Hydrogen sulfide poisoning from toxic inhalations of roofing asphalt fumes.

Hydrogen sulfide poisoning from inhalation of roofing asphalt fumes is a rare but devastating injury. Two cases of toxic inhalation involving exposure to several gases, including hydrogen sulfide, evolved from cooling asphalt, are presented. Both victims were treated with supportive measures, including 100% normobaric oxygen, and one also received sodium nitrite. In one patient rapid, complete recovery was temporally associated with nitrite administration. The patient not treated with sodium nitrite survived with apparently permanent severe neurological sequelae.

Pericardial tamponade after removal of an epicardial pacemaker wire.

Pericardial tamponade may arise from multiple traumatic and nontraumatic etiologies, resulting in unrecognized rapid deterioration and often death. A previously unreported case of pericardial tamponade after removal of an epicardial pacemaker wire is presented, demonstrating the everpresent potential for serious complications from seemingly innocuous invasive procedures.

Extensor tendon repair in the emergency department.

Extensor tendon lacerations of the hand are commonly seen in the emergency department. These injuries can often be definitively managed by the emergency physician who has a working knowledge of the complex extensor mechanism anatomy plus basic surgical skills. A thorough initial assessment including a tourniquet examination for adequate exposure is the key to making the complete diagnosis. Surgical indications, materials, techniques, complications, and postoperative management involved in extensor tendon repair are reviewed. The emergency physician's decision to treat or refer these injuries will depend greatly on the clinical setting, familiarity with the procedure, and the availability of and relationship with appropriate consultants.