Postcoital cyst rupture presenting as peritonitis and hemorrhagic shock: A case report.

INTRODUCTION: This report presents an unusual case of severe post-coital abdominal pain and signs of hemorrhagic shock requiring admission to a surgical intensive care unit (SICU) and emergent laparoscopy. This case was unique given the timing and progression of the patient's symptoms, as well as her age, surgical history, and symptomatic progression. Here we document the notable characteristics and treatment of this patient. CASE PRESENTATION: The patient presented to a local emergency department with signs progressive peritonitis and shock after an episode of non-traumatic intercourse. Her initial computed tomography (CT) scan showed signs of free fluid in the abdomen around the bladder and liver with no definitive source of bleed. She developed worsening shock with severe pain. She was then emergently transferred to a tertiary care center for evaluation by gynecology service and for general trauma surgery evaluation. She was further stabilized in the emergency department, and then admitted to the surgical critical care service. Following additional imaging, she received exploratory surgery with gynecology to control a hemorrhagic ruptured cyst. She remained stable and was discharged the next day. CONCLUSION: This case demonstrated a complication of an often-benign diagnosis, revealing the potential danger of underestimating this chief complaint, as well as the importance of understanding how minimal trauma can lead to cyst rupture.

Availability and use of medications by prehospital providers trained to manage medical complications of patients in hazardous materials incidents.

INTRODUCTION: Little is known about prehospital availability and use of medications to treat patients from hazardous materials (hazmat) medical emergencies. The aim of this study was to identify the availability and frequency of use of medications for patients in hazmat incidents by paramedics with advanced training to care for these patients. METHODS: A prospectively validated survey was distributed to United States paramedics with advanced training in the medical management of patients from hazmat incidents who successfully completed a 16-hour Advanced Hazmat Life Support (AHLS) Provider Course from 1999 to 2017. The survey questioned hazmat medication availability, storage, and frequency of use. Hazmat medications were considered to have been used if administered anytime within the past 5 years. For analyses, medications were grouped into those with hazmat indications only and those with multiple indications. RESULTS: The survey email was opened by 911 course participants and 784 of these completed the survey (86.1 percent). Of these 784 respondents, 279 (35.6 percent) reported carrying dedicated hazmat medication kits, ie, tox-boxes, and 505 (64.4 percent) did not carry tox-boxes. For those medications specifically for hazmat use, hydroxocobalamin was most commonly available, either within or not within a dedicated tox-box. Of the 784 respondents, 313 (39.9 percent) reported carrying hydroxocobalamin and 69 (8.8 percent) reported administering it within the past 5 years. For medications with multiple indications, availability and use varied: for example, of the 784 respondents, albuterol was available to 699 (89.2 percent) and used by 572 (73.0 percent), while calcium gluconate was available to 247 (31.5 percent) and used by 80 (10.2 percent) within the last 5 years. CONCLUSION: Paramedics with advanced training in the medical management of patients in hazmat incidents reported limited availability and use of medications to treat patients in hazmat incidents.