1/6. Complications of a retrograde intubation in a trauma patient.The authors report the case of an elder woman involved in a motor vehicle collision (MVC) requiring emergent intubation using the technique of retrograde intubation (RI). Since RI is a blind technique, potential complications arising from its use are numerous and may result in increased morbidity and mortality. Such was the case of this RI that involved incorrect placement of the endotracheal tube (ETT), resulting in suboptimal ventilation and increased morbidity. Additionally, this case illustrates how the failure to detect this error in multiple settings (ambulance, helicopter, emergency department) led to unnecessary and potentially deleterious procedures and significant delay in providing the basics of trauma care, oxygenation and ventilation. Although theoretical complications of RI have been addressed in the past, there have been very few published reports of actual complications. The emergency physician must be aware of difficult airways, options available to establish alternative airways, and methods to confirm appropriate placement of the ETT. The authors also discuss the indications, procedures, and complications involved in performing an RI.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Fitness to fly in an infant with congenital lobar emphysema.Determining fitness to fly is a difficult task for physicians, especially for those caring for children with respiratory disorders, as the available information for guidance is scarce. This case describes the use of a flight simulation in a decompression chamber in order to assess fitness to fly in an 18-mo-old infant with congenital lobar emphysema (CLE). The case discussion focuses on the need for an understanding of flight physiology in order for physicians to determine the most appropriate method to assess fitness to fly in children with medical concerns.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/6. Submucosal choledochal emphysema after transduodenal sphincteroplasty.The widespread use of sphincteroplasty in the treatment of benign biliary obstruction requires that those physicians who must treat the complications associated with sphincteroplasty recognize the potential diagnostic pitfalls that may delay appropriate treatment. A case demonstrating one such potential pitfall is presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. Orbital emphysema: a potentially blinding complication following orbital fractures.A case of visual loss due to orbital emphysema secondary to a blow-out fracture of the orbit is presented. Because vision returned to 20/20 following an optic nerve decompression procedure, we hypothesize that our patient developed a compressive optic neuropathy with ischemia due to the emphysema. Essential instructions concerning the injury that the emergency physician should give the patient suffering an orbital blow-out are also presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. emphysematous cholecystitis: an insidious variant of acute cholecystitis.emphysematous cholecystitis is an insidious and rapidly progressing disease that requires prompt surgical intervention. As the majority of the patients contracting this disease initially present to the emergency department with complaints of abdominal pain and often mild constitutional symptoms, it is important for the emergency physician to be aware of this clinical entity. Didactic cases have been presented that, in many ways, illustrate classic examples of emphysematous cholecystitis, the diagnosis of which can often be made in the emergency department using an upright abdominal radiograph.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. subcutaneous emphysema of the lower extremity of gastrointestinal origin.Two cases of subcutaneous emphysema of the left lower extremity secondary to perforations of the rectum ,nd sigmoid colon are presented. Although this is an extremely rare syndrome, the true incidence is probably higher, as some cases will be misdiagnosed as gas gangrene unless careful clinical and postmortem examinations are performed. Only rapid recognition of the probable origin of the gas, coupled with aggressive, definitive therapy, can prevent the usually fatal course of this condition. In the absence of trauma to the chest or infection in a previously normal leg, subcutaneous emphysema of a limb should alert the physician to the possibility of a gastrointestinal perforation as a source of the gas. Perforations of the gastrointestinal tract into the subcutaneous tissue can occur anywhere from the neck to the lower extremities.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |