BMJ case reports
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Acquired methaemoglobinaemia is a serious complication caused by many oxidising drugs. It presents as cyanosis unresponsive to oxygen therapy. The case of 33-year-old male patient who presented in our department after noticing blue lips and fingers is presented. ⋯ Therefore, a diagnosis of methaemoglobinaemia due to mephedrone, which is the active ingredient of 'snow', was made. Treatment is with intravenous methylene blue. Our patient started to improve so methylene blue was not used and he was discharged after 8 h.
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A 52-year-old lady was admitted with back pain, fever and reduced sensation in her left leg. Soon after admission she developed acute urinary retention. ⋯ Cultures from theatre grew Staphylococcus aureus sensitive to flucloxacillin. After 12 weeks of intravenous/oral antibiotics, she was discharged without any neurological disability.
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Case Reports
Two days with a broken knife blade in the neck--an interesting case of Horner's syndrome.
A 25-year-old man presented to the Emergency department in a rural South African hospital after a left, submental neck stab with a knife. Examination was deemed unremarkable, and the patient was discharged, but re-attended 2 days later complaining of a painful, swollen neck. Further examination identified Horner's syndrome, and further investigation revealed that the blade of the knife had remained in the patient's neck. ⋯ This case illustrates the importance of careful history, examination and diagnostic imaging in the management of penetrating neck injuries. Horner's syndrome can be easily missed in a busy Emergency department and may indicate life-threatening pathology in the context of neck trauma. The difficulties in assessing and managing this type of injury are discussed.
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This report describes a life-threatening anaphylactic reaction in a 58-year-old woman who was scheduled for subacromial decompression of right shoulder joint. She had a modified rapid sequence induction using fentanyl 100 µg, propofol 150 mg and suxamethonium 100 mg. Following induction her blood pressure and pulse were stable. ⋯ Surgery was postponed. Later she made an uneventful recovery. Her serum tryptase level was raised and a positive intradermal reaction to atracurium confirmed atracurium anaphylaxis.
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Case Reports
'I saved a life': a heroin addict's reflections on managing an overdose using 'take home naloxone'.
Research shows that most heroin addicts, at some point in their drug using careers, accidentally overdose and that accidental overdose is the most common cause of death in this group. As most such overdoses are witnessed by other drug users or their carers, it is argued that providing 'take home naloxone' (a fast-acting opiate antagonist) to them (as potential witnesses to an overdose) can save lives. ⋯ Through this account, we hope to raise clinicians' awareness of this simple yet life-saving intervention. We will also briefly discuss the evidence base for take home naloxone with particular reference to the UK and will also give some practical guidance to clinicians on prescribing take home naloxone.