查看更多>>摘要：? 2022 Elsevier Inc.Hypothermia is a common diagnosis in the Emergency Department. It can cause a multitude of symptoms and complications if not treated promptly. The following case report discusses Brugada pattern on an electrocardiogram in a patient with hypothermia and diabetic ketoacidosis. There was resolution of the Brugada pattern on the electrocardiogram after the patient was warmed to 35.3 °C.
查看更多>>摘要：? 2022 Elsevier Inc.As of January 2022, there have been over 350 million confirmed cases of COVID-19 in the world. The most common symptoms in those infected are fever, cough, malaise, and myalgia, however pulmonary, hematologic, gastrointestinal, renal, and neurologic complications have also been reported. Acute transverse myelitis (ATM) is an uncommon neurological syndrome characterized by acute or subacute spinal cord dysfunction that can lead to paresthesias, sensory and autonomic impairment, and even paralysis. Etiologies are often unclear; however, potential causes include infection, neoplastic, drug or toxin induced, autoimmune, and acquired. Treatment for ATM primarily consists of steroids and plasmapheresis, which often reverses any neurologic symptoms. ATM has rarely been reported as a complication of COVID-19 infections. A 43-year-old female presented to the emergency department for evaluation of progressive numbness and tingling in her legs ten days after developing upper respiratory symptoms from a COVID-19 infection. Physical examination and magnetic resonance imaging confirmed a diagnosis of ATM. During her hospital course, she experienced rapid progression of her paresthesias and developed complete loss of motor function in her upper and lower extremities. Within 48 hours after emergency department arrival, she required intubation due to worsening diaphragmatic and chest wall paralysis. Her treatment included a long-term steroid regimen and plasmapheresis, and unfortunately, she did not have any neurologic recovery. We present a very rare case of ATM progressing to complete quadriplegia following COVID-19 infection.
查看更多>>摘要：? 2022 Elsevier Inc.A 78-year-old man presented to the emergency department with a 10-day history of diarrhea and presyncope. His electrocardiogram showed a type-1 Brugada pattern but also a first-degree atrioventricular block, right bundle branch block, and peaked and symmetrical hyperacute T waves. A blood test revealed a potassium level of 9.3 mEq/L. After hemodialysis with normalization of serum potassium, the electrocardiographic abnormalities disappeared. An ajmaline challenge excluded the possibility of Brugada syndrome.
查看更多>>摘要：? 2022Lactation ketoacidosis is a very rare cause of metabolic acidosis in breastfeeding patients. We present a case of a 34-year-old female, 8-weeks postpartum, who was breastfeeding while also on the ketogenic diet. She developed dyspnea, chest pain, nausea, vomiting, and an inability to tolerate oral intake for several days. She presented with a metabolic acidosis with an anion gap of 33, HCO3 of 5.1 mmol/L, venous pH of 7.045, and serum b-hydroxybutyrate of 7.4 mmol/L. She was treated in the emergency department with intravenous normal saline and intravenous dextrose, with prompt transfer to the intensive care unit for treatment with an intravenous sodium bicarbonate drip and an intravenous insulin drip with dextrose. After normalization of laboratory values, she re-developed an elevated anion gap acidosis after breastfeeding in the ICU overnight. She was started on a carbohydrate-rich diet and made a full recovery without reported repeat incidences. We provide a summary of our case, discuss known causes of lactation ketoacidosis, and emphasize the importance of a thorough history and physical. In this case a dietary history was more helpful than a very expensive laboratory and imaging evaluation.
查看更多>>摘要：? 2022 Elsevier Inc.Background: Severe hypothermia can result in malignant arrhythmias or cardiac arrest and require invasive central rewarming modalities due to a core body temperature < 28 °C. Difficult rescue missions can make continuous CPR challenging, but the decrease in oxygen consumption at these low temperatures allows for successful recovery despite the delay. Although other active warming techniques, such as peritoneal lavage, intravascular warming catheter, and renal replacement therapy can be beneficial, the consensus statements recommend extracorporeal life support as the preferred rewarming method. Case presentation: A 42-year-old female was found in a pond after presumed exposure for 30–40 min with an outside temperature of 17 °F (?8 °C) and was found to be in ventricular fibrillation. ACLS protocol was then initiated. At the hospital, she was intubated and sedated with continuous CPR during multimodal rewarming, including active internal via the ZOLL Icy catheter. One hour after rewarming, with core temperature above 29 °C, she was defibrillated and achieved ROSC. As she continued to warm, she made purposeful movement and was warmed and maintained at euthermia. She was initiated on antibiotics due to aspiration concerns and titrated off vasopressors with extubation on day 2 of hospitalization. She had mild complaints of extremity numbness and chest pain from compressions prior to discharge on hospitalization day 4. Conclusions: This case has a successful resuscitation of severe hypothermia associated with cardiac arrest. The patient was warmed at greater than 4 °C/h with a less invasive, quicker and potentially more available approach to warming. With equipment improvements, the ability to provide prolonged CPR while rewarming may suggest that transferring to an extracorporeal life support center is not necessary.
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