Indian Journal of Emergency Medicine

Electrolyte problems are one of the most common cause of morbidity and mortality in the sick patients coming to the Emergency. Electrolytes measured in central lab usually takes 30-60 minutes or more whereas point of care device can give results within 5 to 10 minutes, however different instruments available and their values varies accordingly. Therefore, this study was done to investigate whether electrolyte i.e. sodium and potassium levels assessed using point of care device and auto analysers were equivalent. Methods: We prospectively studied patients admitted from Emergency Department between January 2021 to October 2021. We had taken 60 paired convenience samples and analysed sodium and potassium levels in point of care device (epoc POC device, Siemens) and in Central Lab Auto Analyser (Siemens Dimension RxL Max Integrated chemistry analyzer or in Johnson & Johnson chemistry analyser model number 51 FS). Statistical method to compare the data included Boxplot view, Regression line, Spearman’s correlation coefficient’s, paired t-test for potassium and Wilcox test for sodium correlation, Regression equation, Deming regression and Bland Altman plots. Results: The mean Sodium concentration in point of care device was 130.2 mmol/l and in Auto analyser was 130.5 mmol/l. The mean potassium level in point of care device was 4.013 mmol/l and in Auto analyser was 4.255 mmol/l. The Correlation coefficient obtained for sodium was 0.92 and for potassium was 0.818. Box plot view and regression line showed a good correlation. A difference above the CLIA criteria was noted for 10 pairs in sodium values and 07 pairs for potassium values. Conclusion: Point of care sodium and potassium values can be used in the Emergency Department for critical decision making.

Penile paraffinoma is a rare cause of penile lump(s) or mass that occurs after self- injecting liquid paraffin or similar substances like vaseline, mineral oils, illicitly performed to augment penis growth. This practice is commonly seen in many parts of central and south east Europe and some parts of Asia like Korea. Although paraffin is an inert substance for human body tissue, it can often cause complications like nodules, lumps, ulcers, pain, deformity etc. when injected into human body. The purpose of this study is to present a case of anadverse consequence of a failed penile augmentation technique that required surgical reconstruction.

Background: Paraquat is a broad spectrum liquid herbicide (1,1'- dimethyl-4,4'- dipyridylium) associated with both accidental and intentional ingestion. It has a very high case fatality rate assuming to be due to inherent toxicity and lack of effective treatments. Poisoning by Paraquat herbicide has been a major medical problem in parts of Asia. Despite widespread availability, reports of Paraquat poisoning is not common due to very high case fatality rate might be due to not reaching to tertiary care centres and non specific clinical features with absence of proper history. Case Presentation: We report a case of previously healthy 19 years old male who was brought to the emergency department 3 days after intentional ingestion of approximately 100ml of 24% Paraquat herbicide with complaints of retrosternal chest pain while breathing & dysphagia followed by several episodes of vomiting followed by the development of pneumomediastinum and death from respiratory failure. Paraquat poisoning should always be considered in the differential diagnosis in patients presenting with spontaneous pneumothorax or pneumomediastinum in places with high paraquat poisoning prevalence. Conclusion: Though Pneumomediastinum being an early predictor of 100% mortality in Paraquat poisoning but an emergency physician should establish the diagnosis early and to pursue aggressive decontamination and prevention of further absorption. Increased awareness of the clinician and availability of the laboratory diagnostic methods will definitely help in successful management of paraquat poisoning and to decrease the case fatality rate. What we already know? There are quite a few case reports that already mentioned about possibilities of occurrence of spontaneous pneumomediastinum, pneumothorax or lung fibrosis along with acute renal failure, liver toxicity and mucosal injury. What this paper adds? This is rare case report of spontaneous pneumomediastinum in Paraquat poisoning presenting to our tertiary care centre. A chest radiograph or a CT chest should be performed which may be useful in early detection of pneumomediastinum, pneumothorax or lung fibrosis for assessing long term damage in survivors. We specifically point towards the fact that no obvious clinical guideline can decrease the case fatality rates in these kind of cases.

A 62 year old male patient was presented in ER due to the sudden onset of a precordial chest pain for an hour which aggravated in the last 30 minutes along with vomiting. The patient had no medical co-morbidities as such but had a known case of haemorrhoids and was a chronic smoker. On admission, he was conscious about the time and place and his vitals were HR: 50, BP: 110/70 mm of hg, RR: 20/min, SPO2: 99% (RA), CBG: 163 mg/dl. We could not find any evidence of MI in ECG, or any wall motion abnormality in ECHO but the patient was still complaining of chest pain and diaphoresis even post getting treated with isosorbide dinitrate and ranolazine. So, we took the patient to the Cath lab for a coronary angiography, which revealed LCX proximal 95-99% disease and RCA minor plaque in mid-part and diffuse disease in distal RCA. Primary PCI to LCX was done and treated conservatively. From this particular case, we learnt the significance of coronary angiography in ACS even if there was no significant finding on ECG, ECHO or cardiac enzymes. Message: Coronary Angiography played a major role to rule out acute coronary syndrome even though there was no change in ECG, cardiac markers and 2D-Echocardiography.