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Search Results: 1 - 10 of 394 matches for " Latha Ganti "
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Altered Mental Status and a Not-So-Benign Rash
Aakash N. Bodhit,Latha Ganti Stead
Case Reports in Emergency Medicine , 2011, DOI: 10.1155/2011/684572
Abstract: Introduction. The authors are presenting a case of Thrombotic Thrombocytopenic Purpura (TTP) that presented with complaints of altered mental status and found to have petechiae. Case Presentation. An 81-year-old female patient presented to the Emergency Department (ED) of a tertiary care hospital with chief complains of dizziness, slurred speech, and weakness. She was found to have lower extremity petechiae on physical examination. On blood exam, she had thrombocytopenia, and her peripheral blood smear showed schistocytes. Her renal function was also impaired. The CT scan of head was without any abnormality. She was finally diagnosed as having TTP and transferred to ICU but ultimately passed away. Conclusion. TTP is a rare syndrome with preventable mortality if diagnosed early and managed appropriately with plasmapheresis. The Emergency Department physicians should be aware of the presenting symptoms and signs of TTP.
Abdominal Trauma: Never Underestimate It
Aakash N. Bodhit,Anjali Bhagra,Latha Ganti Stead
Case Reports in Emergency Medicine , 2011, DOI: 10.1155/2011/850625
Abstract: Introduction. We present a case of a sports injury. The initial presentation and clinical examination belied serious intra-abdominal injuries. Case Presentation. A 16-year-old male patient came to emergency department after a sports-related blunt abdominal injury. Though on clinical examination the injury did not seem to be serious, FAST revealed an obscured splenorenal window. The CT scan revealed a large left renal laceration and a splenic laceration that were managed with Cook coil embolization. Patient remained tachycardic though and had to undergo splenectomy, left nephrectomy, and a repair of left diaphragmatic rent. Patient had no complication and had normal renal function at 6-month followup. Conclusion. The case report indicates that management of blunt intra-abdominal injury is complicated and there is a role for minimally invasive procedures in management of certain patients. A great deal of caution is required in monitoring these patients, and surgical intervention is inevitable in deteriorating patients.
Trimethoprim-Sulfamethoxazole-Induced Hyperkalemia in a Patient with Normal Renal Function
L. Connor Nickels,Christine Jones,Latha Ganti Stead
Case Reports in Emergency Medicine , 2012, DOI: 10.1155/2012/815907
Trimethoprim-Sulfamethoxazole-Induced Hyperkalemia in a Patient with Normal Renal Function
L. Connor Nickels,Christine Jones,Latha Ganti Stead
Case Reports in Emergency Medicine , 2012, DOI: 10.1155/2012/815907
Abstract: The authors present a case of Trimethoprim-sulfamethoxazole-induced hyperkalemia in a patient with normal renal function. While toxicity of this drug has been reported in patients with renal insufficiency, this case highlights the toxicity associated with normal kidney function. Due to its popularity in the medical field and to the largely unrecognized effect of hyperkalemia, it is important to consider such adverse effects when prescribing TMX-SMX. One must be reminded of the possibility of the development of life-threatening hyperkalemia in relatively healthy patients. 1. Introduction Trimethoprim-sulfamethoxazole (TMP-SMX) is a broad-spectrum antibiotic used to treat a variety of infections. Due to its efficacy, its ease of dosing, and to the relatively low expense, it has become a popular choice among many physicians. However, as with any medications, adverse reactions may be experienced. Rash and gastrointestinal upset are the most commonly reported side effects associated with TMP-SMX. In contrast, hyperkalemia is rarely reported and most physicians are not aware of this potentially harmful side effect. The literature has long reported the occurrence of TMP-SMX-induced hyperkalemia in patients with acquired immunodeficiency syndrome (AIDS), patients with end stage renal disease (ESRD), and patients on high dose TMP-SMX [1–11]. More recently, there have been reports of similar symptoms occurring in patients treated with standard dose TMP-SMX [12, 13], and in conjunction with other medications, such as enalapril and spironolactone [14–19]. We present a case of life-threatening TMP-SMX-induced hyperkalemia in a female with a normal creatinine whose only other identifiable risk factor was daily lisinopril. 2. Case A 61-year-old female presented to the Emergency Department (ED) with a complaint of “I feel like I’m going to die.” She reported being in her usual state of health until seven days prior when she developed cold symptoms. She was prescribed TMP-SMX for her upper respiratory tract infection and had completed four days of the antibiotic course at the time of her arrival in the ED. Upon examination, the patient reported two days of progressively worsening weakness and fatigue and one day of chest pressure and shortness of breath. Prior to arrival, she experienced an acute increase in the generalized weakness, rendering her unable to ambulate without assistance. Also, she reported nausea and diaphoresis. She denied any additional accompanying symptoms. The patient’s past medical history was significant for diabetes, hypertension, lupus, and
Role of Bedside Ultrasound in CMV Retinitis: A Case Report
Lauren Westafer,L. Connor Nickels,Eike Flach,Giuliano De Portu,Latha Ganti Stead
Case Reports in Emergency Medicine , 2012, DOI: 10.1155/2012/690598
Abstract: We present a case of retinal detachment diagnosed by emergency department bedside ultrasonography in a patient with CMV retinitis. The indications and findings of ocular ultrasonography are discussed.
