Postintubation Tracheal Perforation While on Long-Term Steroid Therapy: A Case Report.

BACKGROUND: Endotracheal intubation is an essential basic skill for emergency physicians. The procedure can cause complications that should be recognized. Awareness and early identification of complications are needed to allow early intervention to optimize outcomes. The risk factors for tracheal perforation during intubation are typically related to the physician skill and experience and to the patient's comorbidities, including body habitus and chronic use of certain medications. CASE REPORT: We report a case of a 45-year-old man with renal transplant on tacrolimus and prednisolone for 16 years. He presented with decreased level of consciousness due to an acute intracranial hemorrhage and was intubated for airway protection. Post intubation, a significant subcutaneous emphysema was noted on the patient's neck and chest, which was subsequently determined to be caused by a tracheal perforation. The management of tracheal injury depends on the size and location of the tear, as well as the patient's clinical status and comorbidities. In this case, the tracheal perforation was treated conservatively and was successful. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case has been reported to increase awareness about this rare and potentially life-threatening event. The prevention of this rare injury can be difficult but use of a slightly smaller endotracheal tube in a high-risk patient can be of benefit. In addition, early consideration of this complication when there is an acute change in physiologic status will allow for rapid facilitated management.

Sequential Drug-Induced Severe Hyponatremia in a Minimally Symptomatic, 81-Year-Old Patient.

BACKGROUND: There have been previous cases of medication-induced hyponatremia with various causative agents reported. Severe hyponatremia, a common medical emergency, can vary widely in its presentation, ranging from seizures and comas to no clinical manifestations. CASE REPORT: An 81-year-old female patient presented to the Emergency Department with history of a fall. She had a known case of hypertension and was recently started on hydrochlorothiazide. When evaluated at the hospital, her sodium level was measured as 106 mmol/L and her clinical symptoms were unremarkable. She was simultaneously diagnosed with a urinary tract infection, for which she was treated with intravenous ciprofloxacin. A few hours after administration, her sodium level fell even further, and she quickly developed symptoms of hyponatremia. After discontinuation of ciprofloxacin and treatment with hypertonic saline (3% NS), she improved and made a full recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We present an unusual case of minimally symptomatic, severe consecutive multi-medication-induced hyponatremia. As hyponatremia can present asymptomatically, routinely checking sodium levels is recommended, especially when caring for patients who recently experienced a fall or started a thiazide diuretic.

A rare case of subcutaneous emphysema in a young and healthy patient with parainfluenza virus 3 pneumonia.

An 18-year-old healthy male complained of a 7-day history of fever, cough, and sore throat, along with a three-day history of left facial swelling. The x-rays revealed subcutaneous emphysema in the chest, neck, face, and mediastinum region (Pneumomediastinum). Furthermore, an area of infiltration was visible, indicating pneumonia. Therefore, we immediately started him on intravenous antibiotics. We then moved the patient to an isolation room, considering pulmonary tuberculosis as one of the differential diagnoses. However, the Acid Fast Bacilli (AFB), Mycobacterium Tuberculosis Bacteria-Polymerase Chain Reaction (MTB PCR), and sputum for gram stain and culture were all negative. On the other hand, the test for parainfluenza virus 3 was positive. The patient was observed with a daily chest x-ray to monitor the progress of pneumonia and subcutaneous emphysema. Fortunately, the subcutaneous emphysema was significantly reduced on a daily basis until it was completely resolved before discharge home.

Organ Donation in the Emergency Department: Awareness and Opportunities.

Background The only cure for end-organ failure is transplantation. Unfortunately, there are fewer organ donors than patients. Currently, the majority of organ donations come from live or brain-dead donors. In order to expand the pool of potential organ donors, the emergency department should be utilized effectively. Objectives The primary goal of this research is to determine emergency physicians' knowledge, awareness, and attitude about organ donation. Methodology A cross-sectional study was conducted through different hospitals in Saudi Arabia. It includes 106 physicians in the adult emergency departments. Results The majority (84.9%) of the participants never reported any case in the emergency department as a potential case for organ donation. In addition, 54.8% of the participants report having little to no knowledge of the ethical issues of organ donation. Furthermore, 66.1% of respondents claim to have little to no knowledge of the goals and duties of the SCOT (Saudi Center for Organ Transplantation). It was interesting to see that 96.2% of the participants reported that their organizations do not have any policies or procedures in place regarding organ donations. Regarding education, 99 (93.4%) physicians did not participate in any organ donation course, training, or teaching program about organ donation. At the same time, 67 (63.2%) physicians concurred that participation in a training program is essential. Moreover, 68 (64.2%) physicians believed that organ donation should be a part of every end-of-life case. In order to improve the donation process in the emergency department, 88 (83%) physicians would want a well-established program with defined policies and procedures. Conclusion According to our findings, the emergency physician has inadequate expertise and information on organ donation rules and procedures, which has resulted in a missed opportunity to recruit more potential donors. We recommend instituting clear policy and procedures and educating the physicians and all emergency medicine staff to have better outcome.

Communication Challenges While Dealing With a Deaf Patient in the Emergency Department and Suggested Solutions.

Background In the emergency department (ED), dealing with deaf patients presents unique difficulties and obstacles. There is insufficient time to arrange for an interpreter. While the voice of the deaf patient was the focus of earlier studies, in this study, we are interested in learning about ED physicians' difficulties and expertise. In addition, we aim to determine which approaches they suggest to address these issues. Methodology A cross-sectional analysis was conducted among 166 emergency physicians working in pediatric and adult departments. The data were collected from physicians working in different centers in Riyadh city from January 2022 to March 2022. The data analysis was performed using SPSS version 23 (IBM Corp., Armonk, NY, USA). Results In their department policy and procedures, 74.1% of participants claimed no policy or procedure for dealing with deaf patients. The majority of available communication methods were family interpreters (63.9%) and writing on paper (16.9%). Overall, 88% of respondents did not attend any training on dealing with deaf patients, despite the fact that 83.7% thought such training should be available. Furthermore, 90.4% of the participants did not know sign language. Concerning information about the Saudi Association for Hearing Impairment Services, 74.1% were unaware of such services. Concerning modern applications on smartphones, 97.6% were unaware of any existing communication app that could aid in communication with deaf patients. Conclusions In this study, we identified a significant deficiency in the knowledge and skills required to communicate with deaf patients. Hence, we recommend mandating education for physicians and requiring each institution to have an interpreter available 24 hours a day, either in person or via high-quality remote video.