J Emerg Med
-
Review Case Reports
Head and Neck Myiasis, Cutaneous Malignancy, and Infection: A Case Series and Review of the Literature.
There is a paucity of literature on wound myiasis of the head and neck originating in the United States. To our knowledge, only three reports during the past 20 years exist in the literature. Even less common is a case of recurrent myiasis, with only one report published from India during the 1970s. There is often a preconceived notion that larvae are noninvasive and "only eat dead tissue." This mentality must be corrected; invasive larvae exist, there are unique myiasis-related infections, and serious complications can occur. We review the literature and describe recent cases of head and neck myiasis treated at our institution in upstate New York. ⋯ Four cases, all initially presenting to the emergency department, were identified. Each case was superimposed on cutaneous malignancy and all patients presented with leukocytosis and positive blood or wound cultures. In the case of the recurrent myiasis, initial treatment was external beam radiation therapy for the malignancy, which had the added benefit of eradicating the larvae. Treatment for the other cases was limited to antibiotics and supportive care for medical comorbidities. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Serious complications can develop from head and neck myiasis and, in our experience, an underlying malignancy should be suspected. Proper management is critical and should include, at a minimum, empiric antibiotics, tetanus prophylaxis, biopsy of the surrounding tissue, and reporting to the appropriate health agency. Additional management can include bedside debridement, pharmacologic antiparasitics, and treatment of the underlying disorder.
-
Observational Study
Hemodynamic Effects of Nitroglycerin Ointment in Emergency Department Patients.
Nitroglycerin ointment is commonly used in the treatment of emergency department (ED) patients with suspected acute heart failure (AHF) or suspected acute coronary syndrome (ACS), but its hemodynamic effects in this population are not well described. ⋯ Among ED patients who are treated with nitroglycerin ointment, MAP and TFC decrease over time. However, other hemodynamic parameters do not change after application of nitroglycerin ointment in these patients.
-
Anaphylaxis is the quintessential critical illness in emergency medicine. Symptoms are rapid in onset and death can occur within minutes. Approximately 1500 patients die annually in the United States from this deadly disorder. It is imperative, therefore, that emergency care providers be able to diagnose and appropriately treat patients with anaphylaxis. Any delays in recognition or initiation of therapy can result in unnecessary increases in patient morbidity and mortality. ⋯ For patients with anaphylaxis, rapid and appropriate administration of epinephrine is critical for survival. Additional therapy, such as supplemental oxygen, intravenous fluids, antihistamines, and corticosteroids should not delay the administration of epinephrine.
-
Endotracheal intubation is a common procedure in the emergency department, and new devices may improve intubation time, success, or view. ⋯ The KVVL was slightly faster than Macintosh DL in two of four studied airway scenarios, and had a higher success rate in the difficult cadaver airway scenario. Further study is required in the clinical setting.
-
Case Reports
Left-sided Superior Vena Cava and Venous Hyperoxia Masquerading as Inadvertent Carotid Artery Catheterization.
A persistent left-sided superior vena cava (PLSVC) is a rare, often asymptomatic, venous anomaly that may be first diagnosed during central venous catheterization. During chest radiograph interpretation, a PLSVC can be confused with inadvertent arterial catheterization. ⋯ We describe the presentation of a 45-year-old man with end-stage liver disease who required central venous catheterization for treatment of septic shock. An aberrantly placed catheter noted on chest radiograph and an elevated central venous oxygen saturation gave the appearance of inadvertent carotid artery catheterization. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: A persistent left-sided superior vena cava can masquerade as an inadvertent cannulation of the carotid artery during central line placement. It is important for emergency physicians to be aware of this possibility when evaluating a chest radiograph with an aberrantly placed catheter. Venous hyperoxia may further complicate attempts to differentiate between arterial and venous catheterization in patients with septic shock. After confirmatory tests, the emergency physician should consider removal of the catheter due to potential complications.