early diagnosis and&nbsp;management. Although POCUS cannot replace comprehensive... https://escholarship.org/uc/item/3g07934h Fri, 24 Apr 2026 00:00:00 +0000 Dhillon, Reshvinder Mcmullin, Sarah https://escholarship.org/uc/item/2cd7n7dd <p><strong>Case Presentation: </strong>A 64-year-old Black female presented to the emergency department following a new-onset tonic-clonic seizure. The patient had been given 2 milligrams of lorazepam by emergency medical services with cessation of seizure activity. On physical exam she was lethargic and had&nbsp;clear discharge from the right nare. Computed tomography of the brain initially demonstrated&nbsp;findings consistent with sinusitis versus ethmoidal mass. Magnetic resonance imaging of the brain&nbsp;demonstrated a right frontal ethmoidal encephalocele.</p> <p><strong>Discussion</strong>:&nbsp;Basal encephaloceles occur due to a defect in the skull base. Location of the defect&nbsp;and extracranial herniation of brain tissue can cause neurologic sequelae. This case illustrates the&nbsp;importance of maintaining a broad differential diagnosis and for emergency physicians to obtain&nbsp;imaging when evaluating seizures and/or chronic rhinorrhea in adults.</p> https://escholarship.org/uc/item/2cd7n7dd Fri, 24 Apr 2026 00:00:00 +0000 Kim, Kiveum Craig, Taylor Delicio, Lucas Scumpia, Alexander John https://orcid.org/0000-0001-6862-6315 https://escholarship.org/uc/item/2c36p0r0 Letter to the Editor: A Case Report of Delayed, Severe, Paroxysmal Muscle&nbsp;Cramping After Chilean Rose Tarantula (<em>Grammostola rosea</em>)&nbsp;Envenomation https://escholarship.org/uc/item/2c36p0r0 Fri, 24 Apr 2026 00:00:00 +0000 Roque, Luis A https://orcid.org/0000-0003-1969-0315 https://escholarship.org/uc/item/1qn446rw <p><strong>Introduction</strong>: Amyand hernia is a rare condition in which the appendix is found within an inguinal hernia&nbsp;sac, often mimicking incarcerated or strangulated hernias. Diagnosis is typically made intraoperatively,&nbsp;but increasing use of point-of-care ultrasound (POCUS) is enhancing preoperative recognition.</p> <p><strong>Case Report: </strong>A 46-year-old male presented with a chronic, partially reducible inguinal hernia. Point-of-care ultrasound revealed a bowel-containing hernia with fluid. Computed tomography confirmed&nbsp;an inflamed appendix within the sac. Laparoscopic appendectomy and open hernia repair were&nbsp;performed without complications.</p> https://escholarship.org/uc/item/1qn446rw Fri, 24 Apr 2026 00:00:00 +0000 Wallace, Neil Hauger, Aila Suga https://escholarship.org/uc/item/1k44h5x9 <p><strong>Introduction</strong>: Lemierre syndrome is characterized by septic thrombophlebitis of the internal jugular&nbsp;vein, classically caused by&nbsp;<em>Fusobacterium necrophorum</em>. It is typically seen after an episode of&nbsp;pharyngitis where the palatine tonsils or peritonsillar mucosa is affected. It is thought to spread&nbsp;locally into the pharyngeal space toward the internal jugular vein.</p> <p><strong>Case Report: </strong>A 42-year-old male with progressively worsening, atraumatic right-sided neck pain&nbsp;was discovered to have methicillin-resistant <em>Staphylococcus aureus </em>(MRSA) bacteremia, septic thrombophlebitis of the right dural venous sinuses, skull base osteomyelitis, and otomastoiditis.</p> <p><strong>Conclusion</strong>:&nbsp;While septic thrombophlebitis of the dural venous sinuses and internal jugular&nbsp;vein is typically caused by <em>F necrophorum </em>and usually comes from local pharyngeal spread,&nbsp;community-acquired MRSA is... https://escholarship.org/uc/item/1k44h5x9 Fri, 24 Apr 2026 00:00:00 +0000 Kowalczyk, Daniel Ubiñas, George https://escholarship.org/uc/item/1gc895jz <p><strong>Introduction</strong>:&nbsp;Chalk-stick fractures are transverse spinal injuries seen in patients with ankylosing&nbsp;spondylitis due to chronic inflammation and spinal rigidity. These fractures may result from minor&nbsp;trauma and are associated with potentially fatal complications. While spinal fractures in ankylosing&nbsp;spondylitis are well recognized, thoracic chalk-stick fractures complicated by hemothorax from&nbsp;vascular injury remain exceedingly rare. We present a case of an elderly male with ankylosing&nbsp;spondylitis who sustained a thoracic chalk-stick fracture following a ground-level fall, complicated&nbsp;by hemothorax and hemorrhagic shock. This case highlights a rarely reported but life-threatening&nbsp;complication and emphasizes the importance of early imaging and high clinical suspicion in this high-risk population—even after minor trauma.</p> <p><strong>Case Report: </strong>A 90-year-old male with known history of ankylosing spondylitis presented... https://escholarship.org/uc/item/1gc895jz Fri, 24 Apr 2026 00:00:00 +0000 Dehkordi, Armin Akbarpur https://orcid.org/0000-0002-3492-4194 Aloise, Daniel Michael Scheppke, Eric Christodoulou, Mary Gigliotti, Grayson Zitek, Tony https://orcid.org/0000-0002-4357-6611 https://escholarship.org/uc/item/1fp5v5fw <p><strong>Case Presentation: </strong>A 20-year-old female with no past medical history presented to the emergency&nbsp;department (ED) after an episode of exertional syncope. Physical examination, vital signs, and&nbsp;electrocardiogram were unremarkable. Point-of-care ultrasound revealed abnormal invaginations&nbsp;in the interventricular septum. Laboratory evaluation was significant for markedly elevated troponin&nbsp;concerning for cardiac arrest. She was admitted to cardiology with suspicion for genetic cardiomyopathy.&nbsp;The patient underwent placement of an implantable cardioverter defibrillator after cardiac magnetic&nbsp;resonance imaging redemonstrated the septal invaginations known as myocardial crypts. Genetic&nbsp;studies later revealed sarcomere gene mutations associated with hypertrophic cardiomyopathy.</p> <p><strong>Discussion</strong>:&nbsp;Myocardial crypts, which are invaginations within the myocardium, are considered&nbsp;early morphological markers for... https://escholarship.org/uc/item/1fp5v5fw Fri, 24 Apr 2026 00:00:00 +0000 Allen, Christopher Wei Gubbels, Alexandra Duanmu, Youyou Vogel, Jody https://escholarship.org/uc/item/1f65799z <p><strong>Case Presentation: </strong>We present the case of a 53-year-old female with darting eye movements and difficulty walking who was found to have opsoclonus-myoclonus syndrome only after multiple&nbsp;presentations to emergency departments over five days.</p> <p><strong>Discussion</strong>:&nbsp;Adult-onset opsoclonus-myoclonus syndrome is a rare central nervous system&nbsp;disease typically associated with paraneoplastic or idiopathic etiologies. With non-specific symptom&nbsp;presentation, this condition is commonly misdiagnosed in adults, leading to diagnostic delays and&nbsp;long-term motor and cognitive sequelae.</p> https://escholarship.org/uc/item/1f65799z Fri, 24 Apr 2026 00:00:00 +0000 Stephens, Taylor O Imhoff, Bryan Patel, Janak https://escholarship.org/uc/item/1c1110m0 <p><strong>Introduction</strong>: Physician-in-triage (PIT) models have become increasingly common in emergency&nbsp;medicine. The goal is to facilitate rapid patient evaluation and improve key operational emergency&nbsp;department (ED) metrics. However, there is limited time for the PIT encounter, which often involves&nbsp;an abbreviated patient evaluation. Point-of-care ultrasound (POCUS) has been shown to improve&nbsp;patient care and speed diagnosis in a variety of scenarios. Although physicians working within a PIT&nbsp;model must remain mindful of time constraints, POCUS can help identify time-sensitive diagnoses&nbsp;and guide appropriate initial testing during certain encounters. Ocular POCUS can be particularly&nbsp;impactful on timely diagnosis and appropriate deployment of ED resources.</p> <p><strong>Case Series: </strong>We present three cases of acute monocular vision loss wherein the PIT physician&nbsp;used ocular POCUS to arrive at the correct initial diagnosis.... https://escholarship.org/uc/item/1c1110m0 Fri, 24 Apr 2026 00:00:00 +0000 Thom, Christopher https://orcid.org/0000-0003-1435-2712 Spirek, Benton Bhargava, Gitansh Moak, James https://escholarship.org/uc/item/1b33b9mh <p><strong>Introduction</strong>:&nbsp;Neurotoxic envenomation often presents with non-specific neurological symptoms and&nbsp;minimal local signs, which can delay appropriate diagnosis and treatment.&nbsp;This is the first reported&nbsp;case of a neurotoxic snakebite presenting with an atypical symptom of unilateral neck pain.</p> <p><strong>Case Report: </strong>A 12-year-old girl was referred to our emergency centre with neck weakness&nbsp;progressing to quadriplegia, attributed to a fall while playing.&nbsp;A diagnosis of acute flaccid paralysis&nbsp;secondary to cervical trauma was made and treated at the first hospital; however, she developed&nbsp;respiratory distress and was transferred to our centre. Clinical examination and computed&nbsp;tomography ruled out cervical cord injury. A diagnosis of neurotoxic envenomation was considered,&nbsp;given our centre’s high snakebite burden and the symptom of descending flaccid paralysis. Despite&nbsp;initiating antivenom and supportive... https://escholarship.org/uc/item/1b33b9mh Fri, 24 Apr 2026 00:00:00 +0000 T, Neithiya Nair, Jayan Jayapalan Chavali, Krishna Dutt https://escholarship.org/uc/item/1607g892 <p>n/a</p> https://escholarship.org/uc/item/1607g892 Fri, 24 Apr 2026 00:00:00 +0000 CPC-EM, Clinical Practice and Cases in Emergency Medicine https://escholarship.org/uc/item/0x38b68m <p><strong>Introduction</strong>:&nbsp;Purple urine bag syndrome (PUBS) is an uncommon yet visually striking condition&nbsp;observed in patients with long-term urinary catheters. It is associated with urinary tract infections&nbsp;caused by bacteria that metabolize tryptophan into indigo and indirubin pigments. Although typically&nbsp;benign, PUBS can signal underlying medical and social vulnerability.