Oral myiasis in humans.

Myiasis is a parasitic infestation resulting from flies laying eggs in the host tissues. It is common in animals, but can also occur in humans, including in the oral cavity. The diagnosis is usually quite clear in endemic regions such as Brazil, but it can be challenging to clinicians in nonendemic counties when faced with a patient who has acquired the infection elsewhere. We report two clinical cases of human intraoral myiasis and discuss the diagnosis and treatment of this condition. Two men, both of whom were in situations of vulnerability presented with myiasis: the first patient had larvae infesting the alveolar ridge region after tooth extraction, while the second was diagnosed with inflammatory fibrous hyperplasia associated with larvae along the edges of the lesion. Both were treated with ivermectin and antibiotics, and given guidance on preventative care. Such infestations are often a clear sign of neglect, and clinicians need to pay attention to the general health of patients affected by oral myiasis.

Too old to live. Too young to die. Multiple organ dysfunction syndrome in the elderly.

The elderly individual who sustains multiple injuries is one of the ultimate challenges for the trauma team. To deliver optimum care, the provider must be knowledgeable about acute resuscitation, critical care, rehabilitation, and gerontologic medicine. As more people enter their eighth decade of life and greater numbers of trauma victims survive, more critical care beds will be filled with elderly patients with multiple organ dysfunction syndrome. Practitioners of critical care are obliged to learn how best to care for this challenging group.

Using simulation to teach critical thinking skills. You can't just throw the book at them.

Critical thinking is essential in critical care practice. How to define, measure, and teach thinking are subjects of debate with no clearly proven method for doing so. Simulation as a teaching strategy appears to hold great promise for teaching critical thinking. Sophisticated simulators allow real patient situations to be replicated in a safe environment for practice and learning. Research is needed to support this theory. Dr. Gaba, a pioneer in the use of simulation, said "No industry in which human lives depend on the skilled performance of responsible operators has waited for unequivocal proof of the benefit of simulation before embracing it." Embracing simulation in academic and clinical education is appropriate, but efforts must continue to evaluate this strategy.

Trauma and the elderly: the impact on critical care.

The population older than age 65 is growing rapidly. This change in the demographics of our nation is impacting critical care in many ways. Most researchers have found that trauma patients older than 65 have a higher mortality rate, longer hospital stays, more complications, common mechanism of injuries, and poorer outcomes than their younger counterparts. These facts must be taken into consideration when planning care for the elderly trauma patient population. This paper will review the research literature on elderly trauma victims and the impact these patients are having on critical care practice.