Curēus
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Spontaneous isolated celiac artery dissection is a rare disease and patients without evidence of significant complications often resolve with medical therapy alone; however, the extension of the dissection can lead to more serious complications including aneurysmal dilatation, complete occlusion, and rupture of a visceral artery. In these patients, optimal management has not yet been clearly defined and treatment primarily depends on clinical presentation and lesions identified on imaging studies. This case report demonstrates the conservative management of spontaneous celiac artery dissection. ⋯ Ultrasound studies demonstrated a prominent but patent celiac artery with adequate distal perfusion. Therefore, conservative medical management with antiplatelet therapy was initiated in our patient. Follow-up repeat ultrasound three weeks following discharge showed no evidence of dissection flap, stenosis, thrombosis or increase in the size of the aneurysm. This case report demonstrates that conservative medical management with antiplatelet therapy can be sufficient in treating spontaneous isolated celiac artery dissection with pseudoaneurysm formation. We suggest endovascular or surgical intervention should be reserved for patients who present with hemodynamic instability, or other serious complications, such as aneurysm rupture or visceral infarction.
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Introduction Previous studies on specialty choice have investigated specialty characteristics that are appealing to undergraduate students. Little is known about how students' attitudes towards Emergency Medicine (EM) careers evolve over their schooling. Methods An open-ended survey of medical students' career interests was distributed five times over the four-year undergraduate curriculum from 1999 to 2008 at Memorial University. ⋯ Conclusions Medical students' opinions towards EM tended to shift over time, particularly the perception of the work. Medical students' perceptions differ from that of experienced emergency physicians. Medical schools may be able to improve clinical exposure and provide more informed counselling or mentoring with respect to EM.
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Empyema necessitans is a complication of a pleural space infection that dissects through the pleura into the soft tissues of the chest and skin. Due to the widespread availability of antibiotics, empyema necessitans is rare in modern medicine and is most commonly caused by Mycobacterium tuberculosis. A 38-year-old immunocompetent male presented with left shoulder pain and his chest radiograph revealed a mass in the upper left lung and/or pleural space. He underwent multiple debridements of the chest wall due to a left chest wall abscess and empyema necessitans. ⋯ The patient's clinical course was complicated by septic arthritis of the left sternoclavicular joint and first rib, vertebral osteomyelitis/discitis, and pelvic abscesses. This case report illustrates the pathogenic process of empyema necessitans and summarizes the clinical management for practicing clinicians. It also documents the second case of Streptococcus agalactiae-associated empyema necessitans, to our knowledge, with significantly greater disease extension than the first.
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Ludwig's angina is a diffuse cellulitis in the submandibular, sublingual, and submental spaces, characterized by its propensity to spread rapidly to the surrounding tissues. Early recognition and treatment for Ludwig's angina are of paramount importance due to the myriad of complications that can occur in association with Ludwig's angina. Known complications of Ludwig's angina include carotid arterial rupture or sheath abscess, thrombophlebitis of the internal jugular vein, mediastinitis, empyema, pericardial effusion, osteomyelitis of the mandible, subphrenic abscess, aspiration pneumonia, and pleural effusion. ⋯ She was treated with clindamycin and cefoxitin for infection and vigorously hydrated. This case is exemplary for the successful management of this potentially lethal clinical condition. Our early recognition and aggressive treatment helped to prevent complications from Ludwig's angina.
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Cricothyroidotomy is a life-saving medical procedure that allows for tracheal intubation. Most current cricothyroidotomy simulation models are either expensive or not anatomically accurate and provide the learner with an unrealistic simulation experience. The goal of this project is to improve current simulation techniques by utilizing rapid prototyping using 3D printing technology and expert opinions to develop inexpensive and anatomically accurate trachea simulators. ⋯ Skin has been simulated as well to enhance the realism of the model. The result is an accurate simulation that will provide users with an anatomically correct model to practice important skills used in emergency airway surgery, specifically landmarking, incision and intubation. This design is a novel and easy to manufacture and reproduce, high fidelity trachea model that can be used by educators with limited resources.