Lumbar Paraspinal Compartment Syndrome in an Active-Duty Army Special Operations Aviation Soldier.

Lumbar paraspinal muscle compartment syndrome is an uncommon, rapidly progressive, and potentially devastating injury with fewer than 40 cases reported in the literature. It initially mimics nonemergent causes of low back pain, disproportionately affects young men, and is most often secondary to acute physical exertion. The disease process is commonly associated with rhabdomyolysis. Diagnostic tools include physical examination, measurement of lactate and creatine kinase levels, MRI, and direct compartment pressure measurement. While medical and nonoperative management strategies have been explored, the gold standard for treatment is emergent lumbar fasciotomy. Opioid and non-steroidal pain management, as well as physical therapy, are the mainstays of post-treatment recovery, with many surgical patients reporting complete symptom resolution at long-term follow-up. This article discusses the case of a 27-year-old, male, active-duty, Special Operations Aviation Soldier who presented to the emergency department and was found to have lumbar paraspinal muscle compartment syndrome.

Critical Hypophosphatemia in a Special Operations Combat Dive Candidate: A Case Report.

In contrast to shallow water (hypoxic) blackout and swimming-induced pulmonary edema (SIPE), acute electrolyte disturbance secondary to acute respiratory alkalosis is not considered a common Combat Swimmer injury but has the potential to be life-threatening. We present the case of a 28-year-old Special Operations Dive Candidate who presented to the Emergency Department after a near-drowning incident with altered mental status, generalized weakness, respiratory distress, and tetany. He was found to have severe symptomatic hypophosphatemia (1.00mg/dL) and mild hypocalcemia secondary to intentional hyperventilation between subsurface "cross-overs," causing subsequent acute respiratory alkalosis. This is a unique presentation of a common electrolyte abnormality in a highly specialized population that is self-limiting when caused by acute respiratory alkalosis but poses a significant danger to Combat Swimmers if rescue personnel are not able to respond quickly.

Facial Natural Killer/T-Cell Lymphoma: A Deadly Sinusitis Mimic.

Sinusitis and pre-septal cellulitis are common emergency department (ED) conditions, though rare and lethal mimics can present in a similar manner. We present a case of natural killer (NK)/T-cell lymphoma mimicking sinusitis and pre-septal cellulitis. Diagnosis of this condition may include imaging modalities such as CT and MRI, though definitive diagnosis requires tissue biopsy. Therapeutic interventions involve chemotherapy and radiation, with little role for surgical debridement. Complications in treatment can occur including hemophagocytic lymphohistiocytosis. Despite standard treatments, mortality remains high for cases of facial lymphoma.

Mysterious Cause of Respiratory Failure and Multilobar Atelectasis in a 17-Month-Old Male.

A 17-month-old male presented to a community hospital emergency department in respiratory distress suggestive of reactive airway exacerbation or pneumonia. He rapidly deteriorated into fulminant respiratory failure with multilobar atelectasis. He was managed with continuous albuterol, intravenous antibiotics, corticosteroids, intubation, and vasopressors. He was then transported to a tertiary Children's Hospital. The patient was extubated 20 hours after presentation and again developed respiratory failure while in the pediatric intensive care unit. During preparation for extracorporeal membrane oxygenation, he quickly stabilized following reintubation and bronchodilator therapy. He was extubated approximately 24 hours later, and subsequently discharged after a 9-day hospitalization. Outpatient investigation after discharge revealed dysphagia, milk allergy, and eosinophilic esophagitis. In this case, it is highly probable that aspiration secondary to dysphagia and eosinophilic esophagitis led to respiratory failure. This case demonstrates the possible rapid decompensation from aspiration due to insidious inflammation of the esophagus and dysphagia in an otherwise anatomically normal toddler.