Abdominal Pain Ends Up to be an Extensive Spinal Epidural Abscess in a Previously Healthy Toddler

Manal Alkatheeri^1*, M. Abu Shkhaeidem¹, G. Ghatasheh², J Hertecant², M. Salamat³ and E. Elgamal³

¹Pediatric Resident, Tawam Hospital, UAE
²Pediatric Consultant, Tawam Hospital, UAE

Learning Objectives: Spinal epidural abscess (SEA) represents a neurosurgical emergency. We report a case of extensive SEA manifesting as abdominal pain in a previously healthy toddler.

Methods: A 24 month old female presented with two weeks history of fever and abdominal pain. Child had a small cut wound on her right foot that was complicated with a small abscess collection which was self drained. Fever started at that time. Patient complained of neck and back aches and was unable to bear weight. No neurological deficit noted. Spinal MRI showed a large extradural collection extending from the (C2 spine to L1 spine) representing epidural abscess.

Laminectomy for drainage of epidural abscess was done. Patient was started on parenteral antibiotics empirically. Puss material culture grew methicillin sensitive staphylococcus aureus, in light of culture results parenteral flucloxacillin used. Repeated MRI showed regression of the epidural abscess. Patient completed 6 weeks of therapy. She remained neurologically intact and clinically well on follow up visits.

Results: In reviewing the literature, such an extensive abscess collection in the spinal epidural space in an immunocompetent 2 year old toddler is unique. The atypical presentation with fever and abdominal pain had misled clinicians. Using monotherapy after surgical drainage was successful in our case.

Conclusion: High index of suspicion for SEA in children is needed specially when presenting with atypical symptoms. Using monotherapy after surgical drainage of extensive SEA would be successful.

Biography:
Manal Alkatheeri received MBBS from the College of Medicine and Health Sciences — United Arab Emirates University in 2016. Currently she is studying fourth year of Pediatric Residency.

Acute Fatty Liver of Pregnancy, an Atypical Presentation

Ruwanthi Kaushalya De Silva^* and R.S. Wickramasooriya

National Hospital of Sri Lanka, Sri Lanka

Acute fatty liver of pregnancy, is a rare obstetric emergency which carries high incidence of maternal and perinatal morbidity and mortality. It usually occurs in the third trimester of pregnancy or immediate post partum period. The clinical presentation is very variable. Fever is not a common initial presentation.

We report a case of a 29 year old primi who presented with fever and icterus, was diagnosed with Acute Fatty Liver of Pregnancy along with other differential diagnosis of infective hepatitis. Few episodes of vomiting and productive cough was present and the appearance of icterus was her worry. Past medical history was unremarkable and history of blood transfusions or exposure to muddy water was negative. Subsequently she developed vomiting, polydipsia and hypertension and was complicated with Coagulopathy.

The emphasis is on timely diagnosis, detection of derangements of organ functions, and management including supportive care, continuous monitoring of maternal and fetal wellbeing and expedite delivery of the baby. Furthermore, the current treatment options are to be addressed and few novel therapeutic strategies such as plasma exchange is discussed.

Keywords: Acute fatty liver, pregnancy, fever, hypertension, plasma exchange

Biography:
Dr. Maramba Vidanage Ruwanthi Kaushalya De Silva is a registrar in Emergency Medicine graduated from Faculty of Medicine, University of Colombo. Her current placement is Sri Jayawardanapura General Hospital, Kotte, Sri Lanka. She has special interest in obstetric emergencies and their management.

Lessons and Games to Avoid Dog Bites for Preschool Children

Stefania Barbieri^1,2, Bertacco A⁴, Billato P¹, Feltracco P¹, Bertoncello F¹, Pasquale A⁴, Zambolin G⁴, Paoli A², Pietrantonio V², Poles R¹, Salvagno M¹, Barbieri C⁵, Rubini S³, Pavin A¹and Spagna A²

¹Department of Emergency Medicine, University Padova Hospital, Italy
²Unit for Pre-hospital Emergency Care - Padova Hospital University Padova, Italy
³Experimental Zoo-prophylactic Institute of Lombardia and Emilia Romagna, Italy
⁴Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padua University, Padova, Italy
⁵Departmentʼs Court and Tribunal Services Padova, Italy

Purpose of the Study: Dog bites caused an important debate in the medias, particularly regarding pets management related to the public safety the victim of a dog attack is a complex patient that whom is usually not usually easy to manage when the severity of injuries is high. Three-to five-year old children (n85) participated in educational lessons program to correctly interpret dogʼs behaviours. Designed for primary school children. Interactive lesson are organized to prevent dog bite incidents.

Materials and Methods: Scientific articles about dog bites were analysed, including those regarding legislative, health and clinical aspects of dog bites because they are little known scopes. Clinical records of pre-hospital patients following dog bites treated at Azienda Ospedaliera di Padova were analysed to implement the basis of children school lessons.

Results: After a careful analysis of medical literature of the occurred cases, we were able to define a clinical care pathway in our hospital, especially in the first phase: the safety program are useful to examine dangerous situations and understand safe and unsafe situations and a pre-hospital prevention program lessons for children. The excellence in care in Padua hospital represent an opportunity for ED pre-hospital team members to discuss successes and recommendations for children and teachers involved in the projects. Although the number of dog bites is not alarming phenomenon. The consequences of serious bites could force the victim to long and complex cures.

Conclusions: 25 minutes programme lessons (interactive video, toy dogs, coloured cartoon pictures, cartoon child) were useful to give to the children useful information to identify dangerous situations illustrated by pictures to suggest safety education for preschool children.

Neuroimaging in Patients with Headache in the Emergency Department. Are we Over-Testing?

Maryam Siddiqi^*, Chaudhry M and Buhumaid R

Shiekh Khalifa Medical City, UAE

Background: Headache is a very common clinical presentation in the Emergency Department (ED). Emergency Physicians must determine which patients need neuroimaging and which can be appropriately deferred and evaluated in the outpatient setting. The American College of Emergency Physicians (ACEP) clinical policy guideline identifies factors in the patientʼs history and clinical assessment that wouldfavor the use of neuroimaging in ED patients with acute headache¹. Patients with new headache and new abnormal findings in a neurologic examination, new sudden-onset severe headache and HIV-positive patients with a new type of headache should be considered for an emergent neuroimaging in the ED¹. Non-contrast CT of the brain is potentially overused in the assessment of ED patients with headache because of its availability, efficiency, non invasive nature of the study, patient expectations, and providersʼ fear of medicolegal repercussions of missing acute neurological life threatening conditions^2-3.

Objective: The objective of the study was to assess whether emergency physicians are implementing the approved guidelines from ACEP while requesting neuroimaging in the emergency department for patients presenting with acute headache. Method: A retrospective chart review was carried out of all patients older than 16 years presenting to the ED of SKMC hospital with headache without any previous history of intracranial structural anomaly and had neuroimaging done as part of their ED assessment from January to March 2019.

Results: A total of 98 charts were reviewed. 70% were females. The average age of patients was 46 years old. Only 1% of the patients had thunderclap headache, 1% had history of altered mental status, 14% had history of trauma and 4% had focal neurological findings on physical examination. 95% of brain CT scans were reported normal. Only 1% of the patients had a clinically significant finding on brain CT. Review of this cohort of patients, only 6% of the patients with headache met the ACEP clinical policy guidelines for emergent and urgent neuroimaging in the ED.

Conclusion: This study found that 94% of cases of headache presentation in our ED the neuroimaging was required. Emergency physician in our department requested neuroimaging in 6% of the cases only that was consistent with ACEP guideline.