Abstract Proceedings EROC 2011 - New York Osteopathic Medical ...

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EROC 2011 Abstract Proceedings – March 4, 2011 Dept. of Pediatrics, Good Samaritan Hospital Medical Center, West Islip, NY Title: The Life Vest Rubbed Him the Wrong Way Authors: Jacqueline Hernandez, DO, (1) Cynthia Rosenthal DO, (2) Howard Balbi, MD (3) Good Samaritan Hospital Medical Center West Islip, NY (1) Department of Medical Education, (2) Department of Pediatrics Division of Pediatric Critical Care, (3) Department of Pediatrics Division of Infectious Disease. Introduction: Staphylococcal Scalded Skin Syndrome (SSSS) is the most severe manifestation in the spectrum of Staphylococcus aureus exotoxin mediated diseases of the skin. The manifestations of SSSS are age related and they include generalized exfoliation in the neonate, and a scarlatiniform eruption and localized bullous impetigo in older children. Toddlers and older infants can have a combination of both in addition to flaky desquamation of the skin. Bacteremia is rare, but dehydration and superinfections may occur with extensive exfoliation. This report describes a child who presented with what initially was thought to be an allergic reaction but was found to have SSSS. Case presentation: A four year old male presented to the ED with the chief complaint of rash. Several days prior the child had been to a water park where he had been wearing a rented life vest. A rash had developed around his neck, axilla and abdominal areas corresponding to the vest pattern. The child then developed hives and was taken to a pediatrician, who diagnosed him with contact dermatitis, prescribing antipyretics, steroids and antihistamines. Later that day the child developed sloughing of the skin and was admitted to the PICU for IV hydration, antibiotic treatment and pain management. The diagnosis of SSSS was confirmed by a skin biopsy and positive skin, eye and throat cultures for Staphylococcus aureus. Discussion: Skin infections following water exposure may be caused by a wide variety of organisms. Local trauma or injury coupled with water exposure is a common theme in this type of infection. In this instance as the rash initiated at the areas where the skin was in contact with the vest, the initial diagnosis made was dermatitis. As the rash progressed it became more apparent that the child had developed SSSS. With appropriate treatment the child improved, and was discharged home. 32
EROC 2011 Abstract Proceedings – March 4, 2011 Dept. of Emergency Medicine, Good Samaritan Hospital Medical Center, West Islip, NY Title: Internal Decapitation: A New Perspective Authors: Jason Idelson DO, Eric Decena MD, Stephen Henesch DO Emergency Medicine Residency Program, Good Samaritan Hospital Medical Center, West Islip, NY Introduction: Annually, there are approximately 12,000 new cases of spinal cord injury in the United States. Motor-vehicle collisions account for almost half of the injuries. Patients who survive often face devastating physical immobility and a lifetime of related health issues. Case description: This is a case of a 42 year old male presenting after a high speed motor vehicle collision. He presented on a long board with spinal immobilization in place. He had a GCS of 6, thready pulses, tachypnea and tachycardia. The patient was subsequently intubated and aggressive resuscitation initiated. CT imaging revealed a solitary, large distraction injury at C6/C7. Our patient was stabilized, however, died approximately 48 hours later. Discussion: Internal decapitation, otherwise known as atlanto-occipital dislocation, describes a rare medical condition in which the skull separates from the spinal column during severe head injury. This case depicts a decapitation injury, however, at the C6/C7 level. While some may think this highlights the importance of cervical collars, there is growing evidence to support that utilizing these collars might cause increased harm through further distracting the spine. Recent research has proven that applying collars to atlanto-occiptal injuries actually increases the damage. In the most recent study in 2010, proper application of an extrication collar resulted in abnormal separation between these two vertebrae. In effect, application of an extrication collar resulted in separation of the head from the spinal column. This direction is in spite of the absence of proven benefit from spinal immobilization. Quite to the contrary, researchers have demonstrated that rigid spinal immobilization procedures can result in tissue necrosis, increased intracranial pressure, reduced pulmonary function and even death. It is this case which I feel further shows the increasing impact of motor vehicle collisions, and the need to further delineate the role of cervical collars at this time. 33
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