Ping Pong Balls in the Lungs
​"She's worried I had a heart attack."That was the answer I got from the 70ish-year-old patient pointing at his wife when I asked why he came to the emergency department. She quickly added, "He had terrible pain four days ago on the right side, and now he gets winded when he walks."I had already seen his ECG, so I assured her that it appeared normal. I was going to order a chest x-ray, however, because his lungs sounds were pretty quiet. She said he had COPD, and wanted to know if he needed an inhaler.The last time I had seen something like this was in medical school 30 years ago. At that time, I was ...
Source: Lions and Tigers and Bears - October 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The Lunate That Died
​Everyone who works with me knows that I love joint radiographs, and the wrist is my favorite. It was no surprise when I came on shift that someone exclaimed, "I have an x-ray for you. I bet you will know exactly what it is! This 30-ish-year-old lady came in with atraumatic wrist pain."I did know exactly what it was. My eyes were drawn to the lucent lunate target. The patient was still in the ED, so I went to examine her hand. She had increased pain when I walked my fingers proximally down the metacarpal, which dipped into the carpal space. She was also not a fan of volar flexion or dorsiflexion. It made sense....
Source: Lions and Tigers and Bears - September 3, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

A Classic Pediatric Fracture
​"I have an 8-year-old who fell on the playground and now has elbow pain. Can you look at the x-ray?""Of course! Is it a supracondylar fracture?"Interrupting the pregnant pause, I cautioned, "You know, at the elbow, adults tend to break the radial head. Kids, on the other hand, usually break the supracondylar. A boy under 10 with a fall and hyperextended with an outstretched arm is likely supracondylar. The olecranon comes through the weakest link—the narrow part of the elbow's figure eight."When the lateral popped up on the screen, it was classic, showing the four signs of a supracond...
Source: Lions and Tigers and Bears - August 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The Weak Links
​"Can you look at a knee film?""Sure, what is the issue?" I was the coverage doc for Fast Track."It's a 15-year-old who hobbled in here with knee pain. Just before coming in, he was in football practice where he forcefully hyperextended his knee and heard a pop. Since then, he hasn't been able to bear full weight on the leg. He pointed to the fibular head area as the point of maximal pain. What do you think of the fibular head, and is that oval in the femur anything?""The femur oval is likely a benign bone cyst. The fibular head is probably OK, but it is a kid with growth plates. It is ...
Source: Lions and Tigers and Bears - July 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

One for the Win Column
​"The lab called with a critical value on the woman in bed 12. Her hemoglobin is 4.8," the nurse said.That didn't make any sense. The patient didn't look anemic or pale. She didn't seem to have symptomatic anemia. Maybe she had heavy periods."Do you want a type and cross?" the nurse asked."No, I can't believe that is right. Can you draw a new CBC? I'm going back to see her again," I replied.Thirty minutes later, the EMR showed the labs were back. There was no exclamation mark indicating something was amiss, and here's what I saw when I clicked the box. "The hemoglobin's normal&mdas...
Source: Lions and Tigers and Bears - June 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

How Low Did He Go?
​At sign-out, I thrust this VBG at my oncoming colleague.Me: What do you think of this?Colleague: 6.76. That is pretty low. DKA?Me: Nope, the sugar was 107.Colleague: Post code?Me: Not that either.Colleague: Did you intubate him?Me: No, I was scared that would kill him with a worsening acidosis if we don't get his respiratory rate fast enough.Colleague: Did he go to the ICU?Me: He went to tele.Colleague: What made him better?Me: Fluids and midazolam. A lot of midazolam—5 mg IM followed by 15 mg IV. He was brought in crazy agitated after a first-time seizure. I thought he had a toxic delirium or an intense post...
Source: Lions and Tigers and Bears - May 2, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Back on Track
​The 14-year-old girl said she was running when she suddenly developed knee pain. Shortly after, she had trouble walking. She said she had not fallen before the pain, and no one was around her when it happened.Her knee was modestly swollen and diffusely tender anteriorly, and she could not lift it off the bed because of the pain.I assumed I would see a high-riding patella from a patellar tendon rupture or a transverse patellar fracture. After 30 years in emergency medicine, I wasn't expecting to see something I had never seen before—a cortical disruption at the posterior aspect of the inferior pole of the kneecap. ...
Source: Lions and Tigers and Bears - April 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

