RESUMO
In 2021, there were 1.7 million suicide attempts in the US, with firearms being the most common method used, comprising more than 50% of attempts. We present a case report of delayed operative intervention for foreign body removal after a suicide attempt using a nail gun fired into the left hemi thorax. Initial conservative management was complicated by the delayed presentation of hemoptysis requiring surgical intervention. We hypothesize that the delay was secondary to foreign body migration. Initial management was attempted robotically, but dense adhesions were encountered, requiring conversion to an open thoracotomy. Twenty-eight nails were removed. The post-operative course was uncomplicated.
RESUMO
Adenoid cystic carcinoma (ACC) is a rare tumor, described as being one of the most biologically destructive tumors of the head and neck. It is the most common malignancy that affects the minor salivary glands. Lung and bones are the most common regions of ACC distant metastasis. To the best of our knowledge, herein, we report the first ever case of latent isolated sternal metastasis from ACC in a 52-year-old gentleman, who was diagnosed to have ACC of the submandibular gland, excised 10 years ago.
RESUMO
BACKGROUND: Emergency color codes were developed to alert healthcare personnel in a hospital to critical situations. They are often developed independently by each hospital, leading to variability. This could be a source of confusion to healthcare personnel, who move frequently between hospitals and may work at multiple hospitals. This study evaluated the variability of emergency codes for different critical events in hospitals in Riyadh. METHODS: A prospective, cross-sectional survey was carried out on a representative sample of hospitals. Twenty-four of 28 hospitals took part in the study. Semi-structured questionnaires were completed by the Quality/Safety Department of each hospital, on general hospital characteristics, emergency department characteristics, code-response mock-up, code determination, emergency codes used and code meanings. RESULTS: Thirty-four different codes were used across hospitals. The codes used most variably were yellow (10 meanings), orange, black, green (7 meanings each), and gray (5 meanings), while the most consistently used code was 'Code Red' for 'Fire' in 75% of hospitals. Another source of variability was the use of non-color codes, representing 7.7% of total codes. CONCLUSIONS: There is large variability in the type and meaning of emergency codes between hospitals in Riyadh City, reflecting a lack of standardization. Hospitals use color and non-color emergency codes, which could cause confusion to responders and mitigate the effectiveness and speed of response in critical events.
