Veronica Tucci

HCA Oak Hill Hospital · Emergency Medicine

Sepsis is a major cause of mortality as a life-threatening condition that arises when the body's response to an infection injures its own tissue, and in the past decade, emphasis has been placed on early treatment to decrease mortality. In this case, we discuss the presentation of a young patient with sepsis due to acute complicated pyelonephritis...

We describe a case of multiple missed opportunities to diagnose Fitz-Hugh-Curtis syndrome in a sexually active 26-year-old woman in the emergency department (ED). Repeat ultrasound scans showed a hemorrhagic ovarian cyst. Multiple ED providers relied exclusively on these ultrasound findings as the presumed cause of her pelvic pain, to the detriment...

COVID 19 struck us all like a bolt of lightning and for the past 10 months, it has tested our resilience, agility, creativity, and adaptability in all aspects of our lives and work. Simulation centers and simulation-based educational programs have not been spared. Rather than wait for the pandemic to be over before commencing operations and trainin...

The novel coronavirus (COVID‐19) pandemic of 2020 has had profound impacts on medical education, both domestic and abroad. In this consensus paper from the American College of Academic International Medicine, we systematically discuss the impact of the pandemic both immediately and long term on international medical education, bedside teaching, pro...

What started as a cluster of patients with a mysterious respiratory illness in Wuhan, China, in December 2019, was later determined to be coronavirus disease 2019 (COVID‑19). The pathogen severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), a novel Betacoronavirus, was subsequently isolated as the causative agent. SARS‑CoV‑2 is transmitted...

Background and goals It is fairly common for adolescents with a presenting problem of acute agitation to present to the Emergency Department. These patients present challenges with respect to both differential diagnosis and management. Furthermore, with many adolescents having extended stays in emergency departments, it is important for ED physicia...

Background & goals The past few years have seen an increase in the number of children and adolescents presenting to emergency departments with mental health complaints, including, but not limited to, depression, suicidality and substance use-related conditions. This places many demands on the emergency physicians ranging from evaluating medical sta...

Assessment for depression involves ascertaining whether patients meet criteria but also estimating the degree of impairment brought along by the disease, which in turns affects the intensity of treatments suggested. As such, the diagnosis and management of depression is not objective. Openly professing religious faith introduces a layer of subjecti...

Background Adolescent substance use is a dynamic public health problem. Adolescence is a unique developmental period involving overlapping biological, psychological, and social factors which increase the rates of initiation of substance use. The developing adolescent brain is particularly susceptible to the effects of substances and most adults wit...

Introduction: Medical clearance is required to label patients with mental illness as free of acute medical concerns. However, tests may extend emergency department lengths of stay and increase costs to patients and hospitals. The objective of this study was to determine how knowledgeable emergency and psychiatric providers are about the costs of t...

Introduction: Medical clearance is required to label patients with mental illness as free of acute medical concerns. However, tests may extend emergency department lengths of stay and increase costs to patients and hospitals. The objective of this study was to determine how knowledgeable emergency and psychiatric providers are about the costs of te...

For patients with mental illness who require hospitalization, the process of admission to inpatient care involves an assessment of medical status and assurance to the receiving facility that the patient is medically stable and suitable for transfer. An increasing number of facilities have developed checklists that need to be met for a patient to be...

Context Over 6% of all emergency department (ED) visits in the United States involve primary mental health or behavioral issues. The patients are stabilized in the ED but frequently require admission to an inpatient psychiatric unit or institution for longer term treatment and management. To facilitate this process, an emergency physician (EP) must...

The media and public health generally focus on the biological and physical ramifications of epidemics. Mental health issues that coincide with emerging diseases and epidemics are rarely examined and sometimes, even eschewed due to cultural considerations. Psychiatric manifestations of various infectious diseases, especially with a focus on Ebola Vi...

Patients presenting to the emergency department with mental illness or behavioral complaints merit workup for underlying physical conditions that can trigger, mimic, or worsen psychiatric symptoms. However, interdisciplinary consensus on medical clearance is lacking, leading to wide variations in quality of care and, quite often, poor medical care....

Physician-patient encounters in clinical settings, especially in the emergency department, can be of varying degrees of difficulty. Medically complicated, challenging cases can be paradoxically rewarding, whereas psychologically driven difficulty is frustrating and counterproductive for patient care. This article presents 3 different complementary...

This article is an overview of the treatment and management of acutely agitated patients as they present in the emergency department or emergency psychiatric facility. This article focuses on how a patient encounter may unfold and what issues need to be considered along the way. Verbal de-escalation is emphasized as a standard of care, including th...

Patients who present to the emergency department (ED) with mental illness or behavioral complaints merit work-up for underlying physical conditions that can trigger, mimic, or worsen psychiatric symptoms. However, there are wide variations in quality of care for these individuals. Psychiatry and emergency medicine specialty guidelines support a tai...

A 19-year old female with a past medical history of depression and anxiety presents to a FSED following an acetaminophen overdose. The patient is uncertain of how many pills she actually swallowed because she threw up immediately afterward. The patient is rushed back to the treatment area where she is seen and evaluated by the nurse and attending p...

Depression mostly remains underdiagnosed during pregnancy and results in adverse outcomes for both mother nonspecific somatic symptoms, which could be the manifestation of underlying depression. Universal screening for depression should be done at least once during prenatal period Edinburgh Postnatal Depression scale or the nine diagnosed, the PCP...

Abstract Increasing use of psychotropic medications during pregnancy has highlighted the issue of teratogenic risks associated with these drugs. No drug has been deemed completely safe for use during pregnancy by the FDA as all of them have been shown to cross the placenta; however research has shown that different psychotropic drugs contribute var...

Background: There is a strong association between mental illness and poor physical health. However, research indicates that the standard of physical examinations performed on patients with psychiatric illnesses is sub-optimal, falling short of recommended/expected assessments. Objective: This study aimed to assess the completeness of the neurologic...

Rhabdomyolysis is a rare condition caused by the proteins of damaged muscle cells entering the bloodstream and damaging the kidneys. Common symptoms of rhabdomyolysis are muscle pain and fatigue in conjunction with dark urine; kidney damage is a common symptom among these patients. We present a case of a 23-year-old woman who displayed myalgia in t...

Difficult patients are often those who present with a mix of physical and psychiatric symptoms, and seem refractory to usual treatments or reassurance. such patients can include those with personality disorders, those with somatization symptoms; they can come across as entitled, drug-seeking, manipulative, or simply draining to the provider. Such p...

Patients presenting with behavior or psychiatric complaints may have an underlying medical disorder causing or worsening their symptoms. Misdiagnosing a medical illness as psychiatric can lead to increased morbidity and mortality. A thorough history and physical examination, including mental status, are important to identify these causes and guide...

There have been many technological advances improving the work up and treatment of patients in the emergency department (ED). Point of care testing (POCT) is becoming more common, especially in the time compressed clinically high-pressured environment of the emergency department. In present times, emphasis of POCT has spurred search of novel biomar...

Emergency medicine physicians should be able to identify and treat patients whose clinical presentations, including key historical, physical examination, and laboratory findings are consistent with diagnoses of primary, secondary, and tertiary adrenal insufficiency, adrenal crisis, and pheochromocytoma. Failure to make a timely diagnosis leads to i...

Although rare in the general population, mucormycosis can become a rapidly progressive and lethal opportunistic infection in the ketone and carbohydrate-rich milieu of diabetes mellitus and in other conditions. In the past 2 decades, an increasing number of mucormycosis cases have appeared after immunosuppressive treatment for leukemia or bone marr...

Dirofilaria tenuis is a mosquito-transmitted filaria of raccoons in the American Southeast. Here, we report the case of subcutaneous D tenuis in a 72-year-old south Florida resident. A 1-cm nodule on the left forearm progressed to an extensive inflammation and radial neuritis with stiffness and weakness of the thumb, index, and middle fingers. His...

Glycemic control is an important aspect of patient care in the surgical Infections of the nervous system are among the most difficult infections in terms of the morbidity and mortality posed to patients, and thereby require urgent and accurate diagnosis. Although viral meningitides are more common, it is the bacterial meningitides that have the pot...

Aeromonas hydrophila is an aquatic bacterium that causes sporadic, opportunistic warm-weather soft tissue infections and bacteremias, classically among men with predisposing liver disorders or leukemias. Although the portal of entry often remains elusive, the end result in these immunodeficient populations can be devastating. At our institution, we...