That Gissane is Insane!
​The distracting arrow could not draw me away from the critical angle of Gissane. Most people think of the Böhler angle when considering calcaneal fractures but not me. The V created by the anterior and posterior facets is what draws my eyes . The comforting V can usually be spotted in nanoseconds. There was only discomfort on this view (and certainly for the patient): The Gissane is missing!You have to know normal to know abnormal, so here is a comparison.My patient had destroyed her calcaneus. It was obvious. The anterior and posterior facets were not even connected. There was no more Gissane angle!Tip to Remember...
Source: Lions and Tigers and Bears - March 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The Lesson from Three Parents of Children with Cancer
​I grabbed my cell phone to shut off the alarm even before I opened my eyes. As usual on a Sunday morning, I checked the news before my feet left the warmth of the covers so I wouldn't miss a disaster, a tragedy, a loss to remember in the prayers of the day. That day, the first Sunday of Advent, the news of President George H. W. Bush's death led the news. Tears came to my eyes as I read Marshall Ramsey's tribute to the 41st president in The Washington Post. (Dec. 1, 2018; https://wapo.st/2CqDJ8Q.) The cartoonist's tribute showed a TBM Avenger parked in the clouds with Barbara and Robin Bush waiting for his arrival.I had...
Source: Lions and Tigers and Bears - February 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

When Time Stands Still
​It was 6:30 a.m. It should have been easy to dispo the patient with elbow pain by the end of my shift at 7. He had continued pain and swelling, seemingly mostly in the olecranon area. The resident had already put in the x-ray order. A few minutes later, time stopped when I pulled up his lateral. Two decades as a nocturnist without radiology backup for reading plain films has led to my mantras: You have to have a framework to read your x-rays, and my colleagues have to mop up my errors if I don't get this right. It takes time from their patient care, and it makes me look bad.I have an unwavering stepwise approach wi...
Source: Lions and Tigers and Bears - December 31, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Name This Injury with One Clue
​TV game shows were all the rage in the '70s. I particularly liked one that had contestants bid against each other on the lowest number of notes they needed to guess a song after the host gave them a clue. Once in a while, one of the players would say, "I can name that tune in one note." Often, they did! I thought they must have known the answer before the piano player struck that one key.I like to play a similar game with radiographs. Can you name the abnormality in one radiograph with just one clue? Here is the clue: This 9-year-old girl complained of wrist pain after falling on her outstretched right arm.Thi...
Source: Lions and Tigers and Bears - December 3, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

A Rare Fracture
​Colleague: Do think that is broken?Me: Yep.Colleague: Have you ever seen that before?Me: No. Still it is broken. How did he do that?I've been writing this blog long enough that most people I work with know I love the unusual, unexpected, and even classic radiographs. Most also know that I think emergency medicine is the best of all specialties. There is always a chance of something new, something I have never seen before. We are always learning. Thus, I was drawn in by these radiographs of a patient complaining of pain at the base of his thumb after a motor vehicle crash.Typically, the hand has re are five sesamoid bone...
Source: Lions and Tigers and Bears - November 1, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

A Textbook Case
​We went together, the med student and I, to check the eye complaint of a man who had been assaulted a few hours before. The student quickly decided we needed a facial CT to rule out a fracture. I asked him what kind of fracture he suspected; an orbital blowout fracture, he said.I asked the patient to look toward his nose, and a prominent lateral subconjunctival hemorrhage popped prominently into view. This is truly a red flag for a more complex midface fracture. Finding zygomatic arch tenderness, I wondered aloud if our patient had a zygomaticomaxillary complex fracture.There seems to be little need to have a framework ...
Source: Lions and Tigers and Bears - September 30, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

A False Appearance of Fine
​Like a million times before, the tech thrust an ECG in front of you. This one, however, grabbed every neuron's attention. Who was this?​The tech says the patient is a 70ish-year-old diabetic, hypertensive man brought to the emergency department because he has been feeling weak from a couple days of diarrhea.Where was he? Was he talking? What was his blood pressure?The tech pointed at one of the back rooms, and said, "Oh, his blood pressure is good—138/71, and he is talking to his family."He did look pretty good. His heart rate was 37 bpm as he chatted with his family. Staring back at the ECG, I think m...
Source: Lions and Tigers and Bears - August 31, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

