The American journal of emergency medicine
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Boerhaave's syndrome represents a diagnostic dilemma for the emergency physician. The prognosis of this truly life-threatening emergency is darkened by any significant diagnostic delay. Unfortunately, classic or expected symptoms and signs are frequently absent at presentation, a circumstance that leads to frequent misdiagnosis. ⋯ However, emphasis should be placed on the fact that this entity may occur without emesis. The chest radiograph is the most helpful diagnostic aid. Undoubtedly, maintenance of a high degree of suspicion by the emergency physician for Boerhaave's syndrome will lead consistently to earlier diagnosis, and subsequent aggressive intervention should result in considerable reduction in rates of both morbidity and mortality.
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The case of a man who injected turpentine intravenously in an attempt to kill himself is reported. The patient developed immediate pulmonary edema and hypoxia, followed later by cellulitis at the site of injection. Although only one death to date has been attributed to this form of chemical abuse, extensive local reactions, pulmonary involvement, central nervous system depression, and febrile reactions should be anticipated, and such patients should be admitted to the hospital. Patients should be observed for local reactions and myonecrosis around the site of injection, especially as these occur 12-24 hours later.
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Clinical Trial Controlled Clinical Trial
Antibiotic prophylaxis in intraoral wounds.
This study of 100 patients was undertaken to determine the efficacy of penicillin/erythromycin prophylaxis in the management of intraoral lacerations in the pediatric population. Only six patients of the evaluable population developed infections (6.4%). Two of these patients received antibiotic prophylaxis (4%), and the other four were control patients (8%) who developed wound infections (P = 0.41). ⋯ Cross-product ratios for these small sample subgroups indicated that the likelihood of infection for non-prophylactically treated patient wounds of greater than 1 cm length and/or those requiring suturing was two to three times higher than that of patients treated prophylactically. Although no statistical significance could be ascribed to the observed differences of these post hoc categories, benefit from antibiotic prophylaxis may have been quantifiable in a study designed to assess only these major wounds utilizing a large sample size. In general, routine antibiotic prophylaxis appears unwarranted for simple intraoral lacerations in children, although it may be useful when the wounds are large enough to be sutured.
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A case of massive degloving injury of the trunk, with open pelvic fracture, and evisceration of abdominal contents from blunt trauma is presented. The most significant aspect of this case was the transfusion of 173 units of packed cells and 176 units of fresh frozen plasma in the first thirty hours. The patient ultimately recovered and returned to work.
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A case of an unusual caustic ingestion involving Compound W, an over the counter wart remover is presented. Chemical burns of the tongue, pharynx and larynx developed. The active ingredient in this preparation: salicylic acid in a flexible collodion vehicle produces caustic injury through a keratolytic action, which may be enhanced by the presence of collodion.