J Emerg Med
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Acute otitis media is a common pediatric infection that requires appropriate evaluation of the young child to assure that there are no accompanying systemic infections or complications. The examination of the ear must not only assess the appearance of the tympanic membrane, but determine its mobility. Treatment should be initiated with antibiotics and symptomatic relief. Good follow-up must be arranged.
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Warming plastic bags containing intravenous solutions in a microwave oven (MWO) raised the temperature from 18 degrees C to an average of 34.1 degrees, 40.2 degrees, and 42.8 degrees C when treated for 120, 150, and 160 seconds, respectively. Fluids at 18 degrees C, when passed through a blood warmer, resulted in temperatures at the distal end (DE) of about 27 degrees C; but if the bags were priorly warmed to 42 degrees C, fluids arrived at the DE at a temperature of about 30 degrees C. Fluids heated by MWO to 42 degrees C through a single short tubing 180 cm long arrived at the DE at a temperature of 33.7 degrees C. ⋯ One group of 19 patients undergoing repair of injuries to extremities received infusions warmed by MWO to 42 degrees, while other groups received them at about 20 degrees. After an initial fall, average temperature in the former tended toward normal levels while in the latter, body temperature declined. The simple expedience of MWO warming of the bags to 42 degrees C, and flowing through shorter administration tubing, appears to ameliorate this complication and in some cases prevents it.
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A 39-year-old male arrived in the emergency department with multiple stab wounds to the chest. A pneumopericardium was present on initial chest x-ray study. ⋯ All parameters improved following removal of 100 cc of air by pericardiocentesis. The etiology, diagnosis, pathophysiology, and treatment of tension pneumopericardium are discussed.
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Poisoning by blue-green algae occurs after an algal "bloom" caused by warm weather and algal concentration. On death or disintegration, the algae release liver toxins and neurotoxins (fast death factor). Although deaths are common in animal exposures, human exposures have been limited to various allergic reactions, mild liver enzyme elevation, and gastroenteritis. A case of animal deaths and its relationship to human exposures is discussed.