Shoulder pain is a common complaint of patients presenting to emergency department. Various conditions, intrinsic and extrinsic to the shoulder, can result in shoulder pain. Some of these extrinsic conditions can pose a threat to life. We present a case of a young, previously healthy male who initially had bilateral shoulder pain, later developed quadriparesis, and was ultimately diagnosed with a spontaneous cervical epidural hematoma. He underwent an emergency C7-T1 laminectomy with hematoma evacuation and had a full recovery. Cervical epidural hematoma is a rare surgical emergency where timely diagnosis and treatment are crucial.
Background and objectiveSepsis is a life-threatening medical emergency and a significant cause of mortality. Risk stratification scores for sepsis can be unsuitable for use in the emergency department (ED) due to their complexity, and an appropriate solution has yet to be found. In this study, the predictive value of the Sepsis Patient Evaluation in the Emergency Department (SPEED) score in estimating 28-day mortality was assessed among patients with sepsis presenting to the ED, in order to determine its suitability as an efficient risk stratification system. Materials and methodsThis was a single-center, prospective observational study conducted at an urban tertiary care center. We included patients presenting to the ED with suspected or confirmed sepsis who met the inclusion and exclusion criteria of our study. The patients were evaluated with the following scoring systems on arrival: the SPEED score; Predisposition, Infection, Response, and Organ dysfunction (PIRO) score; and Mortality in Emergency Department Sepsis (MEDS) score; the patients were subsequently followed up on the 28th day to record the final outcomes with regard to mortality and discharge rates. ResultsThis study included 127 patients in total. The median age of the study population was 49 years, and the 28day mortality rate was 50.4%. The area under the receiver operating characteristic (AUROC) curve for the SPEED score for predicting mortality was 0.899 (95% CI: 0.847-0.951). In comparison, the AUROC for MEDS and PIRO scores was 0.857 (95% CI: 0.793-0.92) and 0.895 (95% CI: 0.838-0.951), respectively. Based on the DeLong test, no significant difference was found in the diagnostic performances with respect to these scores. ConclusionThe SPEED score is a simple and handy parameter that can be used for the early and appropriate risk stratification of patients with sepsis in the ED.
Acute suppurative thyroiditis is a rare life-threatening endocrine emergency. The thyroid gland has rich vascularity and lymphatic drainage, has large amounts of iodine in the tissue, generates hydrogen peroxide, and is encapsulated. Owing to these factors, infection of the thyroid gland is rare. The clinical presentation of acute suppurative thyroiditis closely resembles that of subacute thyroiditis, with a differentiation possible only on fine needle aspiration cytology (FNAC). However, differentiating these two conditions is important because the management of these two conditions differs drastically. Management includes intravenous antibiotics, drainage of abscesses, and sometimes surgery may be required. Here, we present a case of thyroid abscess caused by methicillin-resistant Staphylococcus aureus (MRSA), diagnosed using FNAC of the thyroid gland and blood culture.
Pesticides include insecticides, herbicides, and rodenticides. Pesticide poisoning can be intentional, accidental, or occupational. Around 385 million cases of unintentional acute pesticide poisoning occur annually worldwide, with approximately 11,000 fatalities. Herbicides are used to kill weeds and can include chlorophenoxy compounds, bipyridyls, urea-substituted herbicides, organophosphates, and glyphosate. Paraquat is a bipyridyl nonselective contact herbicide with high mortality rates upon exposure in humans. Paraquat poisoning causes acute lung injury, rarely leading to pneumothorax and pneumomediastinum, referred to as Daisley Barton Syndrome. We report a case of a 22-year-old female from Uttarakhand, India, who accidentally ingested paraquat. She was initially asymptomatic, but later developed lung, liver, and kidney injuries as well as pneumomediastinum and pneumothorax.
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