Indian Journal of Emergency Medicine

Materials and Methods: A total of 100 patients who fulfilled the inclusion criteria and consented were included in the randomized double blinded trial and divided into two groups; Group 1 received lignocaine combined with adrenaline nebulization and Group 2 received standard nebulized bronchodilators. The treatment response was monitored. Patient’s respiratory secretion was assessed by number of suctions for tracheal toileting per 8 hours and cough severity was assessed by Cough symptom score (CSS). Additionaly day to weaning from ventilator was documented. Data Collection: Data will be collected at baseline and regularly throughout the study period by google forms filled by care taking staff and investigators team of doctors Respiratory parameters were assessed 8th hourly followed by regular assessments and emergency intervention as and when needed were done. Statistical Analysis: We applied independent sample t-test. P-value less than 0.05, so there is a significant difference in average cough [p value of 0.0001], average secretion toileting frequency [p value of 0.0001] between loxicard and control groups. Mean of control group is always more as compare to loxicard group for average cough, average secretion and ventilator weaned days [p value of 0.0001]. Though expected, there was no gender variation among the study or control group and with a p-value of 0.27 hence statistical significance of variation among men and women were nill. Ethical Considerations: Informed consent was obtained from all participants or their legally authorized representatives. Any deterioration warranting a shift from the current medications were duly undertaken and no patient was released from the study group due to unforeseen complications. Objective: To investigate the effectiveness of Lignocaine in combination with adrenaline injury patients. Trying other combinations such as ropivacaine with or without adrenaline can be tested in the future. The findings may guide future clinical practice and research in optimizing respiratory and neurological outcomes in this specific patient population.

Postural Orthostatic Tachycardia Syndrome (POTS) is a complex autonomic disorder characterized by an excessive increase in heart rate upon standing. This case report explores the clinical presentation, diagnostic journey, and management of a patient diagnosed with POTS. The aim is to enhance understanding, highlight challenges in diagnosis, and discuss the multidisciplinary approach to managing this challenging syndrome.

Diaphragmatic rupture injury is usually seen in the setting of a high speed motor vehicle accident. Rupture of the left diaphragm is common when compared to the right side in the setting of diaphragmatic blunt injury. In this case report, we discuss a rare incident of right hepatothorax following a high speed motor accident.

5-month child presenting with high grade fever with cough and noisy breathing to the EMD. On evaluation the baby appears to be in stridor and respiratory distress. Urgent chest X-ray AP View (Fig.1) showed haziiness in the right mid and lower Bone. Airway was secured followed By CECT thorax suggestive of long segment tracheomalacia with aberrant innominate artery Compression. Confirmation was done with a flexible bronchoscope followed by a suctioning To maintain luminal patency. In this article, we re port our experience of Tracheomalacia with aspiration pneumonia in paediatric age group .

An 16 year-old, previously healthy boy reported in the ER with chief complaints of abdominal pain, high-grade fevers, nausea and emesis. Multiple hepatic abscesses were found with the help of ultrasound. Aspiration cultures grew Fusobacterium Necrophorum, a rare bacterium causing potentially fatal liver abscesses in humans. Broad spectrum antibiotics were immediately started but his symptoms worsened. Latter on percutaneous drainage of multiple abscesses was performed and purulent fluid >150 ml was drained after which patient showed significant improvement. After percutaneous drainages and narrowing of antibiotics, the patient showed no signs of infection and was discharged on a 6-week antibiotic course. Because oropharyngeal infections are a potential source of bacteraemia, they must be considered in the differential diagnosis of patients presenting with hepatic abscesses and no evidence of immunocompromise.

A 66 year old Male Preeented to Er with complaints of Facial Swelling since 15 days, Cough non productive with no diurnal Variation since 1 Month, Breathing difficulty since 1 Month with no aggrevating or relieving factors. There was a History of change in Voice for past 3 months for which the patient didn’t neither took any treatment nor Evaluation. There was no History of fever, chest pain, Palpitations, Syncope, Trauma, Decreased Urine Output, Frothy Urine, Insect Bite or any history of similar complaints in the past. Patient was then Evaluated for lower respiratory tract infections, Heart failure, Angioedema, Nephrotic Syndrome. After all the investigations Patient was diagnosed as superior vena cava syndrome caused due to the Mediastinal Mass and Managed conservatively for superior vena cava Syndrome and referred to Oncology Department for further care and Management.

Idiopathic ventricular tachycardia is an uncommon form of ventricular tachycardia that is seen in absence of structural heart disease. These are generally considered to be benign and commonly seen in young individuals.

Lactic acidosis is due to increased serum lactate (>5.0mmol/L) leading to decrease in blood pH. Alcoholic keto-acidosis is one of the several etiologies where serum lactate level rarely exceeds 3mmol/L. Here we present a case of 59yr old male presented to ED with c/o abdominal pain and multiple episodes of vomiting following consumption of alcohol. On examination, patient was tachypneic, tachycardic with BP of 90/60mmHg. Arterial blood gas showed severe metabolic acidosis with a pH of 6.96, pCO2 of 21.4, pO2 of 57.1, HCO3 of 4.7 and Lactate of 14.48. On probing history, attenders revealed consumption of illicit liquor by patient on previous night giving rise to suspicion of methanol toxicity.

In all emergency departments, acute neuromuscular weakness, which is linked to respiratory failure, is a common neurological emergency. Guillain-Barr´e Syndrome (GBS) remains the leading cause of acute ascending quadriplegia presents with ascending muscle weakness associated with paresthesia and loss of deep tendon reflexes and usually preceeded by diarrheal illness or upper airway infection. Here we report 20-year-old female presented with rapidly progressing, ascending weakness of all four extremities for 24 hours duration with subsequently complicated by respiratory paralysis due to severe hypokalemia.

Thyrotoxicosis secondary to levothyroxine overdose presents multifaceted clinical dilemmas influenced by dosage, patient age, and psychiatric factors. Our case, involving a 32-year-old female with chronic hypothyroidism ingested a substantial amount of levothyroxine, highlights the potential severity of such incidents. While accidental poisoning is more common in paediatric age group,our case under scores the significance of adult cases, particularly those with underlying psychiatric conditions. Prompt recognition and intervention are paramount, given the risk of severe manifestations like thyroid storm. Treatment strategies, including symptom management and hormone elimination, facilitated the patient's recovery, emphasizing the importance of comprehensive multidimensional care and heightened clinical vigilance. This case underscores the need for tailored management approaches and multidisciplinary collaboration to optimize outcomes in cases of levothyroxine intoxication induced thyrotoxicosis.

Paget-Schroetter syndrome, also known as effort thrombosis, is a rare condition characterized by the development of a blood clot (deep vein thrombosis, DVT) in the deep veins of the upper extremity, particularly the subclavian or axillary veins. It typically affects young, healthy individuals, often athletes or those engaging in repetitive upper limb activities, leading to compression of these veins. Clinical presentation includes sudden onset of pain, swelling, and discoloration of the affected arm. Diagnosis is confirmed through imaging studies such as ultrasound, CT venography, or magnetic resonance imaging (MRI). Management includes anticoagulation therapy, thrombolysis, and sometimes surgical intervention to relieve venous compression. Early diagnosis and treatment are crucial to prevent complications such as pulmonary embolism or post-thrombotic syndrome.