The American journal of emergency medicine
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Subcutaneous emphysema is an unusual complication of bronchiolitis. The investigators describe a patient with bronchiolitis who developed extensive subcutaneous emphysema. ⋯ Review of the literature shows a multitude of causes of subcutaneous emphysema. The vast majority of cases resolve without intervention.
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Nine consecutive patients presenting with acute gouty arthritis were treated with ketorolac 60 mg intramuscularly (IM). The average age was 58. Seven were male, and six were black. ⋯ There were no side effects of the medication. All of the patients were able to leave the treatment area satisfied with their treatment. None of the patients required crutches at discharge.
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The case of a 42-year-old latex-sensitive female who experienced urticaria, pruritus, soft tissue swelling, and significant hypotension during an outpatient barium enema is described. These signs and symptoms of anaphylaxis occurred immediately after enema tip insertion and before infusion of contrast material. ⋯ This patient experienced an IgE-mediated anaphylactic reaction to the latex enema tip. Emergency physicians need to be aware of the spectrum of latex-induced allergic reactions.
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To determine whether digital endotracheal intubation predisposes to left mainstem intubation, a prospective, convenience sample of postarrest cadavers in the emergency departments of two university medical centers was used. Six postarrest cadavers were reintubated by the same right-handed intubator using accepted digital intubation technique. Endotracheal tubes (7.5 mm internal diameter) with stylets were configured into an open "J" shape and were inserted to a depth of 30 cm to ensure endobronchial intubation. ⋯ This represents a greater than 150-fold increase in the rate of left mainstem intubations relative to right mainstem intubations when compared with data from the literature. Digital intubation technique predisposes to left mainstem intubation. Practitioners must have heightened awareness that decreased right-sided breath sounds after digital intubation may represent an easily corrected left mainstem intubation rather than other pathology.
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Epidural empyema is an unusual cause of headache that may be encountered in the emergency department. The collection of suppurative fluid usually results from local spread of sinusitis, although many other predisposing factors have also been described. ⋯ The case of an adolescent who presented to our emergency department twice in 6 days with persistent headache is reported; cranial computed tomography performed on the second visit demonstrated bilateral epidural empyema. This entity is uncommon, but may certainly be encountered by the emergency physician.