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Original Article 

Evaluation of Empiric Management of Pediatric Community-Acquired Pneumonia

Christie L Clauss, Sherene Samu, Catherine R Messina, Edmund Hayes, Jeannene Strianse and Christy Beneri

Abstract

To assess if there was overuse of broad-spectrum antibiotics in the management of childhood community-acquired pneumonia (CAP). If evident, we sought to determine if proactive dissemination of the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America (PIDS-IDSA) guidelines by utilizing a Computer Physician Order Entry (CPOE) order set would increase adherence to the guidelines.

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Case Study 

Death following a Massive Subcutaneous Emphysema

Avisham Ramphul, Hariharan Ramaswamykanive and Charles Ekwebelam

Abstract

Subcutaneous emphysema is a relatively common finding in clinical practice. It rarely leads to fatalities. The few reported deaths in the literature have all been associated with pneumothorax. We present the case of a 61-year male who developed a fatal massive subcutaneous emphysema on a background of end stage Chronic Obstructive Pulmonary Disease with Type 2 respiratory failure.

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Research Article 

Antimicrobial Medical Textile - An Important Part of the Complex Infection Control Measures in the Burn Units

M đÉrgirova, M Leseva, I Perelshtein, A Gedanken and Eng Gencho Genchev

Abstract

Burn wound infections are one of the most important and potentially serious complications that occur in the acute period following injury. Infection and sepsis are among the most significant causative factors in burn related mortality and morbidity.

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Clinical Image 

Bedside Lung Ultrasonography in the Assessment of the Postoperative Atelectasis

Dominguez D, Gonzalez G, Viera D and Arias J

Abstract

Postoperative atelectasis may complicate the progress of patients after major abdominal surgery. Lung ultrasonography plays a key role in the diagnosis of lung consolidations (atelectasis, pneumonia, etc.) as it not only enables diagnosis at the patient's bedside, but also treatment response assessment in real time.

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Case Report 

The Unusual Presentation of Acute Appendicitis in Pregnancy

A Arnaout, N Aghtarafi, K Mann and GP Copland

Abstract

Acute appendicitis is the most common non-obstetric surgical emergency during pregnancy, and can be difficult to identify due to its unusual and inconsistent signs and symptoms.

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Case Report 

Acute Flank Pain in the Emergency Room: Rare Case and Review of the Literature

Abdullah Osman Kocak, Fatma Cakmak and Ilker Akbas

Abstract

Wunderlich syndrome is defined as spontaneous renal hemorrhage. Generally, the kidney mass may be due to secondary causes such as vascular pathologies. Wunderlich syndrome is rarely idiopathic.

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Case Report 

Haemorrhage Control Following Massive Pelvic Bleeding

Peyman Bakhshayesh

Abstract

Massive pelvic bleeding has a high mortality rate. Several measures like pelvic vessel ligations, mechanical stabilization of disrupted pelvic ring, pelvic packing, and pelvic angiography and ongoing embolization.

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Original Article 

Inadequate Pediatric Procedural Pain Management in the Emergency Room: A Policy Analysis

April A Bice

Abstract

Within the provisions of the Patient Protection and Affordable Care Act (PPACA) are specific guidelines on advancing science related to patient pain outcomes. Invasive painful procedures are a common part of pediatric nursing.

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Case Report 

Noninfectious Subcutaneous Emphysema of the Upper Extremity-Case Report and Review of the Literature

Ido Stahl, Natalia Puchkow and Daniel Dreyfuss

Abstract

Subcutaneous emphysema, defined as gas or air within the subcutaneous tissues is a rare diagnosis which may be attributed to trauma or surgery, perforation of respiratory or gastrointestinal tracts, high-pressure injection injury and factitious disorders.

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Research Article 

Challenges of Treating Methamphetamine-Positive Patients

B Phillips, M Shahid, H Safa, J Wu, S Snyder, L Turco, E Hale, W Weber, J O'Connor and J A Asensio

Abstract

Methamphetamines are addictive stimulants that induce dopamine release, a sense of euphoria, and increased libido. The effects of methamphetamine in inhibiting control of cognitive behavior and increasing arousability are thought to augment the potential for violence.

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Case Report 

Dropped Gallstones: A Case of Persistent Right Flank Abscess Requiring Surgical Management

S Reiter, B French, S Holzmer, Bradley J Phillips and Ryan J Martinez

Abstract

Gallstone spillage is not an uncommon occurrence during laparoscopic cholecystectomy. Once thought to be harmless, the consequences of dropped gallstones, including intra-abdominal abscess, are now recognized as a cause of significant morbidity. Additionally, patients with complications due to such an event may have delayed diagnosis due to remote, unusual presentation and failure of imaging to detect the gallstones. We report the case of a patient who presented with recurrent right flank abscesses.

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Case Report 

A Case Report and Literature Review of the de Garengeot Hernia

S Serio, L Turco, Z Hao and B Phillips

Abstract

Inguinal and femoral hernias are a common condition evaluated and managed by the general surgeon. The femoral hernia is less common of the two and carries a high risk of strangulation, mandating an urgent repair. An exceptionally rare finding is the vermiform appendix within the femoral hernia sac, known as a de Garengeot hernia. Herein we present a case and review of the etiology, incidence, and management of a de Garengeot hernia.

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RESEARCH ARTICLE 

Feeding Practices of Open Abdomen Patients: An Assessment of Energy Intake and Clinical Outcomes

Muhamad Elhusseini Hassan, Sameena Iqbal, Mostafa Alhaboubbi, Dan L Deckelbaum, Jeremy Grushka, Lyne Stlaurent, Eleanor Eckert, Tarek Razek, and Kosar A Khwaja

Abstract

The open abdomen (OA) procedure in the damage control setting has become more common. Optimizing nutritional support for OA patients continues to pose a challenge for surgeons. The objective of this study was to review current practices using the Penn State equation to determine if these critically ill patients were adequately fed.

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