</p> <p><strong>Case Report: </strong>We describe a 78-year-old woman with multiple sclerosis and chronic suprapubic&nbsp;catheterization who presented with failure to thrive and concerns for caregiver fatigue. A striking&nbsp;finding on arrival was the deep purple discoloration of her urine in the Foley bag, consistent&nbsp;with PUBS. Additionally, she was tachycardic and had extensive, unstageable pressure ulcers.&nbsp;Laboratory studies revealed leukocytosis, lactic acidosis, and acute kidney injury. Imaging<br>suggested sacral osteomyelitis, stercoral colitis, and aspiration... https://escholarship.org/uc/item/0x38b68m Fri, 24 Apr 2026 00:00:00 +0000 White, Lindsey McKissick https://orcid.org/0009-0007-8428-8759 Rivera, Megan https://orcid.org/0009-0004-3157-2690 Nash, Christopher James https://orcid.org/0000-0002-0738-409X Natesan, Sreeja https://escholarship.org/uc/item/0vn2b019 The Complexity of Weak Rhesus Positivity in Pregnancy: Challenges and Management https://escholarship.org/uc/item/0vn2b019 Fri, 24 Apr 2026 00:00:00 +0000 Luksanapisitakul, Vimoltip Alojayli, Anas https://orcid.org/0000-0001-7817-3399 https://escholarship.org/uc/item/0g2110tf <p><strong>Introduction</strong>:&nbsp;Kawasaki disease is a vasculitis most commonly affecting children under five years of&nbsp;age but can also occur in older children and adults. When not sufficiently treated, Kawasaki disease&nbsp;can lead to cardiac complications such as myocarditis and coronary artery aneurysms, with aneurysms&nbsp;being the most serious long-term complication as it poses a risk for acute coronary syndrome.</p> <p><strong>Case Report: </strong>A 19-year-old with remote history of Kawasaki disease presented to the emergency&nbsp;department with chest pain, diaphoresis, and emesis after being struck in the chest by another&nbsp;player during a basketball game. Despite his young age and reported mild musculoskeletal trauma,&nbsp;an electrocardiogram and troponin were ordered. Electrocardiogram findings were concerning for&nbsp;ischemia, and troponin was elevated, confirming myocardial infarction and prompting a cardiology&nbsp;consult. Urgent percutaneous... https://escholarship.org/uc/item/0g2110tf Fri, 24 Apr 2026 00:00:00 +0000 Sethman, Chad https://orcid.org/0009-0001-7525-342X Sethman, Jessica End, Bradley https://escholarship.org/uc/item/8tz1c8wf <p>n/a</p> https://escholarship.org/uc/item/8tz1c8wf Tue, 3 Feb 2026 00:00:00 +0000 CPC-EM, Clinical Practice and Cases in Emergency Medicine https://escholarship.org/uc/item/2nq2949g <p><strong>Introduction</strong>:&nbsp;Semaglutide, a glucagon-like peptide-1 receptor&nbsp;agonist, has gained increasing&nbsp;popularity for managing both type 2 diabetes mellitus and obesity. However, as its use increases,&nbsp;new adverse events are emerging. This case report presents a 70-year-old patient who developed&nbsp;pleural and pericardial effusions likely related to semaglutide use.</p> <p><strong>Case Report</strong>: Four weeks after being prescribed semaglutide, a 70-year-old woman presented to&nbsp;the emergency department (ED) with shortness of breath. Diagnostic testing in the ED and hospital&nbsp;revealed that she had both pericardial and exudative pleural effusions, along with a positive anti-nuclear antibody and elevated inflammatory markers. Her signs and symptoms improved with steroid&nbsp;administration, and no other etiology was identified.</p> <p><strong>Conclusion</strong>:&nbsp;The patient was diagnosed with drug-induced lupus, likely triggered by... https://escholarship.org/uc/item/2nq2949g Thu, 22 Jan 2026 00:00:00 +0000 Stark, Maggie Valentini, Nicholas https://escholarship.org/uc/item/6g61255f <p><strong>Introduction</strong>:&nbsp;Guillain-Barré syndrome (GBS) can manifest with progressive paralysis, requiring careful monitoring and treatment with steroids or IVIG. While this disease can be devastating and require ICU level of care, there are few incidences of GBS relapses.</p> <p><strong>Case Report:&nbsp; </strong>A 67-year-old man with a past medical history of Miller Fisher Syndrome (MFS) variant Guillain-Barre Syndrome (GBS), with complete recovery presenting to the emergency department (ED) with ataxia, ophthalmoplegia, dysphonia, and ambulatory dysfunction. The patient noticed his neurologic symptoms after waking up and presented to the ED with physical examination positive for difficulty with upward gaze, mild right lower facial droop, dysmetria with left finger to nose testing, and unsteady gait. &nbsp;A lumbar puncture (LP) revealed albuminocytologic dissociation and he was diagnosed with recurrent MFS. The patient completed a five-day course of intravenous... https://escholarship.org/uc/item/6g61255f Tue, 20 Jan 2026 00:00:00 +0000 Vernier, Larry Barnes Gilmore, Griffin Van Housen, Kelsey https://orcid.org/0009-0008-3906-4438 Zhang, Xiao Chi https://escholarship.org/uc/item/2cp8v219 <p><strong>Introduction</strong>:&nbsp;Carotidynia is a rare, often under-diagnosed condition characterized by idiopathic&nbsp;inflammation around the carotid artery, presenting with unilateral neck pain that typically resolves&nbsp;within two weeks.</p> <p><strong>Case Report: </strong>A 32-year-old male presented with intermittent right anterior neck pain for two&nbsp;years, with no other associated symptoms. Computed tomography revealed carotid perivascular&nbsp;inflammation, consistent with carotidynia.</p> <p><strong>Conclusion</strong>:&nbsp;Although self-limited, carotidynia should be considered in patients with unexplained&nbsp;neck pain, as its recognition is crucial to differentiate it from more serious conditions and to avoid&nbsp;mismanagement or unnecessary interventions.</p> https://escholarship.org/uc/item/2cp8v219 Tue, 20 Jan 2026 00:00:00 +0000 Ibu, Faith https://orcid.org/0000-0003-1950-0809 Keller-Baruch, Olivia Pelletier, Jessica https://orcid.org/0000-0003-1494-6764 https://escholarship.org/uc/item/0px540gp <p><strong>Introduction</strong>: Cardiac arrest remains a major global cause of mortality, with both structural and&nbsp;non-structural cardiac abnormalities implicated. While ischemic heart disease is a common etiology,&nbsp;rare conditions such as papillary fibroelastoma can also result in life-threatening events through&nbsp;embolization or coronary obstruction. Timely recognition and advanced cardiac imaging, particularly&nbsp;transesophageal echocardiography, are essential in such atypical presentations.</p> <p><strong>Case Report</strong>: A 61-year-old female with a history of ischemic heart disease presented to the&nbsp;emergency department following an out-of-hospital cardiac arrest. Initial electrocardiogram (ECG)&nbsp;demonstrated anterior ST-elevation myocardial infarction, which resolved on repeat ECG, prompting&nbsp;reconsideration of the underlying cause. The patient achieved return of spontaneous circulation&nbsp;twice and eventually self-extubated. Further investigation,... https://escholarship.org/uc/item/0px540gp Fri, 16 Jan 2026 00:00:00 +0000 Kanaa, Mohammad Wasim Mohammad Zouhir https://orcid.org/0009-0003-8643-8344 Abbastanira, Shahd H I https://orcid.org/0009-0009-1174-5124 Elameen, Essra Mohamed Abdullah https://orcid.org/0000-0003-3687-8627 Alsultan, Sarah Emad https://orcid.org/0009-0005-9243-8310 https://escholarship.org/uc/item/0f10d1kc <p><strong>Introduction</strong>:&nbsp;Antimuscarinic toxicity, which can cause delirium and unsafe behavior, may result&nbsp;from an adverse effect of prescribed medications or from non-medical substance use. Physostigmine&nbsp;shortages have prompted use of transdermal rivastigmine for management of antimuscarinic toxicity;&nbsp;however, symptom control is equivocal at standard dosing.</p> <p><strong>Case Report: </strong>A patient with antimuscarinic toxicity was treated with physostigmine and transitioned to&nbsp;26.6 milligrams/24 hours transdermal rivastigmine for sustained symptom control. He experienced no&nbsp;adverse effects and tolerated floor admission.</p> <p><strong>Discussion</strong>:&nbsp;There is mechanistic plausibility supporting safe, sustained control of antimuscarinic&nbsp;toxicity with high-dose transdermal rivastigmine. Central distribution is more rapid than serum&nbsp;distribution and higher doses correlate with a shorter time to peak concentration.</p> https://escholarship.org/uc/item/0f10d1kc Fri, 16 Jan 2026 00:00:00 +0000 Watson, Christopher James https://orcid.org/0000-0002-1003-5798 Burrill, Emilie M. Jaffee, William S. https://escholarship.org/uc/item/9fh5w06s <p><strong>Introduction</strong>:&nbsp;Spontaneous splenic vein rupture is a rare condition associated with a high risk of&nbsp;mortality. Only a few cases have been documented, all of which have been linked to underlying&nbsp;predisposing conditions. In this case, however, we present a previously healthy patient with no&nbsp;identifiable risk factors.</p> <p><strong>Case Report</strong>: A 64-year-old male presented to the emergency department with acute-onset&nbsp;abdominal pain and nausea. Physical exam revealed a rigid abdomen with diffuse tenderness and&nbsp;guarding. Serial labs revealed a progressively decreasing hemoglobin and red blood cell count.&nbsp;Computed tomography demonstrated a ruptured splenic vein with a large volume of retroperitoneal&nbsp;hemorrhage. Laparotomy identified a large retroperitoneal hematoma with hemoperitoneum, and&nbsp;embolization was performed by interventional radiology. The patient recovered after one week in the&nbsp;surgical intensive... https://escholarship.org/uc/item/9fh5w06s Wed, 14 Jan 2026 00:00:00 +0000 Franco, Brittany Karski, Amanda Boehm, Kevin https://escholarship.org/uc/item/7ph799nh <p><strong>Introduction</strong>:&nbsp;Sternoclavicular joint injuries are rare and potentially life-threatening injuries&nbsp;due to their proximity to vital mediastinal structures. In adolescents, skeletal immaturity can&nbsp;add complexity to the injury due to potential involvement of the physis. A physeal fracture with&nbsp;displacement can appear as a dislocation on imaging, also known as pseudo-dislocation.