Painless loss of vision: rapid diagnosis of a central retinal artery occlusion utilizing point-of-care ultrasound.

Point-of-care ultrasound (POCUS) has become an essential part of the evaluation of vision loss among emergency physicians in the emergency department (ED). It is frequently used to evaluate for vitreous hemorrhage, foreign bodies, retinal detachment, optic neuritis and posterior vitreous detachment; however, it can also be used to evaluate for a central retinal artery occlusion (CRAO). A POCUS can reveal a hyperechoic density in the optic nerve sheath just proximal to the retinal surface, and this is referred to as a retrobulbar 'spot sign' (RBSS).

Functional testicular torsion secondary to an incarcerated inguinal hernia in a 4-month old: complete recovery at 18-hours.

One of the most common urological emergencies encountered in pediatric patients in the emergency department (ED) is the acute scrotum. We present the case of a 4-month-old male that presented to our community ED with scrotal swelling and vomiting of 16-hours duration. He was diagnosed with a functional testicular torsion from an incarcerated inguinal hernia, transferred to a hospital with pediatric urological capabilities and was taken to the operating room ~2 hours later.

Severe methemoglobinemia secondary to isobutyl nitrite toxicity: the case of the 'Gold Rush'.

Isobutyl nitrite is one of the popular recreational drugs with high abuse potential that is known to cause methemoglobinemia. While inhaling this recreational drug, often referred to as a 'popper', is the typical route of administration, oral ingestion can produce a more rapid and fulminant course of methemoglobinemia. We present the case of a 69-year-old male that presented to our emergency department in extreme, life-threatening methemoglobinemia due to the ingestion of isobutyl nitrite that he obtained from an adult novelty store.

A 2-year-old with a hepatic abscess secondary to an ascending retrocecal appendicitis: case report and review of the literature.

Background: Diagnosing appendicitis within the pediatric population can be challenging, whether it be a neonate with irritability or a toddler with flank pain. Symptoms may mimic a viral illness, constipation, urinary tract infection, or intussusception, all of which are more common in this age group when compared with appendicitis. While a ruptured appendicitis can result in an intra-abdominal abscess, peritonitis, and/or shock, the development of a pyogenic hepatic abscess is extremely rare.

Perforated Small Intestine: A Case of a Delayed Presentation of an Intra-Abdominal Injury in a Pediatric Patient With a Seatbelt Sign.

With the use of seatbelts comes a unique injury profile that has been called "the seatbelt syndrome." The classically described "seatbelt sign" has become a pattern of injury, describing potential underlying damage. As a clinician, clues to the underlying damage follow a thorough physical examination including the removal of all clothing to locate abrasions and bruises to the skin that potentially follow a seatbelt pattern.

Chest pain while gardening: a Stanford type A dissection involving the aortic root extending into the iliac arteries-an uncommon and potentially catastrophic disease process.

Background: An aortic dissection is an uncommon and potentially catastrophic disease process that carries with it a high morbidity and mortality. The inciting event is a tear in the intimal lining of the aorta. This allows passage of blood through the tear and into the aortic media, resulting in the creation of a false lumen.

A tubo-ovarian abscess mimicking an appendiceal abscess: a rare presentation of Streptococcus agalactiae.

A tubo-ovarian abscess (TOA) is a relatively rare medical complication that results from an untreated/unrecognized ascending pelvic infection of the female genital tract. In a right-sided TOA, this clinical entity may mimic appendicitis on computed tomography (CT). In addition, both disease processes can present with pelvic pain, leukocytosis and fever.

Breast abscess in a competitive high school swimmer: a case of toxic shock syndrome.

Toxic shock syndrome (TSS) is a severe, acute, toxin-mediated disease process characterized by fever, diffuse erythroderma, hypotension, multisystem organ dysfunction and desquamation of skin. TSS represents the most severe form of disease caused by exotoxin-producing strains of and . Menstrual and non-menstrual TSS become significant causes of morbidity and mortality.

High-output congestive heart failure: a potentially deadly complication of thyroid storm.

Hyperthyroidism, thyrotoxicosis and thyroid storm are a continuum of disease. A life-threatening and potentially fatal manifestation of thyrotoxicosis is thyroid storm. Thyroid storm is considered rare with an occurrence rate of 1-2% of all patients with hyperthyroidism, making a high index of suspicion important in the early recognition of this debilitating complication.

Perianal abscess in a 2-year-old presenting with a febrile seizure and swelling of the perineum.

An anorectal abscess, specifically a perianal abscess, is a relatively uncommon infection in children. It is a purulent fluid collection under the soft tissue outside the anus. Some of these abscesses may spontaneously drain and heal by themselves, while others may result in sepsis and require surgical intervention.

Septic shock secondary to acute bacterial prostatitis in an HIV-positive male: a novel presentation.

Acute bacterial prostatitis, an acute infection of the prostate gland, results in lower abdominal pain, flank pain, urinary symptoms and the potential for systemic symptoms like fever and shock. With a high mortality rate if left untreated, acute bacterial prostatitis becomes a true urological emergency, which if allowed to progress, may result in bacteremia, severe sepsis/septic shock and death. Diagnosis is mainly clinical with a detailed history and physical and laboratory evaluation to include a urinalysis.

Fournier gangrene: a rare case of necrotizing fasciitis of the entire right hemi-pelvis in a diabetic female.

Fournier's gangrene, a rare polymicrobial infection that affects the genitals and perineum, can present as an insidious onset to a rapid and fulminant course. Early recognition, diagnosis, initiation of broad-spectrum antibiotics and prompt surgical treatment remain the foundation of management. If treatment is not initiated aggressively, the patient will likely rapidly deteriorate, leading to organ failure and death.