Lincoln Hospital

About: Lincoln Hospital is a healthcare organization based out in New York, New York, United States. It is known for research contribution in the topics: Population & Emergency department. The organization has 1033 authors who have published 929 publications receiving 14486 citations. The organization is also known as: Lincoln Medical and Mental Health Center & Lincoln Hospital.

Cervical Impalement Injuries: Principles of Management.

Abstract: A 52-year-old male was brought into the trauma bay by EMS after he was found to have an umbrella impaled into his left neck after an accidental fall on it. He was resuscitated in the trauma bay. He was handling his oral secretions with intact airway and had nonlabored breathing with equal and bilateral breath sounds. His vital signs were within normal limits. There were no hard or soft signs of penetrating neck trauma. An X-ray of the neck and chest was obtained. Hewas taken to the operating room with C-spine immobilized and one person holding the umbrella from outside to prevent relative motion of the foreign body. Once transferred to the operating table, a glide scope was used to intubate the airway. After airway control was achieved, the C-collar was taken off and the whole neck, including the foreign body, was prepped (Fig. 1). Multidisciplinary expertise (vascular surgeon, ENT, and IR) was sought in anticipation of injuries to the major neurovascular and aerodigestive structures of the neck. An incision along the anterior border of sternocleidomastoid was made and access to zone 2 of the neck was achieved. The carotid sheath was identified and proximal control of the common carotid and distal control of the internal carotid were obtained. The umbrella was gradually removed from the track using a gentle rocking movement using the handle from outside. After the umbrella was disconnected from the tract, the tract was explored. Interestingly, it was noted to traverse behind the carotid sheath, trachea, and esophagus and in front of the prevertebral fascia away from the spine and stopped at the level of the hypopharynx on the contralateral side. An intraoperative esophagoscopy was performed to look for any esophageal injuries. The esophageal mucosa appeared normal with no stigmata of injury. The tract was thoroughly irrigated and the wound was approximated. The patient was extubated in the Post Anesthesia care unit (PACU). Immediate post-op recovery was uneventful with preserved speech. He did not manifest any signs of injuries to Cranial Nerves IX, X, or XI after extubation. His sensorimotor examination of the upper extremity was intact with no suggestion of brachial plexus injury. His post-op recovery was uneventful. He was tolerating diet and was back to normal self at the time of discharge. At a follow-up examination in the clinic, his incision had healed and had a satisfactory post-op recovery. Impalement, a popular method of capital punishment in ancient times, is defined as the complete or partial penetration of human body by a rigid object with sharp or pointed tips. It qualifies as penetrating trauma with significant blunt force, usually the result of collision with great force. Epidemiology of impalement injuries is virtually nonexistent. Most of the descriptions of cervical impalement injuries are anecdotal and are at best case reports.1, 2 To the best of our knowledge, an umbrella impaled in the neck is not described in the English literature so far. Impalement injuries may be categorized into two groups: simple impalements by such objects as knives or arrows, and complex impalements, in which the patient is pinned or trapped by the impaling object. Simple impalements are easier to manage by the EMS as the objects generally do not interfere with patient assessment, packaging, and transport. However, in complex injuries, the object may need to be shortened by various tools such as bolt cutters, cutting torch, and saw so that the patient can fit in an ambulance.3 Whenever an object is trimmed, it is prudent to leave a handle for smooth and easy removal of the object later. In the prehospital and the ED, besides the ABCs, the key principle for managing an impaled object by EMS is not to remove it, but rather to stabilize it, if necessary.3 The rationale behind this approach is that removal of an object without vascular control (usually in the OR) can release the tamponading effect of the object and trigger a fatal hemorrhage. During transport or shifting, the object should be stabilized to prevent its Address correspondence and reprint requests to Suman B. Koganti, M.D., Department of Surgery, BLHC, Icahn School of Medicine at Mount Sinai, 1650 Grand Concourse, Bronx, NY 10457. E-mail: sumankoganti@gmail.com.

Getting the wind knocked out of him - Report of a broncho-cutaneous fistula caused by staphylococcal pneumonia, and review of literature.

Abstract: A broncho-cutaneous fistula (BCF) refers to the formation of an abnormal fistulous connection between the tracheobronchial tree and the cutaneous surface of skin. A rare occurrence in and of itself, the disease entity may have varied etiologies, and may or may not be associated with a broncho-pleural fistula. We describe a case of a young patient who developed a BCF as a complication of a necrotizing pneumonic process, and his subsequent clinical course. In so doing, we review the clinical features of this peculiar disease entity, analyzing the available medical literature similarities in etiology and variations in management strategies described in the literature thus far.

21 Hydroxylase Deficiency

Abstract: Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder, caused by the deficiency of one of the enzymes required for the synthesis of cortisol in the adrenal glands. 21-hydroxylase deficiency is the most common cause of congenital adrenal hyperplasia (more than 90% of the cases). Glucocorticoid and mineralocorticoid replacement are the mainstays of treatment.Prenatal diagnosis and treatment of affected females are very important, to minimize genital virilization. Because 21-hydroxylase deficiency is often undiagnosed in affected males until they have severe adrenal insufficiency, all US states and many other countries have instituted newborn screening programs that measure 17-hydroxyprogesterone concentration). Newborn screening can detect almost all infants with classic CAH and some infants with nonclassic CAH. Although false-negative results are uncommon, false-positive results are usually seen in premature infants; therefore, serial measurements of 17-hydroxyprogesterone are advised for premature infants. A positive newborn screening test for CAH must be confirmed by a second plasma sample (17-hydroxyprogesterone), and serum electrolytes should be measured. This activity highlights the diagnosis and treatment of 21 hydroxylase deficiency.