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After an exposure to any potential poison, the basic principles of assessment and stabilization of ABCD (Airway, Breathing, Circulation, Disability) still apply with the addition of an extra D for Decontamination. This includes removing any ongoing exposure or absorption by removing clothes that may be saturated with a toxin, irrigating the skin or manually brushing off cutaneous substances, and preventing further enteral absorption by using activated charcoal to bind the substance or to flush it out of the body using whole bowel irrigation. For some substances, certain patterns of toxicity known as toxidromes exist (See Fig. 28.1), and for some toxins, specific antidotes may be indicated in addition to supportive care (see Box 28.1) [1, 2].

An invasive Fusobacterium infection may originate from an apparent routine pharyngitis and lead to significant distant septic complications. Even without internal jugular thrombosis, the same mechanism of disease exists, and therefore, the same morbidity, prognosis, and treatments are applicable, hence the suitable term incomplete Lemierre syndrome. We present a case of invasive Fusobacterium infection that meets all criteria for Lemierre syndrome except lacking internal jugular thrombosis. A review of the literature that forms the diagnostic criteria for this syndrome and the rationale for our creating this novel term is presented.

Volume 2 • Issue 1 • 1000160 Trop Med Surg ISSN: 2329-9088 TPMS, an open access journal A 33 year-old man presented to the emergency department (ED) after intentional overdose of prescription drugs with concomitant cocaine and alcohol abuse. During assessment, he had a witnessed generalized tonic-clonic seizure that terminated after intravenous lorazepam administration. He was admitted to the Intermediate Care Unit for ongoing close monitoring due to persistently altered mental status. When more alert the following day he complained of bilateral shoulder pain with markedly restricted range of movement. An initial screening chest radiograph demonstrated bilateral anterior shoulder dislocations with an associated fracture of the left greater tuberosity (Figure 1). On further discussion a history of multiple bilateral shoulder dislocations with minimal force was elicited. He was reviewed by the orthopedic service that elected to perform closed reduction under general anesthesia and he was placed in bilateral shoulder immobilizers for 2 weeks. Operative repair was recommended.

When evaluating a dyspneic patient in the office, a quick initial assessment of the airway, breathing, and circulation, while gathering a brief history and focused physical examination are necessary. Most often, an acute cardiopulmonary disorder, such as CHF, cardiac ischemia, pneumonia, asthma, or COPD exacerbation, can be identified and treated. Stable patients who improve can be sent home, but those in acute distress with unstable or impending unstable conditions need to be transferred emergently to definitive care. Because of the difficult logistics involved in attempting to work up an outpatient for new onset of SOB, some patients will need to be transferred to the nearest ED for a definitive diagnosis.

A 49 year-old man with a past medical history of hypertension and tobacco use presented to the emergency department after being found by family with altered mental status. Over the previous few months he had experienced progressive fatigue and slurred speech. More recently over a period of days he had experienced flu-like illness with upper respiratory infection, nausea, vomiting and diarrhea with subjective hearing loss. He was subsequently diagnosed with Cryptococcus neoformans meningitis with fungemia due to idiopathic CD4 lymphocytopenia.