Simultaneous open fracture and rattlesnake bite on the same extremity.

Open fractures and rattlesnake envenomations are two emergencies that each require emergent intervention and treatment. While each is common, when they occur simultaneously on the same extremity, it creates a syndrome that is quintessential Central Texas. We present the case of a 13-year-old boy who sustained a lower-extremity rattlesnake envenomation with concomitant open tibia and fibula fractures after being thrown from an all-terrain vehicle.

Pediatric spontaneous tension pneumothorax in Langerhans cell histiocytosis.

Langerhans cell histiocytosis is a rare hematologic disorder caused by the proliferation of specialized dendritic cells. Pulmonary manifestations occur in 20% to 50% of multisystem disease, but isolated pulmonary disease is rare. Spontaneous pneumothorax occurs in up to 10% of pediatric pulmonary cases.

Delayed Symptomatic Pulmonary Embolism Secondary to Bone Cement After Percutaneous Vertebroplasty.

Background: Percutaneous vertebroplasty (PVP) is a common procedure performed on patients suffering from osteoporotic compression fractures. Complications of the bone cement escaping both locally as well as systemically into pulmonary circulation leading to pulmonary embolism (PE) have been reported in ≤26% of patients.

Case Report: A 57-year-old woman presented to the emergency department with complaints of chest pain, fever, and cough.

Neonatal Acute Lymphoblastic Leukemia.

Acute lymphoblastic leukemia (ALL) in a neonate can have a similar clinical appearance to other serious pathology and should be considered in the ill-appearing infant. We present the case of a 24-hour-old male infant born to a mother with limited prenatal care who was brought to the pediatric emergency department with a rash and decreased movement. His initial white blood cell count was 822 × 10 cells/L.

Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke.

An increased emphasis on stroke care has led to a proliferation of specialized stroke teams despite relatively few trials demonstrating their efficacy. Our academic stroke center incorporated a unique setup allowing for the comparison between stroke teams and emergency physicians. During weekday working hours, a stroke team would respond to the emergency department for stroke activations.

Impact of frailty and anticoagulation status on readmission and mortality rates following falls in patients over 80.

Falls are the leading cause of trauma-related mortality in geriatric patients. We hypothesized that frailty and anticoagulation status are risk factors for readmission and mortality following falls in patients >80 years. A retrospective review was performed on patients over 80 years old who presented to our level 1 trauma center for a fall and underwent a computed tomography of the head between January 2014 and January 2016.

Anomalous left anterior descending artery diagnosed on pulmonary artery computed tomography.

Typically, the left anterior descending artery (LAD) and left circumflex artery (LCX) arise from the left main coronary artery. However, uncommon coronary anomalies may be found in clinical practice. This case presents with a rare finding where the LAD originates from the right coronary artery (RCA) separately from the LCX and takes an interarterial pathway to reach its perfusion territory.

Total body necrotizing fasciitis.

Necrotizing fasciitis is uncommon in the United States. Despite medical advances, its mortality rate has remained unchanged over the past 20 years at 25% to 35%. Risk scoring tools have been created but often fall short when used in the clinical setting.

Bilateral Retinal Detachment in a Pediatric Patient.

Background: Pediatric retinal detachments occur rarely, and thus may be easily missed. Without treatment, this condition leads to permanent vision loss. Patients with Stickler syndrome, an inherited disorder of collagen synthesis, are more likely to have retinal detachments than the general population.

Success Rates with Digital Intubation: Comparing Unassisted, Stylet, and Gum-Elastic Bougie Techniques.

Introduction: The utility of digital intubation, especially in an austere environment with limited equipment, has been previously described. However, evidence supporting best practices for its technique is limited. We seek to quantify the time to intubation and the rate of successful placement of the tube for digital intubation using different approaches and assistance devices.

Enterohemorrhagic colitis with disseminated intravascular coagulation.

Gastroenteritis is a common illness in the pediatric population. Clinicians must be able to recognize severe disease in the milieu of common presentations. All forms of gastroenteritis can lead to significant dehydration and sequelae when considering causes.

Effect of intravenous infusion dead space on time to drug delivery in infants.

Infusion dead space is the internal volume of a catheter and tubing through which a fluid must pass before reaching a patient's intravenous space. It is a factor in time to delivery for intravenous administration and can be significant, depending on the volume and rate of infusion. A 10-kg infant was simulated, receiving an epinephrine infusion with a concentration of 20 mcg/mL at a rate of 0.

Sternoclavicular Joint Infection Presenting as Nonspecific Chest Pain.

Background: Sternoclavicular joint infection (SJI), to include septic arthritis (SA), is a rare cause of chest pain and is often found in patients with significant risk factors and sources for SA. Most acute care laboratory results lack significant sensitivity to rule out SA. Radiographic findings in common acute care imaging often does not reveal findings of SA and osteomyelitis in the acute phase of the infection.

Intubation of the Right Atrium During an Attempted Modified Surgical Airway in a Pig.

In modern medicine, the surgical cricothyrotomy is an airway procedure of last resort. In austere environments, however, its simplicity may make it a more feasible option than carrying a full complement of laryngoscopes. To create a Transportation Security Agency-compliant compact first-response bag, we attempted to establish a surgical cricothyrotomy in a pig, using trauma shears, basic medical scissors, a pocket bougie, and an endotracheal tube.

Lymphangitis From Scolopendra heros Envenomation: The Texas Redheaded Centipede.

Envenomation by Scolopendra heros, the Texas redheaded centipede, can present variably. Although transient pain and erythema are often treated conservatively, complications may include cellulitis, necrosis, myocardial infarction, and rhabdomyolysis. We present a case of an elderly man who came to the emergency department with lymphangitis and dermatitis secondary to a centipede sting that awoke him from sleep.

Arm pain and erythema.

Pyomyositis can be a difficult diagnosis to make, as it can mimic many other disease processes. Various laboratory studies can be abnormal with pyomyositis, but none are specific to the disease. Early disease can generally be treated with antibiotics alone, whereas advanced disease frequently requires emergent surgical intervention with significant resuscitation.

Removal of an embedded crochet needle in the mouth.

A 3-year-old child presented to the emergency department with a crochet needle lodged in her posterior oral cavity. To localize the needle and significant surrounding anatomic structures, bedside transcavitary ultrasound was employed. After careful localization, the needle was removed using a modified needle cover technique.