See Me Now
​A young woman with known psychiatric illness and a tendency toward self-injury was sent to the emergency department for medical clearance. She had presented in the past after ingesting objects, so an upright chest and KUB radiograph were obtained.​Nothing unusual popped out at first glance, but it was an entirely different story when magnified in a dark room. The sharp square edge extending beyond the vertebral body was impossible to miss. The four holes confirmed she had almost certainly swallowed a razor blade. Inversion made it even easier to see.​Identifying the object is only half the battle. What is the next s...
Source: Lions and Tigers and Bears - August 1, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Look for the Signs
​An AP image of a shoulder flashed up on the screen. My colleagues often bring me interesting, rare, difficult, and classic cases because I write this blog. All are intellectually stimulating cases that remind me of the exciting parts of being an EP. It's a challenge to see how many clues I can find to make the diagnosis. These short interactions also help me form stronger bonds with my colleagues, a bonus for my interest in wellness.​First, my eyes were drawn to the wide glenohumeral interval. The space is huge (yellow lines in photo below). The glenoid appeared vacant. It also showed the rim sign where the glenoid ri...
Source: Lions and Tigers and Bears - July 2, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Inspiratory Stridor and Diaphoresis Spell Emergency
​My relief had arrived, and we were just starting sign-outs. The resident broke in, "This guy with the sore throat. I think he's sick!" Glancing up from the computer, she continued. "He's barely talking. He has inspiratory stridor. And he is sweaty."​The resident had me at inspiratory stridor. Diaphoresis on a chilly morning in our ED was just icing on the cake. Intrigued and concerned (we did not have ENT or an open OR at that time in our shop), I followed my oncoming colleague to the bedside. The experience was just as sphincter-tightening as the description. The 20ish-year-old man sitting bolt up...
Source: Lions and Tigers and Bears - June 1, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Fractured? No, Crushed
​"Doc, I broke my foot about three months ago and was in a boot. Tonight I was in a fight. When I went to kick, I twisted my foot. I can walk, but wanted to come in to get it checked out."​Simple. Straight-forward. X-ray ordered.My eyes were rapidly drawn to the two gaping fracture lines—one posteriorly in the calcaneal tuberosity and the other extending from the posterior facet through the subtalar joint to the plantar surface. Böhler's angle confirmed what can be seen intuitively: This calcaneus was crushed.​Böhler's angle is formed from two intersecting lines coming together at the apex o...
Source: Lions and Tigers and Bears - April 30, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Golfers Never Bitch (or the Rodney Dangerfield of Bones)
​The scapula is truly the Rodney Dangerfield of bones: It gets no respect. Every chest x-ray we see gives us two chances to embed in our minds what normal looks like. Few avail themselves of this opportunity. In fact, most do not have any systematic process to look at this bone at all. That will change today!​A 59-year-old man fell down some steps, landing on his left shoulder and upper back. He presented with pain in that area and difficulty lifting his left arm.The wrist has a well-known mnemonic—Some Lovers Try Positions That They Can't Handle—to remember the order of the carpal bones. I'm proposing a br...
Source: Lions and Tigers and Bears - April 2, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

It’s in the Urine
​"I just put a young woman in her mid-30s back in room 9," the triage nurse said. I made a mental note that that was the GYN room. The nurse continued, "She feels bad, fatigued, and just not right in her stomach." The obvious question flew from my mouth. "Is she pregnant?"​"I have the urine, but the quality controls are being run now, so it will be a few minutes."I glanced at the EMR before heading back to the room: normal vitals, no fever, no medications, a couple of kids, no surgeries, last period three weeks before. Not much there to go on, but I could see her while waiting fo...
Source: Lions and Tigers and Bears - February 28, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

DOTT Your ETs, and Cross Out Your DOPES
​The high-pressure alarm continued to ring. Endotracheal tube (ET) in place? Check. ET tube suctioned without problems? Check. Tubing not kinked and ventilator OK? Check. Chest x-ray? Ordered.​This is probably not something you ever want to see: a complete pneumothorax in a patient with an endotracheal tube. Breath entering the lungs under pressure has a high likelihood of making the collapse worse, eventually progressing to a tension pneumothorax. When the vent is screeching that high-pressure alarm, think DOPES and DOTTS.DOPES stands for the causes:D          Dislodged ET tubeO...
Source: Lions and Tigers and Bears - January 31, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The Link Between DOACs and Cancer
​A middle-aged woman was started on a direct oral anticoagulant (DOAC) for an upper-extremity deep venous thrombosis two weeks before presenting to the emergency department. She reported that she had coughed up some blood. She had never had blood clots before and had no other testing.​The whole thing was strange and concerning.Only about 10 percent of DVTs are in the upper extremity. (Circulation 2012;126[6]:768.) One can divide them into primary (or provoked), secondary, or idiopathic. Primary ones are usually related to effort, particularly those who are performing repetitive overhead movement or have thoracic outlet...
Source: Lions and Tigers and Bears - January 2, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

