The American journal of emergency medicine
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Mass Casualty Events (MCI) which have a direct and persisting impact on the safety and well-being of an emergency department (ED) and its staff, secondary to specific targeting of the healthcare setting, represent a distinct and complex operational challenge. ED physicians may be faced with the prospect of providing ongoing patient care while simultaneously experiencing direct threats to their own health or physical safety. In our study we considered the unique operational challenges encountered, and management strategies adopted, by the ED staff and its leadership to an all-hazard MCI impacting an academic urban emergency department. ⋯ Findings from our observational study suggested that in the absence of larger public health interventions a manmade MCI, with direct threats to an ED and its staff, could force EDs to concurrently address the unique clinical needs of two distinct patient populations while simultaneously needing to take measures to protect hospital staff. Additionally, a higher burden of patient volumes and clinical acuity are likely to be encountered by select specialty consultation services. Further studies could focus on quantitative analysis to better understand the operational impact of these types of events on both patients and staff.
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Case Reports
What's the bug?: An unusual cause of bacterial meningitis in a patient with history of transsphenoidal surgery.
Bacterial meningitis is an increasingly rare disease that carries significant morbidity and mortality. We describe the case of a 38-year-old male with a past medical history of pituitary macroadenoma with prior endonasal surgeries on prednisone therapy daily for resultant hypopituitarism and juvenile myoclonic epilepsy on lamotrigine daily who was transferred to an academic tertiary emergency department due to concern for developing pituitary apoplexy. At the outside emergency department, the patient presented complaining of sudden onset severe headache. ⋯ This case demonstrates the variable presentation of bacterial meningitis as the patient was not initially febrile or altered. Emergency physicians index of suspicion for meningitis should be increased with risk factors such as immunosuppression and history of transsphenoidal surgery, as in our patient. Our case is a unique case of Streptococcus salivarius meningitis that has been previously associated with primarily iatrogenic etiologies.