Clinical medicine (London, England)
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This case illustrates a rare cause of facial pain due to glossopharyngeal neuralgia in a 66-year-old male patient. Imaging confirmed an aneurysm of the cervical internal carotid artery as the cause; the aneurysm itself, likely secondary to an elongated styloid process (Eagle's syndrome). The imaging findings and management options are discussed below.
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Case Reports
It all started with a sore throat: Polymicrobial septicaemia, cavitating lung lesions and severe thrombocytopenia.
We report a case of a syndrome first described by French bacteriologist André Lemierre nearly 100 years ago. A young woman presented with fever, chest pain and arthralgia. Admission investigations revealed thrombocytopenia, cavitating pneumonia and an internal jugular vein thrombus. ⋯ Respiratory failure developed within 48 h and was managed with high-flow nasal oxygen in a critical care setting. The investigation findings leading to diagnosis, as well as the antimicrobial and anticoagulation management strategies, are discussed. Lemierre's syndrome is rarely encountered by non-specialists, but a good outcome can be expected with prompt diagnosis and treatment.
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Peripheral intravenous cannulation (PIVC) is an essential skill for newly qualified foundation doctors. It has high failure rates, resulting in care delays, pain and infection. We explored the perceived impact of ultrasound-guided PIVC (US-PIVC) training on confidence when performing difficult-access PIVC. ⋯ Confidence when performing PIVC with difficult access, regardless of US, increased significantly following the course (p < 0.01). This was also true regarding confidence when performing US-PIVC (p < 0.01.). Key themes identified included technical skills, confidence and clinical utility.
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Staphylococcus aureus bacteraemia (SAB) is a multi-system disease associated with a 20-25% mortality in the UK setting. Many patients with SAB are admitted acutely unwell and are treated by the general physician. This review summarises the key management steps that a general physician needs to be aware of when treating patients with SAB. Successful management relies on appropriate empirical and definitive antimicrobial therapy, effective source control, accurate risk stratification and timely identification of metastatic foci of infection, as well as exclusion of infective endocarditis, which can be present in up to 10% of patients with SAB.