Diagnosis and Management of Non-Purulent Cellulitis in the Emergency Department

A 47-year-old homeless male presents to the emergency department (ED) with right lower extremity swelling, erythema and pain. He has diabetes mellitus, and had one prior episode of cellulitis three months ago affecting the same leg. He has a history of medication noncompliance. At triage, his temperature is 38.3°C but the remaining vital signs are unremarkable. On examination of the affected leg, there is an approximately 10 × 10 cm area of erythema, induration and increased warmth. There is mild tenderness to palpation and you wonder if there is a small degree of fluctuance. There is no lymphangitis, crepitus, necrosis or pain out of proportion to clinical findings.

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The Role of Acetyl Cysteine in Cocaethylene (Non-Acetaminophen) Acute Liver Failure

Case Reports in Emergency Medicine ◽

10.1155/2018/4393064 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Getaw Worku Hassen ◽

Amaninder Dhaliwal ◽

Catherine Ann Jenninigs ◽

Hossein Kalantari

Keyword(s):

Emergency Department ◽

Substance Abuse ◽

Liver Failure ◽

Liver Transplant ◽

Acute Liver Failure ◽

Active Substance ◽

Vital Signs ◽

Normal Limits ◽

History Of ◽

Acetyl Cysteine

Background.Acute liver failure can result from acetaminophen overdose, viral infection, toxins, and other disease conditions. Liver transplant is available in limited fashion and the criteria are strict as to who should get an available liver. N- Acetyl Cysteine (NAC) has been used in non-acetaminophen induced liver failure with success. Here we report a case of acute liver failure from cocaethylene that was reversed with NAC along with other medical therapy.Case Presentation.A 50-year-old female patient presented to the Emergency Department (ED) with a two-day history of coffee ground vomiting and hematemesis. She reported occasional substance abuse and heavy alcoholism. She reported shortness of breath and chest pain from the recurrent forceful vomiting. The rest of the review of systems was unremarkable except a fall from intoxication. Physical examination revealed anicteric conjunctiva and nontender abdomen and her vital signs were within normal limits. Initial blood work revealed acute liver and renal failure. The patient was started with general medical management and liver transplant service rejected the case due to active substance abuse. She underwent brief hemodialysis and was started on NAC. Over the course of her hospital stay her liver function and kidney function improved significantly and patient was discharged to home.Conclusion.In cases where liver transplant is not an option for various reasons including active substance abuse, a trial of N-Acetyl Cysteine may be beneficial and should be considered in the Emergency Department.

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Prevalence of abdominal aortic aneurysm and associated lower extremity artery aneurysm in men hospitalized for suspected or known cardiopulmonary disease

BMC Cardiovascular Disorders ◽

10.1186/s12872-019-1265-2 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Anna Hohneck ◽

Michael Keese ◽

Gerhard Ruemenapf ◽

Klaus Amendt ◽

Hannelore Muertz ◽

...

Keyword(s):

