BMJ case reports
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We present two uncommon underlying causes of a sore throat which, if missed or delayed in diagnosis, can lead to disastrous consequences. Our first case is of Lemierre's syndrome diagnosed in a 21-year-old man presenting with a 5-day history of sore throat, fever, right-sided pleuritic chest pain and bilateral pulmonary nodules on CT imaging. Fusobacterium necrophorum cultured from peripheral blood and an occluded left internal jugular vein on ultrasound lead to an eventual diagnosis. ⋯ A left-sided quinsy was diagnosed and aspirated and the patient was discharged home. She represented shortly with worsening pleuritic pain and was found to have a right-sided pleural effusion with descending mediastinitis originating from the tonsillar abscess. Delayed diagnosis resulted in open thoracotomy, decortication and prolonged intravenous antibiotics.
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Case Reports
Systemic arterial air embolism: positive pressure ventilation can be fatal in a patient with blunt trauma.
Systemic air embolism is a potentially fatal condition. Although venous embolism is commonly reported after deep sea diving or neurosurgical procedures, arterial embolism is rare. It usually occurs because of lung trauma after biopsy or lung resection but can rarely affect patients of blunt or penetrating trauma to chest managed on positive pressure ventilation. ⋯ Postmortem CT scan revealed huge amounts of air in left side of the heart, ascending aorta, arch of aorta, bilateral internal carotids and all right-sided intracranial arteries. In emergency departments of non-specialised centres, such complications are universally fatal. Thus, extreme caution needs to be exercised while managing patients of blunt trauma on mechanical ventilation even if the chest and abdominal examinations are normal.
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We report a case of serious lung injury from beanbag bullet. A 46-year-old gentleman, shot with beanbag bullets was brought to the emergency department. Upon arrival he was in obvious respiratory distress and complained of severe pain in the right chest. ⋯ The bullet and skin fragments overlying the lung and along the bullet track were extracted. The pleural cavity was washed with normal saline and haemostasis was confirmed. The patient had an uneventful postoperative recovery.
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Case Reports
Value of an automatic external defibrillator printout as a diagnostic tool after successful AED use on a child.
A 6-year-old girl without any medical history experienced a drowning incident for a duration of 2 min, according to witnesses. This was followed by cardiopulmonary resuscitation, during which the automatic external defibrillator (AED) detected a shockable rhythm and subsequently delivered a single electroshock. ⋯ This case report confirms the assumption that the AED can adequately perform rhythm analysis on children and convert VF into sinus rhythm. Moreover, the AED printout can provide information about the rhythm that is necessary for the diagnosis of an underlying cardiac disease.