Overview of best practices for buprenorphine initiation in the emergency department.

In recent decades, opioid overdoses have increased dramatically in the United States and peer countries. Given this, emergency medicine physicians have become adept in reversing and managing complications of acute overdose. However, many remain unfamiliar with initiating medication for opioid use disorder such as buprenorphine, a high-affinity partial opioid agonist.

Nutmeg Intoxication: A Case Report.

Nutmeg intoxication is an uncommon precipitant of hyperactive delirium with severe agitation (HDSA) with anticholinergic properties that require a high index of suspicion for diagnosis. We present a case of a young adult who presented to the emergency department (ED) with HDSA. The patient was intubated and transferred to the medical intensive care unit (MICU) due to increasing safety threats unresponsive to multimodal de-escalation.

Serotonin Syndrome Precipitated by Paxlovid Initiation.

A female in her early 40s taking buspirone, quetiapine, and daily kratom presented to the emergency department two days after starting a course of Paxlovid for a mild COVID-19 infection with diffuse tremors, ocular clonus, diaphoresis, and confusion consistent with serotonin syndrome (SS). The patient was treated with oral lorazepam, and her symptoms significantly improved within one hour without the need for additional dosing. To our knowledge, this is the first reported case of SS in a COVID-19-positive patient who was prescribed Paxlovid.

Confirmation of endotracheal tube placement using disposable fiberoptic bronchoscopy in the emergent setting.

Background: Patients intubated in the prehospital setting require quick and definitive confirmation of endotracheal (ET) tube placement upon arrival to the emergency department (ED). Direct and adjunct strategies exist, but each has limitations and there is no definitive gold standard. The utility of bronchoscopy in ED intubation has been studied, but scant literature exists on its use for ET tube confirmation.

Current and future treatments for hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) represents a unique challenge for physicians and patients. There is no definitively curative treatment. Rather, many treatment and management modalities exist with differing advantages and disadvantages.

Anatomical relationship of Roos' type 3 band and the T1 nerve root.

Background: The most common clinical presentation of thoracic outlet syndrome stems from compression of the lower trunk of the brachial plexus or ulnar nerve. A plethora of anatomical variations have been implicated in the cause of thoracic outlet syndrome. Roos' identification and classification of scalene muscle and fibrous bands have added an additional dimension to understanding its cause and subsequent treatment.

Increased prevalence of community-acquired methicillin-resistant Staphylococcus aureus in hand infections at an urban medical center.

Background: The purpose of this article is to report the increased incidence of community-acquired methicillin-resistant S. aureus in hand infections at an urban medical center.

Methods: The authors performed a retrospective review of all patients with hand infections over a 21-month period, and all patients with culture-positive methicillin-resistant S.

Expanding the scope of the turnover flap.

Background: Turnover flaps are often utilized as alternatives to more traditional flaps, especially in situations where traditional flap viability is limited. Most turnover flaps are currently used in the lower extremities.

Methods: This study examined the senior author's use of the turnover flap in 103 cases between 1987 and 2004.

Salvage of infected prosthetic grafts of the great vessels via muscle flap reconstruction.

Objective: The infection of an aortic prosthetic graft presents a difficult challenge for surgeons. Conservative treatments such as debridement and antibiotic irrigation routinely fail, and patient survival rates are low. Literature has indicated that flap procedures often provide better treatment.

Treatment of massive thoracolumbar wounds and vertebral osteomyelitis following scoliosis surgery.

Closure of thoracolumbar wounds and vertebral osteomyelitis after scoliosis surgery often proves difficult due to tautness and lack of usable tissue, and the resulting dead space containing metallic fixation devices is predisposed to infections and complications. The authors present their experience with 33 patients in whom massive thoracolumbar wounds and vertebral osteomyelitis developed following scoliosis surgery. Postoperative infection, due to the lack of vascularized tissue and presence of metallic hardware near the wound, is common and extremely counterproductive; within these cavernous wounds lie infected vertebrae, metallic hardware, and bone graft.