Diabetes Mellitus ◽

Abdominal Aortic Aneurysm ◽

High Risk ◽

Aortic Aneurysm ◽

Lower Extremity ◽

Leading Edge ◽

Screening Programs ◽

Cardiopulmonary Disease ◽

Abdominal Aortic ◽

History Of

Abstract Background AAA is a disease affecting predominantly male patients ≥65 years and its dreaded complications such as rupture led to population-based screening programs as preventive measure. Nonetheless, the supposed prevalence may have been overestimated, so that targeted screening of high risk populations may be more effective. This study was performed to evaluate the prevalence of abdominal aortic aneurysm (AAA) of an inpatient high-risk cohort and to estimate the co-prevalence of lower extremity arterial aneurysms. Methods Participants: 566 male inpatients, ≥ 65 years of age, hospitalized for suspected or known cardiopulmonary disease. Primary and secondary outcome measures: Maximal infrarenal aortic diameters using abdominal ultrasound (leading edge to leading edge method). Upon detection of an AAA (diameter ≥ 30 mm), the lower extremity arteries were examined with regard to associated aneurysms. Results In 40 of 566 patients (7.1%) AAAs were detectable. Fourteen patients (2.5%) had a first diagnosis of AAA, none of which was large (> 55 mm), the remaining 26 patients were either already diagnosed (14 patients, 2.5%) or previously repaired (12 patients, 2.1%). The three most common main diagnoses at discharge were acute coronary syndrome (43.3%), congestive heart failure (32.2%), and chronic obstructive pulmonary disease (12%). The cohort showed a distinct cardiovascular risk profile comprising arterial hypertension (82.9%), diabetes mellitus (44.4%), and a history of smoking (57.6%). In multivariate analysis, three-vessel coronary artery disease (Odds ratio (OR): 4.5, 95% confidence interval (CI): 2.3–8.9, p < 0.0001) and history of smoking (OR: 3.7, CI: 1.6–8.6, p < 0.01) were positively associated with AAA, while diabetes mellitus (OR: 0.5, CI: 0.2–0.9, p = 0.0295) showed a negative association with AAA. Among the subjects with AAA, we found two large iliac and two large popliteal aneurysms. Conclusion Ultrasound screening in male inpatients, hospitalized for suspected or known cardiopulmonary disease, revealed a high AAA prevalence in comparison to the present epidemiological screening programs. There was a moderate proportion of newly-screen detected AAA and additional screening of the lower extremity arteries yielded some associated aneurysms with indication for possible intervention.

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How do we manage emergency department patients diagnosed with transient ischemic attack?

CJEM ◽

10.2310/8000.2011.110533 ◽

2012 ◽

Vol 14 (01) ◽

pp. 20-24 ◽

Cited By ~ 7

Author(s):

Jeffrey J. Perry ◽

Jonathan Kerr ◽

Cheryl Symington ◽

Jane Sutherland

Keyword(s):

Emergency Department ◽

Transient Ischemic Attack ◽

Data Extraction ◽

Tertiary Care ◽

Clinical Findings ◽

Stroke Rate ◽

Historical Cohort ◽

History Of ◽

Emergency Department Patients ◽

Ischemic Attack

ABSTRACTIntroduction:Multiple studies have demonstrated low rates of antithrombotic use, low neuroimaging rates, and high subsequent risk of stroke at 90 days following an emergency department (ED) diagnosis of transient ischemic attack (TIA). This study assessed the use of antithrombotic medications, neuroimaging, and subsequent 90-day stroke rate for patients in a more recent cohort of ED patients discharged home with TIA.Methods:We conducted a 1-year historical cohort study of all patients discharged with a TIA at a tertiary care ED (census 60,000 visits/year), which was one of the four sites participating in one of the aforementioned studies. Data were extracted from paper and electronic records onto standardized data extraction forms. Clinical findings, medications, and tests were recorded.Results:A total of 211 patients were enrolled in the study. The patients had the following characteristics: the mean age was 71.2 years (SD 13.8 years), 56.9% were female, 53.1% had a history of hypertension, 26.5% had a history of ischemic heart disease, and 17.1% had a previous stroke. The most frequent neurologic deficit was unilateral weakness (53.6%), and most deficits lasted for more than 60 minutes (71.6%). Antithrombotic medications were used for 96.7% of patients at ED discharge. Neuroimaging was conducted in 94.3% of patients while in the ED. Our cohort had a 90-day stroke rate of 1.9%.Conclusions:This study established that most TIA patients receive neuroimaging in the ED and are started on or maintained on antithrombotic agents. Clinicians are encouraged to ensure that electrocardiography is done routinely and to involve Neurology in follow-up care.

