Military medicine
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During the current military engagements in Iraq and Afghanistan, establishing intravenous (IV) access for resuscitation of critically injured casualties remains a persistent challenge. Intraosseous (IO) access has emerged as a viable alternative in resuscitation. In this case report, a 19 year-old male soldier was severely wounded by a roadside bomb in Iraq. ⋯ Instead, multiple IO catheters were used to initiate fluid resuscitation prior to transfer to a combat support hospital. To our knowledge, this is the first report of such extensive usage of IO catheters. Multiple IO catheters can be placed rapidly and safely and may help solve the challenge of establishing vascular access for resuscitation of critically injured casualties.
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Dexmedetomidine (DEX) is an alpha-2 receptor agonist with sedative and analgesic properties. It has been reported to preserve the patient's ability to cooperate and provide opioid sparing properties. Patients with obstructive sleep apnea (OSA) have demonstrated an increased risk for oxygen desaturation following general anesthesia. We report a case of a 64-year-old male, ASA IV with severe chronic obstructive pulmonary disease, OSA, unilateral vocal cord dysfunction, gastro-esophageal reflux disease, and congestive heart failure undergoing an awake thyroidectomy under local anesthesia and a DEX infusion. The patient was given a loading dose of DEX of 1 mcg/kg and an infusion ranging from 0.2 to 1.0 g/kg/hr. He received a total of 250 mcg of fentanyl and 7.5 mg of ketorolac throughout the case. ⋯ This case demonstrates the successful use of a DEX infusion along with local anesthesia administered by the surgeon for an awake thyroidectomy.
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Rupture of the long head of the biceps is usually seen in older adults, in conjunction with rotator cuff tears or tenosynovitis secondary to chronic subacromial impingement; it is rarely seen as a result of trauma. We present the case of a young active patient who denied prodromal symptoms but ruptured the long head of the biceps brachii tendon (LHB) while performing 25-pound biceps curls. Upon examination, the patient was noted to have a readily apparent biceps defect and decreased strength. ⋯ At the 6-week follow-up evaluation, the patient had regained full range of motion. By 6 months, he had regained his previous strength. This case demonstrates an unusual presentation of a LHB rupture in a young healthy man with no prodromal symptoms.