Indian Journal of Emergency Medicine

Background: Substance use disorders (SUDs) and professional burnout are increasingly prevalent among healthcare professionals, yet they remain under diagnosed due to stigma and fear of professional consequences. This article explores the interplay between prescription drug dependence, smoking relapse, and occupational stress, particularly in cases where financial distress triggers substance use. The role of emergency physicians (EPs) in early identification, intervention, and rehabilitation is discussed. Methods: A case based approach was used to analyze the risk factors, clinical manifestations, and treatment strategies for addiction and burnout among medical professionals. The latest evidence based guidelines from the American Society of Addiction Medicine (ASAM) and the National Institute on Drug Abuse (NIDA) were reviewed. Results: Emergency physicians are often the first responders to impaired healthcare professionals. A structured intervention, including pharmacological management, nicotine cessation support, cognitive-behavioral therapy (CBT), and workplace modifications, was found to improve patient outcomes and professional reintegration. Conclusion: Early detection and a non-punitive, structured intervention model can facilitate long-term recovery among medical professionals struggling with substance dependence, financial stress, and burnout. Emergency physicians play a pivotal role in initiating treatment pathways and advocating for a stigma-free recovery environment.

Cardiac tamponade is a rare but fatal and often underdiagnosed complication of central venous catheter (CVC) placement, associated with high mortality. Imaging and clinical findings with high degree of suspicion helps in diagnosis of the condition in patients. This case emphasizes the critical importance of confirming the correct position of catheter tips prior to initiating any infusion therapy. Clinicians should maintain a high index of suspicion for tamponade in patients whose clinical parameters and vital signs worsen following central line placement. Additionally, caution is advised during resuscitation efforts, and using the catheter in question should be avoided until proper placement is verified. In this case report, we discuss this highly critical case, the immediate emergency diagnosis and prompt treatment she received in the emergency department and final outcome.

Haemorrhagic shock, resulting from rapid and significant blood loss, poses a serious threat in trauma care due to its impact on tissue oxygenation and organ function. Immediate identification of bleeding sources is crucial, yet internal injuries may remain undetected. One such underrecognized condition is the Morel-Lavallée lesion (MLL) a closed soft tissue injury typically caused by highimpact trauma. It occurs when the skin and subcutaneous layers are forcibly separated from the underlying fascia, creating a space that may fill with blood and bodily fluids. Although uncommon, MLL can serve as a concealed site of haemorrhage, contributing to shock if not promptly addressed. We present the case of a 24-year-old female who developed hypovolemic shock after sustaining injuries to physical assault, later diagnosed with MLL. This case highlights the importance of thorough imaging in patients to uncover hidden sources of bleeding and emphasizes the need for early recognition and appropriate treatment of MLL to improve outcomes.

Abdominal pain is a frequently encountered symptom in clinical settings and can be associated with a wide range of conditions, from minor ailments to serious, life-threatening disorders. Recent advancements in diagnostic technology have providedthe healthcare professionalswith better equipped strategies to detect rare but critical conditions. One such uncommon and often overlooked vascular disorder is spontaneous isolated dissection of the celiac artery (SICAD), which remains relatively unfamiliar to many clinicians. In this case report, we discuss the challenging condition of in diagnosis of SICAD, the presentation and the therapeutic challenges faced in the management of a patient presenting to our emergency medicine department with a simple abdominal pain.

Carbon monoxide (CO) poisoning is a potentially life-threatening condition that typically requires prompt administration of high-concentration oxygen, most commonly delivered via a non-rebreather mask (NRB). While this method remains the standard of care, high-flow nasal cannula (HFNC) therapy has gained popularity as an effective alternative for oxygen delivery in various respiratory disorders. HFNC provides heated and humidified oxygen at high flow rates, which may offer physiological benefits such as improved oxygenation, reduced work of breathing, and enhanced patient comfort. This case report describes an innovative application of HFNC in the acute management of CO poisoning. The patient presented with elevated carboxy-haemoglobin levels and was successfully treated using HFNC rather than conventional NRB therapy. This case highlights the potential role of HFNC as a feasible and effective option in the treatment of CO poisoning and encourages further investigation into its utility in similar toxicological emergencies.

Aspergillus fumigatus is a globally distributed mold and major opportunistic human pathogen, known for its ability to grow at high temperatures. This study examined 89 strains from 12 countries to assess variation in thermal growth and potential links to geographic origin. Strains were grown at four temperatures and genotyped at nine microsatellite loci. Results showed significant variation in growth among strains, even within the same region, but no strong correlation between thermal growth profiles and genetic makeup or geographic origin. These findings suggest that A. fumigatus populations have broad thermal adaptability, likely enabling rapid adjustment to changing temperatures. This adaptability has important implications for the pathogen’s evolution and spread, especially under the pressures of global climate change.

Infectious mononucleosis, most often caused by the Epstein-Barr virus (EBV), is a frequently encountered illness in emergency medical settings across the globe. One of the common findings associated with EBV infection is a temporary and usually mild elevation in liver enzymes, particularly transaminases. These abnormalities are typically subclinical and resolve on their own. However, a much less frequent but clinically significant complication is acute cholestatic hepatitis, presenting with signs of biliary flow obstruction. In such cases, patients may exhibit liver function test results that mimic those seen in obstructive jaundice. Notably, advanced imaging techniques, including ultrasound or MRI, often fail to reveal any mechanical obstruction within the biliary system. In this case report, we discuss an interesting case of hepatitis following EBV infection, the prompt emergency diagnosis and management and final outcome.

