Regional Technique Provides Complete Surgical Anesthesia for Above-the-Knee Amputation: A Viable Alternative to General Endotracheal Anesthesia in a Time of COVID-19.

In the initial phase of the coronavirus disease 2019 (COVID-19) pandemic, laboratory test shortages made it impossible to definitively identify patients with active COVID-19 infection or asymptomatic carriers. Without diagnostic certainty, it was imperative to proceed with caution when performing aerosol-generating procedures; this meant that anesthesiologists needed to make conscious decisions to avoid airway manipulation for procedures when it was not completely necessary. This case report describes a regional anesthetic technique that was used as the primary anesthetic for an urgent above-the-knee amputation in a patient with a history of respiratory issue of unknown etiology.

Emergent Management of Clostridium difficle Infection in a Patient With Chronic Inflammatory Bowel Disease.

Clostridium difficle (C. diff) is a well known cause of infectious diarrhea across hospitals in the developed world. An anaerobic, gram positive rod bacteria, C. diff is part of the normal flora of the human colon; however, alterations to the microbiome can promote proliferation leading to pathogenic behavior. Typical symptoms include watery diarrhea in excess of three or more times a day, for at least two days, and abdominal cramping. While most infections do not lead to long term complications, the two complications that are most deleterious to health are toxic megacolon and bowel perforation. Patients with an inflammatory bowel disease are at a higher risk of complications, and thus need to be managed appropriately. This case presents a 39-year-old male, with pertinent medical history of poorly controlled ulcerative colitis, who presented to general surgery with imaging suggesting rectal perforation secondary to a C. diff infection. Due to the free air visualized in the rectum, the patient was urgently transported to the operating room to undergo a total colectomy and end ileostomy surgery. This case discusses the well-known complication of bowel perforation, in order to raise awareness about the management and guidelines. This case is important and significant as it details the appropriate guidelines and structure to follow amongst this unique, and vulnerable to complications, population in order to manage a potentially devastating manifestation of C. diff.

Acute Management of Trimalleolar Fracture.

Extremity trauma is a common emergency department presentation. The authors report a case of an elderly woman who sustained a trimalleolar ankle fracture. Emergency department care includes stabilization of the fracture with a splint, with careful assessment of neurovascular status. Trimalleolar fractures are unstable and thus almost always will require surgical repair. This is true even for elderly patients and those with co-morbidities. Patients who do not get a surgical repair for these fractures are at risk for significant morbidity, including compartment syndrome, arthritis, malunion, and loss of mobility.

Phalangeal Fracture Secondary to Hammering One's Finger.

The authors report the case of a man who smashed his finger while using a hammer, resulting in a fracture-dislocation. The description of this injury type and the emergency management is discussed.