Southern medical journal
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Southern medical journal · May 1995
Case ReportsAcute epidural hematoma of the cervical spine: an unusual cause of neck pain.
Cervical spinal epidural hematoma is an unusual neurosurgical disorder that usually requires emergent surgical decompressive therapy. We report the case of an 85-year-old woman with acute, severe neck and shoulder pain with progressive neurologic deficits. ⋯ It is incumbent on the emergency physician to recognize this disorder and arrange emergent neurosurgical consultation to ensure an optimal outcome. Further, the differential diagnosis of neck pain and progressive neurologic findings should include this entity.
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Southern medical journal · May 1995
Case ReportsEpinephrine-induced lactic acidosis in the setting of status asthmaticus.
A relationship between intravenous epinephrine infusion and the development of lactic acidosis has been well described. We report a temporal association between the administration of subcutaneous epinephrine and the development of lactic acidosis in the setting of status asthmaticus. A 20-year-old woman with a history of asthma came to the emergency service in acute respiratory distress and was treated with subcutaneous epinephrine. ⋯ The lactic acidosis resolved within 15 hours. The patient never exhibited signs of hypotension, hypoxemia, or sepsis, and other potential etiologies for lactic acidosis were excluded. We believe the events of this case constitute a new observation and theorize a mechanism of peripheral vasoconstriction and transient tissue hypoperfusion mediated by the subcutaneous epinephrine.
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Southern medical journal · May 1995
Case ReportsExpanding the envelope of neonatal endoscopic tracheal and bronchial surgery.
Diagnostic evaluation of the neonatal airway requires special training and instrumentation. The subglottis of a normal full-term infant will allow passage of a 3.0 bronchoscope (outer diameter 5.0 mm, inner diameter 4.3 mm). On occasion, diagnostic rigid endoscopy with simultaneous ventilation in premature infants necessitates use of a 2.5 bronchoscope (outer diameter 4.2 mm, inner diameter 3.5 mm). ⋯ Therefore, performance of endoscopic tracheal and bronchial procedures in the premature infant requires innovative techniques with thorough knowledge of instrumentation and anesthetic management, generally including apneic techniques. As advances in neonatology result in survival of smaller and smaller patients, otolaryngologists must keep pace to provide adequate support. A case report of endoscopic removal of a granuloma totally obstructing the right primary bronchus in a 1 kg premature infant illustrates these concepts in neonatal endoscopy.