J Emerg Med
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Case Reports
Influenza-like illness as an atypical presentation of falciparum malaria in a traveler from Africa.
According to the Centers for Disease Control and Prevention, the risk of fatal malaria in non-endemic countries can be reduced greatly if physicians are alert to the atypical presenting features of malaria. ⋯ In this era of heightened influenza alert, differentiating between influenza-like illness and malaria can be challenging. Patients with a history of travel to a malaria-endemic area in the preceding year should undergo a complete blood count (CBC), hepatic panel, and blood smear. Due to logistic reasons, the result of a blood smear may not be available immediately. Thrombocytopenia and hyperbilirubinemia each has a positive predictive value of 95% in the presumptive diagnosis of malaria. Patients who do not appear sick, and those who have a normal CBC and hepatic panel, may be treated symptomatically and discharged (with follow-up advised). Those with a presumptive diagnosis of malaria or unclear speciation should be admitted for anti-malarial therapy.
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Current United States (US) military doctrine emphasizes rapid evacuation of casualties to fixed medical facilities remote from the theater of war. To support this strategy, the Air Force has formed Critical Care Air Transport (CCAT) teams consisting of a physician, nurse, and respiratory therapist. ⋯ US Air Force CCAT teams can safely transport multiple critical patients over long distances while providing intensive care interventions. Medical patients make up over one-third of patients requiring CCAT team transport.
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Splenic artery embolization (SAE) improves non-operative splenic salvage rates in adults, but its utility and safety in the pediatric population is less well defined. ⋯ Splenic artery embolization may be a valuable adjunct in adolescent blunt splenic injury, especially in higher grade injuries or with evidence of splenic vascular injury on ACT.
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Rupture of a splenic artery aneurysm during pregnancy is a rare and serious event, occurring mainly during the third trimester. The risk of rupture for an existing splenic artery aneurysm is very high during pregnancy (from 20% to 50%). When it does rupture, the maternal mortality rate is around 75% and the fetal mortality rate 95%. Of 110 cases reported in the literature, only one ruptured during the first trimester. ⋯ We report this case to increase awareness of splenic artery rupture during pregnancy, even during the first trimester.
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We describe a case with facial wounds over the left upper lip that became contaminated with saliva. A facial necrotizing fasciitis developed 2 days after injury. This produced a serious and almost fatal infection.