Comparison of Patterns and Demographics of Isolated Traumatic Mandibular Fracture Between Incarcerated and General Populations.

Introduction The management of maxillofacial trauma can be challenging in different unique clinical presentations. While maxillofacial fractures vary in location based on the mechanism of injury, the mandibular fracture is noted to be one of the most common facial fractures. The objective of this study was to explore the differences in injury patterns, outcomes, and demographics of isolated traumatic mandibular fractures between incarcerated and general populations. Methods This retrospective study analyzed consecutive patients presenting for trauma care from January 1, 2010, to December 31, 2020, at the Arrowhead Regional Medical Center (ARMC). Patients 18 years and older were included in this study. Patients diagnosed with mandibular fracture as the primary diagnosis at admission and discharge were identified using the International Classification of Disease, Ninth and Tenth Revision (ICD-9, ICD-10) Code. Patient demographics were extracted from their electronic medical records and included race, marital status, and insurance status. Results A total of 1080 patients with confirmed mandibular fractures were included in the final analysis. Among these patients, 87.5% (n=945) were males, 40% (n=432) of the patients were Hispanic, and the average age was 31.55 years old. The most common mechanism of injury was blunt trauma secondary to assault. Compared to the general population with mandibular fracture, the incarcerated patients with mandibular fracture were more likely to be males (96.1% vs 86.1% for incarcerated population vs. general population respectively, p=0.0005). No other variables were statistically different between these two groups. Conclusion The evidence from this study suggests that the patterns, outcomes, and demographics of mandibular fracture in both incarcerated and general populations are similar.

Characteristics and Outcomes Associated With Emergent Rectal Foreign Body Management: A Retrospective Cohort Analysis.

Background Bedside management and outcomes of rectal foreign bodies remain challenging due to the presentation and complexity of the inserted objects. Injuries, such as perforation of the colon and rectum, are among the most commonly reported complications. However, prior studies are unclear regarding the setting in which the complication rates may be minimized. This study aimed to assess whether there was a statistically significant difference among the various extraction methods with regard to complications in the emergency department and operating room. Materials and methods This was a retrospective study of all cases of rectal foreign bodies that were removed in the emergency department at a large county hospital between 1/1/2010 and 12/31/2020. Patients included in this study were adults who were evaluated and treated in the emergency department. Results A total of 78 patients were included in the final analysis. More than half (51.3%, n=40) of the patients were successfully treated in the emergency department. Compared with the emergency department, patients in the operating room were more likely to undergo exploratory laparotomy and colectomy (0% vs. 31.6%, p<0.0001), undergo general anesthesia (84.2% vs. 0%, p<0.0001), have higher complication rates (21% vs. 0%, p=0.0021), and have a longer hospital length of stay (median=1 vs. 0, p<0.0001). Conclusion This study revealed a >50% success rate of rectal foreign body removal in the emergency department without any reported complications. To improve the success rate of bedside retrieval and decrease complications, physicians need to be vigilant, communicative, and compassionate about their evaluations and clinical methodology.

Body stuffing during apprehension resulting in distal esophageal impaction: a case report and review of the literature.

BACKGROUND: Body stuffing and body packing are two methods of concealing illicit drugs. Body stuffing is defined as the oral ingestion of illicit drugs, typically to avoid law enforcement detection or other consequences of possession, and may present a serious medical emergency in patients. Most commonly, body stuffers ingest possibly large or unknown quantities of illicit substances to avoid detection of the drugs during apprehension. This ingestion is typically hasty or impulsive, and therefore the substances ingested are rarely packaged in a way that would be considered safe for ingestion. CASE PRESENTATION: This case highlights a series of rare complications of impacted esophageal foreign body including esophageal edema, pericarditis, and hydro-pneumothorax for a 16-year-old Hispanic male who was booked into a county juvenile detention and rehabilitation facility. He complained of persistent intractable epigastric pain, along with pleuritic chest pain with multiple episodes of vomiting over the previous 4 days. He denied swallowing any foreign body. He underwent esophagogastroduodenoscopy, and a plastic bag with content suspicious for marijuana was discovered in the distal esophagus and removed. CONCLUSIONS: Failure to consider body stuffing and foreign body impaction in individuals during medical evaluation in detention centers with complaints of chest pain, abdominal pain, dysphagia, and/or certain toxidromes can delay diagnosis and lead to a variety of medical complications.

