A 39-Year-Old Woman with Cervicofacial and Mediastinal Emphysema 10 Hours After an Elective Lower Molar Dental Extraction.

BACKGROUND Mediastinal emphysema, also called pneumomediastinum, is a very infrequent condition in patients reporting to an Emergency Department. Mediastinal emphysema is the pathologic presence of free air enclosing the mediastinal structures. In the case of chest pain in a young healthy adult, pneumomediastinum as a differential diagnosis will undoubtedly be omitted. This would be especially likely if the symptoms are not preceded by an injury, intense vomiting, or an infection in this area. CASE REPORT We present a case in which a previously healthy 39-year-old woman experienced painless progressive face and neck swelling, dyspnea, and retrosternal pain several hours after a dental procedure. Physical examination revealed crackles on palpation of the skin on the right part of the face, neck, and chest. Neck and chest computed tomography confirmed subcutaneous neck and upper chest emphysema and pneumomediastinum. The patient was transferred to the thoracic surgery ward. After 2 days of prophylactic intravenous administration of antibiotics, she was discharged for further scheduled treatment at the Maxillofacial Surgery Clinic. CONCLUSIONS This report presented a rare case of a woman who reported to the Emergency Department with subcutaneous and mediastinal emphysema following routine molar dental extraction. Emergency Department physicians should be aware of the possibility of delayed complications after standard dental procedures. A detailed medical history and clinical examination will enable making a correct diagnosis so as not to jeopardize the health of a patient, and in the case of the development of mediastinitis, even the patient's life.

Management of Patient with Simultaneous Overt Gastrointestinal Bleeding and Myocardial Infarction with ST-Segment Elevation - Priority Endoscopy.

BACKGROUND: The current ERC guidelines are the source of many positive changes, reduction of mortality, length of hospitalization and improvement of prognosis of STEMI patients. However, there is a small group of patients whose slight modification in guidelines would further reduce in-hospital mortality and hospitalization costs. These are patients with concomitant STEMI infarction and gastrointestinal bleeding. METHODS: Two separate methods of treatment were compared in patients with concomitant gastrointestinal bleeding and ST-segment elevation myocardial infarction. The first - traditional approach, in the line with the ESC guidelines, the second innovative, with priority for endoscopy. RESULTS: Despite the innovative approach, the patient with endoscopy before PCI was discharged without complication. A patient who has undergone coronary intervention and who has been started on typical antiplatelet therapy prior to gastroenterological diagnosis has died due to massive bleeding. CONCLUSION: For ethical reasons and in connection with the cardiological guidelines of the management of ACS, a study of patients with ASC a high risk of intestinal bleeding, in which endoscopy will have priority, and only later PCI, will probably never be performed. Although, as the described case shows, despite exceeding the 90 minutes time to implement PCI (<120 minutes) in logistic terms such behavior is completely feasible.