Aerial drone misadventure: A novel case of trauma resulting in ocular globe rupture.

PURPOSE: The purpose of this case report is to present the novel findings of a drone causing such a traumatic ocular injury and provide recommendations for how it might be prevented. OBSERVATIONS: We report on a recent case where a child presented to our Emergency Department after incurring a blow to the face by the propeller of a remote controlled drone. The patient suffered significant trauma including rupture of the right globe. CONCLUSIONS: As drone sales continue to rise, it is important that physicians be prepared to treat the potential injuries that may result from using these devices. Furthermore, in an attempt to reduce the number of visits associated with remote controlled drones, physicians should be prepared to provide advice as to how patients can reduce the risks of injury. IMPORTANCE: We hope that the framework and recommendations below will help physicians decrease adverse outcomes related to this unusual injury pattern.

Treating Decompression Sickness: Military Flight Simulation Site-Community Hospital Partnership.

BACKGROUND: High-altitude flight simulation familiarizes military trainees with the symptoms of hypoxia to prepare them for emergency situations. Decompression sickness (DCS) can occur as a result of these simulations. In cases when ground-level supplemental oxygen does not resolve symptoms, hyperbaric oxygen (HBO) therapy is indicated. Many military hyperbaric chambers have been closed because of cost reductions, necessitating partnerships with community hospitals to ensure access to treatment. MATERIALS AND METHODS: This article describes the unique arrangement between a community hospital in Colorado and a military training site to treat DCS cases emergently. We gathered cost data from the community hospital to estimate and compare the cost of providing HBO therapy in the hospital versus a standalone chamber similar to the former military hyperbaric chamber. RESULTS: Since the closure of the military hyperbaric chamber, the community hospital treated an estimated 50 patients with DCS requiring HBO therapy attributed to high-altitude flight simulation between October 2003 and April 2015. Cost to the institution providing HBO treatment varies widely on the basis of patient volume. Assuming a volume of five treatments, per-treatment cost at a standalone center is $95,380. In contrast, per-treatment cost at the hospital assuming a volume of 1,000 treatments commensurate with the hospital's ability to bill for other services is $698 per treatment. CONCLUSION: The cost analysis demonstrates that the per-treatment cost of operating a standalone HBO therapy center may be greater than 100 times that of operating a center at a community hospital, suggesting the arrangement is beneficial to the military.

Effect of troponin I Point-of-Care testing on emergency department throughput measures and staff satisfaction.

Emergency departments (EDs) are challenged to provide rapid triage and evaluation to make appropriate patient disposition and timely treatment decisions. Cardiac troponin is the preferred biomarker for evaluation of patients with chest pain. The objective of this before-and-after study was to determine the impact of Point-of-Care (POC) troponin testing on turnaround times, door-to-troponin result times, ED length of stay (LOS) in patients with chest pain, and staff satisfaction with POC testing. After POC implementation, the average door-to-troponin result time significantly decreased from 105 to 51 min (p < 0.000). The average LOS decreased from 290 to 255 min; however, the change was not significant (p = 0.082). The majority of nurses (81%) felt that POC testing encouraged communication among patient care team members, and satisfaction was high with 82% of all ED staff members rating their satisfaction as excellent.

Caiman bite.

Caiman crocodilus, commonly called the spectacled caiman, is a very widely distributed resident of the western-hemisphere wetlands. Caiman bites to humans can cause trauma and infection. There are few reports of caiman bites; however, there is information about bites by other members of the same family, including Alligator mississippiensis. A case of acute caiman bite to the hand is described, including initial treatment and outcome. The bite resulted in multiple lacerations, interarticular fracture, and infection. One of the lacerations was closed, and the patient was started on moxifloxacin hydrochloride. Preventive care and treatment including wound care and antibiotics are discussed. The patient recovered with only a slight long-term functional deficit.