Adenosine, lidocaine and Mg(2+) update: teaching old drugs new tricks.

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Abstract

Conflict of interest statement: GD is sole inventor of the ALM concept for cardiac surgery, trauma and sepsis. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. 17. Cureus. 2023 Jul 28;15(7):e42609. doi: 10.7759/cureus.42609. eCollection 2023 Jul. Toxic Shock Syndrome After Orthopaedic Surgery. Fernandes SM(1), Luna A(1), Hall T(1), Madden B(2). Author information: (1)Critical Care Medicine, St George's University Hospitals NHS Foundation Trust, London, GBR. (2)Cardiothoracic and Intensive Care, St George's University Hospitals NHS Foundation Trust, London, GBR. Toxic shock syndrome (TSS) is a rare, life-threatening, acute multisystem disorder caused by exotoxin-producing streptococcal or staphylococcal bacteria. It is often characterised by pyrexia, diffuse erythroderma, malaise, confusion, and hypotension which may progress to multiorgan dysfunction and coma. A high index of suspicion along with immediate diagnosis and multidisciplinary management is required to improve the outcome of the disease. A 62-year-old male presented to the hospital a week after an open reduction and internal fixation of a left wrist fracture. He was confused, febrile, and hypotensive with a generalised maculopapular rash on admission. Surgical wound sepsis was a top differential diagnosis; however, other possible sources were considered. Diagnostic imaging and echocardiography effectively ruled out other possible aetiologies. Despite fluids, vasopressor support, and appropriate antibiotics, he showed no significant clinical improvement. Admission blood cultures grew Staphylococcus aureus and after a multidisciplinary meeting, he was taken to the theatre for wound exploration, debridement, and removal of the metal plate. He was eventually weaned off vasopressor support and recovered well. A high index of suspicion is important in recognising TSS in postoperative orthopaedic patients as wounds may appear healthy-looking and the onset of symptoms may be delayed. Early recognition, timely intervention, and multidisciplinary management are vital to the care of these patients. Copyright © 2023, Fernandes et al. DOI: 10.7759/cureus.42609 PMCID: PMC10460546