Role of Bedside Ultrasound in CMV Retinitis: A Case Report
Lauren Westafer,L. Connor Nickels,Eike Flach,Giuliano De Portu,Latha Ganti Stead
Case Reports in Emergency Medicine , 2012, DOI: 10.1155/2012/690598
Abstract: We present a case of retinal detachment diagnosed by emergency department bedside ultrasonography in a patient with CMV retinitis. The indications and findings of ocular ultrasonography are discussed. 1. Introduction Retinal detachments, though uncommon, are devastating ocular emergencies that may result in permanent vision loss. While most retinal detachments are associated with age, myopia, inflammatory disorders, and trauma, individuals with human immunodeficiency virus (HIV) are at risk for CMV retinitis and subsequent detachment [1]. Individuals with CMV retinitis have an incidence of retinal detachment of approximately 50% per patient per year, as a result of the virus-mediated necrosis of the retina [2]. Although early detection of retinal detachment may preserve a patient’s vision, CMV retinitis can infect both eyes and often progress to retinal detachment in days to weeks. As a result, practitioners should maintain a high index of suspicion for retinal detachment in HIV positive patients and use bedside ultrasound as a means of expedient evaluation in patients with visual changes. 2. Case A 38-year-old male presented to the Emergency Department (ED) with a complaint of progressive vision loss in his left eye over the past week. The patient denied trauma and any prior ocular history. He denied photophobia, pain, discharge, pruritus, nausea, vomiting, or headache. Physical exam revealed a pleasant, well-developed male who appeared comfortable. His past medical history was significant for HIV with an unknown CD4+ cell count. He was not on antiretroviral therapy but was undergoing treatment for toxoplasmosis. On exam, he had no facial swelling, erythema, or discharge from his eyes. His conjunctivas were injected bilaterally. His extraocular movements were intact. The patient’s pupils were round bilaterally, but his left pupil was nonreactive to light. There was no pain with movement of his extra-ocular muscles. He reported complete loss of vision in his left eye, including inability to perceive light. Visual acuity in the patient’s right eye was 20/200, his reported baseline. A high frequency 7.5–10-MHz linear array transducer was used to perform the ocular examination. A large amount of standard, water-soluble ultrasound gel was applied to the patient’s closed eyelid. The patient was instructed to look straight ahead. The eye was scanned in both the sagittal and transverse planes, using essentially no pressure on the globe. The ultrasound demonstrated a large retinal detachment in the left eye with no macular sparing (Figure 1). No vitreous
Fibroelastoma as a Culprit of Syncope
Giuliano De Portu,L. Connor Nickels,Eike Flach,Latha Ganti Stead
Case Reports in Critical Care , 2013, DOI: 10.1155/2013/416168
Abstract: We present a case of a valvular mass diagnosed by emergency department bedside ultrasonography in a young patient with syncope. Bedside ultrasound has become a valuable tool in the evaluation of patients with syncope in the emergency department. This patient was believed to have a fibroelastoma on ultrasound that was confirmed by magnetic resonance and ultimately by postsurgical pathological evaluation. The indications and findings of using ultrasonography as part of the workup of syncope in the emergency department are discussed. 1. Introduction Papillary fibroelastomas (PFE) are the most common tumors of the cardiac valves and the third most common tumors of the heart [1, 2]. Although they are usually not clinically significant and histologically benign, they have been associated with valvular dysfunction, increased risk for embolic events, and even myocardial infarction [1, 3]. We will present the case of a 36-year-old female who suffered a syncopal episode while sitting at her computer. She had no prior episodes of syncope, no systemic signs of illness, and no prior history of intravenous drug abuse. A bedside emergency room ultrasound showed a hyperechoic lesion on the right cusp of the aortic valve concerning for a vegetation, but in this case, it was also concerning for a cardiac tumor. 