Ludwig's angina is a cellulitis of the submandibular, sublingual, and submental spaces, which tends to spread rapidly along fascial planes. The most common cause is a dental infection, although any other oropharyngeal infection has the potential to develop into Ludwig's angina. The most feared complication of Ludwig's angina is airway obstruction. Treatment involves early recognition so that an airway can be secured, initiation of antibiotics, and, finally, potential surgical debridement. We describe the case of a 57-year-old male with multiple comorbidities who was seen by a provider three times for dental pain prior to his admission for Ludwig's angina. Upon his index admission, he was found to have Ludwig's angina with impending airway obstruction. He required an emergency surgical airway debridement and extraction of multiple teeth. Although the patient eventually recovered, his hospital stay was prolonged and marked by multiple complications. This case is an example of a severe presentation of Ludwig's angina and the difficulties faced by the medical team in managing this condition. Early recognition and rapid intervention are paramount in the management of this serious condition.

Bullet embolism is a rare but potentially serious complication of a gunshot wound. This case report describes a 26-year-old male who presented with a gunshot to the lower back. Diagnostics revealed a migrating bullet that became lodged in the left pulmonary artery. After two unsuccessful attempts at endoscopic removal, the decision was made by the multidisciplinary team to retrieve the bullet surgically. The patient recovered well postoperatively. Four-and eight-month follow-up in the emergency department revealed no significant postoperative complications. Bullet embolism should be suspected when radiographs reveal a migrating projectile. Treatment options include conservative management, endoscopic bullet retrieval, and surgical removal. No guidelines for the management of a bullet embolism exist. Management should be based on the patient's clinical status and comorbidities, facility resources, and perceived risk of undergoing surgical retrieval of the bullet.

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One of the most significant public health issues faced in Ethiopia is malaria. The most influential problem of this public health issue is overcoming barriers of having proper access to professional care and treatment. This study aims to elucidate the self-interventions undertaken by individuals when they perceive symptoms of malaria in a family-member prior to, or instead of, seeking care at a healthcare facility. Our study found that the prevalence of self-medication for malaria in the Wirtu Yedi kebele is 37.3%. Almost all individuals eventually sought treatment for malaria at the healthcare facility. More than half did so in less than one day. When self-treatment was used, there was a wide array of self-medication practices used, including modern medications not prescribed by a healthcare professional, herbs, and nonpharmacological measures. The more commonly used medications were chloroquine and Coartem® (artemether and lumefantrine). Most reported obtaining these medications at a drug outlet store without a prescription and prior to seeking care at a health center. Of the various herbs reported that were used to self treat malaria the most commonly used were garlic, ginger, and harmaguse. The use of herbs was found to be less common than the use of modern medication. Of the non-pharmacological interventions, rituals were the most prevalent.

Introduction: There is considerable interest in the use of tranexamic acid (TXA) for the control of hemorrhages in trauma patients. Multiple recent studies found that TXA used in the setting of a suspected significant hemorrhage in trauma patients significantly reduced mortality. To date, there are no cited studies that specifically address hemorrhage due to solid organ injury (i.e., kidneys, liver, and spleen) and TXA use in humans. Our current research addresses whether TXA is effective in reducing complications and mortality from traumatic hemorrhage in the setting of a specific solid organ injury.Methods: We conducted a retrospective observational cohort study utilizing propensity score matching at Arrowhead Regional Medical Center (ARMC) from February 1, 2009 to February 1, 2019. This study period marks five years prior to and five years after February 1, 2004, which is the date when TXA first started to be used at ARMC in the management of traumatic hemorrhage. We compared for statistical difference between corresponding injury types in the TXA and non-TXA groups.Results: Before the propensity matching, there were 123 patients who received TXA and 118 patients who did not. After propensity match for age and injury severity score (ISS), 35 patients were included in each group. We found no statistically significant difference between TXA and non-TXA treatment groups in terms of mortality at 24 hours (p-value=0.4945), mortality at 48 hours (p-value=0.4945), and mortality at 28 days (p-value=0.7426). We found no statistically significant difference between the need for interventional radiology intervention at 72 hours (p-value=0.3932), surgical intervention at 72 hours (p-value=0.2123) and possible TXA related complications (p-value=1).Conclusion: Although prior studies showed that TXA use in the setting of trauma may be beneficial, the specific candidate-selection criteria remain unclear. The results of our study suggest that the benefit from TXA in the setting of the isolated splenic, liver, and or renal injury may be negligible. We believe that this first-of-its-kind study adds to the growing body of knowledge about the utility of TXA and helps guide patient-selection criteria.