Indian Journal of Emergency Medicine

The risk for seizure disorder increased in multiple autoimmune disorder. The raised proinflammatory cytokines and auto antibodies against the neuronal antigen may contribute in the pathogenesis of the seizure disorder. In this case report, we will discuss about a young adult presenting to the ER with seizure disorder and later found to have underlying autoimmune disease.

Intraperitoneal rupture of urinary bladder is a complication faced during improper technique and forceful Foley’s catheterisation. Peritonitis following intraperitoneal bladder rupture is a rare complication seen and theoretically noted. In this case report, we see how a forceful Foley’s catheterisation led to intraperitoneal bladder rupture and thus, leading to peritonitis.
 

Methemoglobinemia is a life-threatening condition in which there is a decrease in the oxygen carrying capacity of the blood (hemoglobin). The relative hypoxemia leads to fall in patient blood saturation without any breathing difficulty. We discuss a case of methemoglobinemia in a young adult with leprosy, the presentation and management of the condition in the Emergency room.

Infectious pericarditis is a rare phenomenon in the era of antibiotics and vaccines. The number of patients with Haemophilus influenzae are rising (in rare cases) and commonly affect the adult population. Haemophilus influenzae is rarely seen in children due the advancement of vaccination. We describe a case where a 1 year infant suffering from cardiogenic shock, its management in the emergency room.
 

Background: Appendices Epiploicae, also referred as Epiploic appendages, are 50-100 fat filled finger like projection from the serosal surface of large intestine. Epiploic Appendagitis is a self-limiting, benign disease process which results from the inflammation of these Appendices Epiplocae or thrombosis of the draining vein of Appendices Epiplocae.

Case Report: We report a case of 49 year old female, generally well, presented to the A & E with complaints of a painful lump in her left iliac fossa growing in size for last four weeks. She presented to us because of acute increase in size and pain, resulting in significant discomfort. Owing to her history of CIN-1 we arranged a CT abdomen and pelvis with contrast fearing some sinister underlying ongoing pathology causing her symptoms. But to our surprise Ct reported a underrated cause of her abdominal pain, Epiploic Appendagitis. We were surprised of her presentation as a hard abdominal lump which was quite unusual for EA to present as. We assume it was secondary to an extensive underlying local inflammatory reaction. Patient was reassured and treated with NSAID, antibiotics and follow up with surgery ambulatory care.

Conclusion: We authors are reporting this case of primary epiploic appendagitis because we think every emergency and primary care physicians should be aware of this very rare condition which might present to emergency as an acute abdominal presentation mimicking other common presentations like acute diverticulitis and acute appendicitis. Being aware of this condition is utmost important to diagnose it early and avoid more invasive surgical managements and unnecessary antibiotic usage.

Background and Aim: Several adjuvants have been utilized to enhance the standard of analgesia over the time of post-surgery. We have undertaken this study to evaluate and compare the efficacies of clonidine and dexmedetomidine as an adjuvant to intrathecal hyperbaric 0.5% bupivacaine in patients scheduled for elective lower limb surgeries.

Material and Methods: The present study is blinded randomized case control done in the department of the Emergency Medicine in the medical college and associated hospital. All patients undergoing elective lower limb surgery were included for the study. After obtaining the consent letter signed from the patients; total of 180 patients were included in the study. Patients were divided into 3 groups: Group A (control group): received 15mg of 0.5% hyperbaric bupivacaine with 0.5 ml normal saline. Group B (clonidine group): received 15mg of 0.5% hyperbaric bupivacaine with 50µg clonidine. Group C (dexmedetomidine group): received 15mg of 0.5% hyperbaricbupivacaine with 5µg dexmedetomidine. Various parameters were examined were: Onset of sensory blockade and motor blockade, Maximum level of sensory blockade and time taken for the same, Maximum level of motor blockade and time taken for the same.

Results: There is no clinical significance between group B and group C regarding mean time taken for onset of sensory blockade. The mean duration of analgesia is 194 ± 26.98 mins in group A (controlgroup), 346.37 ± 32.16 mins in group B (clonidine group) 373.37 ± 38.17 mins in group C (dexmedetomidine group). There is a statistically highly significant difference between group A and group B.

Conclusion: The supplementation of bupivacaine with dexmedetomidine 5 μg or clonidine 50 μgin spinal anaesthesia produces significant shorter onset of motor and sensory block with longer duration of sensory and motor block when compared to bupivacaine alone.

