Myiasis is defined as an infestation of the organs or tissues of live vertebrates (humans or animals) by dipterous larvae, commonly referred to as maggots. Wound myiasis is a common presentation in the emergency department. The presence of wild maggots and larvae in wounds is concerning for subsequent myiasis-induced infections and complications. Proper extraction of wild maggots and larvae is required to avoid complications that may occur with wound myiasis. Surgical debridement is often utilized to extract wild maggots and larvae, but can be painful and time-consuming. There is limited literature available on alternative approaches for removal of wild maggots and larvae. We present a case of lower extremity wound myiasis that had wild maggots and larvae successfully removed with no complications using ether. This procedure is a novel, noninvasive, and pain-free way to extract wild maggots and larvae from wound myiasis.

Ketamine for rapid sequence intubation (RSI) is typically dosed at 1 to 2 mg/kg intravenously. The need to ensure dissociation during RSI led some to administer ketamine at doses greater than 2 mg/kg. This study assessed associations between ketamine dose and adverse events. Methods: This multisite, retrospective study included adult subjects undergoing RSI with intravenous ketamine. Subjects were categorized into 2 groups: a standard ketamine dose (≤ 2 mg/kg intravenously) or a high dose (> 2 mg/kg intravenously). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for adverse events. Results: Eighty subjects received standard-dose ketamine, and 50 received high-dose ketamine. The highdose group had a significantly (P < .05) higher proportion of trauma patients, were younger, and had higher predose blood pressure compared with the standard-dose group. High-dose ketamine was associated with greater odds of adverse events including hypotension (OR = 7.0; 95% CI, 3.0-16.6), laryngospasm (OR = 10.8; 95% CI, 1.3-93.4), bradycardia (OR = 7.5; 95% CI, 1.5-36.6), repeat medications (OR = 12.9; 95% CI, 1.5-107.9), oxygen desaturation (OR = 6.0; 95% CI, 1.8-19.9), multiple attempts (OR = 3.2; 95% CI, 1.5-6.8%), and failed airway (OR = 3.6; 95% CI, 1.0-12.7). Conclusion: Ketamine at higher doses was associated with increased odds of adverse events. Studies assessing adverse events of ketamine at lower than standard doses in shock patients are needed.

Background:: Heroin has had an overwhelming impact on public welfare and health resources. National surveillance data indicate a 25% increase in drug overdose deaths in Ohio between 2012 and 2017, ranking the state second in terms of drug overdose deaths associated with opioids. Objective:: The primary objective of this evaluation was to determine the length of hospital stay in suspected or confirmed heroin overdose. Methods:: This retrospective analysis evaluated adult patients presenting to the emergency department (ED) at Mercy Health St Vincent Medical Center with confirmed or suspected heroin overdose. Patient data were obtained from the International Classification of Diseases, 10th revision, code reports. The study site is a 462-bed academic medical center with a level 1 trauma designation located in downtown Toledo, OH. Results:: One-hundred and one patients were included in this study: 49 presented to the ED and were subsequently admitted, while 52 were evaluated in the ED and discharged. No statistically significant differences in demographic data were identified. The average length of stay for admitted patients was 4.39 days (range = 0-22 days) with an average of 1.91days in the intensive care unit and 2.48 days on a general medicine floor. Higher average amounts of naloxone administered prior to presentation to the ED were found to predict an admission to the intensive care unit (6.48 mg vs 2.43 mg, P = .0208). The most frequent necessary interventions were central line placement (16/49, 32.7%) and mechanical ventilation (15/49, 30.6%). Seven patients (14.3%) experienced a cardiac arrest. Conclusion:: Heroin overdoses continue to require emergent interventions and consume numerous health care resources. Investment in strategies for prevention of overdose and the subsequent utilization of resources is paramount in controlling the heroin epidemic in Ohio and nationally.