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Biomedical subjects

A E Muñiz

Publications and source records attributed to A E Muñiz.

13 recordsLinked to original sources
PubMed2001

Acute gastrointestinal manifestations associated with use of crack.

Crack, the free-base form of cocaine, causes pulmonary, cardiac, obstetric, neurologic, musculoskeletal, and gastrointestinal complications. As the popularity for crack use increases, it follows that the number of cocaine-related emergency department (ED) visits, hospitalizations, and deaths should increase. We report 3 cases of patients arriving to the ED with acute onset of abdominal pain after smoking crack. These patients required surgical correction of their intestinal perforations. Although the exact pathophysiology of intestinal ischemia is not known, cocaine blocks the reuptake of norepinephrine, which leads to mesenteric vasoconstriction and focal tissue ischemia that may lead to perforation. The chronologic relationship of crack consumption to gastrointestinal perforation leads us to surmise that a possible crack-related ischemic event is the cause of perforation in these patients. Physicians examining patients with abdominal pain should be aware of the potential gastrointestinal complications of crack and consider bowel ischemia whenever a cocaine abuser presents with abdominal pain.

Acute Disease↗
PubMed2001

Management of febrile infants and children by pediatric emergency medicine and emergency medicine: comparison with practice guidelines.

OBJECTIVES: Management of febrile infants and children remains controversial despite the 1993 publication in Pediatrics and Annals of Emergency Medicine of practice guidelines. Our aim was to determine the management of febrile infants and children by pediatric emergency medicine (PEM) fellowship directors and emergency medicine (EM) residency directors and compare their approach with the published practice guidelines. METHODS: Four case scenarios were sent to 64 PEM directors and 100 EM directors in the United States and Canada, describing four febrile, nontoxic infants and children aged 25 days (case 1), 7 weeks (case 2), 5 months (case 3), and 22 months (case 4). Respondents were asked to select which laboratory tests and radiographs they would obtain and to decide on treatment and disposition for each hypothetical case. RESULTS: Ninety-two percent (53/64) of PEM directors and 64% (64/100) of EM directors responded (overall response rate 74%). Compliance with the guidelines (PEM/EM) was 54%/16% for case 1, 31%/6% for case 2, 35%/19% for case 3, and 20%/11% for case 4. Only 11% of PEM and 2% of EM directors followed the guidelines for all four cases. Overall, directors performed fewer laboratory tests, ordered more chest radiographs and treated fewer patients with antibiotics than the expert panel suggested. EM directors ordered more chest radiographs (cases 1-4) and admitted more patients (case 2) than PEM directors. CONCLUSIONS: There is poor compliance with published practice guidelines in the management of febrile infants and children among PEM and EM directors.

Acute Disease↗
PubMed2000

Chronic paronychia, osteomyelitis, and paravertebral abscess in a child with blastomycosis.

Blastomycosis is an unusual fungal infection in children. It is often a chronic infection characterized by granulomatous and suppurative lesions. Clinical manifestations include either pulmonary findings or disseminated disease. Disseminated blastomycosis usually begins with a lung infection that spreads to the skin, bones, and central nervous system. This is a case report of a child with chronic blastomycosis presenting with chronic paronychia, fever, cough, malaise, and back pain. The child underwent surgical drainage of a paravertebral abscess and administration of intravenous amphotericin B. He was discharged in good condition on oral therapy with ketoconazole. The literature on blastomycosis, with particular emphasis on clinical presentations and management, is reviewed. When the history and physical examination suggest a chronic granulomatous or disseminated disease, such as tuberculosis, the physician must include blastomycosis in the differential.

Abscess↗
PubMed2000

Prochlorperazine-induced extrapyramidal effects mimicking meningitis in a child.

Certain medications, such as the phenothiazines, may cause side effects that result in neck stiffness and may actually mimic the presentation of meningitis, especially in children. Despite the controversial use of antiemetics, they continue to be used in children with viral gastroenteritis. I describe the case of a child who had a febrile seizure and meningismus during the course of a viral gastroenteritis, not due to meningitis but to the untoward side effect of an antiemetic. Clinicians must be aware that these medications may cause extrapyramidal side effects that may mimic other more serious diseases and lead to unnecessary evaluations; therefore, their use cannot be strongly encouraged. If antiemetics are prescribed, physicians should emphasize possible side effects so that corrective treatment can be initiated promptly.

Antiemetics↗
PubMed1999

Unusual wrist pain: pisiform dislocation and fracture.

Injuries to the wrist can be challenging to the emergency physician. Injuries to the pisiform bone are rare entities, and their diagnosis may be delayed, increasing the morbidity to the patient. The report describes the cases of a 62-year-old woman with a pisiform dislocation and a 35-year-old man with a pisiform fracture. Excision of the pisiform bone was required in both cases, and both patients had good clinical response.

Accidental Falls↗
PubMed1999

Atlantoaxial rotary subluxation in children.

Traumatic torticollis is an uncommon complaint in the emergency department (ED). One important cause in children is atlantoaxial rotary subluxation. Most children present with pain, torticollis ("cock-robin" position), and diminished range of motion. The onset is spontaneous and usually occurs following minor trauma. A thorough history and physical examination will eliminate the various causes of torticollis. Radiographic evaluation will demonstrate persistent asymmetry of the odontoid in its relationship to the atlas. Computed tomography, especially a dynamic study, may be needed to verify the subluxation. Treatment varies with severity and duration of the abnormality. For minor and acute cases, a soft cervical collar, rest, and analgesics may be sufficient. For more severe cases, the child may be placed on head halter traction, and for long-standing cases, halo traction or even surgical interventions may be indicated. We describe two patients with atlantoaxial rotary subluxation, who presented with torticollis, to illustrate recognition and management in the ED.

Acute Disease↗
PubMed1998

Scapular dislocation.

Isolated dislocation of the scapula is a rare entity encountered in the emergency department. Two mechanisms have been proposed, a distraction injury to the arm or direct trauma to the posterior scapula. With blunt trauma, a search for adjacent injuries should be performed. Radiographs, especially anterior oblique views, will demonstrate lateral displacement of the scapula. Acute presentations should be managed by closed reduction, whereas for those presenting later or if the diagnosis is not initially suspected, open surgical reduction may be required. A case is reported of 32-year-old man with a scapular dislocation, and the literature is reviewed.

Adult↗