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Efek Pemberian Jamu Selama 45 Bulan terhadap Fungsi Ginjal pada Pasien Geriatri dengan Hipertensi dan Diabetes Mellitus di Rumah Riset Jamu Tawangmangu: Studi Kasus

Talenta Conference Series Tropical Medicine (TM) ◽

10.32734/tm.v1i3.263 ◽

2018 ◽

Vol 1 (3) ◽

pp. 061-066

Author(s):

Fajar Novianto ◽

Agus Triyono ◽

Peristiwan R Widhi Astana

Keyword(s):

Diabetes Mellitus ◽

Filtration Rate ◽

Geriatric Patients ◽

Alternative Therapy ◽

Vital Signs ◽

Term Therapy ◽

Kidney Glomerulus ◽

History Of ◽

Long Term Therapy

Pasien geriatri adalah pasien usia lanjut yang memiliki karakteristik multipatologi, daya faali menurun, dan dengan tanda penyakit yang tidak khas. Terapi pengobatan yang diterima pasien geriatri sangat kompleks sehingga sering menimbulkan Drug Related Problem terutama pada organ ginjal. Jamu menjadi terapi alternatif pada pasien geriatri yang memerlukan terapi jangka lama. Tujuan studi kasus ini adalah untuk melihat pengaruh pemberian jamu pada pasien geriatri yang sudah berobat dalam jangka waktu 45 bulan terhadap fungsi ginjal. Metode penelitian ini merupakan studi kasus berdasarkan data rekam medis di Rumah Riset Jamu Tawangmangu terhadap pasien geriatri yang secara rutin kontrol dan periksa ureum atau kreatinin selama 45 bulan dan masih mengkonsumsi jamu hingga bulan April 2018. Untuk melihat pengaruh jamu pada ginjal dilakukan pemeriksaan Glomerulus Filtration Rate (GFR). Hasil: Seorang laki-laki umur 61 tahun dengan keluhan tangan kanan merasa kesemutan. Pasien memiliki riwayat penyakit hipertensi dan diabetes mellitus lebih dari 15 tahun. Tekanan darah 140/90 mmHg dan tanda vital serta pemeriksaan fisik lainnya dalam batas normal. Pemeriksaan laboratorium Gula Darah Puasa (GDP) 227 mg/dL, ureum dan kreatinin diperiksa setelah bulan kelima pasien minum jamu yaitu ureum 35 mg/dL dan kreatinin 0,89 mg/dL. Selama minum jamu terjadi fluktuasi nilai GFR pasien tetapi tidak sampai menurun hingga kategori berat. Pada akhir bulan ke-45 meskipun terjadi penurunan GFR pasien dibanding pemeriksaan GFR yang pertama tetapi masih dalam kategori yang sama dengan nilai GFR pertama kali periksa (kategori ringan). Kesimpulan: Pemberian jamu dalam jangka waktu 45 bulan secara berturut-turut pada pasien geriatri tidak menyebabkan penurunan GFR signifikan. Geriatric patients are elderly patients who have the characteristics of multi pathology, decreased physiology, and atypical symptom of a disease. Treatment received by geriatric patients is very complex so it often leads to Drug-Related Problems, especially in the kidney organs. Jamu is an alternative therapy for geriatric patients who need long-term therapy. The objective of this case study was to evaluate the effect of Jamu (herbs) on kidney function of geriatric patients who have been treated for 45 months. The research method was a case study based on the medical record of geriatric patients at Jamu Research Center in Tawangmangu who routinely control and examine for their urea or creatinine levels for 45 months and still consume herbs until April 2018. In order to evaluate the effect of jamu on the kidney, Glomerulus Filtration Rate (GFR) was examined. Results: A 61-year-old male with a right hand feeling tingling. Patients have a medical history of hypertension and diabetes mellitus for more than 15 years. His blood pressure was 140/90 mmHg, meanwhile, the vital signs and other physical examinations were within normal levels. Laboratory tests of Fasting Blood Sugar (GDP) showed a level of 227 mg / dL, urea and creatinine levels were examined after the fifth month consumed jamu, the urea level was 35 mg / dL and creatinine level was 0.89 mg / dL. During jamu consumption there was a fluctuation in the patient's GFR but not until the severe category. At the end of the 45th month, despite a decrease in the patient's GFR compared to the first GFR examination but still in the same category as the first GFR score (mild category). Conclusion: Jamu consumption for 45 consecutive months in geriatric patients did not cause a significant reduction in GFR

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Features of revascularization of the lower extremity in patients with diabetic foot

Клінічна та профілактична медицина ◽

10.31612/2616-4868.3(13).2020.04 ◽

2020 ◽

Vol 3 (13) ◽

pp. 35-44

Author(s):

D. Shapovalov ◽

Y. Hupalo ◽

V. Shaprynskyi ◽

A. Shamray-Sas ◽

A. Kutsin ◽

...

