A preadolescent female presented to the emergency department with an acute asthma exacerbation. Chest radiograph and computed tomography scan showed extensive pneumomediastinum with a small pneumopericardium without a distinct source for this air leak. The patient was admitted for noninvasive monitoring, analgesia, and high concentration oxygen. Serial chest radiographs showed marked improvement following high concentration oxygen, and she was discharged on hospital day 3. Spontaneous pneumomediastinum and pneumopericardium are rare complications of asthma that can often be managed conservatively but should be considered on the differential for this patient population, and may be a complication of COVID-19.

RESULTS: Patients were 80.0 ± 9.1 years old, 71.9% were female, they had 1.9 ± 1.3 previous fall-related injuries, and they sustained 0.5 ± 0.9 falls during the tracking period. With confounders held constant, each additional previous fall predicted a 3.9-fold increase in the odds of experiencing a future fall (p < 0.001; 95% CI of OR: 3.131 to 4.961); the overall model was significant (p < 0.001; pseudo R 2 = 0.460). Age (p = 0.351) and sex (p = 0.236) were not significant predictors. Holding the same confounders constant, negative binomial regression found each additional previous fall to predict a 94.9% increase in the number of future falls (p < 0.001; 95% CI of IRR: 1.728 to 2.198); age (p=0.283) and sex (p=0.163) were not significant. CONCLUSIONS: Our findings highlight the importance of screening older adults for a history of falls prior to exercise prescription. For clients and patients who report experiencing a fall, it may be prudent to incorporate safe forms of balance and stability training.

Injuries and illnesses at ultra-endurance events are common, often requiring medical care. While these occurrences have been previously investigated in the scientific literature for initial care, the factors and characteristics of the athletes returning for medical care within the same race have not been previously reported. PURPOSE: To analyze the injury and illness characteristics of athletes who returned to the medical tent following initial care during the same race using three decades of Ironman-distance triathlon medical data. METHODS: Medical tent records from a single Ironman-distance triathlon event during 1989-2019 were reviewed retrospectively. All athletes presenting to the medical tent for at least one visit were included. Demographics, symptoms, and injury types were explored using descriptive statistics. The likelihood of athletes presenting to the medical tent for additional visits and their associated diagnoses were explored using odds ratios with 95% confidence intervals. RESULTS: Of the 10,533 athletes who presented to the medical tent, 940 (8.9%), 113 (1.1%), and 16 (0.1%) returned for one, two, or three additional visits in the same race. Female athletes (23.1%) presented for additional medical visits more frequently than males (17.5%)(T-test, p < .001). Returning athletes (12.36 hrs) had significantly slower race finishing times than those with only a single visit (11.52 hrs)(T-test, p < .001). No correlation was found between age and multiple visits. Following an initial care, the odds of returning for the same reason were particularly high for headache, altered metal status, diarrhea, abdominal pain, and vomiting (Fig. 1). CONCLUSIONS: Various initial presentations clearly show an increased likelihood of returning later in-race for the same reason. Careful surveillance of athletes with these medical diagnoses at initial presentations can optimize athlete care and medical tent resources allocation during ultra-endurance races.

No abstract