Southern medical journal
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Southern medical journal · Jun 1993
Predicting severity of trauma by admission white blood cell count, serum potassium level, and arterial pH.
Traumatized patients frequently have leukocytosis, hypokalemia, and acidosis. The purpose of this study was to determine whether the admission serum potassium level (K+), white blood cell count (WBC), and arterial pH predicted the severity of injury in trauma patients. The injury severity score (ISS), total length of stay in the hospital (tLOS), and length of stay in the intensive care unit (LOS-ICU) were used to measure the severity of the injury. ⋯ Leukocytosis (WBC > or = 10,500/mm3) correlated with a higher mean ISS, and LOS-ICU. Patients with hypokalemia (K+ < 3.6 mEq/L) had an increased mean ISS and tLOS. Our findings suggest that the admission white blood cell count, serum potassium level, and arterial pH have a predictive value as to the severity of injury.
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Chlorine and chloramine gas are frequently produced in the home when cleaning products are mixed. These gases are strong irritants with the potential for tissue damage. Numerous literature citations report industrial exposures to chlorine/amine gas, but there are few reports regarding home exposures. ⋯ Only one patient in the study group required admission for continued respiratory distress, but he had a preexisting chronic respiratory problem as well as an upper respiratory tract infection at the time of exposure. Although the gas produced by mixing cleaning products in the home can cause severe respiratory irritation, most of the patients exposed to chlorine and chloramine gas can safely be treated at home with comfort measures. Appropriate follow-up must be done to determine resolution of symptoms.
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Physicians should question their elderly patients and those who know their life-styles and habits best (ie, family, friends, caretakers) regarding use of over-the-counter medications. Salicylates are commonly used by the elderly, and long-term unsupervised use may lead to salicylate toxicity that can cause delirium. In the southern United States, BC and Goody's Headache Powders are widely marketed and used, and their overuse can produce salicylate intoxication.
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We have reported the cases of two patients who had acute pylephlebitis associated with portal vein thrombosis and septic hepatic emboli as a result of right colonic diverticulitis. Although rare, pylephlebitis is a treatable but often lethal complication of intra-abdominal sepsis. Several bacterial pathogens, especially Escherichia coli are associated with pylephlebitis. ⋯ Surgery may not be required. Our two patients received ampicillin--the best first-line drug--until specific antibiotic therapy could be given. Early administration of a broad spectrum antibiotic is essential.
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Southern medical journal · May 1993
Case ReportsSpontaneous migration of an intracranial bullet into the cervical canal.
We have reported a case of intracranial to intraspinal migration of a retained bullet fragment over a course of approximately 4 years. The patient remained asymptomatic. The bullet was removed via a posterior cervical laminectomy. Migration of bullet fragments, though rare, should be included as one of the delayed complications of gunshot wound to the head.