&nbsp;Additionally, this anatomic area is difficult to visualize with plain radiographs, which can result in&nbsp;misdiagnosis and delayed treatment.</p> <p><strong>Case Report: </strong>We present a case of a 15-year-old male athlete who presented to the emergency&nbsp;department with severe right clavicular pain four hours after sustaining a football injury. Plain&nbsp;radiographs obtained at an outside facility as well as repeat plain radiographs at our facility showed&nbsp;no evidence of fracture or dislocation. The patient’s degree of pain and physical exam findings&nbsp;prompted... https://escholarship.org/uc/item/7ph799nh Wed, 14 Jan 2026 00:00:00 +0000 Kofman, Rochelle Allen, Ryan Smartt, Addison B https://orcid.org/0009-0007-3161-9358 Drechsel, Kevin Pollock, Jordan Riley Rappaport, Douglas https://escholarship.org/uc/item/6fz4w39f Syncope in a Patient with Takotsubo Syndrome:&nbsp;Additional Issues to Consider https://escholarship.org/uc/item/6fz4w39f Wed, 14 Jan 2026 00:00:00 +0000 Madias, John E. https://escholarship.org/uc/item/3w71h2v8 <p><strong>Introduction</strong>:&nbsp;Pectus excavatum (PEX) is the most common congenital chest wall deformity,&nbsp;characterized by posterior depression of the sternum and lower costal margin. While often&nbsp;asymptomatic, severe PEX can lead to compression of the heart and great vessels, potentially&nbsp;causing right ventricular dysfunction, syncope, and other cardiovascular symptoms. Syncope due to&nbsp;right ventricle compression in PEX is rare but can significantly impact quality of life and may require&nbsp;surgical intervention.</p> <p><strong>Case Report</strong>:&nbsp;An 18-year-old female presented to the emergency department after an unwitnessed&nbsp;syncopal episode. The patient reported feeling lightheaded while showering, followed by collapse and&nbsp;brief loss of consciousness. Diagnostic testing revealed normal neurological and metabolic parameters&nbsp;including point-of-care glucose, electrocardiogram, serum troponin, electrolytes, and head computed&nbsp;tomography.... https://escholarship.org/uc/item/3w71h2v8 Wed, 14 Jan 2026 00:00:00 +0000 Christensen, Matthew John https://orcid.org/0009-0006-1224-1399 Foti, Jennifer https://escholarship.org/uc/item/7jx7d00h <p><strong>Introduction</strong>:&nbsp;Acute lymphoblastic leukemia (ALL) is typically a childhood disease but may present&nbsp;in older patients in rare occurrences. Due to its significant morbidity and mortality, early diagnosis&nbsp;is crucial. The symptoms of ALL may be non-specific, making the initial diagnosis difficult leading to&nbsp;delayed treatment.</p> <p><strong>Case Report: </strong>We present the case of a 34-year-old, healthy male runner presenting to the&nbsp;emergency department with a common complaint of bilateral knee pain, who was ultimately&nbsp;diagnosed with ALL with signs of tumor lysis syndrome leading to premature death.</p> <p><strong>Conclusion</strong>:&nbsp;We discuss the presenting symptoms of acute lymphoblastic leukemia, which may&nbsp;include joint or knee pain as well as leukemic arthritis. We further discuss the importance of&nbsp;clinicians maintaining a high level of suspicion for the “bounce-back” patient and avoiding taking&nbsp;cognitive... https://escholarship.org/uc/item/7jx7d00h Mon, 5 Jan 2026 00:00:00 +0000 Rosselli, Michael Sanoja, Alejandro Jesus Apicella, Matthew https://escholarship.org/uc/item/12q6f8hs <p><strong>Introduction</strong>: Aortic dissection is a rare but life-threatening condition with a high mortality rate if&nbsp;diagnosis is delayed. Aortic dissection classically presents with sudden-onset, sharp pain in the chest&nbsp;or back. However, atypical presentations can also occur, which could lead to a delay in diagnosis.</p> <p><strong>Case Report: </strong>A patient initially presented to the emergency department (ED) with left testicular pain&nbsp;ongoing for several hours. On examination, he had tenderness in the left lower quadrant abdomen&nbsp;and left testicle. A testicular ultrasound revealed decreased blood flow to the left testicle, raising&nbsp;concern for testicular torsion. The patient was taken to the operating room, where no torsion was&nbsp;found, and he was subsequently discharged home. Several days later, the patient returned to the ED&nbsp;with worsening pain radiating to the back. A computed tomography revealed an acute type A aortic&nbsp;dissection... https://escholarship.org/uc/item/12q6f8hs Mon, 5 Jan 2026 00:00:00 +0000 Lo, Bruce M https://orcid.org/0000-0001-6210-9667 Christensen, Megyn K Byrns, Coral E Chidester, Benjamin https://escholarship.org/uc/item/10r9605c <p><strong>Case Presentation: </strong>A healthy 32-year-old man presented to the emergency department with&nbsp;bilateral knee pain after landing from a jump. He was unable to extend his knees and had pain to&nbsp;palpation superior to the patella. Bilateral quadriceps tendon rupture was confirmed using point-of-care ultrasound, and the patient underwent operative repair the next day.</p> <p><strong>Discussion</strong>:&nbsp;Bilateral quadriceps tendon rupture is exceedingly rare, which often leads to&nbsp;misdiagnosis. Magnetic resonance imaging is the gold standard diagnostic imaging study but has&nbsp;multiple disadvantages, especially in emergency settings. Point-of-care ultrasound is an excellent&nbsp;tool to screen for this injury and prevent morbidity from delay in surgical repair.</p> https://escholarship.org/uc/item/10r9605c Mon, 5 Jan 2026 00:00:00 +0000 Guo, Edward Duran, Akaysha Kuc, Alexander Cheng, Alfred https://escholarship.org/uc/item/6wj9x771 <p><strong>Introduction</strong>:&nbsp;Milk-alkali syndrome is characterized by the triad of hypercalcemia, metabolic&nbsp;alkalosis, and acute kidney injury resulting from excessive intake of calcium and absorbable alkali.&nbsp;Despite falling out of prominence with the advent of modern ulcer treatments, milk-alkali syndrome&nbsp;has experienced a resurgence with the widespread availability of over-the-counter calcium&nbsp;preparations,&nbsp;which now account for up to 10% of hypercalcemia cases.</p> <p><strong>Case Report: </strong>A 60-year-old man with multiple comorbidities presented to the emergency department with altered mental status after his scheduled kyphoplasty was canceled due to concerning neurological findings. Laboratory evaluation revealed severe hypercalcemia, marked metabolic alkalosis, and acute kidney injury. Further history revealed excessive antacid consumption for heartburn. The patient was diagnosed with milk-alkali syndrome, treated with intravenous... https://escholarship.org/uc/item/6wj9x771 Thu, 1 Jan 2026 00:00:00 +0000 Abubshait, Layla https://orcid.org/0000-0002-5577-7074 Beso, Samir https://escholarship.org/uc/item/5nc3w288 <p><strong>Introduction</strong>: Patients with psychiatric concerns often present to an emergency department (ED) for medical evaluation prior to inpatient psychiatry placement. One diagnosis to consider prior to disposition is autoimmune encephalitis (AIE). This report describes a pediatric patient who presented with psychiatric symptoms that required inpatient admission and workup to diagnose a rare form of AIE.</p> <p><strong>Case Report: </strong>A 16-year-old female with no known past medical history presented as a transfer from an outside hospital for medical evaluation of two days of auditory and visual hallucinations. Initial labs and imaging were unremarkable. Due to the acuity of her symptoms and abnormal vital signs, she was admitted to the hospital for further medical workup. After almost three weeks inpatient and multiple specialist consultations, she was diagnosed with anti-heavy chain neuronal intermediate filament AIE. The next month of admission included treatment... https://escholarship.org/uc/item/5nc3w288 Thu, 1 Jan 2026 00:00:00 +0000 Bjornstad, Amanda Oberhauser-Lim, Natalie Phan, Tammy Samones, Emmelyn Young, Tim https://escholarship.org/uc/item/63z929k8 <p><strong>Introduction</strong>:&nbsp;We present the case of a patient with the unusual occurrence of phantom arm&nbsp;pain and an acute exacerbation of chronic tinnitus during an ST-segment elevation myocardial&nbsp;infarction (STEMI).</p> <p><strong>Case Report: </strong>A 56-year-old man was having several classic symptoms associated with acute&nbsp;coronary syndrome, along with perceived pain in an arm lost years earlier in a traumatic accident&nbsp;and a sudden worsening of his chronic tinnitus. Emergency medical services responded and&nbsp;diagnosed a STEMI on scene. A 100% occlusion of his right coronary artery was rapidly identified&nbsp;in the hospital and treated with the deployment of two drug-eluting stents. After the procedure his&nbsp;symptoms resolved. He was discharged without incident two days later.</p> <p><strong>Conclusion</strong>:&nbsp;Whereas arm pain is a well-documented presenting symptom of acute coronary&nbsp;syndrome, phantom limb pain and exacerbation... https://escholarship.org/uc/item/63z929k8 Tue, 16 Dec 2025 00:00:00 +0000 Porter, John Liedl, Chad P. Steever, Kevin P. Lumby, Hunter D. Hanson, Chase M. Vaden, Hannah Rae R. Klassen, Aaron https://escholarship.org/uc/item/1ns354pg <p><strong>Introduction: </strong>Ewing sarcoma is a relatively common neoplasm occurring in pediatric patients 10-20&nbsp;years of age, commonly presenting with bone fracture, fever, and pain and swelling at the site of the&nbsp;primary tumor. Here we present an unusual case of Ewing sarcoma in the cervical spine leading to&nbsp;neurological symptoms including left lower extremity hemiparesis and left upper extremity hemiplegia.