No abstract

Necrotizing fasciitis is a serious infectious condition that may compromise the patient's life. In the present case study, a 42-year-old male patient was reported. The condition manifested as the presence of subjective fever, general malaise, myalgia, non-productive cough, dysphagia and neck pain ~1 week prior to hospital admission. Vascular dissection was considered as the initial diagnostic suspicion, and thus, angiotomography of neck vessels was performed, ruling out aortic and neck vessel dissection. Radiology indicated negativity for aortic syndrome and cervical vascular disease, but the presence of cervical-mediastinal edema, lamellar fluid between muscular and fatty planes and posterior pulmonary atelectasis, absence of pleural fluid or consolidations, and tonsillar hypertrophy without abscesses. Due to the rapid evolution of the condition, the presence of dyspnea with the need for supplemental oxygen, and the disproportion between the intensity of the pain described by the patient and the external findings observed, the presence of necrotizing fasciitis was considered. Point-of-care ultrasonography was performed, indicating a cobblestone pattern of the subcutaneous cellular tissue, with diffuse thickening of the anterior cervical fascia and increased echogenicity with soft tissue edema posterior to the fascia. Magnetic resonance imaging confirmed the inflammatory findings in the fascia and other cervical soft tissues, without exhibiting any signs of necrosis, but with the presence of abscesses in the visceral and carotid space.

Kounis syndrome (KS) is defined as an acute coronary syndrome triggered by the release of inflammatory mediators after an allergic attack. It usually occurs secondary to allergic injuries from foods, medications, and insect bites. However, there are no known reports of KS secondary to the intake of laxatives. This article reports the case of a 43-year-old woman who, after ingesting a dose of sodium phosphate monobasic/sodium phosphate dibasic, presented a maculopapular rash on the trunk and extremities. The electrocardiogram showed ST depression in V4-V5-V6 and signs of prolonged QTc; troponin I uptake was positive. Due to presumed myocardial injury and high suspicion of coronary disease, coronary angiography was requested, which showed epicardial coronary arteries, without angiographically significant stenosis, thus confirming the presence of KS secondary to the ingestion of a laxative.

La sobreocupación de los servicios de urgencias es un problema global que cada vez afecta más las instituciones de salud que atienden pacientes de mediana y alta complejidad, haciendo que estos permanezcan más tiempo en una sala de espera con la consiguiente demora en los tiempos de atención, bajo nivel de satisfacción de los usuarios, retraso en la toma de ayudas diagnósticas, retrasos al definir altas del servicio y favorecimiento de complicaciones médicas, entre otros. Para mejorar esta situación se han desarrollado estrategias como la creación de unidades de observación, unidades fast track o asignación de citas prioritarias para los pacientes que no requieren una atención urgente, de modo adicional el triaje, los exámenes point of care y la vinculación de especialistas en medicina de urgencias. Todo esto con el fin de mejorar la calidad de la atención de los pacientes, evitar que se presenten eventos adversos durante su proceso y disminuir la sobreocupación del servicio.