Visual EM

Propafenone Overdose-induced Arrhythmia and Subsequent Correction After Administration of Sodium Bicarbonate

Patrick Bruss, MD^* and Peter Fuller, MD^{^}

DOI: https://doi.org/10.21980/J8D925Issue 3:2 No ratings yet.

The first ECG in this case showed sinus tachycardia with a widened QRS (black arrow), a rightward axis, prolonged corrected QT interval (QTc), and terminal R wave in AVR (white arrow). There are several potential causes for these ECG findings, but put together with the patient’s history, we were suspicious of sodium channel blockers being the most likely cause. The second ECG, after sodium bicarbonate was administered, demonstrated a normal QRS (black arrow) and no rightward axis deviation, reduction of the QTC and resolution of the terminal R wave (white arrow). We later learned that the patient’s cardiologist recently increased her propafenone dose.

Toxicology Visual EM

Herpes Zoster Ophthalmicus

Shayna Adams, BS^* and Darren Knight, MD^{^}

DOI: https://doi.org/10.21980/J88H07 Issue 3:2 No ratings yet.

Physical exam was significant for an erythematous maculopapular rash in the right ophthalmic nerve (V1) region, a crusted vesicle at the right upper eyelid, and surrounding eyelid edema. Visual acuity remained at baseline and intraocular pressure was within normal limits. External slit lamp exam with fluorescein staining was remarkable for pseudodendrites in the inferior-temporal cornea approximately 1.5 mm from the limbus. Ophthalmology was consulted and completed an in-depth evaluation of the corneal lesions. They found no evidence of anterior chamber reaction and performed a complete dilated fundus examination which demonstrated no retinal involvement. The patient was then discharged on acyclovir and erythromycin ointment with close follow-up.

Ophthalmology Visual EM

Evaluation of Snake Bites with Bedside Ultrasonography

Josef E Jolissaint^*, Alexis Salerno, MD^{^} and Daniel Sheets, MD^{^}

DOI: https://doi.org/10.21980/J84S7D Issue 3:2 No ratings yet.

History of present illness: While watering his lawn, a 36-year-old man felt two sharp bites to his bilateral ankles. He reports that he then saw a light brown, 2-foot snake slither away from him. He came to the emergency department because of pain and swelling in his ankles and inability to bear weight. Physical examination revealed bilateral ankle swelling and

Wilderness Ultrasound Visual EM

Procedural Sedation for the removal of a rectal foreign body

John Costumbrado, MD, MPH^*, Valerie Lew, BS^* and David Wagner, MD^*

DOI: https://doi.org/10.21980/J81332Issue 3:2 No ratings yet.

Axial and coronal views on CT showed evidence of a large, tube-shaped foreign body in the rectum (see arrows) without evidence of acute gastrointestinal tract disease.

Abdominal/Gastroenterology Procedures Visual EM

Glass Foreign Body Hand Radiograph

Hamid Ehsani-Nia, DO^* and Joshua Bucher, MD^*

DOI: https://doi.org/10.21980/J8W92HIssue 3:2 No ratings yet.

History of present illness: A 27-year-old female sustained an injury to her left hand after she tripped and fell on a vase. She presented to the emergency department (ED) complaining of pain over the laceration. Upon examination, patient presented with multiple small abrasions of the medial aspect of the left 5thdigit that are minimally tender. Additionally, she has one 0.5cm

Trauma Ultrasound Visual EM

A Case of Otomastoiditis

Chad Correa, BS^* and Claire Thomas, MD^{^}

DOI: https://doi.org/10.21980/J8RK89Issue 3:2 No ratings yet.

The patient underwent computed tomography (CT) of the head which revealed opacification of the left middle ear (red arrow) and mastoid air cells (red circles). Additionally, there was thickening of the soft tissues of the external auditory canal (blue arrowhead), likely reflecting concurrent otitis externa. Based on the imaging, he was admitted for findings consistent with acute otomastoiditis.

ENT Infectious Disease Visual EM

Osborn Waves in a Severely Hypothermic Patient

Jon Van Heukelom, MD^*

DOI: https://doi.org/10.21980/J8H34SIssue 3:2 No ratings yet.

The initial EKG shows marked elevation of the J-point (point where the QRS segment joins the ST segment), otherwise known as an “Osborn Wave” (see black arrows). A subsequent EKG obtained after active rewarming, showed resolution of the Osborn waves.

Cardiology/Vascular Visual EM

Acromioclavicular joint separation

Devan Pandya, BS^* and John Costumbrado, MD, MPH^{^}

DOI: https://doi.org/10.21980/J8C91G Issue 3:2 No ratings yet.

History of present illness: A 30-year-old male was brought in by ambulance to the emergency department as a trauma activation after a motorcycle accident. The patient was the helmeted rider of a motorcycle traveling at an unknown speed when he lost control and was thrown off his vehicle. He denied loss of consciousness, nausea, or vomiting. The patient’s vital signs

Orthopedics Visual EM

Torsades de Pointes

Richard J Chen, MD^*, Grant Wei, MD^* and Chirag Shah, MD^*

DOI: https://doi.org/10.21980/J87K91 Issue 3:2 No ratings yet.

The patient was found to be in a polymorphic ventricular tachycardia; he was alert, awake and asymptomatic. A rhythm strip showed a wide complex tachycardia with the QRS complex varying in amplitude around the isoelectric line consistent with Torsades de Pointes.

Cardiology/Vascular Visual EM

Pediatric Pulmonary Abscess

Kyle Barbour^* and Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J83S6QIssue 3:2 No ratings yet.

Upright posterior-anterior plain chest films show a left lower lobe consolidation with an air-fluid level and a single septation consistent with a pulmonary abscess (white arrows). A small left pleural effusion was also present, seen as blunting of the left costophrenic angle and obscuration of the left hemidiaphragm (black arrows).

Respiratory Infectious Disease Visual EM