</p> <p><strong>Case Report: </strong>A 19-year-old Bengali-speaking male presented to the emergency department with&nbsp;a three-week history of left lower extremity hemiparesis and left upper extremity hemiplegia. Due to&nbsp;concern for spinal cord compression, a computed tomography of the cervical spine without contrast was&nbsp;obtained, which revealed a lucent lesion in the left fifth cervical (C5) vertebral body. Magnetic resonance&nbsp;imaging of the cervical spine revealed a left cervical extradural mass present from C3-C7. The patient&nbsp;subsequently... https://escholarship.org/uc/item/1ns354pg Wed, 10 Dec 2025 00:00:00 +0000 Adler, Alexander Messman, Anne https://escholarship.org/uc/item/1nk255m4 <p><strong>Introduction</strong>: Ectopic pregnancy is a serious pregnancy complication that occurs when a gestational&nbsp;sac implants outside the uterus, most commonly in the fallopian tubes. However, a rare form of&nbsp;ectopic pregnancy, the cesarean scar ectopic pregnancy, occurs within a prior cesarean section&nbsp;scar and is becoming more common as cesarean delivery rates continue to rise. Cesarean scar&nbsp;ectopic pregnancies are challenging to diagnose and pose significant risks, including rupture and&nbsp;hemorrhage, which can lead to maternal death.</p> <p><strong>Case Report</strong>: A 27-year-old woman presented to the emergency department with a 16-day history of&nbsp;abdominal pain and vaginal bleeding, initially believed to be her menstrual period. She had a history&nbsp;of one previous lower uterine segment cesarean section. On examination, her beta-human chorionic&nbsp;gonadotropin (β-hCG) levels were elevated, and transvaginal ultrasound revealed an empty... https://escholarship.org/uc/item/1nk255m4 Wed, 10 Dec 2025 00:00:00 +0000 Schindler, Hanna Keeler, Leila https://escholarship.org/uc/item/41h5t3zv <p><strong>Introduction</strong>:&nbsp;Hyperkalemic emergencies can present with weakness, paralysis, sensorimotor&nbsp;deficits, and potentially fatal cardiac conduction abnormalities even in the absence of an elevated&nbsp;serum potassium. Common antihypertensive medications, such as angiotensin-converting enzyme&nbsp;inhibitors or angiotensin II receptor blockers, are associated with serum potassium elevations and&nbsp;can exacerbate hyperkalemia, especially in patients with renal impairment.</p> <p><strong>Case Report: </strong>We report a 49-year-old patient who presented to the emergency department six&nbsp;hours following an intentional ingestion of potassium supplements totaling 600 milliequivalents&nbsp;(mEq). The patient also reported chronic use of ibuprofen and losartan 50 mg. Symptoms on&nbsp;presentation included weakness, chest pain, and shortness of breath. Initial labs revealed a&nbsp;potassium &gt; 10 mEq/L which was beyond the upper limit of assay detection... https://escholarship.org/uc/item/41h5t3zv Mon, 8 Dec 2025 00:00:00 +0000 Naseem, Ahmed Schoenborn, Mark Scheidler, James Barclay, William Volk, Garrett https://escholarship.org/uc/item/5dk3f72j <p>Chest tightness and shortness of breath are relatively common reasons for presentation to the&nbsp;emergency department (ED), often triggering protocolized workups and dispositions. A good history,&nbsp;however, can reveal additional elements that may dramatically alter the differential diagnosis and&nbsp;management. A 70-year-old woman presented to the ED complaining of subacute chest tightness&nbsp;with dyspnea on exertion. This case offers a thoughtful analysis of how to integrate key findings&nbsp;within a patient’s history, exam, and workup in the ED. The surprising final diagnosis and case&nbsp;outcome are then revealed.</p> https://escholarship.org/uc/item/5dk3f72j Sun, 7 Dec 2025 00:00:00 +0000 Dunn, Robert E Klucher, Brianna Bontempo, Laura J Gatz, John David https://orcid.org/0000-0002-3380-2419 https://escholarship.org/uc/item/1xf3f47b <p><strong>Introduction: </strong>Acute hypercapnic respiratory failure secondary to foreign body aspiration is a rare&nbsp;but severe complication seen in pediatric patients. Foreign body aspiration is one of the leading&nbsp;causes of death in children and requires prompt intervention and stabilization when definitive&nbsp;bronchoscopy is not readily available.</p> <p><strong>Case Report: </strong>We describe the case of a 16-month-old male who developed acute hypercapnic&nbsp;respiratory failure following the aspiration of a foreign body. On presentation to the emergency&nbsp;department, the child was in respiratory distress, appeared cyanotic, and had severely impaired&nbsp;oxygenation, all indicating respiratory failure. Initial management involved stabilization, advanced&nbsp;airway management, and ventilatory adjustments. Efficient communication with multiple specialists<br>coordinated the appropriate transfer of the patient to a tertiary pediatric facility for bronchoscopy... https://escholarship.org/uc/item/1xf3f47b Sun, 7 Dec 2025 00:00:00 +0000 Lee, Sabrina Combs, Kallie Shin, Richard https://escholarship.org/uc/item/6f29p8pj <p><strong>Introduction</strong>:&nbsp;Foreign bodies in the external auditory canal are an uncommon presentation in&nbsp;emergency settings. Among adults, insects represent a frequent organic foreign body, often causing&nbsp;symptoms such as otalgia, tinnitus, vertigo, and anxiety. Prehospital management of such cases is&nbsp;rarely addressed in the medical literature, with minimal guidance available for emergency medical&nbsp;services (EMS) personnel. In this report we discuss their role in stabilizing patients and reducing&nbsp;discomfort through appropriate interventions.</p> <p><strong>Case Report: </strong>A 40-year-old male called EMS after a live insect entered his left ear, causing severe&nbsp;otalgia and distress. Prehospital medical personnel clinically confirmed the presence of the insect&nbsp;and assessed for signs of tympanic membrane perforation. A medical command physician authorized&nbsp;the use of 2% lidocaine to euthanize the insect, which alleviated movement-related... https://escholarship.org/uc/item/6f29p8pj Wed, 26 Nov 2025 00:00:00 +0000 Bashline, Colin https://orcid.org/0009-0005-7926-2859 Jester, Matthew Morris, Christopher https://escholarship.org/uc/item/3pm5r47t <p><strong>Introduction: </strong>Temporal lobe epilepsy is a form of focal epilepsy that originates in the temporal lobes,&nbsp;often presenting with a variety of symptoms including altered consciousness, automatisms, and&nbsp;focal seizures with or without impaired awareness. Given such a diversity of manifesting symptoms,&nbsp;recognizing temporal lobe epilepsy in the emergency department (ED) can be challenging. Early&nbsp;identification is crucial for appropriate management, including timely initiation of antiepileptic therapy&nbsp;and differentiation from other neurological emergencies.</p> <p><strong>Case Report: </strong>A 50-year-old male with no prior history of seizures or neurological conditions&nbsp;presented to the ED after experiencing unusual sensations that had begun three days earlier. The&nbsp;patient described an intermittent sensation of warmth rising from his pelvis to his head, accompanied&nbsp;by an experiential déjà vu-like feeling he described as “dream... https://escholarship.org/uc/item/3pm5r47t Sat, 22 Nov 2025 00:00:00 +0000 Felker, Ashlynn Alexandria Tanner, Jason https://escholarship.org/uc/item/6mb946wd <p><strong>Introduction</strong>: Emergency physicians can use point-of-care ultrasound (POCUS) to identify lymph nodes in certain clinical scenarios, and advanced users can determine significant information (such as concerns for malignancy or differentiating them from abscesses for incision and drainage) based on a large volume of literature and images associated with those pathologies. However, current&nbsp;literature does not contain a similar volume of images and cases of suppurative lymph nodes, or&nbsp;buboes, limiting the ability to make the diagnosis sonographically at the bedside.</p> <p><strong>Case Report: </strong>We report on a man who presented to the emergency department (ED) with a worsening inguinal mass that changed size with positioning, as well as a 20-pound weight loss&nbsp;occurring over the course of a month. Point-of-care ultrasound of the mass was concerning for&nbsp;a necrotic suppurative lymph node, which was further evaluated with cross-sectional imaging.&nbsp;The... https://escholarship.org/uc/item/6mb946wd Mon, 17 Nov 2025 00:00:00 +0000 Campillo Luna, Julian https://orcid.org/0000-0001-8509-0700 Shaffer, Robert Woodworth https://escholarship.org/uc/item/5s53776r <p><strong>Introduction</strong>: Evaluating patients with acute neurologic deficits is a regular occurrence in the&nbsp;emergency department (ED), but some presentations warrant increased concern.&nbsp;This case&nbsp;highlights the importance of repeat evaluations and how resolution of symptoms does not rule out a&nbsp;more ominous underlying pathology.</p> <p><strong>Case Report</strong>: A 59-year-old male with a past medical history of coronary artery disease and Human&nbsp;immunodeficiency viruses (HIV) presented to a Level II trauma and comprehensive stroke center&nbsp;for left-sided facial droop and left- sided hemiparesis. Computed tomography of the brain including&nbsp;angiography and perfusion was performed revealing no hemorrhage or large vessel occlusion. Given&nbsp;his National Institutes of Health Stroke Scale score of 11, he received alteplase and subsequently&nbsp;experienced several episodes of resolution and recurrence of his symptoms while in the ED.&nbsp;Magnetic... https://escholarship.org/uc/item/5s53776r Mon, 17 Nov 2025 00:00:00 +0000 Tarahomi, Targol Serio, Sean Scumpia, Alexander John https://orcid.org/0000-0001-6862-6315 https://escholarship.org/uc/item/0g21p50z <p><strong>Introduction</strong>:&nbsp;Dislocations of the pisiform bone are rare, and literature on this injury is sparse. The&nbsp;uncommon nature of this condition, as well as limited data, makes recognition and diagnosis difficult,&nbsp;increasing the chances these injuries may be overlooked. Missing this diagnosis can lead to pain,&nbsp;reduced joint function, and nerve damage.