Spontaneous Femoral Artery Pseudoaneurysm Rupture in Systemic Lupus Erythematosus Patient

Femoral artery pseudoaneurysm, a very uncommon disease, is usually reported trauma, iatrogenic vascular intervention, and nail fixation in the treatment of fracture. The femoral artery is a major vessel for blood supply to the lower extremities. If the femoral artery is injured, the patient will experience cardiovascular collapse and hypovolemic shock due to massive hemorrhage. We report on the case of a 49-year-old male patient who had been diagnosed with systemic lupus erythematosus (SLE), who was admitted to our hospital with progressive swelling of the right thigh without any trauma history. A computed tomographic scan with arterial enhancement showed a large pseudoaneurysm of the right femoral artery, which was then treated successfully with great saphenous vein graft surgery.

A Patient with "Rebound Methemoglobinemia" during Treatment of Methemoglobinemia Caused by Propanil Intoxication

Methemoglobinemia results from the oxidation of ferrous iron (Fe++) to ferric iron (Fe+++) within hemoglobin. It is caused by various etiologies, including the herbicide Propanil. Patients with low levels of methemoglobin (metHb) are asymptomatic but symptomatic patients and patients with high levels of metHb require treatment. Methylene blue is the first choice for the treatment of methemoblobinemia, but has some complications such as hemolytic anemia and rebound methemoglobinemia. We report the case of a 91-year-old woman who died of aniline herbicides poisoning. The level of metHb in her blood was initially 20.7% and her mental status was drowsy. She was intravenously treated with methylene blue within a therapeutic range for methemoglobinemia. After treatment with methylene blue, the level of metHb decreased but later increased above 20%. Methylene blue treatment was repeatedly attempted, but the patient suffered from hemolytic anemia and rebound methemoglobinemia. The patient finally died from renal failure and cardiopulmonary collapse. We must be careful because methemoglobinemia can occur even when treated pesticides such as propranil.

A Case of Small Bowel Obstruction and Perforation by Anisakiasis

Anisakiasis is a disease that often occurs after the ingestion of raw marine fish infected with nematodes of the Anisakis genus. Ingested Anisakis causes a variety of symptoms, including abdominal pain, nausea, and vomiting, when they invade the gastric wall. Although invasion of the gastric wall is common, rare cases of Anisakis invading the small bowel have been reported. These rare cases have resulted in small bowel obstruction and perforation and usually require surgical treatment. A 57-year-old man visited the emergency room suffering from abdominal pain and distension. He ate raw marine fish three days prior and suffered from epigastrium pain a day after this meal. X-ray and computed tomography showed small bowel obstruction without adhesion and required an operation for treatment. A laparotomy revealed dilated and congested jejunum and ileum with perforated distal ileum. We found a small thin long worm, confirmed by histopathology as a member of Anisakis. The patient was discharged after surgery without any complication.

Validation of the Pentax-AWS Airwayscope as a Prehospital Intubation Device by Korean Level 1 Emergency Medical Technicians; A Simulation Study Using an Airway Training Manikin

PURPOSE: Tracheal intubation in the pre-hospital setting may be lifesaving in severely ill and injured patients. The aim of the current study was to evaluate whether use of the video laryngoscope, when used by Korean level 1 emergency medical technicians, resulted in faster or more secure facilitation of tracheal intubation, compared with the conventional laryngoscope with the immobilized cervical spine lying on the ground. METHODS: Thirty two level 1 EMTs working as 119 rescuers performed tracheal intubation on a manikin using the Macintosh laryngoscope (McL) and the Pentax-AWS(R) airwayscope (AWS) "on-the-bed" and "on-the-ground" in simulations with or without cervical spine immobilization. We compared intubation time, dental injury, and visual analog scale for both types of laryngoscope. RESULTS: In the McL trial, four participants failed on the bed, and 11 failed on the ground with cervical immobilization. In the AWS trial, all participants successfully secured the airway regardless of cervical spine immobilization both on the bed and on the ground. With the AWS, intubation time was not lengthened due to cervical spine immobilization either on the bed or on the ground. The AWS score was better than the McL on the visual analog scale in ease of handling the laryngoscope both on the bed and on the ground. And use of the AWS resulted in the lowest number of dental compressions. CONCLUSION: We conclude that the AWS is an effective and safe device for use in pre-hospital intubation with cervical spine immobilization, not only on the bed but also on the ground, when used by Korean level 1 EMTs. However, conduct of further studies is required in order to validate the clinical relevance of these findings.