Introduction:Texas has approximately 200 species of wild mushrooms, including toxic and hallucinogenic varieties. Mushroom ingestions in Texas were studied for [2005][2006].Methods: Data was obtained via Texas Poison Control Centers and retrospectively reviewed. Case notes were reviewed individually regarding initial reporting, age, signs and symptoms, toxic effect, management, and patient outcomes.Results: A total of 742 exposures occurred during the study period. All exposures were acute and intentional. Of these exposures, 59 (7.9%) were admitted to the hospital, with 17 (28.8% of admissions) requiring admission to a critical care unit. Four cases required inpatient psychiatric admission. The average age of admitted exposures was 20.5 years, with a male-to-female predominance of 3.3:1. Eleven (22.9%) of the admitted exposures were identified, with Psilocybin being the most common agent (n = 10, 91%). Among the admissions, co-ingestions were identified with the mushroom ingestion in eleven patients (40.7%). The most common symptoms in admitted patients were vomiting (n = 34, 57.6%), nausea (n = 19, 32.2%), altered mental status (n = 17, 28.8%), abdominal pain (n = 13, 22%), and diarrhea (n = 10, 16.9%).Conclusions: All mushroom exposures examined were acute and intentional. Major toxic reactions were uncommon, and no deaths were reported. Serious poisoning from mushroom ingestion is rare in Texas; however, there is greater need for information dissemination on morbidity.
Pneumomediastinum occurs as a result of traumatic or iatrogenic causes or in patients with preexisting lung conditions such as interstitial lung disease, asthma, and chronic obstructive pulmonary disease. Spontaneous pneumomedi-astinum (SPM), however, is rarely seen in clinical practice. The authors report the case of a 14-year-old boy who presented to the emergency department with chest discomfort and shortness of breath after a 1600-m run as part of a physical education class. The patient was found to have SPM, was admitted to the pediatric service for monitoring and pain control, and made a full recovery within 24 hours. This case is notable because SPM occurred in the absence of identifable organic causes and as the result of sustained noncontact physical activity. A review of the literature provides background information and highlights pathophysiologic processes of SPM and suggested treatment. Physicians should consider pneu-momediastinum in young patients or runners presenting with chest pain even in the absence of any known inciting event.
Acute carpal tunnel syndrome is a rare diagnosis in orthopedic medicine. This article describes a 35-year-old man who presented to the ED with complaints of discomfort and paresthesias in his right wrist after a fall, and was subsequently diagnosed with acute carpal tunnel syndrome. The article reviews the pathophysiology of the syndrome and suggested treatment.
Introduction
Studies show that patients who spend more than 2 hours in the emergency department (ED) report more dissatisfaction with their visits. To remedy this situation, several EDs have implemented programs that insert a medical provider into triage. The objective of this study was to determine whether a Physician Assistant (PA) and Combat Medic performing triage care during peak hours could increase patient throughput.
Methods
This study is a comparative analysis. We implemented an Emergency Department Provider Level Triage Team (PLTT) that consisted of 1 Emergency Medicine Physician Assistant and 1 Combat Medic to intervene in patient care in the ED at Womack Army Medical Center (WAMC), Fort Bragg, North Carolina, USA. Three days of 12 hours shifts were selected during the peak hours of the ED and compared to the same period on days that did not have the intervention. Only patients categorized with an Emergency Severity Index of 2 or 3 were selected and compared. No additional medical, nursing and medic staff were used. This study was approved by the WAMC Institutional Review Board.
Results
In total, there were 241 cases during the trial period and 231 controls. Median times were significantly reduced (p=
Lunate and perilunate dislocations are rare in children, but should be suspected in patients with significant wrist swelling and decreased range of motion after trauma or falls on an outstretched hand.
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