1/11. lightning strikes at a mass gathering.Among natural disasters, lightning is a leading cause of morbidity and mortality throughout the world. A well-informed bystander and an astute physician can make the difference between an outcome of death or lifelong disability versus complete or near-complete recovery. What is done in the first few minutes after such an event is the predominant predictor of success. This case report describes a young woman who was struck by lightning while talking on a cellular telephone at a mass gathering in an outdoor stadium. The discussion that follows the case centers on the pathophysiology of being struck by lightning and on issues unique to being struck in a stadium full of people.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/11. Botulinum toxin to minimize facial scarring.Botulinum toxin injection has been used for a variety of indications in humans, including blepharospasm and hyperfunctional facial lines. This article describes a novel formulation of botulinum toxin, which supplies immediate feedback to the injecting physician. Additionally, recent findings are described that indicate the immediate injection of botulinum toxin into the muscles underlying a wound can improve the cosmetic outcome of the facial cutaneous scar. Future applications of these findings are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/11. Craniofacial trauma in children.Craniofacial trauma is relatively uncommon in children, but the potential involvement of the structures at the base of the skull and the intracranial space makes it important for physicians to understand the potential dangers presented by such injuries. This report delineates the different types of injury that can damage the upper facial skeleton and the brain of a child. The author reviews initial management and diagnosis of such injuries and examines the approach to definitive reconstructive surgery using three case studies as examples for discussion.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/11. Unusual primary and secondary facial blast injuries.PURPOSE: To discuss unusual facial injuries resulting from a bomb blast. MATERIALS AND methods: In March 1997, a bomb consisting of a bag of nails was detonated in a coffee shop in Tel Aviv. Two of the wounded were brought to our level 1 Trauma Center with unique facial injuries. Computed tomography (CT) scan and CT angiogram were performed. RESULTS: The blast occurred to the immediate right of the victims who were sitting in an open cafe. Both had tympanic perforation. The first patient showed indirect damage to the facial nerve from a piece of shrapnel located anterior to the carotid artery and medial to the right mandibular angle. The second had a piece of shrapnel lodged in the parapharyngeal space that was initially missed and discovered only on reexamination 3 days later after the patient complained of pain in the temporomandibular joint; there was no facial nerve deficit. The port of entry was probably a small wound in the anterior wall of the external ear canal. CONCLUSIONS: The wounds are probably attributable to the spalling effect of the shrapnel passing through the parotid gland, which has mixed-density tissue. These cases show that nerves are susceptible to damage even in the absence of direct engagement and that the emergency room physician should be alert to even small skin imperfections in blast victims to avoid missing penetrating wounds.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/11. The traumatic bone cyst: review of literature and report of two cases.The traumatic bone cyst, seen by clinicians both physician and dentist alike, is a well recognized yet poorly understood entity whose pathogenesis remains obscure. Generally asymptomatic, this lesion is most often found as an incidental finding on routine radiographic survey. Its diagnosis, however, is important to rule out more significant pathology. A brief review of pertinent literature and two new cases of traumatic bone cyst have been presented, including an infrequently reported case of traumatic bone cysts occurring bilaterally in the mandible.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/11. Difficult airway management.airway management is unequivocally the most important responsibility of the emergency physician. No matter how prepared for the task, no matter what technologies are utilized, there will be cases that are difficult. The most important part of success in the management of a difficult airway is preparation. When the patient is encountered, it is too late to check whether appropriate equipment is available, whether a rescue plan has been in place, and what alternative strategies are available for an immediate response. The following article will review the principles of airway management with an emphasis upon preparation, strategies for preventing or avoiding difficulties, and recommended technical details that hopefully will encourage the reader to be more prepared and technically skillful in practice.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/11. Fatal epistaxis in craniofacial trauma.Facial trauma often results in minor and infrequently results in major bleeding in the structures of the face. We have recently observed two patients who suffered fatal hemorrhages which could have been controlled using relatively simple measures. Treating physicians often overlook this serious and potentially life-threatening source of hemorrhage until the patient has been in shock for long periods of time and irreversible ischemic brain damage and renal failure have occurred. With careful attention to examination of the face and oropharynx, hemorrhage from these sites can be identified early and the appropriate measures taken to control epistaxis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/11. Profound atelectasis following alkaline corrosive airway injury.We report a case of life-threatening acute atelectasis following intubation for alkaline corrosive injury to the upper airway. The risk factors for and diagnosis of acute atelectasis as well as current methods of treatment are reviewed. It is important for emergency physicians to be familiar with this potentially fatal respiratory emergency during care for acutely ill and injured patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/11. Management of traumatic oral-facial injury in the hemophiliac patient with inhibitor: case report.This report describes identification of factor viii inhibitor in a patient who then received immune tolerance therapy. The precipitating event was a traumatic orofacial injury that was nonresponsive to traditional factor-replacement therapies. An inhibitor complicates medical and dental management of the hemophiliac patient because it counteracts usual techniques of hemorrhage control using coagulation agents derived from factor viii (Monoclate--Armour, Blue Bell, PA). Successful identification and management of the inhibitor patient require communication and consultation between the physician and dentist, up-to-date knowledge regarding the hemophiliac patient's bleeding and infusion history and aggressive application of local adjunctive hemostatic therapies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/11. Periorbital necrotizing fasciitis: trivial facial injury resulting in cardiac arrest.facial injuries in the context of alcohol abuse are a common presentation to casualty departments. While the majority are self limiting, the presence of periorbital or facial oedema should alert physicians to the development of periorbital necrotizing fasciitis. Here, a case illustrates this unusual manifestation of streptococcal infection, and emphasises the rapid onset and devastating systemic and local cosmetic consequences of this condition.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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