Indian Journal of Emergency Medicine

Rhabdomyolysis is a medical emergency characterized by the break down of skeletal muscle leading to the release of intracellular contents into the blood stream, which can lead to acute kidney injury and even death. Drug abuse is one of the potential causes of rhabdomyolysis. This case report describes a 18-year-old male with a history of drug abuse who presented to the emergency department with severe muscle pain, weakness, dark and reduced amount of urine. The patient was diagnosed with rhabdomyolysis, which was likely due to a combination of high doses Marijuana, Chlorpheniramine, Dextromethorphan (Corex Syrup), Dicyclomine, Tramadol, Acetaminophen and cigarette smoking over period of 4-5 years, landed up in rhabdomyolysis after joining gym. The patient was immediately started on aggressive intravenous fluid resuscitation, and his urine output and electrolyte levels were closely monitored. Patient required initiation of Hemodialysis over period of 15 days. Patient's muscle pain and weakness gradually improved over the next few days, and he was discharged with a diagnosis of AKI due to Rhabdomyolysis due to drug abuse. Prompt recognition and treatment of rhabdomyolysis are crucial to prevent serious complications, and addiction treatment should be pursued to prevent future episodes of rhabdomyolysis and other drugrelated complications.
 

Acute bilateral renal cortical necrosis (RCN) is a rare but potentially lethal form of renal injury that poses a diagnostic and therapeutic challenge for clinicians. The causes of renal cortical necrosis are multi-factorial. Renal cortical necrosis shows a higher incidence in men than women in non-obstetric cases, and its clinical presentation is heterogeneous, ranging from asymptomatic to severe renal failure. In this case report, we describe the clinical course of a patient who presented with acute renal failure following a venomous snake bite and was subsequently diagnosed with renal cortical necrosis. Despite aggressive management, the patient ultimately succumbed to death on the 24th day of admission. The present case highlights the importance of early diagnosis, prompt initiation of appropriate management, and effective prevention of complications in patients with renal cortical necrosis to improve patient outcomes and reduce morbidity and mortality. A timely and accurate diagnosis of renal cortical necrosis is critical for initiating appropriate interventions, and management should aim to address the underlying cause and prevent potential complications.
 

Compartment syndrome is a medical condition with high rates of morbidity if not diagnosed and treated on time. Compartment syndrome usually occurs following a trauma, but, nontraumatic conditions also exist which can lead to compartment syndrome. In this case report, we will discuss the diagnosis and treatment of gluteal compartment syndrome following intramuscular injection, along with review of literature.
 

• Hypothyroidism is a prevalent condition in the general population.1 42 million people in India have thyroid disorders and hypothyroidism is the most common, affecting one in ten adults.

• Myxedema coma is a rare and life threatening emergency with a high mortality rate.2 It results from severe hypothyroidism and affects almost every organ

• Patients will present with myxedema coma, characterized by hypothermia, hypotension, bradycardia, and altered mental status in the setting of severe hypothyroidism.3 Myxedema coma has also been known to manifest in a number of unusual and dangerous forms.

• A high index of suspicions is needed among clinicians in order to rapidly recognize the condition and make an early diagnosis. Treatment should be commenced on clinical grounds while waiting for laboratory results.

• Here, we present the case of a male who presented to the emergency department with altered mental status, Anasarca and in abilty to walk.
 

There are many ways to manage status epilepticus. The rationale for aggressive treatment of generalized convulsive status epilepticus lies solely on the premise that best outcomes rely upon rapid seizure control. Metabolic and toxic seizures can be particularly refractory to therapy, exposing a patient to the threat of aspiration, hyperkalemia, rhabdomyolysis, hyperthermia, myocardial infarction, and arrhythmias.The role of intubation is controversial. Neurologists tend to view intubation as a form of “treatment failure”, reflecting inability to treat the seizure with traditional agents.1 However, it is our opinion that intubation is often the key therapeutic intervention to not only control the seizure, but prevent its deadly complications.In our case report, we highlight the emergent airway management of a 29-year-old pre-morbidly healthy female who was referred to us from a secondary care center with generalized convulsive status epilepticus and refractory hypoglycemia, following an alleged history of propranolol overdose.

Background: Emergency Department (ED) re-attendances are one of the clinical quality indicators to measure the quality of care delivered in the UK. There isn’t much information on ED re-attendance rates and reasons responsible for it during the COVID-19 pandemic. We aim to establish the ED re-attendance rate during the COVID-19 pandemic.

Methods: Data for this single centre study was compiled from Symphony, the department’s electronic patient records. We chose the month of April 2020 for this study and subsequently followed up to 28 days for re-attendances. Only patients aged 18 years and older, presenting with COVID-19 symptoms who were discharged from ED were included (n=310). We also studied the hospital admission and mortality rates among the patients who had re-attended.

Results: Of the 310, 65 (21%) patients re-attended the ED more than once within 28 days and 27.6% of them belonged to the 41-50 age group. 30 (46.1%) patients were males and 35 (53.8%) were females. The majority (44.6%) of them were of white ethnicity. Among the re-attendees, most of them re-attended only once and within 7 days. Most of the re-attended patients were discharged and only 21 (32.3%) patients had a hospital admission. Of the admitted patients, 6 (28.5%) died in the hospital. Of the patients who died, 5 had tested positive for COVID-19.

Conclusions: ED re-attendances were significantly high during the COVID-19 pandemic compared to the national average from previous years.
 

Medicolegal cases (MLC) are injuries or medical conditions which require additional input from law enforcement agencies to help in the diagnosis and determining the nature of injury sustained by the patient. Any incorrect input or incomplete documentation may lead to delay in the legal proceedings and thus, patient rights will be violated. In this article, we will enlist the errors in the medicolegal records over the period of 3 years in our institute and guide the doctors in the emergency department for proper documentation of the medicolegal cases.
 

Background: Utility of biomarkers in early prediction of multiple organ dysfunction syndrome (MODS) in suspected cases of sepsis presenting to the Emergency Department (ED).

 Aim and Objectives: To correlate the biomarker values (Pro-calcitonin (PCT), C-reactive protein (CRP), NT-pro BNP and Neutrophil gelatinase associated lipocalin (NGAL) with multiple organ dysfunction (MOD) score and to evaluate their role in early prediction of MODS in suspected sepsis patients presenting to ED.

Methods: This is a prospective observational study conducted on 65 patients with suspected sepsis. Patients of 18-65 years presented in the ED with triage complaints of fever, respiratory, urinary and abdominal infections, who were sepsis screen positive on arrival and admitted, were enrolled in the study. They were categorized into two groups: Group 1 (MODS score Positive at 48 or 72 hours) and Group 2 (MOD score Negative). Biomarker values in both the groups and its correlation with MOD score was analyzed.

Results: At 48 hours, 40 (61.5%) patients were MODS positive with PCT (Sensitivity 100%, OR-12.6, CI-0.6-255.04, p=0.098), CRP (Sensitivity 100%, OR-27.0, CI-1.44-504.0, p=0.027), NTpro BNP (Sensitivity 82.5%, OR-7.07, CI-2.55-22.16, p=0.0008) and NGAL (Sensitivity 77.5%, OR-82.9, CI-9.7-698.16, p=0.0001) with PPV of NGAL (96.88%) and NT-pro BNP (76.74%) and 100% NPV for PCT and CRP.

Conclusion: This study established a good correlation of NT-pro BNP and NGAL with positive MODS score suggestive of and highly predictive of developing MODS in suspected cases of sepsis. The normal value of PCT and CRP on arrival in patients with suspected sepsis rules out MODS even at 72 hours during their hospital stay.
 

Objective/Hypothesis: Objective of this study was to find out the diagnostic accuracy made by emergency physician, this will ensure improvement in patients care and will help to implement better accuracy in determining diagnostic accuracy.

Background: Department of emergency medicine is a specialized care facility in tertiary health care centre whose main function is to take care of patients with immediate and emergent health issues. In view limited literature in EM in India a study between PD vs FD was performed for future reference in continuous quality improvement.

Methods: A prospective, observational study was done among 200 patients between provisonal diagnosis made in emergency department vs final discharge diagnosis.

Results: Majority of the patients (n=153, 76.5%) were from the age group of patients between 15-64 followed by (n=40, 20%) in the age group with patients of >65 years age, followed by (n= 7, 3.5%) in the age group of 1-14 years. Most matched diagnosis were from department of internal medicine (18.5%) followed by department of cardiology (16%), followed by department of neuromedicine (13%). It was found that 81% (n=162) cases were accurately matched) diagnosed during Emergency department admission, while there was unmatched diagnosis of 19% cases (n=38).

Conclusion: Result obtained suggests that the provisional diagnosis was made by the emergency physicians were mostly matched with final discharge diagnosis that was made by the concerned specialist doctors. This shows that the choice of treatment done in the ER were a prompt and accurate treatment. This has a positive effect on the prognosis, mortality and outcome in patients. Department of internal medicine had more diagnostic errors. Improving history taking of patients with proper clinical evaluation correct diagnosis in the ER. Early availability in blood reports during emergency stay will help as a better diagnostic interpretation of disease. it is required to upgrade clinical skills of emergency physicians in diagnosing pediatric age group.