Notes

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While rare, acute myocardial infarction must be considered. Most injuries result as direct trauma to the artery causing either dissection or acute thrombosis resulting in a myocardial infarction as opposed to acute plaque rupture with thrombosis, as seen in this case.
Emergency department physicians should incorporate point-of-care-ultrasound (POCUS) in the assessment of patients presenting with acute scrotal pain for rapid identification of the time sensitive urologic emergency, testicular torsion.

A 20-year-old otherwise healthy male, with a history of monorchism, presented to the emergency department with vague testicular pain. A POCUS was performed, which demonstrated attenuated arterial flow of the patient's single testicle as well as twisting ("whirlpool sign") of the spermatic cord, both highly specific ultrasonographic findings of testicular torsion.

These findings expedited definitive management resulting in the salvage of the single ischemic testicle.
These findings expedited definitive management resulting in the salvage of the single ischemic testicle.
Unilateral facial weakness is a concerning symptom, particularly in a resources poor setting. Distinguishing between peripheral and central causes is critical to the evaluation, treatment, and prognosis.

An unusual case of recurrent, transient Bell's palsy occurring during ascent in a commercial airplane is presented.

Emergency physicians should be aware of the possibility of barotrauma to the facial nerve (cranial nerve VII) during flights because accurately diagnosing this condition can prevent costly aircraft diversion, calm the passenger's anxiety, and forgo an expensive medical workup.
Emergency physicians should be aware of the possibility of barotrauma to the facial nerve (cranial nerve VII) during flights because accurately diagnosing this condition can prevent costly aircraft diversion, calm the passenger's anxiety, and forgo an expensive medical workup.
Ring avulsion injuries consist of a characteristic injury pattern resulting from sudden intense force pulling on a finger ring. While ring avulsion injury is a known entity in the hand surgery literature, there is scant description of the injury pattern in emergency medicine, much less its management and transfer implications in the emergency department (ED).

This is a report of a patient presenting to the ED with ring avulsion injury after a workplace accident, initially transferred to a tertiary care hospital with general hand surgery, who then required a second transfer for consideration of microsurgical revascularization.

In addition to fully assessing the degree of injury, including neurovascular and tendon involvement, emergency physicians must recognize cases of severe ring avulsion injuries without complete amputation as potential opportunities for microsurgical revascularization.
In addition to fully assessing the degree of injury, including neurovascular and tendon involvement, emergency physicians must recognize cases of severe ring avulsion injuries without complete amputation as potential opportunities for microsurgical revascularization.
The use of peripherally inserted central catheters (PICC) has been integral to the advancement of medical care in both in-patient and out-patient arenas. However, our knowledge of PICC line complications remains incomplete, particularly in regard to venous perforation and extraluminal migration. Utilization of displaced catheters harbors lethal complications and is an infrequently reported phenomenon, with traumatic etiologies only referenced as possible mechanisms; however, to date no formal cases have been reported.

We report a case of a fall associated with extraluminal PICC migration and perforation causing mediastinitis and severe sepsis after total parenteral nutrition (TPN) infusion in a 54-year-old woman. Our patient required a right-sided PICC for long-term home TPN due to severe malnutrition following gastric bypass surgery. During a routine home care visit our patient was found tachypneic, hypoxic, and short of breath. Computed topography imaging in the emergency department (ED) identified the injury, likely related to the recent fall. The patient experienced a complicated hospital course after removal of the PICC. SBP-7455 nmr Although rare, PICC line migrations and perforations cause serious complications that should be considered by emergency physicians evaluating patients with chronic indwelling vascular access.

Given the efficacy and widespread use of PICC lines, we present this case as a rarely reported but life-threatening complication that requires particular attention. Emergency physicians should be aware of such PICC line complications when encountering patients with chronic indwelling vascular access.
Given the efficacy and widespread use of PICC lines, we present this case as a rarely reported but life-threatening complication that requires particular attention. Emergency physicians should be aware of such PICC line complications when encountering patients with chronic indwelling vascular access.
Appendicitis is a common disease, and as we have improved in early diagnosis and management of this disease process, late stage complications have become extremely rare, but can have indolent presentations.

A 37-year-old male with no past medical history presented to the emergency department (ED) with vague abdominal pain as well as 12 days of cyclical fever. He had no significant findings on laboratory workup with the exception of a mild aspartate transaminase and alanine transaminase and relative neutrophilia between outpatient, urgent care, and ultimate ED visit. His ED workup included cross-sectional imaging of his abdomen revealing multiple liver abscesses and septic thrombophlebitis secondary to ruptured appendicitis.

Liver abscesses and septic thrombophlebitis are an extremely rare complication of appendicitis that has only been documented twice previously.
Liver abscesses and septic thrombophlebitis are an extremely rare complication of appendicitis that has only been documented twice previously.
A 20-year-old man with a reported history of asthma presented to the emergency department in cardiac arrest presumed to be caused by respiratory failure.

The patient was discovered to have central airway obstruction and concomitant superior vena cava compression caused by a large mediastinal mass-a condition termed mediastinal mass syndrome. While the patient regained spontaneous circulation after endotracheal intubation, he was challenging to ventilate requiring escalating interventions to maintain adequate ventilation.

We describe complications of mediastinal mass syndrome and an approach to resuscitation, including ventilator adjustments, patient repositioning, double-lumen endotracheal tubes, specialty consultation, and extracorporeal life support.
We describe complications of mediastinal mass syndrome and an approach to resuscitation, including ventilator adjustments, patient repositioning, double-lumen endotracheal tubes, specialty consultation, and extracorporeal life support.
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