1/5. Occult craniocerebral injuries from dog bites in young children.Although dog bite injuries to the head and scalp of children occur frequently, penetrating dog bite wounds to the cranial vault occur only occasionally and may go unnoticed on initial examination. Substantial morbidity and mortality can ensue if these penetrating injuries are not detected and treated. The authors detail the evaluation of dog bites of the scalp in young children. They highlight the ease with which puncture wounds of the calvarium may be missed during physical examination as a result of scalp displacement at the time of puncture. The cranial puncture may not be large and may later be covered by scalp that returns to its native position. Well-scrutinized skull films and a careful, methodical physical examination are advocated. Recognized craniocerebral injuries should be explored. Depressed cranial fractures should be irrigated, debrided, and elevated. Dural tears should be repaired. Expedient management is necessary to prevent meningitis and its associated sequelae.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/5. Shark attack.Shark attacks are rare but devastating. This case had major injuries that included an open femoral fracture, massive hemorrhage, sciatic nerve laceration, and significant skin and muscle damage. The patient required 15 operative procedures, extensive physical therapy, and orthotic assistance. A review of the literature pertaining to shark bites is included.- - - - - - - - - - ranking = 0.058155192160218keywords = physical (Clic here for more details about this article) |
3/5. Human rabies.A 40-year-old man who farmed in mexico and raised dogs as a hobby presented with dysphagia, hydrophobia, insomnia, anorexia, malaise, fever, and decreased strength and sensation in his dominant arm. After a repetitive three-hour history and physical examination, a tentative diagnosis of rabies was made in an atmosphere of patient denial followed by reluctance of hospital personnel to accept such a rare diagnosis. Upon confirmation of the diagnosis by the Center for disease Control, Atlanta, the patient underwent aggressive therapy, including maximum respiratory support, anticonvulsants, steroids, pressors, hemodialysis and interferon treatment, but died on the 16th day following admission. This case is presented because of its rarity and to review the disease, clinical history, current therapy, and recent literature regarding emergency department differential diagnosis.- - - - - - - - - - ranking = 0.5keywords = physical examination, physical (Clic here for more details about this article) |
4/5. Evaluation of fatal dog bites: the view of the medical examiner and animal behaviorist.The multidisciplinary evaluation of fatal dog bites in the context of a case is discussed. This approach emphasizes detailed examination of the animals including matching of bite marks, autopsy, and canine behavioral analysis. It further provides details such as contributory medical conditions, past animal behavior and physical evidence linking the dogs to the attack. Such information is important in the legal proceedings that usually accompany these events.- - - - - - - - - - ranking = 0.058155192160218keywords = physical (Clic here for more details about this article) |
5/5. Acute urticaria caused by pigeon ticks (argas reflexus).A 28-year-old man was admitted to our institute because of acute urticaria appearing a few hours earlier. The patient stated that during sleep he had been bitten by a large number of "insects," which had dropped from wooden ceiling beams under the roof of his room. The patient was living in the center of Milan in a very old house, where numerous pigeons had built their nests under the rooftop. The patient brought along with him some examples of these "insects," which were later classified as pigeon ticks (argas reflexus) (Figs. 1,2). Dermatologic examination revealed the presence of numerous wheals and erythemato-papular lesions on the neck and trunk. These lesions were of different shapes and sizes, bright red in color, and with a small central ulceration corresponding to the tick bite. In addition, there were numerous excoriated lesions due to scratching; the patient in fact complained of very intense pruritus. The general physical examination was within normal limits. Laboratory examinations revealed only slight leukocytosis (9300 WBC/mm3). All other laboratory tests were negative; in particular, the assay for anti-borrelia burgdorferi IgG and IgM was within normal ranges (< 1:256 and < 1:64, respectively). These results were confirmed on subsequent blood samples. Positive radioallergosorbent tests (RAST) to a somatic extract and to the saliva of the tick were observed. A diagnosis of acute urticaria caused by A. reflexus was made. The patient was treated with betamethasone (4 mg intravenously) and chlorpheniramine (10 mg intramuscularly), with resolution of the clinical picture within 3 days.- - - - - - - - - - ranking = 0.5keywords = physical examination, physical (Clic here for more details about this article) |