No Fracture, No Problem?
​"It's been hurting for months, but now I'm really having pain and difficulty walking too."​The resident relayed those words said by a 60ish-year-old woman in our emergency department. Now the resident was waffling over whether to get an x-ray. On one hand, ordering radiographs will increase her length of stay, and will certainly not show a fracture. On the other hand, the patient's satisfaction might improve by taking some pictures. The resident decided to do the x-ray; adding it probably won't help much anyway.​The AP film seemed to confirm his fear of wasted time and resources.When the lateral popped up ...
Source: Lions and Tigers and Bears - December 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Two Views are Better than One
A middle-aged man was found on the highway. A concerned passerby called 911, and then EMS made him a patient of mine. Approaching the stretcher, the aroma of alcohol permeated the air. Such is my life as an inner-city nocturnist.This patient was a little different, though. He said he had been short of breath before passing out. Peeking out from the bottom of the sheet was an ankle boot. The patient provided little assistance with his history. His exam was otherwise completely normal.Just that week at the mortality and morbidity conference, a case bearing similarities struck terror in our hearts. A middle-aged man with a le...
Source: Lions and Tigers and Bears - November 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

A Case of Missing Teeth
​An older man presented to the emergency department for respiratory complaints, and a routine series of studies—blood work, ECG, and a chest x-ray—almost automatically appeared in the orders.​Haziness on the left side—left hilar fullness probably isn't good. A CT scan would likely confirm the fears of cancer.​The large mass wasn't unexpected, but did you see the metallic foreign body in the stomach? There was something on the left side under the diaphragm on the upright chest radiograph. The same thing appeared on the coronal CT image. Did he swallow something?Upon detailed questioning, the patient ...
Source: Lions and Tigers and Bears - October 2, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Don’t Forget that You Can Help
​Working in emergency medicine, I sometimes look through the retrospectoscope and think, "Next time I'm going to do that differently." There are cases where it's excruciatingly painful to look back and imagine what could have been. Others come with a sigh of relief knowing that I dodged a bullet but may not be so lucky in the future. This case was one of them.​It was the middle of the night. Walking into the room, the patient looked pretty good. It was a pleasant surprise, given the trepidation that came over me during the mid-shift sign-out, leaving me the only attending for the rest of the night.​The hand...
Source: Lions and Tigers and Bears - September 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Exactly What the Patient Said
​"I have tonsillitis," claimed the 20-something young woman who showed up at 2:30 a.m. because the pain was keeping her awake. She pointed dead midline between her chin and hyoid bone when asked the location of the pain. The back of her throat looks normal: uvula midline, no exudates, no vesicles, normal voice, and handling secretions. But the midline.... Should I be worried? The epiglottis sits right there. Before the Hib vaccine, it used to be almost all kids, but these days adults get epiglottitis. What to do? Soft tissue lateral neck? CT? Discharge?​I went with a soft tissue lateral neck, which was not at...
Source: Lions and Tigers and Bears - August 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Hidden Hip Fractures
​An elderly woman arrived via ambulance at the emergency department after being knocked to the ground. Right hip pain prevented her from getting up. She had bilateral hip replacements, and was concerned that the right one could have come out of place. The area she indicated didn't seem dislocated. There was range or motion of the hip, and the leg was not shortened. Certainly, x-rays would confirm this.​The prostheses were intact. She had neither a hip fracture nor a dislocation. The patient still complained of pain, and was unable to ambulate. On closer inspection, the right superior pubic rami's inferior aspect had a ...
Source: Lions and Tigers and Bears - July 3, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Fractures are Not the Only Bone Injury
​A ballplayer had jumped and stretched for the ball but missed. Descending toward the ground, he put out his right hand to protect his face from hitting the pavement. The pain in the hypothenar eminence and lateral wrist was immediate, but he thought he could shake it off. A few hours later, though, he came in with pain in the lateral wrist, difficulty with full supination, inability to bear weight on the ulnar-deviated wrist when placing his hand on the bed and trying to push himself up, and a superficial abrasion on the hypothenar eminence.​Hypothenar eminence sports injuries are well known to be the cause of pisifor...
Source: Lions and Tigers and Bears - June 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