2. Case The patient is a 36-year-old female with past medical history of ocular migraines who presented to the emergency department complaining chest pressure and mild shortness of breath. She had a syncopal episode 5 days prior to our hospital visit and was seen and admitted at an outside hospital. Neuroimaging was done as part of her initial syncope workup with negative findings. She signed out against medical advice from the outside hospital, and as she was driving near our facility she developed chest pain. Her family urged her to stop at our emergency department for further evaluation. Patient had never had similar previous chest pain prior to these episodes. On exam, she had intermittent chest pain located mid to left substernal and described as a “constant dull pressure” (up to severity 6/10). She had no worsening or alleviating factors, and her discomfort was nonpleuritic. She had also described dizziness, palpitations, and mild shortness of breath. An electrocardiogram showed sinus rhythm with a rate of 67, and no other abnormalities were noted. Cardiac enzymes were negative. No focal deficits on neurological exam and no cranial nerve deficits were observed. A bedside echocardiogram showed a hyperechoic well-circumscribed lesion on the right cusp of the
The Use of Bedside Ultrasound in the Evaluation of Patients Presenting with Signs and Symptoms of Pulmonary Embolism
Adarsh N. Patel,L. Connor Nickels,F. Eike Flach,Giuliano De Portu,Latha Ganti
Case Reports in Emergency Medicine , 2013, DOI: 10.1155/2013/312632
Abstract: Evaluation of patients that present to the emergency department with concerns for the diagnosis of pulmonary embolism can be difficult. Modalities including computerized tomography (CT) of the chest, pulmonary angiography, and ventilation perfusion scans can expose patients to large quantities of radiation especially if the study has to be repeated due to poor quality. This is particularly a concern in the pregnant population that has an increased incidence of pulmonary embolism and may not be able to undergo multiple radiographic studies due to fetal radiation exposure. This paper presents a case of a pregnant patient with signs and symptoms concerning pulmonary embolism. The paper discusses the use of bedside ultrasound in the evaluation of patients with pulmonary embolism. 1. Case Presentation A 20-year-old G2P1 pregnant female at 22 weeks from her last menstrual period presents to the emergency department as a transfer patient from an outside hospital. She was evaluated for two days of progressively worse shortness of breath. The major concern at the outside hospital was a pulmonary embolism. They performed a chest CT scan that was reported as inconclusive for pulmonary embolism secondary to poor quality, and thus she was transferred for further evaluation of pulmonary embolism. Upon arrival to the ED, the patient denied any personal or family history of DVT, pulmonary embolism, or clotting disorders. Her only identifiable risk factor for pulmonary embolism was her pregnancy. On physical examination the patient was well appearing and oriented to person, place, and time. She was clearly tachypneic with a heart rate of 120–140?s?bpm. The rest of her vital signs and physical examination were normal. An EKG was performed in the emergency department which showed sinus tachycardia without S1Q3T3 sign. Ultrasound evaluation in the emergency department was performed with the focus on evaluation of pulmonary embolism. A 2–4?MHz phased-array probe was used to perform the echocardiogram. A subxiphoid view of the heart was performed, and no pericardial effusion or wall motion abnormalities were noted. The IVC diameter was not dilated and had normal variation with respirations (Figure 1). A parasternal short axis view at the level of the pulmonary artery was performed and did not show any free-floating thrombus in either the right heart or pulmonary artery. The parasternal short axis view at the level of the papillary muscles did not show any flattening or bowing of the intraventricular septum into the left ventricle. No right ventricular dilation was noted
Acute on Chronic Venous Thromboembolism on Therapeutic Anticoagulation
Byron Bassi,L. Connor Nickels,F. Eike Flach,Guiliano DePortu,Latha Ganti
Case Reports in Emergency Medicine , 2013, DOI: 10.1155/2013/295261
Abstract: A case of proximal venous thromboembolism in a patient who presented to the ED with lower extremity pain is presented. Making this diagnosis is very important as fifty percent of patients with symptomatic proximal DVTs will go on to develop PE without treatment. This report underscores the utility of bedside ultrasonography in the emergency department. 1. Introduction Venous thromboembolic disease is fairly common, with an approximate yearly incidence exceeding one in every 1000 adults [1], and two-thirds of these will present as isolated deep vein thrombosis (DVT) [2]. While more of these patients will have distal rather than proximal DVT, the mortality rate of proximal DVT is almost double that of distal DVT due to its propensity to migrate to the lungs and cause acute pulmonary embolus (PE) [3]. Multiple characteristics have been looked at in an attempt to differentiate acute from chronic DVT, as these are treated very differently. It can be difficult to differentiate acute from chronic DVT with ultrasound alone [4]. However, lumen echogenicity and vessel elasticity are two characteristics that have shown promise in aiding with this difficult diagnosis [5, 6], as chronic thrombi are more echogenic and less elastic than acute thrombi [7, 8]. 