Emergency Management Strategies and Antimicrobial Considerations for Nonmammalian Marine Vertebrate Penetrating Trauma in North America, the Caribbean, and Hawaii: A Review Article.

There are numerous emergency department visits in the United States for all types of marine animal injuries each year. These injuries may result in significant morbidity or mortality if not managed appropriately. Accurate identification of the offending species, thorough wound hygiene, and judicious use of antibiotics are important for preventing infections. This review aims to describe management strategies and antimicrobial considerations for nonmammalian marine vertebrate penetrating trauma in North America, the Caribbean, and Hawaii. A literature search was performed to identify studies on this subject. This literature consisted of clinical case reports and case series. Reports extracted included those on sharks, barracuda, eels, catfish, stingrays, lionfish, stonefish, and scorpionfish. The majority of reported trauma occurred to beachgoers, fishermen, or commercial aquarium employees who routinely handle these animals. Injury patterns depended on the species but most commonly affected the lower extremities. Infections were seen from saltwater bacteria, human skin flora, or marine animal oral flora. After thorough wound irrigation and exploration, most authors recommended prophylactic antimicrobials to cover Vibrio species, in addition to other gram-negative and gram-positive species. The literature is notable for the lack of controlled studies. Some authors recommended radiographic and/or ultrasonographic imaging to identify retained foreign bodies, such as spines, sand, or teeth.

Evaluating the Need for Prolonged Telemetry Monitoring in Patients With Isolated Sternal Fractures.

INTRODUCTION: Isolated sternal fractures (ISFs) often result from deceleration or chest wall trauma. Current guidelines recommend screening ISF patients for blunt cardiac injury (BCI) with electrocardiogram (ECG) and troponin. If either is abnormal, 24-h telemetry monitoring is recommended. This study sought to determine if ISF patients with abnormal ECG will manifest any cardiac-related complications within 6 h of hospital arrival. METHODS: A retrospective study was performed at a single level I trauma center. Patients with diagnosed sternal fracture and an Abbreviated Injury Scale <2 for head/neck, face, abdomen, and extremities were included. Patients with multiple rib fractures or hemopneumothorax were excluded. Demographic data, ECG, troponin, and echocardiogram results were collected. The primary outcome was cardiac-related complications or procedures. Complications included hypotension, arrhythmia, and hemodynamic instability. Procedures included sternal stabilization, cardiac catheterization, or sternotomy/thoracotomy. Descriptive statistics were performed. RESULTS: One hundred twenty-nine ISF patients were evaluated, 68 (52.7%) had an ECG abnormality. Eight patients had elevated troponin (6.2%). One patient (0.78%) suffered a cardiac-related complication (arrhythmia); however, this was 82 h into hospitalization. Two patients suffered noncardiac complications (urinary tract infection and acute kidney injury) (1.55%). Three patients had echocardiogram abnormality (2.33%), but no patients sustained a BCI or underwent a BCI-related procedure. CONCLUSIONS: After ISF, <1% of patients suffered a cardiac-related complication and none had BCI. These findings suggest 24-h monitoring for patients with ISF and abnormal ECG may be unnecessarily long. A prospective multicenter study to evaluate the validity of these results is needed prior to change of practice.

A comparison of handheld and standard ultrasound in Swiss medical students.

BACKGROUND: The use of ultrasound (US) within healthcare has inspired the development of new US technology. There have been few studies comparing the use of handheld US to standard US for medical education. This research aims to determine whether a handheld US device can provide a comparable primary learning experience to that of a standard US machine. METHODS: Over two days of instruction, participants were taught and evaluated on core US fundamentals. The standard group received instruction on standard US machines, while the handheld group received instruction on handheld US devices. Participants completed a qualitative survey regarding their experience. Six hundred and four images were obtained and graded by two emergency medicine physicians. RESULTS: A total of 119 Swiss medical students were enrolled in our study. There was no statistically significant difference in the US assessment measurements, except for faster endpoint septal separation (EPSS) vascular setup time in the handheld group (P=0.001). There was no statistically significant difference in participants' perceived difficulty of US learning (P=0.198), comfort level (P=0.188), or self-estimated capability to perform US in the future (P=0.442). There was no statistically significant difference in the percentage of correctly obtained images (P=0.211) or images that were clinically useful (P=0.256). The median quality score of images obtained by the standard group was eight compared to seven in handheld group (P<0.01). CONCLUSION: Our data suggest a handheld US machine can perform as well as a standard US machine as an educational tool despite sacrifices in image quality.

A Case Report of a Transected Carotid Artery Caused by a Stab Wound to the Neck.

Penetrating wounds to the neck occur in 5-10% of trauma cases and are associated with very high mortality due to proximity to and involvement of vital structures. Emergent airway management and rapid diagnosis in these injuries are essential for life-saving treatment. This case study presents the case of a stab wound to the neck in an adult patient which elicited major concern for cardiovascular, neurological, and airway compromise. In such a high-risk trauma airway, this case shows the importance of keeping a wide differential and the value of expeditious management to prevent anoxic brain injury and stroke. The rapid diagnosis of a left common carotid artery transection and subsequent surgical repair were essential in this patient's full neurological recovery. Topics: Trauma, stab wound, neck hematoma, deviated trachea, carotid artery injury, carotid artery transection.

An Atraumatic, Idiopathic Case Report of Intraperitoneal Bladder Dome Rupture.

Bladder rupture is a rare condition often seen in trauma patients that is associated with a high mortality.1 Spontaneous, intraperitoneal rupture is even rarer in the literature. In this case report we present a middle-aged woman presenting to the emergency department (ED) with abdominal pain, the need to strain to void, and gross hematuria with prior history of urological procedures and cervical cancer. A computed tomography (CT) cystography revealed an intraperitoneal bladder rupture, and the patient underwent an emergent laparotomy. The patient's postoperative course was uneventful and she was discharged with a Foley catheter. This case represents the importance of keeping bladder rupture in the differential diagnosis even without a history of trauma. Furthermore, an expeditious diagnosis, preferably with CT cystography, and management of the rupture is essential in assuring fortunate outcomes. Topics: Bladder rupture, urological emergencies, spontaneous bladder rupture.