Amrithanand Velluridathil Thazhathidathil

Introduction: Anaphylaxis is a life-threatening emergency that can involve significant cardiovascular manifestations. Transient electrocardiographic (ECG) changes during anaphylaxis and following epinephrine administration may closely mimic acute coronary syndrome, creating a diagnostic dilemma in the emergency department (ED). Failure to recognize these reversible patterns can result in delayed anaphylaxis treatment or unnecessary activation of invasive cardiac pathways. Case Series: We report a case series of three adult patients presenting to the ED with anaphylaxis who developed alarming ECG changes, including ST-segment elevation, ST-segment depression, and hyperacute T waves. One patient demonstrated transient ECG changes temporally related to intramuscular epinephrine administration, while two patients exhibited features suggestive of hypersensitivity-associated coronary vasospasm or thrombosis manifesting as ECG changes. In all cases, serial ECGs, high-sensitivity cardiac troponin testing, and focused echocardiography revealed resolution of ECG abnormalities without dynamic biomarker elevation or regional wall motion abnormalities. All patients improved with prompt anaphylaxis-directed therapy and were managed conservatively without coronary intervention. Conclusion: Transient ECG changes during anaphylaxis and after epinephrine administration can closely resemble acute coronary syndrome but may resolve completely with appropriate allergy-directed treatment. Serial ECG assessment, cardiac biomarkers, and focused echocardiography are essential tools for emergency physicians to differentiate transient allergic or catecholamine-mediated effects from true myocardial ischemia. Recognition of these patterns allows timely treatment of anaphylaxis while avoiding unnecessary invasive cardiac interventions.

Electrolyte abnormalities may masquerade as acute neurological or cardiac emergencies in the emergency department (ED). In such atypical presentations, a timely bedside electrocardiography (ECG) often provides the earliest and most critical clue, facilitating an accurate diagnosis, guiding appropriate management, and improving patient outcomes. A 32-year-old male presented with rapidly evolving flaccid quadriparesis without sensory or autonomic involvement. A bedside ECG provided a critical clue, revealing a Mobitz type I block with ischemia-mimicking ST–T changes and prominent U waves. This prompted urgent testing, which confirmed profound hypokalemia and hypomagnesemia. Swift intravenous repletion reversed both paralysis and conduction abnormalities within 72 h. Although electrolyte abnormalities are known to produce typical ECG changes, their presentation with conduction disturbances such as Wenckebach block is rare and easily misinterpreted as ischemia or structural heart disease. Prompt recognition of these atypical ECG findings at the bedside is critical to avoid unnecessary invasive workups and to initiate lifesaving electrolyte correction.

Anisocoria following severe head injury is traditionally interpreted as an impending neurological emergency, often prompting immediate empiric intervention

Background and Objective: Endotracheal intubation is a lifesaving procedure in critically ill patients. This study compared ultrasonography with 5‐point auscultation and the gold standard, quantitative waveform capnography, for confirming tube placement. Sensitivity, specificity, and time taken to confirm each method were evaluated, along with the frequency of tracheal and esophageal intubations. Methods: This hospital‐based single‐center observational study was conducted in the emergency department of a tertiary care hospital. Three observers independently confirmed tube position after intubation using 5‐point auscultation, ultrasonography, and waveform capnography, with time to confirmation recorded simultaneously. Results: 88 patients were included, out of which, four had esophageal intubation. A single A–M interface was observed in 94.3% of patients, confirming tracheal placement. Agreement between ultrasonography and 5‐point auscultation showed a kappa ( k ) value of 0.918 ( p = 0.001), whereas ultrasonography and capnography also had a kappa of 0.918, both indicating strong agreement. The mean confirmation times were as follows: ultrasonography 9.74 s, 5‐point auscultation 18.22 s, and capnography 29.63 s. Conclusion: Capnography, ultrasonography, and clinical methods showed comparable sensitivity and specificity for confirming ETT position. However, ultrasonography provided significantly faster confirmation. Clinical Significance: Rapid and accurate ETT confirmation is critical in emergency settings, and ultrasonography offers a reliable time‐efficient alternative to conventional techniques.