European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Radial head fractures are a common orthopaedic injury presenting to Emergency Departments. Most are diagnosed radiographically, either with a visible fracture or by the presence of abnormal fat pads. We present two cases of delayed radiological diagnosis of radial head fractures despite a high index of clinical suspicion of a fracture at initial consultation.
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Case Reports
Expect the unexpected: malposition of a large-bore central venous catheter in the urinary bladder.
We report the case of a femoral vein cannulation in a critically ill trauma patient with the malposition of a large-bore central venous catheter in the urinary bladder. Recognition of the malposition was hampered by bloody tamponade of the bladder in the context of blunt thoraco-abdominal trauma with kidney and liver laceration. ⋯ We discuss the anatomy of femoral veins, including their close relation to a distended bladder. The application of ultrasound even in emergency situations is stressed.
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Excessive oxygen administration in hypercapnic chronic obstructive pulmonary disease predisposes to worsening respiratory failure during intercurrent respiratory illness. Chronic hypercapnia is thought to downregulate carbon dioxide chemoreceptor sensitivity, adversely affecting respiratory function/mechanics and worsening ventilation-perfusion inequality. These patients are dependent on hypoxic drive to maintain adequate spontaneous respiration. ⋯ Although unrestricted oxygen is beneficial and safe in children and young adults with asthma, it may lead to progressive hypercapnia in older patients with asthma, a potential risk highlighted by this case. To avert progressive hypercapnia, oxygen therapy that is carefully adjusted to achieve adequate, but not maximal, tissue oxygenation may be a safer strategy than unrestricted oxygen use in older asthmatic patients. However, the correction of hypoxia overrides strategies to avert oxygen-related hypercapnia.
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A 38-year-old man was admitted to the Emergency Department suffering from an exacerbation of atopic dermatitis, fever and a burning sensation in the eyes. He was first treated with systemic corticosteroids. A subsequent dermatological and ophthalmological examination established the diagnosis of Kaposi-Juliusberg disease or eczema herpeticum with bilateral herpetic keratitis. ⋯ Because it is a possible life-threatening condition, this disease must be recognized by all emergency physicians. The association with herpetic keratitis is not frequent but is a major ophthalmological problem. Treatment consists of the administration of high-dose intravenous acyclovir and acyclovir ophthalmic ointment.
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Mass casualty incidents (MCI) resulting from terrorist bombings pose special problems and may overwhelm even the most experienced trauma centre. Although role assignments for MCI management and control are documented, we would like to share several aspects that we have found to be crucial for the management of terrorist bombing MCI. Twelve topics and possible answers were brought up and discussed extensively in MCI debriefing sessions in our institution. ⋯ The second category encompasses the concept of triage hospital, the unidirectional patient flow, ancillary evaluation during MCI, the consultancy, and tertiary survey. All were identified as critical for proper event handling. The integration and implementation of the topics discussed throughout the medical system may enable emergency departments to handle MCI resulting from terrorist bombings better.