RESUMEN
We present a case of acute Candida epiglottitis in an otherwise healthy and Haemophilus influenzae type B-immunized 4-year-old child. A query of the literature reveals this disease to be commonly found in patients who are immunocompromised by problems including human immunodeficiency virus disease and lymphoma and leukemia. However, there are no published reports of acute Candida epiglottitis in immunocompetent and vaccinated patients. Our case should emphasize to the emergency physician the need to remain vigilant for subtle and atypical presentations of airway-destabilizing diseases.
Asunto(s)
Candidiasis/diagnóstico , Epiglotitis/diagnóstico , Enfermedad Aguda , Antifúngicos/uso terapéutico , Candida/aislamiento & purificación , Candidiasis/tratamiento farmacológico , Preescolar , Endoscopía/métodos , Epiglotitis/tratamiento farmacológico , Epiglotitis/microbiología , Femenino , Humanos , InmunocompetenciaRESUMEN
BACKGROUND: Fungal nervous system infection can be a difficult diagnosis to make, due to the fact that there are no specific manifestations of the disease and laboratory confirmation is difficult to confirm. CASE REPORT: We report a young male who presented to our emergency department with a variety of unilateral visual field complaints. While he initially denied recent IV drug abuse, his physical examination was highly suggestive of a fungal infection known to result from brown heroin use. He was ultimately diagnosed with meningitis, ventriculitis, and endogenous endophthalmitis believed to result from a Candida species. The response to treatment with vitrectomy and broad-spectrum antimicrobials gave support to the presumed diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We provide a rarely described report of a possible complication from the use of IV brown heroin that led to a central nervous system infection involving vision loss by fungal infection.
Asunto(s)
Enfermedades del Sistema Nervioso Central/etiología , Heroína/efectos adversos , Micosis/complicaciones , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Candida/patogenicidad , Ventriculitis Cerebral/etiología , Diagnóstico Diferencial , Servicio de Urgencia en Hospital/organización & administración , Endoftalmitis/etiología , Humanos , Masculino , Meningitis/etiología , Abuso de Sustancias por Vía Intravenosa/complicaciones , Campos Visuales/fisiología , Voriconazol/farmacología , Voriconazol/uso terapéutico , Adulto JovenRESUMEN
Emergency Medical Services (EMS) activities are a required component of Emergency Medicine (EM) residency training. To determine resident involvement with EMS, all 135 Accreditation Council for Graduate Medical Education-accredited and 34 American Osteopathic Association-accredited EM residencies were surveyed in June 2005 regarding the EMS activities required of their residents. One hundred twelve surveys were completed (66% response rate). Observing with ground EMS is required in 88% (n = 98) of residencies; working as an EMS provider is required in 28% (n = 31). Helicopter-based EMS involvement is uncommon, only 16% (n = 18) require observing and 21% (n = 23) require working as a provider. Most residencies (60%, n = 67) allow optional helicopter observation. Insufficient time is the most common reason for limiting EMS activities. Residents routinely provide on-line medical command (79%, n = 88). Most residencies (72%, n = 81) require lecturing to prehospital personnel; a minority require serving as Advanced Cardiac Life Support (38%, n = 42) or Advanced Trauma Life Support (13%, n = 14) instructors. Disaster training is required of most residents (73%, n = 82), whereas providing medical care at a mass gathering is not frequently required (28%, n = 31). Except for reviewing EMS patient care reports (54%, n = 60), quality improvement activities are rarely required. Serving as a medical director or assistant medical director for an EMS service is seldom required (6%, n = 7), and most residencies (63%, n = 70) do not specifically provide financial support for EMS physician-related training.
Asunto(s)
Educación de Postgrado en Medicina/organización & administración , Servicios Médicos de Urgencia , Medicina de Emergencia/educación , Internado y Residencia , Humanos , Encuestas y Cuestionarios , Estados Unidos , Recursos HumanosRESUMEN
We present the case of an 11-year-old male who had a dissection of his left internal carotid artery following a rather innocuous mechanism of injury. Although this phenomenon is documented in the medical literature, it remains a relatively rare event following blunt injury to the head and neck (0.3% occurrence rate in 1 study spanning 7 years). (Despite its rarity, it remains an important cause of cerebrovascular accidents in children. 2) Children presenting with gross neurologic abnormalities following blunt trauma to the head or neck should be considered to have sustained injury to the carotid arteries until proven otherwise.
Asunto(s)
Enfermedad Cerebrovascular de los Ganglios Basales/etiología , Disección de la Arteria Carótida Interna/etiología , Arteria Carótida Interna , Corteza Cerebral/irrigación sanguínea , Infarto Cerebral/etiología , Traumatismos del Cuello/complicaciones , Carrera/lesiones , Heridas no Penetrantes/complicaciones , Accidentes por Caídas , Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiología , Disección de la Arteria Carótida Interna/diagnóstico , Infarto Cerebral/diagnóstico , Niño , Confusión/etiología , Urgencias Médicas , Ataxia de la Marcha/etiología , Cefalea/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Trastornos del Habla/etiologíaRESUMEN
OBJECTIVES: Automated external defibrillators (AEDs) are increasingly available in industrial settings, but many industries have high electromagnetic fields (EMFs), which can interfere with the function of electronic devices. This study evaluated the performance of several AEDs when exposed to high EMFs. METHODS: Three commercially available AEDs were evaluated in the setting of a public utility coal-fired electrical generation plant. Each AED was placed in three areas of high EMF ranging from 310 to 1,600 milligauss. A signal generator, used to simulate various cardiac rhythms, was connected to the AEDs. Rhythms simulated were ventricular fibrillation, asystole, and normal sinus rhythm. Each of the AED's interpretations of various rhythms were evaluated in the different EMF settings. RESULTS: Rhythms of ventricular fibrillation, asystole, and normal sinus rhythm were correctly recognized by each AED in each of the three areas of high EMF. Each AED appropriately recommended defibrillation when presented with ventricular fibrillation. No misinterpretations or inappropriate defibrillations were observed. CONCLUSION: Electromagnetic fields generated by an electrical power plant did not interfere with three commercial AEDs' abilities to correctly interpret simulated rhythms and recommend appropriate defibrillation.