RESUMO
Centipede bites occurring in tropical countries are rare, however vigilance must be exercised during activities in the open air and dwellings should be checked in the event of rain. The bite is very painful and can be accompanied by generalised signs. An initial wound disinfection and a check of antitetanus vaccination status is all that is usually needed to ensure an uneventful outcome. There are however, rare cases where local toxicity and a bacterial super-infection, often with Gram+ cocci, can lead to a cellulitis or even necrotizing fasciitis of the hand. The diagnosis of a centipede bite can be made by the double marks made by the fangs. Wound debridement and antibiotics led to a good outcome in both our cases.
Assuntos
Braço , Artrópodes , Mordeduras e Picadas/complicações , Celulite (Flegmão)/microbiologia , Fasciite Necrosante/microbiologia , Infecções Estafilocócicas/etiologia , Adolescente , Idoso de 80 Anos ou mais , Animais , Feminino , Humanos , MasculinoRESUMO
We report a case of anterior thigh compartment syndrome (TCS), which occurred after a closed femoral fracture internal fixation using an intramedullary rod. A 20 ml ropivacaine hydrochloride single-injection femoral block had preceded general anaesthesia to conduct the surgical procedure. The compartment syndrome diagnosis was made the morning after surgery when the level of pain was interpreted as disproportionate to the treated lesion; in addition, compartment pressure measure had increased to 54 mmHg. A compartment fasciotomy was performed. Diagnostic delays have previously been observed and attributed to nerve blocks in cases of tibial fracture. This patient's report raises the question of whether a femoral block may be responsible for delays in diagnosing compartment syndrome, although no series have been published of such occurrences in large numbers. When nerve blocks are used, they should be more analgesic than anaesthetic. Careful patient monitoring remains important.