1/38. Localized tetanus in a child.The majority of physicians in practice today in developed countries have never seen a case of tetanus. The last pediatric case reported in canada occurred in 1992. We present the case of a child who had localized tetanus despite previous partial immunization.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/38. A new hazard for windsurfers: needlefish impalement.Marine-related injuries and envenomations are common to the coastal physician. Needlefish injuries, which occur almost exclusively in the Indo-Pacific region, have not previously been reported along the Atlantic seaboard. This case report describes a penetrating injury to the lower extremity from a needlefish. Treatment is guided by general resuscitative procedures as well as antibiotic therapy directed against infections unique to the marine environment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/38. Cerebral abscess after presumed superficial periorbital wound.Penetrating wounds in the periorbital region may appear superficial and minor at first glance. The unique shape and thin bony roof of the orbit give these injuries a significant risk of associated intracranial penetration. This can initially be asymptomatic, and a high index of suspicion is essential to properly diagnose and treat these injuries. We report a case of an 8-year-old female who presented with delayed seizures from a frontal abscess resulting from such an injury. This article reviews the literature and discusses the appropriate management that should be used by emergency room and military physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/38. High-pressure injection injuries to the hand.High-pressure injection injury hides the true extent of the lesions behind an apparent small and harmless puncture of the finger or the hand. Through clinical description, we wish to point out the need for prompt treatment to avoid mutilating and function-threatening complications. We wish to outline the role of the emergency physician who must be aware of the incidence of high-pressure injection injury and become accustomed to early referral to a surgeon, experienced in extensive surgical exploration, removal of foreign bodies, and rehabilitation. The open-wound technique gives the best results. We also point out that failure to refer may become an increasing focus of negligence claims.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/38. Cactus thorn arthritis: case report and review of the literature.synovitis secondary to penetrating plant thorn injuries is an infrequently reported event. Despite its wide geographic distribution, thorns from the prickly pear cactus (Optunia ficusindica) are a rare source of this type of inflammatory arthritis. We hereby present an unusual case of an individual who developed an acute monoarthritis of the knee shortly after sustaining a penetrating cactus thorn injury. The clinical and pathophysiologic features of cactus thorn arthritis are reviewed and the unusual features present in this individual are highlighted. Treatment options, with an emphasis on rapid diagnosis and therapeutic interventions, are discussed. Increased physician awareness and recognition of this unusual but not rare entity are essential as a means of improving clinical outcome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/38. aneurysm of the internal carotid artery following soft tissue penetration injury.Aneurysms of the extracranial arteries are in most cases secondary to atherosclerosis but may also be due to degeneration, congenital abnormalities, trauma or unclear etiology. They present either with bulging in the lateral pharyngeal wall or the neck. Therefore, otolaryngologists are often among the first physicians to see the patient. In this report, we present a case of spontaneous oral bleeding that was caused by a pseudoaneurysm following 2 weeks after a soft tissue penetration injury in a child. The facial swelling of the child was initially diagnosed to be mumps by its pediatrician and the fever treated with aspirin. A pseudonaneurysm of the internal carotid artery was identified by arteriography as the source of the abrupt oral bleeding and required immediate surgical treatment including radiological means. Our report should illustrate the importance of careful preoperative evaluation as well as a high index of suspicion especially in children, where evaluation of history is difficult.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/38. 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) |
8/38. Penetrating trauma to the head and neck from a nail gun: a unique mechanism of injury.Published reports of nail gun injuries to the head and neck are rare. We describe the cases of three patients who sustained nail gun injuries to the head and who were managed at our institution. All patients were treated successfully and all recovered with minimal morbidity. Any physician who is called on to manage a nail gun injury to the head or neck should understand that most likely the patient will have sustained a surprisingly limited amount of tissue injury, owing to the relatively low velocity of the projectile compared with that delivered by firearms. Computed tomography and selective angiography can play a vital role in assessing the integrity of relevant vascular structures. Moreover, catheter angiography with embolization can be a most useful nonsurgical adjunct to control the extent of vascular injury.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/38. Rectal impalement: a case review.Pediatric impalement injuries to the rectum are rare, and delays in diagnosis can be life threatening. We report the case of a young girl who was accidentally impaled on a dive stick. A review of historical aspects of rectal trauma and current management techniques are discussed. Rectal injuries in the pediatric population most often result from accidental impalement, sexual abuse, or blunt trauma. In contrast, most rectal injuries in adults are caused by missile wounds. Moreover, because rectal injury is fairly uncommon in children, physicians evaluating patients may miss signs of serious injury. Signs of external trauma may be minimal when rectal perforation exists, so delays in diagnosis are not uncommon.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/38. Wooden transnasal intracranial penetration: an unusual presentation.A 2 1/2-year-old child presented to the emergency department with a wooden stick lodged firmly in her right nares. No nasal discharge or neurological abnormalities were noted at presentation. After plain radiographs failed to demonstrate any evidence of a foreign body, computed tomography (CT scan) was obtained that revealed a hypodense region in the right frontal lobe corresponding to the projected tract of the branch. The patient underwent a right frontal craniotomy with debridement of her contused right frontal lobe. She was discharged 8 days postoperatively without evidence of neurologic sequelae. This case illustrates an unusual presentation of intracranial penetration, with only six similar cases found in the literature. It also highlights the need for the emergency physician to be concerned about intracranial penetration when treating intranasal foreign bodies, particularly those of the nonmetallic type. The literature is reviewed regarding transnasal intracranial penetration by wooden foreign bodies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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