Ischemic colitis (IC) secondary to air embolism from decompression sickness or barotrauma during diving is an extremely rare condition. After extensive review of the available literature, we found that there has been only one reported case of IC secondary to air embolism from diving. Although air embolization from diving and the various medical com...

Invasive fungal infections continue to plague the immunocompromised population, and Fusarium species have become an increasing threat. This species of fungus is a frequent cause of local infections, such as keratitis and onychomycosis, in the immunocompetent but can bring about locally invasive and disseminated infections in the immunocompromised....

Bipolaris is an opportunistic pathogen widely distributed in air, soil, and plants. It is increasingly being recognized as the cause of fungal sinusitis in both normal and immunocompromised hosts. We report a case of disseminated infection due to Bipolaris in a 43-year-old man with prolonged neutropenia after chemotherapy for leukemia. A high-resol...

Cutaneous Acremonium infection is a rare condition that may affect both immunocompetent and immunocompromised patients. We present the case of a 52-year-old woman with a history of acute myelogenous leukemia and neutropenia who developed necrotic lesions on her knees after trauma and whose fungal culture returned positive for Acremonium spp.

Background: BK virus infection is common but is usually asymptomatic. However, it can become life threatening as severe hemorrhagic cystitis (HC) or the polyomavirus-associated nephropathy (PVAN) particularly in immune compromised and transplant recipients. Some investigators have studied the pathophysiology and there are anecdotal and uncontrolled...

Surgical maggots have been used successfully for wound debridement over the past millennium. At Johns Hopkins University in 1929, Baer introduced maggots into the wounds of 21 patients with chronic intractable osteomyelitis. The development of methicillin-resistant Staphlococcus aureus has been a major impetus to resurgent interest in maggot debrid...

Eosinophilic esophagitis is an under-recognized inflammatory disorder of the esophagus. It has been frequently diagnosed in pediatric patients; however, over the last few years, there has been an increase in the number of cases recognized in adults as well. Despite this fact, eosinophilic esophagitis (EE) is often a delayed diagnosis in the primary...

Invasive fungal infections are a significant cause of morbidity and mortality. Endogenous fungal endophthalmitis is a rare intraocular infection with potential vision threatening consequences. Our review of the literature revealed only one other case of Trichosporon endophthalmitis. Ocular fungal infections are difficult to eradicate because of the...

Background: Malignant external otitis (MEO) is a relatively uncommon infection caused by Pseudomonas aeruginosa seen primarily in immunocompromised patients, classically, diabetics. MEO is treated effectively with antibiotics but can be associated with significant morbidity including cranial nerve palsies. Objective: To report a case of MEO seen in...

Background: Pseudomonas aeruginosa is a gram negative facultative anaerobe and well-documented scourge of immunocompromised patient populations. Objective: To study the prevalence and predisposing conditions for Pseudomonas aeruginosa infections of cartilaginous structures. Method and results: We conducted an exhaustive search of the current litera...

Background: Cutaneous Curvularia is a rare fungal infection which presents itself as erythematous, non-tender, non-pruritic, ulcerative lesions. To the best of our knowledge, only a few cases reported in the literature have occurred in immunocompromised and/or neutropenic patients, none of which have been published within the past five years. Objec...

Mucorales species are deadly opportunistic fungi with a rapidly invasive nature. A rare disease, mucormycosis is most commonly reported in patients with diabetes mellitus, because the favorable carbohydrate-rich environment allows the Mucorales fungi to flourish, especially in the setting of ketoacidosis. However, case reports over the past 20 year...

Background: Trichomoniasis is currently the leading non-viral sexually transmitted infection. The causative agent is the protozoan, Trichomonas vaginalis. Infection generally occurs after either heterosexual or homosexual intercourse. Most of T. vaginalis infections in men are asymptomatic; urethritis has also been reported. Objective: We present a...

Trichomonas vaginalis may be the most underestimated sexually transmitted infection worldwide. Although trichomoniasis often spontaneously resolves in male patients, it can lead to significant urogenital morbidity. Despite the ease with which it may be treated using metronidazole or tinidazole, men are not routinely screened for trichomoniasis and...