Thyroid storm is a challenging medical emergency that requires urgent assessment and management in a timely manner. In this article, we report on a case of a 37-year-old female who presented to the emergency department with a thyroid storm complicated by atrial fibrillation (AF) with a rapid ventricular response with no clinical signs of heart failure. As part of her medical management to rate control her AF, she was started on an infusion of a short-acting beta blocker, esmolol, and shortly after, she developed cardiac arrest. This is the second case report published to highlight the significant response (cardiac arrest) of patients with thyroid storm complicated by AF to a low dose esmolol infusion as part of their medical management.

Unplanned emergency department (ED) revisit is one of the major challenges faced by emergency care facilities and reflects their quality of care. It is an important key performance indicator (KPI) for emergency medical care. Often, inadequate medical care by physicians is claimed to be the main cause of unplanned ED revisits, yet this assumption is not well studied in the literature. Thus, this study aimed to identify the causes of unplanned ED revisits within 72 hours from the initial visit to the emergency department which could help in developing an action plan and improve quality of care and patient safety.A retrospective study was conducted in Rashid Hospital Trauma Center, from December 2019 to January 2020, using electronic medical records reviewed by two independent investigators. The reasons for the ED revisits were categorized into the following four domains: illness, physician, patient, and system related. A total of 584 revisits were found which accounted for 1.9% of ED attendance from December 2019 to January 2020. Majority of them were male patients, and 63% of the population had a mean age of 33 years. Majority of the ED revisits were due to illness (54%), followed by patient related (20%), physician related (18%), and system related (8%) factors. Most of the patients were discharged on the second visit. The two most common reasons for revisits in the ED department that were seen within the 72 hours were illness related and patient related, followed by physician related. The cause is mainly rooted in suboptimal discharge plans.

The development of air in the spinal canal is an uncommon and usually asymptomatic event. Also known as pneumorrhachis (PNR), the main information about this phenomenon is based on a few case reports published previously. It is highly difficult to identify this entity clinically, and in most publications, PNR was incidentally identified during image procedures, mainly computed tomography (CT) scans. With the advancement of technology and the development of guidelines for the treatment of penetrating and neck injuries, the number of PNR diagnosis has increased. It is also a common agreement among the articles reviewed that the least common cause of PNR is traumatic events. This report presents a rare case of pneumorrhachis as a consequence of a penetrating neck injury. The studied patient was a 27-year-old female with multiple stab wounds on the left posterior side of the neck and left shoulder, thereby developing leftside body weakness as a consequence of the wound. The patient was immediately evaluated and managed by the emergency team, and as the patient was vitally stable, she was shifted to an urgent CT scan. CT scan showed subarachnoid air focus, multiple extradural air foci, and spinal cord injury on the cervical spine. This patient was treated conservatively, but her neurological symptoms persisted until discharge.