A Child With an Unusual Retained Oral Foreign Body.

BACKGROUND: Pediatric foreign-body ingestions are common. Oral foreign bodies are rare but can be life-threatening. Management of their extraction requires knowledge and careful consideration of removal techniques, pharmacology, and potential complications. CASE REPORT: A 5-year-old boy presented to the emergency department with a wooden block retained in his mouth after a fall. The block was lodged behind the patient's primary central incisors without causing apparent oral or dental trauma. Initial manipulation was unsuccessful given patient apprehension and muscle spasm. The patient was given i.v. diazepam for anxiolysis and muscle relaxation, and a tenaculum was used to extract the object. He was observed for a period of time and had no complications. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Retained oral foreign bodies in children require a careful approach and understanding of pharmacologic anxiolysis, as patients may not be candidates for moderate sedation. Emergency physicians must be aware of potential complications of oral foreign bodies, including palatal injury, temporomandibular joint dislocation, epiglottitis, and retained foreign bodies.

An Isolated Ureteropelvic Junction Injury Following a Low-impact Mechanical Fall.

OBJECTIVE: To describe the presentation of a rare isolated ureteropelvic junction injury resulting from a mechanical fall on ice. MATERIALS AND METHODS: A 71-year-old previously healthy man presented to the emergency department at the University of Massachusetts Medical School 3 hours following falling on ice with complaints of gross hematuria and flank pain. Patient records were accessed via the institution's electronic medical records system between March 22, 2018 and April 22, 2018. RESULTS: Abdominal imaging revealed urinary extravasation without evidence of accompanying injury to surrounding structures, confirming an isolated left ureteropelvic junction injury. CONCLUSION: Isolated ureteral injury following low-impact blunt abdominal trauma is exceedingly rare. Furthermore, this patient's presentation challenges the accepted conventions for both mechanism of injury and accompanying clinical factors in ureteral trauma.

The Association of Complementary Health Approaches With Mood and Coping Strategies Among Orthopedic Patients.

Background: Variation in pain intensity and magnitude of disability among patients with musculoskeletal illness is largely accounted for by variations in symptoms of depression, catastrophic thinking, and heightened illness concern. It is possible that patients with greater stress, distress, and less effective coping strategies might be more likely to seek the use of Complementary Health Approaches (CHA). This study addressed the primary null hypothesis that there are no demographic, illness-related, or psychological factors associated with CHA use among patients with upper extremity illness. Methods: A cohort of 170 patients completed a web-based Complementary and Alternative Medicine (CAM) questionnaire the Patient Reported Outcomes Measurement Information System (PROMIS) Depression and Pain Interference questionnaires. We evaluated differences between patients who sought CAM treatment regarding the PROMIS Pain Interference and PROMIS Depression scores. Ninety-four patients (56%) use or plan to use CAM treatment. A CAM provider was consulted by 61 patients (37%): most commonly a massage therapist (30/61), chiropractor (26/61), or acupuncturist (14/61). Results: In bivariate analysis patients who sought CAM reported greater average PROMIS Pain Interference than those who did not. In multivariable logistic regression, CAM use was associated with a higher Pain Interference Score and the specific surgeon. Conclusion: In conclusion, CHA use is prevalent amongst orthopaedic patients and associated with less effective coping strategies. Orthopaedic surgeons might consider asking patients about CHA use and determining whether those patients are interested in cognitive behavioral therapy.