2. Case A 40-year-old male presented to the emergency department with the complaint of left lower extremity pain and swelling for three weeks which had acutely worsened. His past medical history was significant for PE and DVT, most recently five months prior to presentation. He was on daily Coumadin but had difficulty consistently maintaining a therapeutic INR. His most recent INR was 3.9 three days prior to admission. He had been instructed by his primary care physician to hold Coumadin for two days and then restart, which he did the day prior to presentation. Physical exam revealed a warm, erythematous left lower extremity. He was tender to palpation of the calf and had 2+ pitting edema distally from his knee. Distal pulses of his left leg were intact, and he had full strength and range of motion of the knee and ankle. A high frequency 7.5–10?MHz linear array transducer was used to perform the lower extremity ultrasound. Standard, water-soluble ultrasound gel was applied to the patient’s groin. The femoral region was scanned in the transverse plane, proximally from the level of the common femoral vein (CFV) just proximal to the junction of the long saphenous vein, distally through the division of the superficial and deep femoral veins. The vein was compressed every 2-3?cm in the usual fashion. The ultrasound
Female Gender Remains an Independent Risk Factor for Poor Outcome after Acute Nontraumatic Intracerebral Hemorrhage
Latha Ganti,Anunaya Jain,Neeraja Yerragondu,Minal Jain,M. Fernanda Bellolio,Rachel M. Gilmore,Alejandro Rabinstein
Neurology Research International , 2013, DOI: 10.1155/2013/219097
Abstract: Objective. To study whether gender influences outcome after intracerebral hemorrhage (ICH). Methods. Cohort study of 245 consecutive adults presenting to the emergency department with spontaneous ICH from January 2006 to December 2008. Patients with subarachnoid hemorrhage, extradural hemorrhage, and recurrence of hemorrhage were excluded. Results. There were no differences noted between genders in stroke severity (NIHSS) at presentation, ICH volume, or intraventricular extension (IVE) of hemorrhage. Despite this, females had 1.94 times higher odds of having a bad outcome (modified Rankin score (mRs) ) as compared to males (95% CI 1.12 to 3.3) and 1.84 times higher odds of early mortality (95% CI 1.02–3.33). analyzing known variables influencing mortality in ICH, the authors found that females did have higher serum glucose levels on arrival ( ) and 4.2 times higher odds for a cerebellar involvement than males (95% CI 1.63–10.75). After adjusting for age, NIHSS, glucose levels, hemorrhage volume, and IVE, female gender remained an independent predictor of early mortality ( ). Conclusions. Female gender may be an independent predictor of early mortality in ICH patients, even after adjustment for stroke severity, hemorrhage volume, IVE, serum glucose levels, and age. 1. Introduction Stroke is a priority public health problem for health systems worldwide today. Each year there are nearly 795,000 individuals who suffer from a new or recurrent stroke; 10% of these are cases of intracerebral hemorrhage. Stroke is the 4th leading cause of mortality according to the latest CDC statistics. Among all strokes, the case fatality rate for hemorrhagic strokes (37-38% mortality) is the highest [1], and most survivors have poor functional outcomes. Female gender has been recognized as an important risk factor for stroke, with NHANES reporting that women between 45 and 54 years of age were almost twice as likely to suffer from a stroke than males [2]. A greater decline was also seen in stroke-related deaths among males as compared to females between 1980 and 2005 [3]. There is a significant literature published on gender differences in outcomes of ischemic stroke. A recent review concluded that although the incidence of stroke was higher in males, females were more severely ill [4]. Internationally, it has been reported that the stroke burden is higher in females, because of a higher prestroke and poststroke disability [5–8]. This difference in disability after stroke between men and women is seen not only physically but also psychologically [9]. No published literature,
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