Thevetia peruviana (yellow oleander) is an ornamental shrub found in tropical and subtropical regions, including tropical America. All parts of the plant are toxic due to cardiac glycosides, which can cause severe cardiotoxicity and arrhythmias. Poisoning is associated with significant mortality, often due to deliberate self-harm. This report describes a case of accidental ingestion of Thevetia peruviana seeds by a patient who believed that they could treat benign prostatic hyperplasia (BPH). The patient presented to the emergency department within 30 minutes of ingesting yellow oleander seeds with nausea, vomiting, and abdominal cramps. Although initial vital signs were stable, he developed sinus bradycardia and symptoms of cardiac glycoside toxicity, including dizziness, tachypnea, and visual disturbances. Lab results later showed a serum digoxin level of 4.04 ng/mL, and the poison control center recommended digoxin immune fab (DigiFab). He received a total of 15 vials intravenously, resulting in marked clinical improvement. He was monitored on continuous telemetry in the cardiac unit and discharged in stable condition after four days. Although DigiFab is not approved by the U.S. Food and Drug Administration for oleander poisoning, it remains the most effective reported antidote, and timely administration is crucial for successful management. Given the limited reports of oleander toxicity in the United States, this case highlights the risks of unregulated herbal remedies and the clinical presentation and management of oleander toxicity, underscoring the need for public education about oleander toxicity and the dangers of unregulated herbal remedies.

Cardiac tamponade is a medical/traumatic emergency characterized by the increased intrapericardial pressure from the accumulation of excessive fluid (either exudate, transudate, or blood) in the pericardium. Emergency sonography is a vital part of the rapid assessment of cases with traffic accidents and chest traumas, as pericardial injuries are among the hidden affected organs. Here, we present a case of successful resuscitation of cardiac tamponade.

We report the case of a 70-year-old female with a history of hypothyroidism who presented following an unwitnessed fall with bradycardia and hypothermia. She was found to have myxedema coma complicated by signs of early cardiac tamponade, requiring urgent pericardiocentesis. Myxedema coma is a rare but life-threatening manifestation of severe decompensated hypothyroidism, carrying a high mortality rate despite treatment. It commonly presents with hypothermia and altered mental status and may be precipitated by infection, trauma, medication nonadherence, or cold exposure. Early recognition and prompt treatment with intravenous stress-dose steroids and thyroid hormone replacement are essential to improve outcomes. This case highlights the potentially severe complications of inadequately treated hypothyroidism. It emphasizes the importance of considering cardiac tamponade as a rare but life-threatening consequence of this disease, requiring a high index of suspicion, timely diagnosis, and urgent intervention.