J Emerg Med
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Case Reports
Sacrococcygeal Foreign Body Progressing with Pilonidal Sinus Clinical Picture: Report of a Case.
Pilonidal sinus is a benign anorectal disease that is frequently seen in the sacrococcygeal area when a foreign body reaction develops after the invasion of hair follicles. ⋯ The presence of a foreign body in cases progressing with a single and wide inlet and frequently recurring abscess formation is a condition of which to be aware.
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ST-segment elevation myocardial infarction (STEMI) due to coronary artery occlusion in the setting of acute carbon monoxide (CO) poisoning is a very rare presentation. ⋯ Patients with toxic CO exposure who have symptoms of STEMI should be carefully evaluated with serial ECG, cardiac necrosis marker measurements, and an echocardiogram. When there is evidence of myocardial injury, a wider use of coronary angiography can identify patients who could benefit from PCI.
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On April 14, 2010, a catastrophic earthquake hit Yushu, China, causing 2698 deaths and 12,135 injuries. A large number of patients were evacuated by air to hospitals in unaffected areas for specialty treatment. ⋯ Aeromedical evacuation of a large number of patients after major disasters in remote areas can be done safely and effectively; however, problems such as a lack of suitable AE aircraft and medical equipment, as well as insufficient professional medical training in AE, were revealed after the Yushu earthquake.
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Necrotizing fasciitis (NF) is an infection of the soft tissue, and is fatal if not promptly and aggressively treated. Although it is rare, it is not exceptional; nevertheless, its presentation may be misleading and may delay the diagnosis. We highlight the possible synchronous development of NF in multiple noncontiguous areas. ⋯ "Synchronous" multifocality is not an expected presentation of NF, and it complicates the diagnosis and delays treatment, with a potentially negative impact on outcome.
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Ingestion of a sulfonylurea by toddlers can cause profound hypoglycemia and neurologic sequelae. Although mild cases can be managed with dextrose and boluses of octreotide, optimal management of patients with severe hypoglycemia and cerebral injury has not been well established. ⋯ Continuous infusion of octreotide resulted in rapid stabilization of blood glucose levels while maintaining fluid-restriction goals. Our patient demonstrated reversibility of diffuse cerebral edema in this setting with near complete recovery of neurologic function. Octreotide administration by continuous infusion may be preferable to subcutaneous bolus administration for the treatment of severe sulfonylurea-induced hypoglycemia with associated neurologic injury.