Cervicofacial Emphysema Complicating a Dental Procedure.

BACKGROUND: Cervicofacial subcutaneous emphysema can occur rarely after a dental procedure, especially tooth extraction, and can be misdiagnosed as an allergic reaction or post-procedure swelling. CASE REPORT: We report a rare case of a 29-year-old man who developed extensive cervicofacial subcutaneous emphysema after a dental hygiene procedure. A review of the relevant literature is presented in our report. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early identification and management of this potentially life-threatening condition is particularly important and can prevent serious complications, leading to improved patient outcomes.

Penetrating Thoracic Injury and Fatal Aortic Transection From the Barb of a Stingray.

Stingrays are found in open waters and are also kept in exhibits in many aquariums throughout the world. They are generally nonaggressive creatures by nature, but they can inflict injuries with their spines if provoked. We present a case of a 62-y-old diver who was pierced in the chest by the barb of a stingray while transferring the animal to another tank as part of his work in a public aquarium. He was rescued immediately from the tank but was found to be in cardiac arrest. Bystander cardiopulmonary resuscitation was promptly initiated by his colleagues. He was rapidly evacuated to the nearest emergency department, where he was noted to be in pulseless electrical activity. A single puncture wound was noted over the right second intercostal space, with the spine of the stingray still impaled in the chest. Trauma surgeons were activated promptly, and resuscitation was continued based on advanced cardiac and trauma life support guidelines, which included ongoing cardiopulmonary resuscitation, securing the airway, and emergency blood transfusion. An emergency department thoracotomy was performed, but despite aggressive resuscitation the thoracic injury was fatal. An autopsy revealed transection of the aorta by an impaled barb. We present a review of stingray injuries and suggest a general approach to management.