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
