Envenomations.

Numerous types of envenomations may be encountered by health care workers depending on where in North America they work. Clinicians should be familiar with the animals in their region that may lead to envenomation.A rational approach with use of poison center or medical toxicology consultation services ensures that cases are managed appropriately.

Femoral nerve palsy secondary to traumatic pseudoaneurysm and iliacus hematoma.

The authors report a case of traumatic femoral nerve palsy caused by a pseudoaneurysm of the iliolumbar artery and a iliacus muscle hematoma. This case report details not only the classic history and physical findings seen in patients such as this one, but also illustrates an unusual source of the hematoma and a discussion of its treatment. A 20-year-old man was assaulted and presented to the authors's institution with a 1-week history of severe pain in the left anterior thigh and groin, weakness in the left quadriceps muscle, and numbness in the anterior thigh and medial distal leg. Imaging studies demonstrated a large, 9.4 x 6.4 x 5.2-cm iliacus hematoma as well as a pseudoaneurysm originating from the left iliolumbar artery. The patient underwent angiographic embolization of the pseudoaneurysm followed by surgical evacuation of the hematoma. The embolization was performed before surgery to prevent any possible rebleeding from the pseudoaneurysm during evacuation of the hematoma. Femoral nerve palsy caused by traumatic iliacus hematoma is an infrequent diagnosis often missed because of its insidious presentation. In this case, embolization of the iliolumbar artery pseudoaneurysm followed by surgical evacuation of the hematoma resulted in a nearly full recovery of the femoral nerve as of the last follow-up examination.

Arthroscopic meniscus repair with bioabsorbable arrows.

PURPOSE: The clinical results of a single surgeon's experience with Meniscus Arrows (Bionx, Blue Bell, PA) for meniscal repair are reviewed and reported to determine the safety and efficacy of this device. TYPE OF STUDY: Consecutive sample. METHODS: Over a 3-year period, the senior author has used only Meniscus Arrows for all meniscal repairs. All patients who underwent meniscal repair with at least 12 months of follow-up were evaluated for this study. Thirty patients had a meniscal repair, and 29 were available for follow-up. The average age at surgery was 29 years (range, 15 to 45 years) and there were 24 male and 5 female patients; 25 patients had an anterior cruciate ligament (ACL) reconstruction with the meniscal repair, 2 repairs were performed in ACL-deficient knees, and 2 repairs were performed in ACL stable knees. The average follow-up was 24 months (range, 12 to 42 months). RESULTS: The average Lysholm knee scores for ACL reconstruction, ACL-intact, and ACL-deficient knees improved from 47, 6, and 35, respectively, to 91, 96, and 81 postoperatively. Tegner activity scores improved from 2.7, 0, and 1.5, respectively, to 7.4, 6.5, and 4.5 after surgery. There were no surgical complications, no infections, and no neurovascular injuries. Five patients had mild subcutaneous irritation caused by the Arrow tips, but in each case this resolved within 3 to 7 months. There were 2 failures (7%) that required later arthroscopy and partial meniscectomy. One failure was in an ACL-deficient knee, and the other was in an ACL-reconstructed knee. CONCLUSIONS: Although the data presented in this report are based on short-term clinical follow-up, the preliminary results of the Meniscal Arrow repair are encouraging.

A simulation course on lifesaving techniques for third-year medical students.

BACKGROUND: The University of Virginia School of Medicine discontinued animal vivisection in February 2004 for teaching lifesaving procedures to third-year medical students. Consequently, a 1-day course using simulation technology was developed to meet objectives previously covered in the animal laboratory. The authors sought to evaluate the course and hypothesized that the students' confidence in lifesaving procedures as well as their acceptance of simulation technology as a teaching tool would increase. METHODS: The course was designed in a two-session format. The first session (first half of the day) concentrated on individual procedure skills, utilizing part-task trainers. The second session (second half of the day) used a Medical Education Technologies Inc. (METI) Emergency Care Simulator (ECS) full-body patient simulator to present a major trauma scenario. The study design was a prospective, pretest-posttest study without a control group. A 10-question pre and post survey used a Likert scale to explore students' confidence in their skills as well as their acceptance of simulation technology. A course evaluation used a similar Likert scale for evaluation of the course substations, the trauma scenario, and students' self-assessment of their skill levels as well as a 100% point scale for an overall rating of the course. RESULTS: A total of eight 1-day courses were successfully held over 2 years with a total enrollment of 240 students utilizing 20 instructors inclusive of faculty, residents, and other emergency medicine health care providers. For the pre and post survey results, there was a significant increase in students' confidence in performing lifesaving procedures as well as their acceptance of simulation as a teaching tool (P < 0.05 for each question with pre n = 222 and post n = 226). For the course evaluation results (n = 190), all of the course substations were rated in the good to excellent range and the course received an overall score of 97.55 +/- 7.23% out of 100%. Furthermore, students reported a significant increase in their skill level (P < 0.05). CONCLUSION: This lifesaving techniques course utilizing simulation technology successfully covered objectives previously taught with animal vivisection, increased students' confidence levels in performing lifesaving procedures and was highly accepted by the medical students.