Esophageal perforation following use of esophageal obturator airway (EOA).

Esophageal perforation following use of the esophageal obturator airway (EOA) has been reported in a small number of patients. However, it has generally been discovered only in the presence of obvious clinical signs in patients otherwise resuscitated from cardiac arrest. Since it may well be overlooked in patients who succumb following the combined insult or primary cardiac arrest and secondary esophageal perforation, the true incidence of this adverse consequence of EOA use is unknown. We present a case of esophageal intubation with the EOA, and review in detail previous reported cases. We further suggest possible mechanisms leading to this catastrophic consequence of intubation with the EOA, and comment on its significance with regard to the controversy over EOA versus endotracheal (ET) tube training for paramedic pre-hospital personnel.

Neurologic complications following immobilization of cervical spine fracture in a patient with ankylosing spondylitis.

Axial traction is widely recommended for stabilization of cervical spine fractures. This procedure may be inappropriate and even dangerous in patients with long-standing ankylosing spondylitis (AS). We present the case of an 80-year-old woman with AS who fell at home and suffered an unstable large C5-C6 fracture/dislocation associated with left-sided weakness and decreased sensation. Medical treatment included placing her neck in a neutral position, despite her preference for neck flexion. This procedure increased her pain and paresthesias; the complications decreased, but did not entirely resolve, when the patient resumed a semi-flexed position. This patient's neurologic sequelae may have been exacerbated by attempts to stabilize her neck in a neutral position. Standard stabilization recommendations should be appropriately altered in some patients with cervical spine AS.

Traumatic dislocation of the hip.

Traumatic dislocation of the hip (TDH) is an absolute orthopedic emergency that is increasing steadily in incidence. Sixty-two to ninety-three percent of reported cases were the result of high-speed motor vehicle accidents in which seat belts were not used. Post-TDH complications and morbidity, particularly femoral head necrosis, are related to the severity of injury, skeletal maturity, and duration of dislocation. Prompt, gentle reduction within 12 hours remains the cornerstone of successful therapy. In a variety of other clinical condition, TDH may be masked, and specific appropriate evaluation is thus necessary to detect the occasionally occult TDH. The regular use of seat belts would virtually eliminate this injury.