Variation in Trauma Team Response Fees in United States Trauma Centers: An Additional Undisclosed Variable Cost in Trauma Care.

BACKGROUND: The rising costs associated with trauma care in the United States is an important topic in today's healthcare environment. Factors such as innovations in technology, increasing governmental and organizational regulations, and the specialization of care have led to increasing costs to the patient. A component of trauma cost is the one-time trauma team response fee (TTRF). The determination process of the TTRF's dollar amount is elusive as no apparent standardized process exists and the literature is scant regarding this aspect of trauma care. METHODS: A nationwide cross-sectional convenience sample was conducted using SurveyMonkey. Surveys were sent to 525 trauma centers in the continental United States, including Alaska and Hawaii, between October 8, 2019 and March 11, 2020. Additionally, hospital medical directors and trauma medical directors were queried on their knowledge of their facility's TTRF amount. RESULTS: Only 46 out of 525 trauma centers, or 8.8% of those surveyed shared their scheduled fees. Comparisons of TTRFs among different trauma centers, activation levels, and geographical locations were not statistically significant. CONCLUSIONS: Understanding the true costs of trauma care and fees for patients in the United States remains elusive due to inadequate data and low response rates. Trauma centers struggle to maintain financial viability as regulatory agencies and the public push for transparency of TTRFs. Collaboration between trauma centers and regulatory agencies is needed to ensure a balance between providing quality trauma care with justified associated charges and financial sustainability.

Spontaneous Rupture of Empyema Necessitans in the Emergency Department.

An empyema necessitans is a rare complication of a collection of purulent material in the pleural space that spreads outside of the pleural cavity and involves the soft tissues of the chest wall. Due to compression forces created by the size of the collection of empyema in the chest cavity, patients are usually symptomatic and present with severe dyspnea. Chest X-ray or ultrasound of the chest cavity are the ideal screening tools to visualize the empyema and followed by computerized tomography scan of the chest to confirm the presence and extent of the pathology. In rare occasions, the empyema can rupture spontaneously, which may lead to critical situation requiring emergent intervention. We report the case of a 72-year-old male who presented to the emergency department with severe dyspnea and was diagnosed with empyema necesitans. During the initial management of the case, the empyema necessitans ruptured spontaneously and required emergent interventions to stabilize the patient.

Emergent Management of Traumatic Posterior Sternoclavicular Joint Dislocation: A Case Report and Literature Review.

Sternoclavicular joint (SCJ) dislocation is a rare but serious orthopedic injury. Posterior dislocations are more concerning due to the SCJ's proximity to visceral structures such as the trachea, esophagus, subclavian vessels, and brachial plexus. Due to the potential long-term sequelae of missed diagnosis, clinical suspicion should be high when a patient presents with a compression-type injury to the shoulder girdle and pain or deformity to the SCJ.  Here we present a case of a 15-year-old soccer player who presented to the emergency department (ED) after a fall onto his right shoulder with additional compound injuries. A posterior SCJ dislocation diagnosis was suspected and confirmed after a computed tomography scan. A successful closed reduction was done in the ED after consultation with cardiothoracic and orthopedic surgery.  This case adds to the body of literature describing diagnosis and management of posterior SCJ dislocations.

Acute Inhalant-Induced Atrial Fibrillation With Severe Hypocalcemia: A Case Report and Review of the Pathophysiology.

The recreational use of inhalants is associated with various detrimental health effects ranging from inebriation to cardiac arrest. It also presents a challenging clinical problem as the diagnosis is made by the presentation and patient's history, which is often difficult to obtain in an intoxicated or obtunded individual. The incidence of inhalant use is relatively high. National surveys have reported that nearly 21.7 million Americans aged 12 and older have used inhaled substances at least once in their lives. There is no reversal agent or antidote for inhalants and supportive care is generally recommended. We present a case of a young patient presenting with acute inhalant toxicity accompanied by atrial fibrillation with a rapid ventricular response and severe hypocalcemia.

The Impact of Quality Improvement Measures in the Management of Asthma Patients in Juvenile Detention Facilities.