A Matter of Perspective
​I have a passion for interesting x-rays. All of my colleagues know that by now. I'll have just arrived in the ED for my night shift and still be shoving my backpack under the counter when I'll hear a not-so-uncommon comment, "We had a great case today." These stories always energize me. The sharing, the learning, the awesome pickup, the right fight for the patient all remind me of why we do this job.The signing out doc (knowing my absolute favorite thing is a wrist radiograph) recently popped open some radiographs on the computer, announcing, "You are going to love this."I scanned the AP and oblique ...
Source: Lions and Tigers and Bears - May 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Mind the Gap and Smile
​A man came to the ED in the middle of the night saying he was jumped and struck on the knee with some object. He complained of severe pain, difficulty ambulating, and swelling. When the tech tried to get the standard series of four knee views, the patient said he couldn't do more than one, at least not without more pain meds. The tech, arms crossed, asked me what I wanted to do. "Do you want to give him more meds, and I'll try again?" he asked.​Popping the sole image up on the screen, I said, "I'll give him more pain meds because he almost certainly has a tibial plateau fracture. I'm going to send him f...
Source: Lions and Tigers and Bears - March 31, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Mind the Gap and Smile
​A man came to the ED in the middle of the night saying he was jumped and struck on the knee with some object. He complained of severe pain, difficulty ambulating, and swelling. When the tech tried to get the standard series of four knee views, the patient said he couldn't do more than one, at least not without more pain meds. The tech, arms crossed, asked me what I wanted to do. "Do you want to give him more meds, and I'll try again?" he asked.​Popping the sole image up on the screen, I said, "I'll give him more pain meds because he almost certainly has a tibial plateau fracture. I'm going to send him f...
Source: Lions and Tigers and Bears - March 31, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

An Aunt Minnie in Hand Injury
​An afebrile diabetic patient came in a week after a drawer was slammed on his hand. He insisted that his hand wasn't broken but hurt much more now than it did when it was initially injured. Do you know the disposition just by looking at the picture?I did. It was an Aunt Minnie. I gave him IV antibiotics, admitted him, and arranged a visit to the operating room for him.The origin of the term Aunt Minnie is somewhat unclear, but it definitely came from radiology. The literature claims that Edward B. D. Neuhauser, MD, a chief radiologist at Boston Children's Hospital, coined this term to mean something so visually distinct...
Source: Lions and Tigers and Bears - March 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

A Bullet with a 90-Degree Turn
​"Anything interesting last night?" my colleague asked.​"Yeah, take a look at this. Tell me how this happened." I popped an image up on the screen for the oncoming doc to see.Noting the air in the soft tissue, he guessed, "Shot by someone lying on his back on the ground?""That would explain how the bullet started at the elbow and ended at the clavicle. But if that were true, how did the bullet make a 90-degree turn?" I asked.My colleague shrugged. I didn't know either. After the patient told me what she was doing, I felt foolish that I hadn't tried to put the two points on the sa...
Source: Lions and Tigers and Bears - February 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Rare Stones
​A middle-aged traveler came to the emergency department with her son. He said his mother did not have a medical history because she rarely saw a doctor. She had been having intermittent abdominal pains, however, so he brought her to the emergency department.​There was little to go on, so why not try a bedside ultrasound to see if there are any clues? Surprisingly, shadowy objects showed up in the bladder.The abdominal flat plate confirmed two giant, egg-shaped bladder calculi. Bladder stones are uncommon, accounting for only five percent of all urinary tract stones. It is believed that bladder calculi have had a ...
Source: Lions and Tigers and Bears - January 3, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Rare Stones
​A middle-aged traveler came to the emergency department with her son. He said his mother did not have a medical history because she rarely saw a doctor. She had been having intermittent abdominal pains, however, so he brought her to the emergency department.​There was little to go on, so why not try a bedside ultrasound to see if there are any clues? Surprisingly, shadowy objects showed up in the bladder.The abdominal flat plate confirmed two giant, egg-shaped bladder calculi. Bladder stones are uncommon, accounting for only five percent of all urinary tract stones. It is believed that bladder calculi have had a ...
Source: Lions and Tigers and Bears - January 3, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Beware of Unhealed Disruptions
​A middle-aged man came to the ED for a separate complaint, but his wife was very concerned about his wrist. He said he had injured it several years earlier but never followed up on the injury. Since then, he had been experiencing increasing stiffness and pain. His wife said he could hardly move his wrist. She wanted an x-ray and hoped that something could be done.My first thought as the image appeared on the screen was, "That's not normal." It was difficult even to identify where the lunate was. The capitate also seemed to have driven its way down through the proximal row. There was a massive disruption of Gil...
Source: Lions and Tigers and Bears - December 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Look Beyond the Surface
​"I have this older patient who fell on his buttock at home. He has shoulder pain even though he didn't come down on the shoulder, but he was diagnosed with adhesive capsulitis here within the past month. He has x-rays and is going to see the orthopedist this week. I was only going to x-ray the hips. What do you think?"​"Let me take a look," I said to my resident while pulling up the old images.The glenoid fossa was completely obliterated. The bony destruction seemed to have extended as far medially as the coracoid process. The joint space was also impressively widened.I cautioned the resident to th...
Source: Lions and Tigers and Bears - November 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs