No abstract

The rate of injury for each area of the body is within previously reported rates, with lower extremity injuries making up the largest category and leading to the majority of admissions. The most common time to sustain an injury was during landing, which represented a majority of both emergency room visits and hospitalizations.

Background: Atherosclerotic coronary plaque dissection (ACPD) is one cause of acute coronary syndrome (ACS) caused by underlying atherosclerosis. Spontaneous coronary artery dissection (SCAD) occurs outside the setting of atherosclerosis among young women and individuals with few or no conventional atherosclerotic risk factors, and has emerged as an important cause of ACS, and sudden death. A comparison between ACPD and SCAD has not been previously addressed in the literature. Our study will compare ACPD and SCAD. Methods: Patients with confirmed diagnosis of SCAD and ACPD were retrospectively identified from 30 centers in 4 Arab Gulf countries between January 2011 and December 2017. In-hospital (ventricular tachycardia/ventricular fibrillation, myocardial infarction (MI), percutaneous coronary intervention, dissection extension, cardiogenic shock, death, implantable cardioverter-defibrillator placement) and follow-up (MI, de novo SCAD, spontaneous superior mesenteric artery dissection, death) events were compared between them. Results: Eighty-three cases of SCAD and 48 ACPD were compared. ACPD patients were more frequently male (91.67% vs. 49.40%, P < 0.001) and older (58.5 vs. 44, P < 0.001). Cardiovascular risk factors were more prevalent in patients with ACPD, including diabetes mellitus (60.4% vs. 25.3%), dyslipidemia (62.5% vs. 38.5%), and hypertension (62.5% vs. 31.3%), P < 0.001. Hospital presentation of ST-elevation MI was diagnosed in 48% of SCAD versus 27% of ACPD patients (P = 0.012). SCAD patients received medical-only treatment in 40% of cases and ACPD in 21% (P = 0.042). In-hospital and follow-up events were comparable in both groups (P = 0.25). Conclusions: Despite a completely different pathophysiology of ACS between SCAD and ACPD, in-hospital and follow-up events were comparable.

Iatrogenic bacterial meningitis (IBM) is a rare but serious complication of neuraxial procedures, such as spinal and epidural anesthesia or lumbar puncture. We report a case of a 46-year-old female who presented to the emergency department with bacterial meningitis after spinal anesthesia. We review the existing literature outlining the pathogenesis, vector hypothesis, diagnosis, treatment, and prevention as they relate to IBM. We highlight the role of the emergency physician in the rapid diagnosis of this disease, and underscore the need for sterile technique when performing lumbar punctures. RÉ SUMÉLa mé ningite bacté rienne iatrogé nique (MBI) est une complication rare mais grave d'interventions centrales comme la rachianesthé sie, l'anesthé sie pé ridurale, et la ponction lombaire. Il sera ici question du cas d'une femme de 46 ans, qui s'est pré senté e au service d'urgence pour une mé ningite bacté rienne aprè s une rachianesthé sie. Nous passerons en revue la documentation actuelle et exposerons briè vement la pathogenè se de la MBI, les vecteurs possibles, le diagnostic, le traitement, et la pré vention de la maladie. Nous ferons ensuite ressortir le rô le de l'urgentologue dans la pose rapide du diagnostic et insisterons sur la né cessité de la sté rilité des techniques dans les ponctions lombaires.

No abstract