Asthma is a serious chronic lung disease with a significant economic burden. The population of the San Bernardino County Juvenile Detention and Assessment Centers have higher odds of asthma as compared to the general population. Research has shown that a significant number of patients with a prior history of asthma were misdiagnosed. A protocol using objective testing, along with the detailed patient's history, was successfully implemented to verify the diagnosis and guide more effective medical care. After the implementation of those steps, the prevalence of asthma was found to be lower with the new protocol, from 18.1% in the pre-protocol period to 11.2% in the post-protocol period. This decrease resulted in an associated reduction in both direct and indirect healthcare costs and more efficient medical care.

Novel Bedside Utilization of Foley Catheter in the Emergent Removal of Colorectal Foreign Body: A Case Report and Literature Review.

Rectal foreign bodies (RFBs) present unique challenges to the emergency physician. Failure to emergently remove the RFB may lead to additional intraoperative procedures with increased likelihood of complications. We present a case of retained RFB in the emergency department, in which the usual standard approaches to transanal removal had failed. A last-ditch effort by utilizing a Foley catheter inside the object rather than around it led to the successful removal of the RFB. An intense review of the literature highlights the importance of using various novel applications of a Foley catheter to consider cases of RFBs.

Emergent needle thoracostomy in prehospital trauma patients: a review of procedural execution through computed tomography scans.

BACKGROUND: Traumatic tension pneumothoraces (TPT) are among the most serious causes of death in traumatic injuries, requiring immediate treatment with a needle thoracostomy (NT). Improperly placed NT insertion into the pleural cavity may fail to treat a life-threatening TPT. This study aimed to assess the accuracy of prehospital NT placements by paramedics in adult trauma patients. METHODS: A retrospective chart review was performed on 84 consecutive trauma patients who had received NT by prehospital personnel. The primary outcome was the accuracy of NT placement by prehospital personnel. Comparisons of various variables were conducted between those who survived and those who died, and proper versus improper needle insertion separately. RESULTS: Proper NT placement into the pleural cavity was noted in 27.4% of adult trauma patients. In addition, more than 19% of the procedures performed by the prehospital providers appeared to have not been medically indicated. DISCUSSION: Long-term strategies may be needed to improve the capabilities and performance of prehospital providers' capabilities in this delicate life-saving procedure. LEVEL OF EVIDENCE: IV.

Early diagnosis and critical management of wound botulism in the emergency department: a single center experience and literature review.

BACKGROUND: Clostridium botulinum remains a major threat to a select population of subcutaneous and intramuscular drug users. We conducted a retrospective study of patients who were diagnosed with wound botulism and their clinical presentations to the Emergency Department (ED). RESULTS: A total of 21 patients met the inclusion criteria and all had a confirmed history of heroin use disorder. Initial presentation to the ED included generalized weakness (n = 20, 95%), difficulty swallowing (n = 15, 71%), and speech/voice problems (n = 14, 79%). Sixteen patients (76%) also presented with visible skin wounds and fifteen (71%) required mechanical ventilation (MV). Patients who presented with dysphagia as well as dysarthria and/or dysphonia were more likely to require a percutaneous endoscopic gastrostomy (PEG) tube. Patients who required MV and PEG tubes were noted to have a longer hospital length of stay (LOS) due to the severity of the disease progression. CONCLUSIONS: Emergency physicians should remain vigilant about early recognition of wound botulism, especially in patients who inject drugs.

Patients' Perception of Telemedicine in a Large Urban Inner-City Emergency Department: A Cross-Sectional Survey.

Introduction Telemedicine has the potential to ease emergency department (ED) overcrowding, improve ED throughput, and decrease the cost of medical care. Much of the current knowledge of telemedicine systems focuses on bringing more specialty care to the ED or improving access in rural areas. Limited research exists on patients' perception of telemedicine in an urban ED. Methods A survey exploring perceptions of telemedicine encounters was distributed to both providers and patients following mirrored encounters between October 2015 and August 2016. Chi-square analysis was conducted to identify associations between factors and openness to telemedicine from the patients' perspective. Results A total of 174 patients were included in the analysis. Factors associated with patient willingness to try telemedicine included: having access to a tablet with internet (p=0.0023), having access to a tablet with camera (p=0.0025), having downloaded apps in the past (p=0.0028), having used an app in the past (p<0.0001), and had frequent video chat in the past (p=0.0142). Conclusion With widespread access to smartphones with internet connectivity and pressing demands for healthcare services, telemedicine may provide a potential solution to low acuity medical care needs.