</p> <p><strong>Case Report</strong>: We present a case of pediatric pisiform dislocation and discuss the diagnosis and&nbsp;treatment in an emergency department setting.</p> <p><strong>Conclusion</strong>: Prompt diagnosis and treatment of pisiform dislocations are vital to ensure favorable&nbsp;outcomes.</p> https://escholarship.org/uc/item/0g21p50z Mon, 17 Nov 2025 00:00:00 +0000 Wahhab, John Vimalan Jeya, Iswarya Huttner, Jackson Robert https://escholarship.org/uc/item/3mx9n0xk <p><strong>Introduction</strong>: Takotsubo cardiomyopathy is characterized by stress-induced left ventricular&nbsp;dysfunction. The reverse form accounts for &lt; 25% of all cases. We present a case of reverse&nbsp;Takotsubo cardiomyopathy in a young, otherwise healthy, woman following illicit drug use.</p> <p><strong>Case Report: </strong>A 19-year-old female patient presented to the emergency department (ED) complainingof insomnia, left-sided chest pain, palpitations, and heightened energy levels after ingesting a significant&nbsp;quantity of small, rounded chocolate chips containing unidentified pills at a rave party the previous&nbsp;night. Her electrocardiogram revealed sinus tachycardia with ST-segment elevation in leads I and aVL.&nbsp;At the ED she developed respiratory distress and required oxygen supplementation. Her troponin level&nbsp;was 1.048 nanograms per milliliter (ng/mL) (reference range &lt; 0.03 ng/mL), and her urine drug screen<br>was positive for methamphetamines.... https://escholarship.org/uc/item/3mx9n0xk Mon, 3 Nov 2025 00:00:00 +0000 Rabil, Anthony Fakhereddine, Omar Rebeiz, Abdallah El Zahran, Tharwat https://escholarship.org/uc/item/87j9p168 <p>n/a</p> https://escholarship.org/uc/item/87j9p168 Sat, 1 Nov 2025 00:00:00 +0000 CPC-EM, Clinical Practice and Cases in Emergency Medicine https://escholarship.org/uc/item/8qg4d2cf <p><strong>Introduction</strong>:&nbsp;Urethral foreign bodies are an uncommon presentation in the emergency department&nbsp;(ED) and can be difficult to assess and diagnose. There are examples in the literature of ultrasound&nbsp;detecting urethral foreign bodies. While not standard of practice, point-of-care ultrasound (POCUS)&nbsp;may be a useful tool for this unique pathology.</p> <p><strong>Case Series: </strong>We describe three cases in which POCUS was used in the care of patients presenting&nbsp;with urethral foreign bodies. Ultrasound aided in diagnosis and helped facilitate further management.</p> <p><strong>Conclusion</strong>:&nbsp;While urethral foreign bodies are relatively uncommon, they can lead to significant&nbsp;morbidity, which makes their prompt identification and treatment important. Ultrasound provides&nbsp;a rapid means of evaluation that allows the patient to stay under observation by ED staff while&nbsp;removing exposure to radiation or contrast.</p> https://escholarship.org/uc/item/8qg4d2cf Fri, 24 Oct 2025 00:00:00 +0000 Tomasi, Luca Zampi, Michael Schroeder, Michele L Cooper, Michael McIntyre, Norah https://escholarship.org/uc/item/7bk7764v <p><strong>Case Presentation</strong>:&nbsp;A 62-year-old man was brought into the emergency department by ambulance&nbsp;with right hip pain and deformity following a suspected hip dislocation.&nbsp;A plain film radiograph&nbsp;confirmed the diagnosis. He was sedated for closed reduction at the bedside. Despite apparently&nbsp;successful reduction, his case was complicated by persistent intraprosthetic dislocation of a&nbsp;polyurethane liner component of his prosthetic joint articulation. Computed tomography confirmed&nbsp;displacement of the liner, which required operative intervention.</p> <p><strong>Discussion</strong>:&nbsp;Intraprosthetic dislocation is a complication specific to dual-mobility hip prosthetics,&nbsp;characterized by displacement of the polyurethane liner unique to this type of device. This liner&nbsp;was designed to offer some benefits over other types of hip prosthetics, including improved&nbsp;biomechanics and lower risk of dislocation. The liner can become... https://escholarship.org/uc/item/7bk7764v Fri, 24 Oct 2025 00:00:00 +0000 Barden, Matthias https://orcid.org/0000-0002-1731-4933 Benbassat, Marissa benbassat, emilio https://escholarship.org/uc/item/9x15h83v <p><strong>Introduction</strong>:&nbsp;Ruptured aneurysms are associated with significant mortality limiting a patient’s&nbsp;chances of survival, making early and accurate diagnoses crucial. A commonly overlooked cause<br>is the hepatic artery aneurysm, where most patients exhibit no distinct symptoms and detection&nbsp;typically occurs only after the aneurysm has ruptured. Hepatic artery aneurysms are linked with&nbsp;high rupturing rates resulting in substantial mortality when compared to other splanchnic artery&nbsp;aneurysms. Enhancing recognition and consideration of splanchnic artery aneurysms, including&nbsp;hepatic artery aneurysms, will increase a patient’s odds of a successful recovery. The following&nbsp;case report illustrates the critical nature of these cases and highlights how important early&nbsp;diagnosis and aggressive intervention are to prevent death once rupture of the hepatic artery<br>aneurysm has occurred.</p> <p><strong>Case Report: </strong>A 57-year-old... https://escholarship.org/uc/item/9x15h83v Wed, 22 Oct 2025 00:00:00 +0000 Hladik, Andrea Zorgrabyan, Vahe Espinoza, Lysdie Cruz, Manuel https://escholarship.org/uc/item/38c4m6d1 <p><strong>Introduction: </strong>This case is unique in that it documents isolated, painless vaginal bleeding as&nbsp;the sole presenting symptom of a Stanford type A aortic dissection (STAAD), a presentation not<br>previously reported. It adds to the literature by expanding the spectrum of atypical aortic dissection&nbsp;presentations and underscores the need to consider this diagnosis in elderly patients with vascular&nbsp;risk factors, even when they present with non-classical symptoms such as unexplained bleeding.</p> <p><strong>Case Report: </strong>We present a novel case of STAAD in a 72-year-old woman with a history of&nbsp;hypertension, dyslipidaemia, prior hysterectomy, and cholecystectomy. Her primary complaint was a<br>single, transient episode of painless vaginal bleeding. Notable clinical findings included a diminished&nbsp;right radial pulse, a significant inter-arm blood pressure discrepancy, and unremarkable systemic and&nbsp;vaginal examinations. Given these... https://escholarship.org/uc/item/38c4m6d1 Wed, 22 Oct 2025 00:00:00 +0000 Chandramaniya, Vijay https://orcid.org/0009-0006-4840-0419 Mehta, Sanjay Kapadia, Nandkishore Chandramohanan, Harikrishnan Custodio, Jasmin https://escholarship.org/uc/item/2sg5006q <p><strong>Introduction</strong>: Subclavian artery pseudoaneurysms are a rare complication of blunt thoracic trauma&nbsp;with high mortality and incidence of long-term disability.</p> <p><strong>Case Report</strong>: We describe a 49-year-old female who suffered a midshaft clavicle fracture after a&nbsp;motorcycle collision who presented five weeks later with right arm weakness, paresthesias, and&nbsp;persistent clavicle pain and swelling. She was diagnosed with a subclavian artery pseudoaneurysm&nbsp;on point-of-care ultrasound performed in the emergency department, which was confirmed with&nbsp;computed tomography angiography. She underwent endovascular stenting but continued to suffer&nbsp;from long-term neurologic deficits related to her condition.</p> <p><strong>Conclusion</strong>: This case underscores that the diagnosis of subclavian artery pseudoaneurysm&nbsp;requires a high index of suspicion. In addition, the case also highlights the utility of point-of-care&nbsp;ultrasound... https://escholarship.org/uc/item/2sg5006q Wed, 22 Oct 2025 00:00:00 +0000 Mollman, Matthew E Mays, Lauren https://escholarship.org/uc/item/14v804s2 <p><strong>Introduction</strong>: Ogilvie syndrome is described as the dilation of the colon without a clear mechanical&nbsp;obstruction. One predisposing factor to Ogilvie syndrome is hypothyroidism. The hypothyroid state&nbsp;can cause decreased gastrointestinal motility; however, hypothyroidism resulting in Ogilvie syndrome&nbsp;is a rare complication and is referred to as myxedema ileus. A review of literature shows limited&nbsp;reports of this specific process and none in the emergency medicine literature.</p> <p><strong>Case Report</strong>: A 54-year-old woman with a history of hypothyroidism presented to the emergency&nbsp;department with three days of fatigue, generalized weakness, chills, diarrhea, and shortness of&nbsp;breath without chest pain or cough. Lab work showed high levels of ultra thyroid-stimulating hormone&nbsp;and decreased thyroid hormone levels. A computed tomography angiography of the chest, abdomen&nbsp;and pelvis showed multiple dilated loops of large... https://escholarship.org/uc/item/14v804s2 Wed, 22 Oct 2025 00:00:00 +0000 Mounce, Sophia Kim, Sharon Waymack, James Roy https://escholarship.org/uc/item/11b3m7cn <p><strong>Introduction</strong>:&nbsp;Patients with symptoms suggestive of acute coronary syndromes account for up to&nbsp;10% of emergency department (ED) visits, and of those visits 2% are diagnosed with takotsubo&nbsp;syndrome. Takotsubo syndrome associated with left ventricular outflow tract (LVOT) obstruction is an&nbsp;important but uncommon cause of chest pain and syncope in patients presenting with ST- segment&nbsp;elevations. Although rare, this variant is associated with worse clinical outcomes. Early recognition of&nbsp;LVOT obstruction in these patients is important to help guide proper management.</p> <p><strong>Case Report</strong>: We report a case of a 66-year-old female presenting to the ED after a syncopal&nbsp;episode with ST-segment elevations on the electrocardiogram. Point-of-care ultrasound revealed&nbsp;apical hypokinesis, thickened basal septum with LVOT obstruction and systolic anterior motion.