A Rare Cause of Dysphagia to Remember: Calcific Tendinitis of the Longus Colli Muscle.

Longus colli tendinitis (LCT) is an acute inflammatory condition with symptoms typically consisting of acute neck pain and stiffness with or without dysphagia. Once more severe etiologies for these symptoms are ruled out, this self-limiting condition usually resolves spontaneously with nonsteroidal anti-inflammatory drugs and corticosteroids. We present a case of LCT that presented as acute neck pain, dysphagia, and odynophagia that rapidly resolved once diagnosed and treated with anti-inflammatory agents. Though exceedingly rare, LCT must be considered in the differential diagnosis of acute neck pain, dysphagia, and odynophagia when more common etiologies do not correlate with the clinical presentation.

Wikipedia vs peer-reviewed medical literature for information about the 10 most costly medical conditions.

CONTEXT: Since its launch in 2001, Wikipedia has become the most popular general reference site on the Internet and a popular source of health care information. To evaluate the accuracy of this resource, the authors compared Wikipedia articles on the most costly medical conditions with standard, evidence-based, peer-reviewed sources. METHODS: The top 10 most costly conditions in terms of public and private expenditure in the United States were identified, and a Wikipedia article corresponding to each topic was chosen. In a blinded process, 2 randomly assigned investigators independently reviewed each article and identified all assertions (ie, implication or statement of fact) made in it. The reviewer then conducted a literature search to determine whether each assertion was supported by evidence. The assertions found by each reviewer were compared and analyzed to determine whether assertions made by Wikipedia for these conditions were supported by peer-reviewed sources. RESULTS: For commonly identified assertions, there was statistically significant discordance between 9 of the 10 selected Wikipedia articles (coronary artery disease, lung cancer, major depressive disorder, osteoarthritis, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, back pain, and hyperlipidemia) and their corresponding peer-reviewed sources (P<.05) and for all assertions made by Wikipedia for these medical conditions (P<.05 for all 9). CONCLUSION: Most Wikipedia articles representing the 10 most costly medical conditions in the United States contain many errors when checked against standard peer-reviewed sources. Caution should be used when using Wikipedia to answer questions regarding patient care.

Stings and bites: what to do about envenomation injuries.

Although serious envenomation injuries are rare in the United States, all emergency workers should be prepared for them. Most severe complications occur in people with previous allergies or pre-existing conditions. Many people, especially those with prediagnosed allergies, will be capable of self-treatment prior to EMS's arrival; however, prepare for the worst. EMS personnel should know how to treat virtually any envenomation injuries with general practices, and should inform the receiving hospital so venom-specific treatment can be prepared. Crews should also know what creatures are indigenous to their areas and know what to expect when the tones go off. Be aware that a side effect of any animal bite or sting, whether venomous or not, is bacterial infection. Remind patients of this. The hospital physician will also educate them about infection. If you respond to a call but the patient refuses transport and signs a waiver, you must educate him about possible bacterial contamination from the bite or sting. Never waive a patient until he has been educated regarding his injury and still refuses transport.

A bad way to end a vacation.

Although EMS units are frequently sent to calls that differ from their radio description, the fault for this does not necessarily lie with the dispatcher. The dispatcher can only relay information given over the phone, which is often a frantic, indecipherable description of an event. Dispatchers should be careful to avoid a premature diagnosis based on that information. They should relate only a chief complaint, event or presenting symptoms to crews. A description of anaphylaxis as a chief complaint should instead be given as "respiratory problems following a jellyfish sting." Once given a proper description, an astute EMS crew can begin a mental and verbal process of differential diagnoses on the way to the call. This will allow the crew to prepare for patient contact and avoid any tunnel vision caused by the dispatcher. Both crews in this situation performed admirably despite the darkened beach crowded with teenagers. They treated the presenting symptoms rather than focusing on the jellyfish sting and a possible anaphylaxis. An anaphylactic incident caused by a jellyfish sting is rare. The diagnosis at the hospital was an asthmatic attack induced by the anxiety of the sting. Ultimately, the sting only played a small part in the larger incident.