Background: This case series assessed the clinical outcomes and characteristics of barotrauma in COVID19 patients. Methods:The electronic medical records of all patients admitted with confirmed COVID 19 infection who eventually developed barotrauma between March 17 th , 2020 and April 17 th , 2020 were reviewed, information about patient characteristics, pattern and characteristic of barotrauma were analyzed and reported in a descriptive manner.Results: 25 patients developed evidence of barotrauma on Chest Xray or Computed tomography (CT) with a mean age of 60.1 at the time of diagnosis, 12 (48%) developed severe ARDS with PaO2/FiO2 ratio of <100. 14 (56%) patients developed pneumothorax, 7 had evidence of subcutaneous emphysema and 6 developed pneumomediastinum. More barotrauma occured in the first day of ventilation than any other day, the median time between mechanical ventilation and development of barotrauma is 3.5 days. Conclusion:Barotrauma in COVID 19 is associated with an increased mortality (64%) which may reflect worse acute lung injury in these cases. The median time to develop barotrauma in these patients is similar to the one described in ARDs literature.

IntroductionSpinal fixation is a common surgical procedure. Frequently, fixation for spinal stabilization requires use of instrumentation such as pedicle screws and fixation plates. Aerodigestive and vascular perforations from such procedures are infrequent albeit known complications from these procedures.Presentation of caseThis case details an uncommon situation in which a patient with anterior cervical spine fixation in the distant past was found to have a migratory pedicle screw. The patient had symptoms of neck pain and dysphagia. Radiographic studies were helpful in demonstrating the problem. While undergoing a physical examination, the patient was witnessed to expectorate the screw. Further work up with panendoscopy was undertaken and the patient managed conservatively.DiscussionThe upper aerodigestive system rarely experiences perforation from spinal stabilization hardware. When it occurs, management should include a dedicated investigation of the involved portions of the digestive system to avoid further complication.ConclusionThis case presents an rare occurrence of aerodigestive perforation of a spinal pedicle screw which was self-removed.

This is a case report describing the delayed presentation of injury to all three lower extremity infrapopliteal arteries after a 34 year old male sustained multiple gunshot wounds, including one to his left lower extremity. As part of his initial assessment, ankle brachial index was performed and was found to be abnormal. Further work up for this was delayed due to need for emergent trauma laparotomy. After this procedure, more detailed evaluation with CT angiography of the extremity injury was performed. Though imaging indicated adequate perfusion of the lower extremity, serial neurovascular examination revealed inadequate perfusion. The patient required arterial reconstruction and fasciotomies.This case demonstrates the need for continued surveillance of extremity perfusion in atypical trauma cases when index of suspicion suggests the degree of injury may be worse than initial work up may indicate.