Background: Sarcoidosis, a systemic inflammatory disease characterized by nonnecrotizing granulomas, presents significant diagnostic challenges, particularly in regions like India where tuberculosis (TB) is highly endemic. Both conditions share clinical, radiological, and even some histological features, leading to potential misdiagnosis. This confusion is especially pertinent when sarcoidosis manifests with atypical radiological patterns, such as a miliary pattern, classically associated with disseminated TB. Accurate differentiation is critical, as the standard immunosuppressive therapy for sarcoidosis can have deleterious effects if administered for unrecognized TB. Case Presentation: We present the case of a 45-year-old male residing in Kolkata, West Bengal, India, with comorbidities of type 2 diabetes mellitus and hypertension, who presented with a two-month history of progressive exertional dyspnea, dry cough, and chest discomfort. High-resolution computed tomography (HRCT) of the thorax revealed diffuse bilateral micronodules consistent with a miliary pattern, raising strong initial suspicion for miliary TB. However, comprehensive investigations were pursued. Sputum examinations for acid-fast bacilli (AFB) were repeatedly negative, as was polymerase chain reaction (PCR) for Mycobacterium tuberculosis in bronchoalveolar lavage (BAL) fluid. Fiberoptic bronchoscopy with transbronchial lung biopsy (TBLB) was pivotal, demonstrating multiple wellformed non-necrotizing epithelioid cell granulomas, characteristic of sarcoidosis. Serum angiotensin-converting enzyme (ACE) levels were notably elevated at 140 U/L. Fungal cultures and other relevant investigations were negative. Conclusion: Based on the compatible clinical picture, supportive ACE levels, exclusion of infectious etiologies (particularly TB), and definitive histopathological findings, a diagnosis of pulmonary sarcoidosis was confirmed. The patient was initiated on oral corticosteroids, with mycophenolate mofetil added early due to concerns regarding poor glycemic control. This case strongly emphasizes that sarcoidosis must be considered a key differential diagnosis for miliary patterns on chest imaging, even in high TB prevalence settings. It highlights the insufficiency of relying solely on radiological findings and underscores the essential role of histopathology via TBLB or other biopsy methods for accurate diagnosis, thereby preventing inappropriate anti-tuberculosis treatment and enabling timely, targeted therapy for sarcoidosis.

A 25-year-old female presented with acute left-sided chest pain for one hour. She reported a history of dull chest pain for three days, which had worsened in the past hour. On examination, she was tachypneic, hypoxic, and had decreased air entry on the left side of chest. Point of care ultrasonography (POCUS) suggested absent lung sliding. Based on physical examination and POCUS findings suggestive of a possible pneumothorax, tube thoracostomy was considered. However, a history of prior fundoplication for a hiatus hernia led to suspicion of a left diaphragmatic hernia. Prompt imaging with chest X-ray and non-contrast CT of the thorax confirmed the diagnosis of diaphragmatic hernia, thereby ruling out pneumothorax. Surgical intervention was promptly undertaken. This case emphasizes the importance of a thorough history and imaging before invasive procedures. Misdiagnosing a diaphragmatic hernia as a pneumothorax and proceeding with tube thoracostomy could have led to severe complications. Clinicians should maintain a high index of suspicion for alternative diagnoses in patients with a history of upper abdominal surgery presenting with chest pain and respiratory distress.

Methemoglobinemia, a condition characterized by the oxidation of hemoglobin to its ferric state, compromises oxygen delivery and can lead to life-threatening hypoxia. We present a case of a patient with refractory hypoxemia and cyanosis, ultimately diagnosed with methemoglobinemia and associated supraventricular tachycardia (SVT). While congenital cases are rare, acquired methemoglobinemia is frequently induced by medications and oxidant exposures. Our case underscores the importance of early recognition, as methemoglobinemia-induced hypoxia can precipitate severe cardiovascular complications. Prompt administration of methylene blue led to rapid clinical improvement, reinforcing its role as the firstline treatment. This case highlights the need for heightened clinical vigilance, thorough exposure history, and multidisciplinary management to optimize outcomes in methemoglobinemia-related emergencies.

Introduction: Abdominal aortic aneurysm (AAA) dissection is an exceedingly rare clinical entity, distinct from the more common thoracic aortic dissection or ruptured AAA. Aortic aneurysms, often present with symptoms such as chest pain, back pain, or syncope. However, in some rare cases, the clinical presentation can be atypical, including the presentation of hypotension without the typical signs of rupture or acute dissection. This report discusses an unusual presentation of an unruptured aortic aneurysm dissection, which presented primarily with hypotension and mild abdominal discomfort, in a patient without the classic symptoms of chest pain or back pain. Case report: A 68-year-old female who presented to the emergency department with complaints of gradually worsening pain abdomen for 3 days; associated with fever, vomiting and vertigo. She was found unconscious on the floor. On arrival to ER, the patient’s blood pressure was non-recordable; per abdomen examination revealed aortic pulsations palpable on left side of umbilicus. CT Aortogram showed two segments of aortic dissection in descending thoracic aorta and infrarenal abdominal aorta respectively. Following CTVS consultation, the patient was managed conservatively and discharged in a stable condition. Conclusion: This case underscores the importance of considering AAA dissection in atypical presentations of abdominal pain and the need for tailored management strategies. We review the pathophysiology, diagnostic modalities, and therapeutic options, emphasizing the rarity of unruptured AAA dissection and its implications in clinical practice.