Background and Aim: Spinal anesthesia is a widely used technique providing faster onset with effective and uniformly distributed sensory and motor block. Due to decreased cardiovascular and central nervous system toxicity, levobupivacaine is a good alternative for spinal anesthesia. Present study was done to compare the effects of adding of dexmedetomidine to levobupivacaine in prolonging the analgesia produced by epidural levobupivacaine alone in patients undergoing infraumbilical surgeries.

Material and Methods: A prospective study was carried out which included 100 adult patients between the age group of 20 and 65 years of physical status American Society of Anesthesiologists Classes I and II who underwent infraumbilical surgeries. Group L patients received 3 ml (15 mg) of 0.5% isobaric levobupivacaine + 0.3 ml normal saline while Group LD patients received 3 ml (15 mg) of 0.5% isobaric levobupivacaine + 0.3 ml (3 μg) dexmedetomidine. The two groups were compared with respect to the onset and duration of sensory and motor block and hemodynamic stability.

Results: In Group LD, increase in VAS was observed at 210 min and the first dose of rescue analgesia was given at 5th h postoperatively. The second dose of recue analgesia was given at 12th h and the third dose was given at 21st h. Postoperative VAS scores at different time intervals were significantly lower in Group LD than Group L, thus indicating superior analgesia. The time of request of the first dose of rescue analgesia was delayed in Group LD and the difference in the two groups was highly significant (P < 0.001).

Conclusion: Epidural administration of dexmedetomidine with levobupivacaine hydrochloride 0.5% results in faster onset of sensory and motor blockade compared to levobupivacaine hydrochloride 0.5% alone. Dexmedetomidine as an adjuvant to levobupivacaine hydrochloride 0.5% provides superior quality of analgesia without any significant hemodynamic instability.

Introduction: Sepsis is a clinical syndrome that has physiologic, biologic, and biochemical abnormalities caused by a dysregulated inflammatory response to infection. The present study aimed to estimate the dose of injection of norepinephrine in micrograms/ kg/min after 12 hours of starting the vasopressor infusion to keep an MAP of above 65 mm Hg.

Materials & Method: The study was done for the period of two years. Patients who were 18 years and above; who were diagnosed with septic shock during their ICU course and whose relatives gave informed written consent were included in the study.

Result: Total of 12 patients were lost during the study period and so in total 100 patients were enrolled for the study. Both the groups were comparable with respect to the MAP (p = 0.655). The norepinephrine dose in group I vs group II at 12 hours was found to be 0.163 ± 0.089 vs 0.396 ± 0.18 μg/kg/min (p <0.001). Reduction in blood lactate concentration in 12 hours was significantly higher in group I [1.479 ± 1.46] than group II [0.08 ± 1.50] mmol/L (p = 0.002). Increase in the urine output of the patients in 12 hours in Group I [0.72 ± 0.44] than group II [0.47 ± 0.460] mL/kg/hour (p = 0.001).

Conclusion: A low-dose continuous infusion of terlipressin may have a significant role in ensuring better organ perfusion, preventing renal injury, and improving the SOFA score of the patients when used in adjunct to norepinephrine, early in the management of septic shock.

Background and Aim: The incidences of sepsis and septic shock depend on how acute organ dysfunction and infection are defined as well as on which data sources are studied. Hence this study was conducted to bring out the correlation between hyperuricemia in clinically diagnosed sepsis patients and morbidity and mortality.

Material and Methods: Total of 150 patients was included in the study. For the uric acid estimation of the included patients; blood samples were taken from the patient. For the biochemical estimation of the uric acid level the collaboration was done with the department of biochemistry, medical college and hospital.

Results: Among the 150 study participants, 64 patients had elevated uric acid levels which constitutes about 42.7%, whereas 86 patients constituting 57.3% had normal uric acid levels. It can be inferred that among the study population, patients had type 2 diabetes mellitus as the most common comorbidity at 40%. The most prevalent comorbidities among the patients with hyperuricemia were diabetesmellitus type 2 and type 1, decompensated liver disease and cerebrovascular accident. Patients without any comorbidities about 36% of the study population also developed sepsis.

Conclusion: This study demonstrates that Serum Uric acid may be potentially used as a marker of severity of illness as well as predictor of mortality and morbidity in patients with clinically diagnosed sepsis in the IMCU. This study recommends further studies on a large basis to confirm the observations.