Kratom Ingestion and Emergency Care: Summary and a Case ReportKratom ingestion for its psychotropic effect or to self-treat opioid withdrawal symptoms has increased over the last 10 years in the United States. Although mild adverse effects have been observed in users, reports of respiratory failure and shock after kratom consumption remain rare. In this case, a 35-year-old man initially presented to the emergency department with profound circulatory shock, metabolic acidosis, hypoxia, and symptoms of autonomic nervous system dysfunction. The patient required vasopressor support, multiregimen sedation and rapid sequence intubation, mechanical ventilation, and emergent hemodialysis.
Collaborative Rescue from Double Trouble: Case ReviewA 76-year-old woman was discovered down in the bathtub of her home, aphasic with right-sided paralysis by her husband, who called 911. She had no previous significant medical history, but her husband reported complaints of right arm and chest pain from the patient in the previous 2 days. Although transporting prehospital emergency medical service (EMS) providers did not perform a 12-lead electrocardiogram (ECG), they did place the patient on monitoring equipment for lead II heart rate, pulse oximetry, and noninvasive blood pressure measurements.
Retrospective Diagnosis of Congenital Long QT Syndrome in a Patient With Febrile SyncopeA 72-year-old man presented to a level-1 urban trauma center by ambulance after a witnessed syncopal event. The syncope was sudden and without prodrome, resulting in facial injuries. He was feeling well until the day before when he developed fever and chills. History was obtained from his family who witnessed the event and emergency medical services because the patient did not recall the events preceding the syncope. The patient’s medical history included hypertension and prostate cancer with robotic prostatectomy.
Blast Incidents and Their SequelaA 39-year-old male patient is en route to your facility after an explosion of unknown origin occurred while he was getting into his car. The paramedics report that the patient is awake and alert but is confused and disoriented with regard to the place and date, with a resulting Glasgow Coma Score (GCS) of 14 (E-4, V-4, M-6). They also report that the patient has sustained a partial amputation to the left lower extremity. Bleeding has been controlled by placing a tourniquet around the thigh just above the knee.
Alpha-Gal: A Delayed Onset of Anaphylaxis and Uncovering the CauseA 67-year-old man was driving his car down the expressway when he noticed that his hands were swollen, red, and extremely itchy. The patient was having difficulty breathing, swallowing, and talking, and his tongue was swollen. He pulled over at a rest stop, got out of his car, found 2 men working at the rest stop building, and asked for help. The patient was experiencing extreme itching and shaking. The 2 men sat him in a chair and called 911. The patient appeared to be very confused, and, as the paramedics arrived, the patient had a sudden loss of consciousness.