</p> <p><strong>Conclusion</strong>: Point-of-care ultrasound... https://escholarship.org/uc/item/11b3m7cn Wed, 22 Oct 2025 00:00:00 +0000 Virella, Aileen Jose, Stephanie Mirro, Joseph cohen, allison Bielawa, Nicholas nelson, mathew https://escholarship.org/uc/item/4kh536z4 <p><strong>Introduction</strong>:&nbsp;Discovery of pearl-like, radiopaque foreign bodies is not widely documented in the&nbsp;literature. In this report, we describe an unusual radiological finding of bubble tea pearls (small,<br>chewy spheres derived from cassava starch) on computed tomography (CT) from an increasingly&nbsp;popular drink among adolescents.</p> <p><strong>Case Report: </strong>An 11-year-old female presented to the emergency department with severe abdominal&nbsp;pain. Physical examination revealed generalized abdominal tenderness, with increased pain in&nbsp;the right lower quadrant. The patient’s history was concerning for acute appendicitis. Laboratory&nbsp;results were unremarkable, and ultrasound was inconclusive for suspected appendicitis. A contrast-enhanced CT of the abdomen found several ingested radiopaque densities within the stomach.&nbsp;Further toxicology testing was negative or within normal limits. It was later found that the patient had&nbsp;consumed... https://escholarship.org/uc/item/4kh536z4 Tue, 21 Oct 2025 00:00:00 +0000 Ewaldt, Jesse Waymack, James Roy Kim, Sharon https://escholarship.org/uc/item/37x1c5f3 <p><strong>Introduction</strong>:&nbsp;Dysarthria-clumsy hand syndrome (DCHS) is a rare finding reported in lacunar&nbsp;strokes. Lesions in various anatomic locations have been reported. While the association of DCHS<br>with a caudate nucleus lesion has been documented, such reports remain infrequent.</p> <p><strong>Case Report: </strong>In this case we present a 52-year-old male who presented with DCHS following a&nbsp;stroke affecting the caudate nucleus. Neurological examination revealed left-sided motor deficits.<br>Magnetic resonance imaging confirmed an isolated infarct in the right caudate nucleus.</p> <p><strong>Conclusion</strong>:&nbsp;This case report describes a patient with dysarthria-clumsy hand syndrome, due&nbsp;to a lesion in the caudate nucleus and the internal capsule</p> https://escholarship.org/uc/item/37x1c5f3 Thu, 2 Oct 2025 00:00:00 +0000 Niknam, Janan Al-Zaher, Sarah Kotikalapudi, Sivarma https://escholarship.org/uc/item/5hj4g117 <p><strong>Introduction</strong>:&nbsp;Chlorine and chloramine gases are pulmonary irritants that can cause pulmonary&nbsp;edema and acute respiratory distress syndrome (ARDS). We present two cases that show effective&nbsp;treatment with noninvasive positive pressure ventilation (NIPPV).</p> <p><strong>Case Reports: Case 1. </strong>A 9-year-old male developed chloramine pneumonitis and ARDS with&nbsp;hypoxia to 78% on room air after urinating in a bucket of sodium hypochlorite. He was placed on<br>NIPPV with improvement in symptoms and discharged on day four. <strong>Case 2. </strong>A 58-year-old male&nbsp;developed chlorine gas pneumonitis with hypoxia to 85% on room air. Point-of-care ultrasound of this patient demonstrated greater than three B-lines in bilateral lower lung fields, which resolved after initiating NIPPV. He ultimately left against medical advice.</p> <p><strong>Conclusion</strong>:&nbsp;Noninvasive positive pressure ventilation can be an effective treatment... https://escholarship.org/uc/item/5hj4g117 Tue, 23 Sep 2025 00:00:00 +0000 Fisher, Richard https://orcid.org/0009-0009-7544-1592 Kuschner, Cyrus E Goldstein, Michael A Jhaveri, Soha Mohan, Sanjay Sud, Payal https://escholarship.org/uc/item/5bp46915 <p><strong>Introduction</strong>:&nbsp;A posterior circulation stroke at the level of the basilar artery can cause ischemia to&nbsp;the brainstem, cerebellum, and occipital lobes.<br>Posterior circulation strokes are notoriously more&nbsp;difficult to clinically diagnose than anterior circulation strokes, with a variety of presenting symptoms&nbsp;including altered mental status, dizziness, vision changes, nausea, and vomiting. Anisocoria has&nbsp;been reported to occur in rare cases.</p> <p><strong>Case Report</strong>: We present two cases where patients had an acute episode of altered mental&nbsp;status with a key exam finding of anisocoria, or unequal pupil sizes.&nbsp;The combination of anisocoria<br>and acute mental status decline are classically associated with traumatic brain injury, increased&nbsp;intracranial pressure, or both. In each of the two cases presented, acute basilar artery occlusion was&nbsp;seen on computed tomography with angiography.</p> <p><strong>Conclusion</strong>:... https://escholarship.org/uc/item/5bp46915 Tue, 23 Sep 2025 00:00:00 +0000 Ryu, Andrew https://orcid.org/0009-0008-1616-716X Chhabra, Karizma George, Thomas Kasparov, Elizabeth Wali, Mohamed Lee, Christopher C. https://escholarship.org/uc/item/3790h51q <p><strong>Introduction: </strong>Determining a mother’s Rhesus (Rh) antigen status is a critical component of prenatal care, guiding the administration of Rh immunoglobulin (Rh Ig) to prevent Rh alloimmunization, a condition that can lead to hemolytic disease of the newborn (HDN). HDN is a blood disorder where the blood types of a mother and fetus are incompatible and causes hemolysis of the fetus’ erythrocytes, a major cause of fetal death. Rh Ig is commonly administered to Rh-negative (Rh-) women as a prophylactic measure. However, categorizing a patient’s Rh status is not always straightforward as individuals can exhibit “weakly Rh+” or “formerly Rh+” phenotypes, complicating clinical management.</p> <p><strong>Case Report: </strong>This is a case of a 28-year-old Gravida three Para two (G3P2) woman whose Rh status has varied across multiple pregnancies, who presented to the emergency department with an active miscarriage requesting a dose of Rh Ig. &nbsp;Her blood typing... https://escholarship.org/uc/item/3790h51q Tue, 23 Sep 2025 00:00:00 +0000 Warner, Meghan Grace Villa, Nicole Winebrenner, Jordan Lewis, Steven Tjiattas-Saleski, Lindsay https://escholarship.org/uc/item/02d9c5t6 <p><strong>Introduction</strong>: Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention that has&nbsp;become more prevalent in the emergency department (ED) for patients with potentially reversible&nbsp;cardiac or pulmonary failure.</p> <p><strong>Case Report</strong>: We report a case of a young male patient who presented in septic shock and ultimately suffered a cardiac arrest in the ED. Extracorporeal membrane oxygenation was initiated&nbsp;after multiple rounds of cardiopulmonary resuscitation proved futile. Transthoracic echocardiography&nbsp;(TTE) was employed in the ED to guide ECMO cannulation, and the patient was able to make a full&nbsp;recovery after a one-month admission in the intensive care unit.</p> <p><strong>Conclusion</strong>: Transesophageal echocardiography and fluoroscopy are often favored over TTE for ECMO cannulation due to greater resolution of the former modalities.Transesophageal echocardiography is invasive, less accessible, and requires... https://escholarship.org/uc/item/02d9c5t6 Tue, 23 Sep 2025 00:00:00 +0000 Osae, William Gurysh, Kevin https://escholarship.org/uc/item/4gm2k1bw <p><strong>Introduction</strong>: Paralysis from hypokalemia commonly presents with generalized weakness; however,&nbsp;in rare cases it may present with unilateral or focal symptoms. Unilateral paralysis in hypokalemia&nbsp;is particularly challenging due to its mimicry of central nervous system (CNS) disorders such as&nbsp;ischemic stroke. Patients often undergo extensive and costly neuroimaging before a metabolic&nbsp;etiology is recognized.</p> <p><strong>Case Report: </strong>A 19-year-old male presented to the emergency department reporting an abrupt onset&nbsp;of inability to hold things in his right hand. He denied any precipitating factors but did note that he&nbsp;was fasting for the Muslim holy month of Ramadan. On exam, the patient was seen to have absent&nbsp;grip strength in the right hand. The patient’s metabolic panel showed hypokalemia with a potassium&nbsp;of 2.4 millimoles per liter (mmol/L) (reference range: 3.5 to 5.2 mmol/L). Following neurology&nbsp;consultation,... https://escholarship.org/uc/item/4gm2k1bw Mon, 15 Sep 2025 00:00:00 +0000 Adler, Alexander Shelbaya, Samy McCormick, Sean https://escholarship.org/uc/item/4w37471w <p><strong>Introduction</strong>:&nbsp;Foreign body airway obstruction is a high-stakes airway emergency that can rapidly&nbsp;become fatal without timely intervention.</p> <p><strong>Case Report: </strong>We present a case of a 65-year-old male in respiratory extremis due to aspiration of a&nbsp;chicken bone. Following double setup for rapid sequence intubation and cricothyrotomy, the foreign&nbsp;body was successfully removed using Magill forceps under video laryngoscopic guidance.</p> <p><strong>Conclusion</strong>: This case highlights the critical role of early recognition, team readiness, and familiarity&nbsp;with Magill forceps technique in managing foreign body airway obstruction in unstable patients</p> https://escholarship.org/uc/item/4w37471w Wed, 10 Sep 2025 00:00:00 +0000 Sayed, Ossama Garcia, Samuel I Sandefur, Benjamin https://escholarship.org/uc/item/4h83s5nn <p><strong>Introduction</strong>:&nbsp;Prolonged emergency department (ED) wait times pose problems for both patients&nbsp;and ED staff. Poor patient outcomes can result in litigation that could have been prevented by faster&nbsp;access to care.</p> <p><strong>Case Series: </strong>We present 10 lawsuits involving patients who experienced poor outcomes allegedly due to inappropriate management in the waiting room. These cases involved allegations of violations of the Emergency Medical Treatment and Labor Act (EMTALA) or general negligence and were&nbsp;levied against both the physicians and hospitals involved.