Annals of emergency medicine
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A 64-year-old man presented with a history of four days of lower abdominal pain and 12 hours of cutaneous discoloration, bullae formation, and swelling of the soft tissues of abdominal wall and right thigh. Myonecrosis of abdominal wall and an adenocarcinoma of the cecum were found at operation. Cultures of blood and fluid from the bullae yielded Clostridium septicum. ⋯ Presumptive diagnosis often can be made by Gram stain of the bullous fluid that reveals gram-positive bacilli and a paucity of leukocytes. Favorable outcome depends on prompt institution of appropriate antimicrobial therapy and surgical debridement of involved soft tissues, as well as correction of the underlying disorder. This disease should be considered to be a medical-surgical emergency.
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Prehospital and interhospital emergency care is moving from the ground to the air, with the realization that such a move will further reduce the morbidity and mortality of the critically ill or injured patient. This move is not without inherent risks, for altitude and take-off further compromise the critical patient. To preclude this risk and improve air ambulance services, Indiana is adopting rules and regulations to govern the operation and administration of air ambulance services. Indiana is the first state to adopt air ambulance standards, although other agencies have established or are attempting to establish similar guidelines.