Indian Journal of Emergency Medicine

Breastfeeding is a natural phenomenon which is showing a global decline in the last few years. Young, new generation mothers are more inclined towards the use of artificial milk for their newborn rather than breastfeeding. Exclusive breastfeeding is not practiced in the Indian sub continent. In this study, we will report 3 incidents of failure of breastfeeding and the role of healthcare providers, especially nurses, in imparting knowledge and education to the young mothers.

Low back pain is a common complaint in adults of all ages, and is being increasingly seen in children and adolescents. The lifetime occurrence of low back pain is around 59%.1 Mechanical low back pain is globally one of the most common presentations seen by the Emergency Physician.14 Most cases of low back pain treated in the

Emergency Department (ED) are not true emergencies, a notable exception being the Cauda Equina Syndrome (CES).

Owing to the low occurrence and low index of suspicion in the pediatric/adolescent age group, there may be a significant delay in diagnosis of Cauda Equina Syndrome. This is concerning, because delay in diagnosis and there by treatment, runs the risk of permanent neurological damage and disability. Unequivocally, the most common predictor of a favourable outcome in CES is early diagnosis.

We present the case of a 16-year-old male who presented to the ED on three separate occasions complaining of low back pain. The patient had red flag signs during the second visit; however, the relevant history and clinical findings were not elicited at the time. On the third ED visit, a clinical diagnosis of CES was made and urgent magnetic resonance imaging of the lumbo-sacral spine revealed a large right para-central herniation of the L4-L5 disc indenting the right L5 nerve root.

Our aim in highlighting this case is two fold:

1. To make the Emergency Physician aware of the rare diagnosis of CES in this uncommon

age group.

2. To stress the importance of early recognition of red flag signs in CES which will lead to an early diagnosis, and thereby a favourable outcome.

Aneurysmal SAH is a life threatening event which can cause permanent disability, the mortality and morbidity will be increased with associated complications like ACS and Acute pulmonary edema, which are rare complications of aneurysmal SAH. The combination of these three conditions imposes important treatment dilemmas. These patients tend to have electrocardiographic changes along with elevated cardiac biomarkers and neurogenic stress cardiomyopathy and pulmonary edema.

Acetaminophen, commonly called “Paracetamol” is an over the counter medication available in all the pharmacies in the Indian subcontinent. The emergency and critical care department is commonly involved in the diagnosis and treatment of acetaminophen poisoning patients. The treatment guidelines are ages old but in recent times, the presentation for acetaminophen poisoning has been varied. In this case report, we will discuss the diagnosis and management of acetaminophen poisoning in a child, along with review of literature.

Deep venous thrombosis of the upper limb is a less common phenomenon than lower limb deep vein thrombosis. The commonest reasons are trauma secondary to sport or job related arm movements and arm positions, predisposing for upper limb deep venous thrombosis. In this case report, we will discuss the diagnosis and management of upper limbs deep vein thrombosis, along with review of literature.

Brash syndrome stands for Bradycardia, Renal Failure, AV Node Blocker, Shock and Hyperkalaemia, and is a rare complication of patients suffering from chronic kidney disease, who are usually on dialytic support. These patients are usually on AV node blockers (either calcium channel blockers or beta blockers) and renal failure causes the accumulation of these medicines plus hyperkalaemia.1 Here we present a case of a patient who was diagnosed with Brash syndrome, was treated medically and was discharged. The purpose of this article is to highlight BRASH syndrome, recognise it and improve its’s medical management.

Lead is a toxic element found in the environment which leads to major complications once it enters the body in more than normal levels, affecting multiple organs and systems of the body. In this case report, we discuss a female girl child who got occupational exposure from her family pottery and toy business, we discuss the diagnosis, review of literature and management of lead toxicity.

Neuromyelitis optica spectrum is order (NMOSD) is a rare auto-antibody mediated disease of the central nervous system involving the central nervous system. The symptoms should alert the clinician to the diagnosis. Prompt diagnosis in the emergency department plays a crucial role as delay in diagnosis and initiation of management will lead to increased chances of morbidity and mortality. Approximately 80% of NMO patients have auto-antibodies against aquaporin-4, a water channel expressed on astrocytes. In this case report, we discuss a patient with NMO disease, the diagnosis and its management.