</p> <p><strong>Conclusion</strong>:&nbsp;Both common law and EMTALA’s medical screening exam requirements impose&nbsp;significant obligations on physicians and hospitals to proactively manage patients in the waiting&nbsp;room. Being familiar with these requirements may help minimize legal risks</p> https://escholarship.org/uc/item/4h83s5nn Wed, 10 Sep 2025 00:00:00 +0000 Carpenter, Kayla P Walker, Laura https://orcid.org/0000-0002-1127-327X Lindor, Rachel https://orcid.org/0000-0003-3099-8388 https://escholarship.org/uc/item/0hj0378n <p><strong>Introduction</strong>:&nbsp;Acute vision loss constitutes a true medical emergency, as a delay in diagnosis&nbsp;and treatment may lead to permanent visual impairment. Orbital compartment syndrome is most<br>commonly associated with blunt trauma causing a retro-orbital hematoma and resulting compromise&nbsp;of the optic nerve. Orbital compartment syndrome, however, can occur in other scenarios including&nbsp;status post blepharoplasty.</p> <p><strong>Case Report: </strong>This is a case of a 67-year-old male who presented less than 24 hours after a bilateral&nbsp;upper blepharoplasty due to decreased visual acuity of his right eye. A lateral canthotomy was&nbsp;performed despite the absence of elevated intraocular pressures on tonometry. He regained visual&nbsp;acuity in his right eye shortly after the cantholysis.</p> <p><strong>Conclusion</strong>:&nbsp;It is vital to consider the range of entities that can cause orbital compartment syndrome,&nbsp;including blepharoplasty.... https://escholarship.org/uc/item/0hj0378n Wed, 10 Sep 2025 00:00:00 +0000 Libet, Lev Garcia, Jairo Dalia, Abdelhamid https://escholarship.org/uc/item/9fk1q56s <p><strong>Introduction</strong>:&nbsp;Fat embolism syndrome (FES) is a rare, life-threatening condition most seen in&nbsp;traumatic orthopedic injuries, especially long bone fractures. Classically, FES presents with<br>hypoxemia, neurological abnormalities, or a petechial rash; however, clinical findings can extend&nbsp;beyond this classic triad. Since FES is a clinical diagnosis, emergency physicians must recognize&nbsp;both classic and subtle presentations.</p> <p><strong>Case Report: </strong>A 22-year-old female presented as a transfer from an outside hospital for multiple long&nbsp;bone fractures secondary to gunshot wounds. Upon arrival, she was found to be hypoxic, despite no&nbsp;signs of thoracic injury on exam or initial imaging. Her presentation, laboratory findings, and repeat&nbsp;imaging were consistent with FES. She was given supportive care through supplemental oxygen and&nbsp;close monitoring. She improved with supportive care and was discharged home in stable... https://escholarship.org/uc/item/9fk1q56s Fri, 5 Sep 2025 00:00:00 +0000 Husain, Irfan Andrews, Danielle https://escholarship.org/uc/item/59h773bh <p><strong>Case Presentation</strong>:&nbsp;An otherwise healthy, 30-year-old female was referred to the emergency&nbsp;department by a local optometrist after having flashers and blurry vision for two weeks. Point-of-<br>care ultrasound revealed partial retinal detachment with underlying mass, and dilated fundoscopic&nbsp;examination suggested hyperpigmented lesions. Ophthalmology was consulted, and the diagnosis of&nbsp;amelanotic choroidal melanoma was confirmed.</p> <p><strong>Discussion</strong>: Choroidal melanoma is the most common primary malignant tumor in the eye, but&nbsp;its diagnosis is often delayed due to non-specific symptoms. Early identification is crucial given<br>relatively high rates of metastasis. This case highlights how a tentative diagnosis, made using point-of-care ultrasound and funduscopic examination, can drive timely referral to ophthalmology.</p> https://escholarship.org/uc/item/59h773bh Fri, 5 Sep 2025 00:00:00 +0000 Matin, Adiba Klinger, Jacob A Xu, Timothy Homme, James L. https://escholarship.org/uc/item/6kz986f2 <p><strong>Introduction</strong>:&nbsp;Neuroleptic malignant syndrome (NMS) is a rare but life-threatening condition&nbsp;often associated with dopamine antagonist use. However, its overlap with other hyperthermic and&nbsp;toxidromic syndromes presents significant diagnostic challenges. We present the case of a 27-year-old man with severe hyperthermia, altered mental status, and diffuse rigidity, ultimately managed as&nbsp;possible NMS but with multiple differential diagnoses.</p> <p><strong>Case Report: </strong>We describe a diagnostically challenging case of a 27-year-old male with an&nbsp;unknown medical history presenting with altered mental status, absence of personal identification,&nbsp;severe hyperthermia, and positive systemic inflammatory response syndrome criteria.&nbsp;The patient&nbsp;initially presented with hyperthermia (42.1 °C), tachycardia, tachypnea, diaphoresis, agitation, and&nbsp;rigidity. Initial lab findings demonstrated leukocytosis, elevated creatine... https://escholarship.org/uc/item/6kz986f2 Tue, 26 Aug 2025 00:00:00 +0000 O'Brien, Joseph P Carvey, Matthew https://orcid.org/0000-0001-5474-1742 https://escholarship.org/uc/item/67b689pq <p><strong>Introduction</strong>:&nbsp;Renal colic is a common reason for patients to present to the emergency department&nbsp;(ED). The most common reasons for this pain are usually renal in origin. Here we present the case&nbsp;of a 45-year-old woman with severe right-sided flank pain and associated hydronephrosis secondary&nbsp;to ureteral obstruction caused by the suction of a menstrual cup.</p> <p><strong>Case Report: </strong>A 45-year-old female presented to the ED with sudden severe right-sided flank pain.&nbsp;The patient endorsed nausea without vomiting, fever, chills, hematuria, or dysuria. She stated&nbsp;that she was currently having her menstrual period. On physical exam, the patient was in distress&nbsp;but had no tenderness with palpation of the flank or abdomen. A computed tomography of the&nbsp;kidneys, ureters, and bladder did not show renal or ureteral stones but demonstrated right-sided&nbsp;hydronephrosis secondary to an anatomical blockage of the ureter,... https://escholarship.org/uc/item/67b689pq Tue, 26 Aug 2025 00:00:00 +0000 Yoshida, Cassidy Teo https://orcid.org/0009-0002-4231-0026 Vu, Angela Lam, Robert Donahue, Sean https://escholarship.org/uc/item/4vp5r7jg <p><strong>Introduction</strong>:&nbsp;Orbital compartment syndrome (OCS) is a rare but high-morbidity emergency&nbsp;requiring prompt recognition and management.</p> <p><strong>Case Report: </strong>We present a case of a man who developed OCS from external compression of the&nbsp;globe while lying in a prone position. Initially obtunded and unable to provide any history, the patient&nbsp;exhibited anisocoria, which later progressed to severe chemosis and proptosis. Intraocular pressure&nbsp;reached nearly 100 millimeters of mercury, improving immediately after emergent lateral canthotomy&nbsp;with cantholysis. His course was complicated by ipsilateral limb compartment syndrome and<br>worsening renal failure requiring dialysis.</p> <p><strong>Conclusion</strong>:&nbsp;This case highlights the critical role emergency physicians play in the rapid diagnosis&nbsp;and treatment of orbital compartment syndrome.</p> https://escholarship.org/uc/item/4vp5r7jg Tue, 26 Aug 2025 00:00:00 +0000 Rosenblum, Jillian Leigh https://escholarship.org/uc/item/3300t7bj <p>Introduction: Cold agglutinin hemolytic anemia is a rare but serious complication of infections, including <em>Mycoplasma pneumoniae</em>. This case highlights the importance of considering infectious causes in patients with unexplained hemolysis.&nbsp;</p> <p>Case Report: A 62-year-old previously healthy male developed jaundice, dyspnea, and fatigue three weeks after returning from South America. Labs showed hemolysis with agglutination, a positive direct Coombs test, and elevated cold agglutinin titers. <em>M. pneumoniae</em> was identified via PCR (polymerase chain reaction), confirming the diagnosis. He required uncrossmatched blood transfusion and was treated with doxycycline, with clinical improvement over four days.</p> <p>Conclusion: This case underscores the need for emergency physicians to recognize <em>M. pneumoniae</em>-induced hemolysis in returning travelers. Early diagnosis, targeted testing, and awareness of macrolide resistance are critical for timely intervention... https://escholarship.org/uc/item/3300t7bj Tue, 26 Aug 2025 00:00:00 +0000 Molin, Andrea Crowe, Molly Matt, Brionna Jackson, Jessica Ray https://escholarship.org/uc/item/1342j657 <p><strong>Introduction</strong>:&nbsp;Wunderlich syndrome (WS) is a rare condition characterized by spontaneous,&nbsp;atraumatic renal hemorrhage. It often presents with non-specific symptoms and is typically&nbsp;diagnosed through computed tomography (CT). The most common presentation of WS includes the&nbsp;Lenk triad, which consists of flank pain, a palpable flank mass, and hypovolemic shock.&nbsp;If diagnosis&nbsp;and treatment are delayed, WS can rapidly progress and lead to unfavorable patient outcomes.</p> <p><strong>Case Report: </strong>A 65-year-old male presented to the emergency department with severe sudden-onset left flank pain with subsequent CT angiogram demonstrating an actively bleeding left renal&nbsp;hematoma. The patient was managed conservatively with supportive care. His vitals remained&nbsp;stable, and he did not require any surgical or vascular interventions.</p> <p><strong>Conclusion</strong>:&nbsp;Wunderlich syndrome is a spontaneous renal or perinephric... https://escholarship.org/uc/item/1342j657 Tue, 26 Aug 2025 00:00:00 +0000 Ranson, Tabitha Ostapowicz, Zachary Ruddy, Gregory Joyner, Leah https://escholarship.org/uc/item/6kd2n02f <p><strong>Introduction</strong>: Idiopathic intracranial hypertension is a disorder typically affecting females with common&nbsp;complaints of headaches and visual disturbances. Diagnostic criteria have been described with clinical&nbsp;findings, high opening pressures in lumbar punctures, and magnetic resonance imaging (MRI) findings.