Background: Detection of various types of shock in patients presented to the emergency department for early resuscitation and management with the use of lung ultrasound at the patient's bedside. Aim: The study aimed to evaluate the undifferentiated shock patients presented to the emergency department by using the KH screening tool in our hospital. Materials and methodology: All patients who presented to the emergency room (ER) with undifferentiated shock were included in this study. The KH screening tool was performed on the patient by the emergency physician taking of the patient. This study was single-centre prospective diagnostic study conducted in our hospital using the KH screening tool. Results: This study included 159 patients who presented to our emergency department. The KH screening was found to be >90% accurate in identifying patients with undifferentiated shock. In our study, of the cases, 41% fall into the 61–70 age group, 27% fall into the 51–60 age group, 13% fall into the more than 70 age group, 12% fall into the 41–50 age group, and only 8% fall into less than 40 age group, 73% of the patients were males and 27% were females and 71% of the patients in whom the KH screening tool was performed has been discharged after appropriate treatment. Conclusion: The use of the KH screening tool was successful in the majority of the patients for it was performed. The KH screening tool was easy, quick and done at the patient bedside in identifying the undifferentiated shock patients who presented to our emergency department.

Penile strangulation is an acute urological emergency which requires a specialised multidisciplinary approach to management of the patient. We present to you two cases managed in our ER. Through these cases, we aim to understand the underlying psychiatric implications of such patients while learning how to remove the objects in the emergency. The metallic objects from both patients were retrieved in time to prevent loss of organs and maintain the preservation of the function of penis. Psychiatric evaluation of the patients was done and both were diagnosed to be having compulsive sexual behaviour disorder (CSBD).

Toxic epidermal necrolysis (TEN), is an acute, potentially life-threatening mucocutaneous disease often induced by drugs due to an inappropriate immune reaction. It is characterized by the widespread detachment and exfoliation of the epidermis and mucous membrane, leaving large areas of raw, exposed tissue. It is a medical emergency and requires immediate treatment. The condition might result in sepsis, a deadly complication if not treated promptly. It involves >30% of the total body surface area (TBSA), which helps to differentiate it from Stevens-Johnson syndrome (SJS) which involves 10% of TBSA. It usually occurs within a few weeks of treatment initiation, and requires a detailed medication history that plays a pivotal role in the diagnosis. The severity-of-illness score for TEN (SCORTEN) is used to estimate the prognosis. In this report, we report three cases of drug-induced severe TEN who were presented to the emergency room (ER). The presence of the characteristic skin lesions led to the diagnosis of TEN in these cases. Their TBSA was >30%, with a positive Nikolsky sign. Two of the cases had a SCORTEN of 2, and one had a SCORTEN of 6 with a significant history. Treatment was initiated with the withdrawal of the potential agent and pulse therapy with conservative treatment.

Introduction: Various non-cardiac conditions had been known to mimic electrocardiographic changes seen in acute myocardial Ischaemia or infarction. However, the electrocardiographic changes mimicking ST-elevation myocardial ischaemia (STEMI) in acute pancreatitis (AP) have been occasionally reported and is rare. Case description: A 63-year-old male with no comorbidities or past medical illness presented to the emergency department (ED) with complaints of sudden onset of severe epigastric and retrosternal chest pain. In the ED, vitals were stable. ECG revealed ST-elevation in leads II, III, and aVF consistent with acute inferior wall MI. Bedside 2D electrocardiography was unremarkable. A point of care troponin-T test was done which came out to be negative. Laboratory workup revealed high levels of serum amylase (353 U/L) and serum lipase (1681 U/L) consistent with AP. Further, abdominal CT scan was done which confirmed changes consistent with acute inflammatory non-necrotising pancreatitis, thus confirming the diagnosis. Cardiac marker tests were negative and the patient was managed conservatively and discharged after 2 days in a stable condition with follow-up advice from gastroenterology team. Discussion: A variety of non-cardiac abdominal pathologies like AP can mimic electrocardiographic findings suggestive of acute myocardial ischaemia. However, even with high sensitivity, ECG can have false-positive ST-T changes. It mandates a thorough history, clinical examination, and comprehensive investigation to establish a diagnosis and make a proper disposal from ED.

Liver transplantation (LT) improves outcomes and quality of life in patients with end-stage liver disease (ESLD). As a result of improved accessibility and recipient survival, transplant candidates are becoming increasingly older, have more comorbidities, and experience more long-term complications, all of which create new challenges in post-transplantation care. In the post-transplant period, a multitude of factors can influence cardiovascular risk in transplant recipients due to aggravation in recipient populations from new-onset dyslipidaemia, hypertension, glucose intolerance, and nephrotoxicity as side effects of immunosuppressive agents. Traditional cardiovascular risk factors are becoming increasingly prevalent in the ageing population of liver transplant candidates, and coronary artery disease (CAD) is considered to be more common than previously thought. Cardiovascular events are recognised as prominent causes of early and late mortality in liver transplant recipients. The most common cardiovascular diseases in transplant candidates are ischaemic CAD and cardiomyopathy. We describe a complex case of a liver transplant recipient in a 50-year-old male patient with no known history of CAD who developed progressive acute myocardial infarction within 6 months of liver transplant and was ultimately thrombolysed to optimise myocardial perfusion. Management of myocardial ischaemia is complicated by a high risk of bleeding in the setting of coagulopathy. Once thrombolysis and haemodynamic stability were achieved, the patient was immediately shifted for coronary angiography, and staged coronary angioplasty was performed for triple vessel coronary disease in the patient at the cardiac institute.

Background: The emergency department (ED) is a place where there is an encounter of various surgical and medical emergencies. However, timely diagnosis and early treatment are paramount for good outcomes. Here we present an interesting case of abdominal pain who underwent laparoscopic appendicectomy later diagnosed with stump appendicitis. Case summary: A 28-year-old male presented to ED with complaints of right lower abdominal pain for 2 days which was sudden in onset, intermittent, colicky, non-radiating, no exacerbating and relieving factors nausea and vomiting. History of laparoscopic appendicectomy one month back. Family and personal history were insignificant. On arrival, the patient was hemodynamically stable with a pain score of 5/10. On examination, abdomen was soft, non-distended, there were scars over the lower abdomen, tenderness in the right iliac fossa without guarding and rigidity, and bowel sounds were present. Laboratory investigations were suggestive of the total count of 19,990 cells/cumm with a neutrophilic predominance and CRP was 24. The plain radiograph of the abdomen as well as ultrasonography were normal. We proceeded with contrast-enhanced computerised tomography (CECT) of the abdomen which was suggestive of stump appendicitis. A surgical reference was done. Discussion: In the case of stump appendicitis, the time interval for the onset of symptoms could range from 2 weeks to years after appendicectomy. Appendicectomy is one of the most commonly performed surgical emergencies. Stump appendicitis is one of the rare and delayed complications after appendicectomy with a reported incidence of 1 in 50,000 cases. The advantage to ongoing reporting on this relatively rare diagnosis is to continue to raise awareness so it is part of the provider's differential. Prompt recognition is important to lead to early treatment, thus avoiding serious complications like intra-abdominal abscess, intestinal perforation, and peritonitis. Clinically, patients present with signs and symptoms mimicking appendicitis or acute abdomen along with the previous history of appendicectomy as seen in our case. Conclusion: By presenting this case, it is highly recommended to consider stump appendicitis as one of the differential diagnoses in patients with a history of appendicectomy who present with abdominal pain to avoid detrimental complications due to missed diagnosis.