BMJ case reports
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Case Reports
Two days with a broken knife blade in the neck--an interesting case of Horner's syndrome.
A 25-year-old man presented to the Emergency department in a rural South African hospital after a left, submental neck stab with a knife. Examination was deemed unremarkable, and the patient was discharged, but re-attended 2 days later complaining of a painful, swollen neck. Further examination identified Horner's syndrome, and further investigation revealed that the blade of the knife had remained in the patient's neck. ⋯ This case illustrates the importance of careful history, examination and diagnostic imaging in the management of penetrating neck injuries. Horner's syndrome can be easily missed in a busy Emergency department and may indicate life-threatening pathology in the context of neck trauma. The difficulties in assessing and managing this type of injury are discussed.
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'Legal highs' are recreational drugs sold over the internet and the so-called 'head shops' all over the UK. They are freely available to buy and use as they are not covered by the Misuse of Drugs Act 1971. Mephedrone (4-methylmethcathinone) was sold as a 'legal high' until 17 April 2010 when it was made a class B drug under the Misuse of Drugs Act 1971. ⋯ Not much is known of the effects of mephedrone on mental health. We present a case of dependence and psychosis in a patient using mephedrone (4-methylmethcathinone). The patient needed inpatient hospital care, was treated with antipsychotic olanzapine and recovered well.
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Alteplase used for thrombolysis in ischaemic stroke may be complicated by orolingual acute angioedema (OAA), a rare but potentially life-threatening side effect. We report the case of a 32-year-old woman who over 24 h experienced OAA after thrombolysis for an acute ischaemic left hemispheric stroke. We discuss the pathophysiology of this rare phenomenon.
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Case Reports
Hydroxocobalamin treatment of acute cyanide poisoning with a jewellery-cleaning solution.
Acute cyanide poisoning by ingestion is often severe and lethal among jewellery industry workers. Clinical experience with hydroxocobalamin alone in severe acute cyanide poisoning by ingestion remains limited. This case concerns a 50-year-old goldsmith who tried suicide by ingestion of a jewellery cleaner solution containing approximately 1.2 g of potassium cyanide. ⋯ Following hydroxocobalamin treatment, neurologic and metabolic disorders rapidly improved. He was discharged home 4 days later, without neurological sequelae. The case reinforces the safety and effectiveness of hydroxocobalamin in acute cyanide poisoning by ingestion.
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Case Reports
'I saved a life': a heroin addict's reflections on managing an overdose using 'take home naloxone'.
Research shows that most heroin addicts, at some point in their drug using careers, accidentally overdose and that accidental overdose is the most common cause of death in this group. As most such overdoses are witnessed by other drug users or their carers, it is argued that providing 'take home naloxone' (a fast-acting opiate antagonist) to them (as potential witnesses to an overdose) can save lives. ⋯ Through this account, we hope to raise clinicians' awareness of this simple yet life-saving intervention. We will also briefly discuss the evidence base for take home naloxone with particular reference to the UK and will also give some practical guidance to clinicians on prescribing take home naloxone.