</p> <p><strong>Case Report: </strong>A 36-year-old female presented with double vision and headaches. Point-of-care&nbsp;ultrasound demonstrated tortuosity of the optic nerve, a finding previously described in MRI studies,&nbsp;which may serve as an additional marker for ideopathic intracranial hypertension.</p> <p><strong>Conclusion</strong>:This case highlights the potential of point-of-care ultrasound to detect tortuous optic&nbsp;nerves, which may help in the early diagnosis of ideopathic intracranial hypertension, facilitating&nbsp;more timely and effective management.</p> https://escholarship.org/uc/item/6kd2n02f Sun, 24 Aug 2025 00:00:00 +0000 Delicio, Lucas Pearl, Adam Tran, Vu Huy https://escholarship.org/uc/item/06j8p24z <p><strong>Introduction</strong>:&nbsp;Carotid artery dissections are uncommon but critical vascular injuries. They involve a&nbsp;tear to the intima, the innermost layer of the arterial wall, leading to formation of a false lumen. This&nbsp;false lumen can disrupt blood flow, weaken the wall, and lead to thrombus or rupture of the artery.&nbsp;Carotid artery dissections can occur spontaneously or in the setting of trauma. Traumatic carotid&nbsp;artery dissections (TCAD) are rare and occasionally present with third-order Horner syndrome,<br>characterized by ipsilateral ptosis, miosis, and anhidrosis. The presence of subtle physical exam&nbsp;signs like Horner syndrome reinforces the importance of maintaining a high index of suspicion and&nbsp;obtaining vascular imaging in trauma-related cases. While there have been case reports of bilateral&nbsp;TCAD, these have been rarely reported in the literature.</p> <p><strong>Case Report: </strong>We present a case involving a 53-year-old... https://escholarship.org/uc/item/06j8p24z Sun, 24 Aug 2025 00:00:00 +0000 Spevack, Eli Weisner, Zachary Michael Nokovich, Evgenia Joyner, Michelle Exley, Lauren https://escholarship.org/uc/item/7786n3st <p><strong>Introduction</strong>:&nbsp;Thyroid storm is a rare, life-threatening emergency with a 3.6-17% mortality rate&nbsp;despite proper management. Elevated levels of circulating thyroid hormones can increase metabolic&nbsp;demand, leading to adverse effects on multiple organ systems, particularly critical cardiovascular&nbsp;complications such as cardiomyopathy, myocardial infarction, ventricular arrhythmias, or coronary&nbsp;vasospasm.&nbsp;Precipitating factors can include infection, surgery, or trauma, with infection being the&nbsp;most common. The potential for cardiovascular mortality is high. While beta blockers are key for&nbsp;treatment, they can potentially reduce necessary cardiac output, risking hemodynamic collapse.&nbsp;Traditionally, propranolol has been recommended. We report a rare case of an adolescent&nbsp;experiencing cardiac arrest after propranolol administration in thyroid storm and acute appendicitis.</p> <p><strong>Case Report: </strong>A 17-year-old... https://escholarship.org/uc/item/7786n3st Mon, 18 Aug 2025 00:00:00 +0000 Ringer, Mark Phan, Tammy Samones, Emmelyn Wolk, Brian https://escholarship.org/uc/item/3cr6b7pf <p><strong>Introduction</strong>:&nbsp;Coronary artery disease is uncommon in adults under the age of 35, and studies show&nbsp;a lower incidence in women of this age group. Physicians should suspect myocardial infarction in all&nbsp;patients who present with cardiac arrest and a shockable rhythm.</p> <p><strong>Case Report: </strong>We report a case of a 34-year-old female who presented after return of spontaneous&nbsp;circulation following both pulseless electrical activity and ventricular fibrillation.&nbsp;The initial emergency&nbsp;department 12-lead electrocardiogram (ECG) demonstrated ST-segment elevation in the anterior&nbsp;precordial leads. The second, more notable, ECG showed a unique ischemic pattern of ventricular&nbsp;bigeminy with each beat containing a different morphology of injury pattern. Emergent cardiac&nbsp;catheterization found a 100% occlusion of the proximal left anterior descending artery.</p> <p><strong>Conclusion</strong>:&nbsp;Premature ventricular... https://escholarship.org/uc/item/3cr6b7pf Mon, 18 Aug 2025 00:00:00 +0000 Huttner, Madelyn McMurray, Mitchell Ikram, Sohail Huecker, Martin https://escholarship.org/uc/item/6dw390gt <p>Introduction: Compartment syndrome is an emergent condition of increased pressure within a muscle compartment. &nbsp;Paraspinal is a rare location for compartment syndrome and is typically secondary to exertion, trauma, or surgery.</p> <p>Case report: We present a case of paraspinal compartment syndrome in a patient who presented after fentanyl overdose. &nbsp;This patient was likely exposed to Xylazine, also known as “tranq”, which may have contributed to his presentation.</p> <p>Conclusion: Emergency medicine physicians must be aware of paraspinal compartment syndrome to facilitate rapid diagnosis and treatment and prevent associated morbidity and mortality.</p> https://escholarship.org/uc/item/6dw390gt Wed, 13 Aug 2025 00:00:00 +0000 Habiyaremye, Terrence Holz, Kelly Jackson, Jessica Ray https://escholarship.org/uc/item/2904j6q3 <p><strong>Introduction</strong>: Burkitt lymphoma is a highly aggressive subtype of non-Hodgkin lymphoma with&nbsp;varied clinical presentation, including in some cases involvement of the intraoral cavity. Early&nbsp;recognition of this malignancy is critical, as it typically responds well to prompt and intensive&nbsp;treatment. In this case report, we present a rare manifestation of Burkitt lymphoma presenting as an&nbsp;oropharyngeal mass.</p> <p><strong>Case Report</strong>:&nbsp;An eight-year-old male presented with tonsillar swelling and new-onset oral&nbsp;bleeding. A month earlier, he had been seen in the emergency department (ED) for similar swelling&nbsp;following a streptococcal infection. At that time, a needle aspiration for suspected peritonsillar&nbsp;abscess yielded no drainage, and he was treated with a week of clindamycin, resulting in brief&nbsp;symptom improvement. He subsequently developed difficulty breathing, a muffled voice, and oral&nbsp;bleeding, prompting... https://escholarship.org/uc/item/2904j6q3 Wed, 13 Aug 2025 00:00:00 +0000 Rosario, Diormi Ariel Aronson, Stephanie Zerzan, Jessica https://escholarship.org/uc/item/5wd730wf <p><strong>Introduction</strong>:&nbsp;Traumatic injury is the leading cause of death in individuals under 45 years of age,&nbsp;and point-of-care ultrasound (POCUS) has become an essential component of the initial trauma&nbsp;evaluation. However, positive findings on the extended focused assessment with sonography in&nbsp;trauma (eFAST) may be misinterpreted as evidence of an acute surgical emergency, particularly in&nbsp;the context of blunt trauma, underscoring the need for careful clinical correlation.</p> <p><strong>Case Report: </strong>We present a case in which a hemodynamically unstable patient had significant free abdominal fluid on eFAST after a fall from standing height. She was ultimately diagnosed with a high-risk pulmonary embolism as the cause of her hemodynamic instability, while the free abdominal fluid&nbsp;was identified as originating both from a ruptured ovarian cyst and from moderate-volume ascites.</p> <p><strong>Conclusion</strong>:&nbsp;The eFAST exam... https://escholarship.org/uc/item/5wd730wf Wed, 30 Jul 2025 00:00:00 +0000 Jansen, Natalie Fritz, Christie Lea https://orcid.org/0000-0002-0206-6164 https://escholarship.org/uc/item/50c843rr <p>n/a</p> https://escholarship.org/uc/item/50c843rr Tue, 29 Jul 2025 00:00:00 +0000 CPC-EM, Clinical Practice and Cases in Emergency Medicine https://escholarship.org/uc/item/2b48k2nn <p><strong>Introduction</strong>:&nbsp;Despite the success of emergency department (ED)-based universal HIV screening&nbsp;programs in select cities, widespread integration of similar programs across the United States&nbsp;has not followed. Within the US Centers for Disease Control and Prevention (CDC)-designated&nbsp;“Ending the HIV Epidemic (EHE)” areas, ED-based HIV screening is low. This case series highlights&nbsp;successful strategies for notification and linkage to care of patients with various challenging social&nbsp;determinates of health (SDoH). The goal is to inspire more EDs to offer universal HIV screening by&nbsp;providing insight into these challenging SDoH and successful strategies to overcome them.</p> <p><strong>Case Series: </strong>We describe four cases, two from a site in upstate South Carolina and two from&nbsp;Cuyahoga County in Ohio, that highlight successful notification and linkage to care of these&nbsp;perceived “worst-case” scenarios. Both ED-based... https://escholarship.org/uc/item/2b48k2nn Tue, 29 Jul 2025 00:00:00 +0000 Moschella, Phillip Gormley, Mirinda Ann Faryar, Kiran https://escholarship.org/uc/item/9d01h52c <p><strong>Case Presentation:</strong> An 18-year-old female, gravida 0, para 0, with no significant past medical history presented with spontaneous left vulvar hematoma that started two hours prior to arrival. History also revealed amenorrhea for the past nine months, menorrhagia three days ago, and oral contraceptive use. Her vitals demonstrated tachycardia to 130s beats per minute but otherwise were normal, consistent with an early stage of hemorrhagic shock. Physical exam was remarkable for significant left labia majora hematoma with active hemorrhage on computed tomography from the right internal iliac artery. She underwent emergent gelfoam embolization with interventional radiology and subsequent hematoma evacuation with an obstetrician gynecologist.&nbsp;</p> <p><strong>Discussion</strong>: Etiologies of vulvar hematomas fall within two categories: obstetric or non-obstetric. In rare circumstances, hematomas that lack evidence of obstetric or traumatic events are presumed... https://escholarship.org/uc/item/9d01h52c Thu, 24 Jul 2025 00:00:00 +0000 Raveiro, Roger Bengio, Moshe Mir, Danial Sharp, Justin Lindblad, Geoffrey Serio, Sean