IMA Journal – July 2022

Message from Team IMA Chennai Kauvery Alwarpet Branch

Dear colleagues

Doctor’s day greetings and best wishes from IMA Chennai Kauvery branch.

Emergency Room is like the sanctum of any hospital and the emergency physicians are always alert to receive the patients in distress.

They need to be quick in decision making, be dynamic and handle the anxiety of the patient attenders as well.

Our emergency physicians are the pillars of our hospital. The department has evolved over 10 years and is one among the best emergency departments in our country.

All the articles in this edition is contributed by the ER team and my best wishes to them.

Yours in IMA service,
Dr S Sivaram Kannan

In every hospital, emergency department is the gateway and it plays such an important role in patient care.

Our emergency department is a vibrant one with young doctors, ready to serve people, day in and out.

This month’s IMA Journal carries interesting case studies and experiences, all written by emergency doctors.

Reading is learning and learning leads to development.

Please read and enjoy this month’s issue.

Long live IMA.

Dr. Bhuvaneshwari Rajendran

Dear friends

Happy to release our next IMA Journal.

This month the department of Accident and Emergency Medicine has taken the credit by submitting their work.

We thank Dr Aslesha and her team for this.

Our thanks to the editorial and branding teams as well.

Kindly give your feedbacks and suggestions.

Long live IMA.

With regards
Dr R Balasubramaniyam

Kounis Syndrome


  • Anaphylaxis is a severe, potentially life-threatening allergic reaction. The most common anaphylactic reactions are to foods (peanut, sea foods), insect stings, medications and latex.
  • Anaphylactic shock cases are rare but life-threatening, with its incidence rate of 1.5-7.9 per 100,000 people.
  • Acute myocardial injury or infarction in the setting of an anaphylaxis can be due the anaphylaxis itself, when it is known as Kounis Syndrome

Case report

28 years aged gentleman, with no comorbids and no known drug allergy, presented to ER with history of consumption of sea food the previous day following which he had noticed small eruptive rashes with itching…

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Hyperkalemia and Cardiac Arrest – A Challenge to Treat


Severe hyperkalemia is a potentially life threatening cardiac emergency, especially in patients with renal failure, which can lead to fatal arrhythmias such as ventricular tachycardia (pulseless), ventricular fibrillation or even asystole, leading to cardiac arrest. VT Storm a rare electrical phenomenon that is life threatening and involves recurrent episodes of ventricular arrhythmias. We discuss in our case report, a 72 years gentleman, with recurrent severe hyperkalemia, recurrent cardiac arrest and VT storm.


Hyperkalemia, kidney failure, cardiac arrest, emergency hemodialysis, VT Storm

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Non Traumatic Splenic Laceration


Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The management of splenic trauma patients aims to restore the homeostasis and the normal pathophysiology especially considering the modern tools available for bleeding management. Thus, the management of splenic trauma should be based on the physiology of the patient, the anatomy of the injury, and the associated lesions.


Splenic injury, non-traumatic, CT Abdomen, left shoulder pain, pain abdomen, splenic rupture

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A Case of Post Traumatic Basilar Artery Thrombosis with Brain Stem Infarct


Basilar thrombosis is a potentially fatal event, whose traumatic etiology has been repeatedly stated. Here we discuss about a case of 19 years girl who had basilar artery thrombosis secondary to road traffic accident

Case Presentation

A 19 years aged girl presented to our Emergency department with alleged history of road traffic accident 4 wheeler vs 4 wheeler at around 2.30pm on 12/06/2022 near Dindivanam, she was immediately taken to Villupuram Government Hospital with GCS OF 15/15. Initially stabilized there and imaging done there included CT brain, CT whole spine and CT abdomen…

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Coronary Artery Calcium Scoring - A Risk Predictor

Coronary artery disease is the foremost cause of death in many countries and hence, its early diagnosis is concerned as a major healthcare priority. Coronary artery calcium scoring using either electron beam computed tomography or multislice computed tomography has been applied to provide an early CAD diagnosis in clinical practice.

Most of the coronary events occur in the territory of coronary arteries do not demonstrate prior high-grade stenosis. Although atherosclerotic plaque is invariably present in an acute coronary event, significant stenosis is not necessarily seen. The complications of atherosclerotic plaque like erosion / rupture and followed by thrombus formation are important events leading to acute coronary syndrome.

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Multiple Myeloma

Mrs. Mamulla Begum, 62-year-old female, a known case of hypertension, presented to ER with complaints of shortness of breath(grade III – IV), sudden onset for 2 days, cough with expectoration, mucoid in nature for 2 days, palpitation, on and off, for 2 days on 26/3/22. She also had lower back pain, and left shoulder pain since January 2022. On arrival @ ER, her temperature was 99.1 F, blood pressure- 160/90 mmHg, pulse – 146/min, respiratory rate-20/min, SpO2- 98% Room air, CBG- 132 mg/dl, GCS- 15/15. On examination, she was conscious, orientated and febrile. Pallor +, bilateral pitting pedal edema +

CVS- S1 S2 heard, no murmur, jvp- normal
PER ABDOMEN- soft, non-tender, no organomegaly
CNS- no focal neurological deficit
RS- bilateral air entry, left infraaxillary and inframamillary coarse crepitations…

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Highlights at Kauvery

Restart a heart – Bystander CPR training program

Restart a heart – “lend your hands to save a life” was launched as a program on Women’s day (ie)March 8th 2022, to create awareness amongst the common people regarding the importance of bystander CPR when a patient is in cardiac arrest. As we know only about 5-10% Out of Hospital Cardiac Arrest (OHCA) survive, we at Kauvery hospital’s Emergency Department, want to strive to improve the outcomes of OHCA by creating awareness regarding early recognition of cardiac arrest.

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