Ischemic stroke (IS) in the pediatric population is extremely rare. In this age group, the occurrence of IS often concurs with underlying congenital heart disease, haematological, metabolic or immunological conditions. In contrast, the association between IS and minor head injury in children has been sparse. The authors report a case of a healthy 10 yrs 8 months old male who was found to have a right middle cerebral artery territory infarct. An extensive medical workup was performed, and it was negative for any previously undiagnosed comorbidities. Given the paucity of such cases, the condition and its management are discussed in corroboration with current literature.

Dengue infection during the peripartum period is always a challenging situation for the obstetrician as well as other clinical departments involved in the management for these patients. The risk increases to a greater instant if the infection occurs during the third trimester as it possesses the risk of serious bleeding during parturition. In this case report, we will see the incidence and management of dengue fever in a peripartum female.

Rhabdomyolysis is a life threatening condition with various end organ damage like acute kidney injury, disseminated intravascular coagulation and others. In this case report, we discuss a patient who presented to the Emergency department after developing severe right gluteal and lower limb pain after having a weightlifting session, the diagnosis and management.

Central cyanosis is common clinical presentation in neonates and infants which is highly associated with congenital heart diseases (CHD) but this presentation is very unusual in adults presenting only with fever. However, thinking of central cyanosis in adults can lead us to variety of causes ranging from pulmonary embolism to valvular heart defects as well as arteriovenous malformation and poisoning. Through clinical evaluation and point of care echocardiography gives the insight of unusual diagnosis.

Eclampsia and severe pre-eclampsia are usually rare, but potentially life threatening medical disorders that the emergency physicians should diagnose and treat promptly. In this case report, we discuss a young female with generalized tonic clonic seizure in the postpartum period, the diagnosis and management in the emergency department of our hospital along with review of literature.

Coronary angiography and catheterisation of the heart are most widely performed tests for the diagnosis and quantification of coronary artery diseases, identification of structural abnormalities of the heart (including valvular heart diseases), and hemodynamic status monitoring. There are very high risks and complications associated with these procedures that relate to the patient’s conditions and also, the skill and operational abilities of the operator. In this case report we see a very interesting case of fractured coronary guide wire retention in the heart, its migration to distant artery and later its retrieval through surgical approach.

DIC and obstetrical hemorrhage are leading causes of maternal death and fetal complications worldwide, especially in under developed and developing nations. DIC induced PPH is a rare complication seen in pregnancy, often fatal. In this case report, we discuss an interesting case where a primigravida had delivery at home (unregistered) with postpartum hemorrhage and how she was managed effectively.

The patient waiting in the Emergency room for both the patient assessment and patient transfer out to the assigned destination (ward or intensive care unit) are major indicators in healthcare reform. This is generally assessed by patient satisfaction score. This score is usually lowest in the emergency room worldwide, mostly due to the patient load in the emergency room. We aim to assess the patient satisfaction score and the cause of delay in patient shifting out of the emergency room in our institute as the emergency department is the first point of contact in patients.

Background & Aims: Emergency endotracheal intubation is a life-saving procedure in any setting. We compared the outcomes of emergency endotracheal intubation calls for Anesthesiologists in General ward, Critical care unit and Triage in a single medical centre.

Settings and Design: Prospective, Cross sectional study.

Methods and Material: We evaluated all patients admitted to the Ward, Critical care unit and Triage between October 2021 to November 2022. A total of 186 patients, >18 years of age, who required emergency endotracheal intubation were included in this study. Primary outcome was to estimate the proportion of difficult & failed endotracheal in tubation. Secondary outcome was to assess the incidence of complications, survival and neurological outcome.

Results: General ward had the highest proportion of difficult intubations (67.74%), followed by Triage (62.9%), and CCU (61.29%). General ward had 4.83% failed intubation followed by Triage 1.61%. The incidence of hypoxemia (33.87%) and hemodynamic collapse (12.9%) was higher in General ward as compared to CCU (12.9% & 9.68%) and Triage (24.19% &11.2%), (P=0.02 & 0.04 respectively). There was a trend of higher survival rate in CCU (67.74%) as compared to General ward (25.61%) & Triage (51.61%). Among these locations, CCU had the highest rate of neurologically intact (53.23%) survival to hospital discharge as compared to General ward (16.13%) & Triage (30.63%). Conclusions: We concluded that the proportion of difficult and failed intubation, was highest in General ward followed by Triage and CCU. Incidence of complications was least in CCU followed by Triage and General ward.