J Emerg Med
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Alternative medicine is frequently used by patients even though most treatments are without demonstrable benefit and have not been properly evaluated for medical safety. Intravenous ozone is a modern form of alternative medicine. Even though ozone has been used medically for more than a century, ozone as an infusion is scientifically untested and potentially dangerous. This case notes a patient who underwent an ozone infusion who experienced syncope and a non-ST elevation myocardial infarction immediately thereafter. ⋯ A 50-year-old white woman presented after experiencing syncope after completion of ozone infusion therapy. The ozone infusion consisted of her blood being drawn and ozone gas being injected into the sample. This blood was subsequently transfused back into the patient's blood stream via peripheral intravenous catheter. An initial electrocardiogram revealed no signs of infarction or ischemia, but her initial troponin I was elevated and continued to rise. She was admitted for a non-ST elevation myocardial infarction and underwent an extensive cardiac evaluation. It was determined that the oxidative myocardial stress secondary to ozone was associated with the non-ST elevation myocardial infarction. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: More patients are turning to alternative medicine. Unfortunately, the published literature regarding intravenous ozone exposure is scant; however, a multitude of studies have shown that ozone can have hazardous effects, including that of detrimental cardiovascular oxidative stress. Emergency physicians need to be aware of these novel treatments and their potential undetermined effects.
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Traumatic spinal epidural hematomas (TSEDH) are rare, with the reported incidence being < 1% of all spinal injuries. Causes of TSEDHs include vertebral fractures, obstetrical birth trauma, lumbar punctures, postsurgical bleeding, epidural anesthesia, and missile injuries. The retrodental location has not been reported as a location for spontaneous epidural hematoma. ⋯ A 4-year-old boy was admitted to our Emergency Department after falling down and experiencing head trauma. Glasgow Coma Scale score was 15/15 with no neurologic deficit. Brain computed tomography scan showed isolated hyperdense hematoma in the retrodental area without any fractures in the skull or cervical vertebrae. Brain and cervical magnetic resonance imaging showed a retrodental acute hematoma that was isointense in T1-weighted sequences and hypointense in T2-weighted sequences. The hematoma was in the epidural space with possible odontoid process intracapsular origin. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Isolated retrodental epidural hematoma without dens fracture is an extremely rare pathology and finding, and to the best of our knowledge, this is the first case to be reported in the literature. Emergency physicians should consider this pathology for any patients presenting for head trauma with head hematoma.