Keyword(s):

Diabetes Mellitus ◽

Lower Extremity ◽

Diabetic Foot ◽

Treatment Plan ◽

Hybrid Procedures ◽

Peripheral Arterial Diseases ◽

History Of ◽

Artery Disease ◽

Peripheral Arterial ◽

Foot Pad

Objective: To determine specific features of peripheral arterial diseases in patients with diabetic foot that influence the choice of revascularization method. Introduction. Peripheral arterial diseases in patients with diabetic foot (PAD/DF) have significant differences in pathogenesis, manifestations and course compared with peripheral arterial diseases (PAD). These differences cause creating classifications to access severity PAD/DF and PAD separately. But approaches to revascularizations in PAD/DF and PAD remain the same. The choice of revascularization method taking into account the features can significantly improve its results. Materials and methods. We analyzed results of 98 revascularizations of 77 lower extremities in 74 patients in the period from 2014 to 2019рр. Angioplasties were performed 72,3%, open operations – 21,4%, hybrid procedures 6,1%. Results. Amputation-free survival during the year was 84,6%. Healing of trophic disorders during the year was 70,5%. Conclusions. At the diagnostic stage, patients with PAD and PAD / DM should be separated for creating the optimal treatment plan and the choice of revascularization technique. Different approaches to the PAD/DF patients can improve the results of revascularizations. Abbreviations and defititions PAD (peripheral arterial diseases) - atherosclerotic occlusive diseases of the lower extremity arteries. DF (diabetic foot) - infection, ulceration or destruction of tissues of the foot associated with neuropathy and/or peripheral artery disease in the lower extremity of a person with (a history of) diabetes mellitus. PAD/DF - peripheral arterial diseases in persons with diabetes mellitus.

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A case of Fournier’s gangrene diagnosed with POCUS

POCUS Journal ◽

10.24908/pocus.v4i1.13314 ◽

2019 ◽

Vol 4 (1) ◽

pp. 3

Author(s):

Marco Badinella Martini, MD ◽

Antonello Iacobucci, MD

Keyword(s):

Type 2 Diabetes ◽

Emergency Department ◽

Alzheimer Disease ◽

Physical Examination ◽

Subcutaneous Emphysema ◽

Vital Signs ◽

Fournier’S Gangrene ◽

Fournier's Gangrene ◽

History Of

An 87-year-old man with a history of type 2 diabetes and severe Alzheimer disease was admitted to the emergency department with a lesion of the perineum for two days. The patient appeared agitated and not collaborating on the visit. His vital signs were normal. Physical examination revealed an edematous, suppurative, and foul-smelling perineal-scrotal lesion, with possible subcutaneous emphysema.

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122 In Patients with Lower Extremity Burns and Osteomyelitis, Diabetes Mellitus Increases Amputation Rate

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.126 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S81-S82

Author(s):

Kathleen A Iles ◽

Lori Chrisco ◽

Stephen Heisler ◽

Booker King ◽

Felicia N Williams ◽

...

Keyword(s):

Diabetes Mellitus ◽

Lower Extremity ◽

Burn Injury ◽

Healing Process ◽

Common Mechanism ◽

P Value ◽

Diabetic Patients ◽

Significant Difference ◽

History Of ◽

The Impact

Abstract Introduction Diabetes mellitus (DM) is a critical comorbidity with burn injury due to the disrupted healing process. Previous reports have confirmed the increased rate of osteomyelitis (OM) and subsequent amputation in this cohort, however this has yet to be studied in comparison to non-diabetic patients. In this retrospective analysis, we investigate OM and amputation in both the diabetic and non-diabetic lower extremity burn populations to determine the impact of DM on these outcomes. Methods The burn registry was used to identify all patients admitted to our tertiary burn center from January 1, 2014 to December 31, 2018. Only patients with lower extremity burns (foot and/or ankle) were included. Patients with burns to additional body areas were excluded. Amputations were categorized by time from injury. Statistical analysis was performed using Student’s t test, chi-squared test, and Fischer’s exact test. Results Of the 315 patients identified, 103 had a known diagnosis of DM and 212 did not. Scald injury was the most common mechanism and average TBSA was similar. Differences were observed in average length of stay (LOS) and admission cost, with diabetics demonstrating both a higher LOS (13.7 days vs 9.2 days, p-value= 0.0016) and cost ($72,883 vs $50,500, p-value= 0.0058) (Table 1). In total, 17 patients were found to have radiologically confirmed OM within three months of the burn injury. Fifteen of these patients had a history of DM and two had no history of DM (p-value= < 0.001) (Table 2). The DM OM patients were found to have a higher blood glucose level on admission (219 mg/dL vs 110 mg/dL, p-value= 0.0452). No significant difference was seen in Hgb A1c in diabetics with or without OM (9.26% vs 8.81%, p= 0.2743). Notably, when non-diabetics were diagnosed with OM, significant differences were observed in both LOS and cost in comparison to their counterparts without OM (36 days vs 9 days; p= 0.0003; $226,289 vs $48,818, p=0.0001). Of the 11 patients who required an amputation, 10 (90.9%) of these patients had comorbid DM. Conclusions DM patients with lower extremity burns are more likely to develop OM than their non-diabetic counterparts. When radiologically confirmed OM is present, DM patients have an increased rate of amputation. OM incurs significant healthcare utilization and cost in both the diabetic and non-diabetic populations.

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Simultaneous Pneumopericardium and Pneumomediastinum following pericardiocentesis: an unusual condition

Clinical Cardiology and Cardiovascular Interventions ◽

10.31579/2641-0419/168 ◽

2021 ◽

Vol 04 (10) ◽

pp. 01-03

Author(s):

Ehsan Khalilipur

Keyword(s):

Diabetes Mellitus ◽

Chronic Obstructive Pulmonary Disease ◽

Chronic Kidney Disease ◽

Emergency Department ◽

Kidney Disease ◽

Chronic Obstructive ◽

Shortness Of Breath ◽

Obstructive Pulmonary Disease ◽

Unusual Condition ◽

History Of

An 80-year-old lady was referred to our cardiology emergency department with complaints of increasing shortness of breath since 45 days earlier, which had gradually worsened over the last week. She had a history of chronic obstructive pulmonary disease, diabetes mellitus, hypertension and chronic kidney disease

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Isolated Hyperreligiosity in a Patient with Temporal Lobe Epilepsy

Case Reports in Neurological Medicine ◽

10.1155/2015/235856 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Rocio Garcia-Santibanez ◽

Harini Sarva

Keyword(s):

Emergency Department ◽

Sexual Behavior ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Religious Experiences ◽

Medication Noncompliance ◽

History Of ◽

Patients With Epilepsy

A 40-year-old man with history of temporal lobe epilepsy presented to the emergency department with hyperreligiosity after medication noncompliance. After medications were resumed, he returned to baseline. Many famous prophets are believed to have suffered epilepsy. Waxman and Geschwind described a group of traits in patients with temporal lobe epilepsy consisting of hyperreligiosity, hypergraphia, altered sexual behavior, aggressiveness, preoccupation with details, and circumstantiality. The incidence of religious experiences ranges from 0.3 to 3.1 percent in patients with epilepsy. Religious experiences can be ictal, interictal, or postictal. Treatment is aimed at the underlying seizure etiology.

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