Eye Spy a Laceration
I tucked my backpack under the counter as I arrived for my night shift, and a palpable angst descended over my left shoulder. As I started to turn around, I panicked, thinking I'd hear something along the lines of, ""I want you to come now!" Instead, the triage nurse whispered, "Can you see this eyelid laceration I brought back?" A picture is worth a thousand words, or in this case, just one: Transfer.Clearly, the blow from a ringed fist caused more damage than our shop without ophthalmology could handle. The medial vertical laceration from orbital rim to orbital rim tearing through bot...
Source: Lions and Tigers and Bears - February 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Never Be Satisfied
It was a typical Friday night. A fight breaks out. It all happened fast, and now there's pain. What's wrong with this shoulder?
To figure it out, follow a deliberate sequence: acromion, coracoid, glenoid, borders of the body and spine.
Everything is fine until you get around to the superior border where you find an obvious cortical break and a wide lucency.
Diagnosis: Superior Scapular Fracture
But wait! There's more!
Too often, folks stop looking once their search is satisfied by the fracture. But ligamentous injuries are common companions. Make sure you check the acromioclavic...
Source: Lions and Tigers and Bears - January 4, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The Situation
Shortly after starting my night shift, a nurse motioned me into the med room whispering, “We have a situation.”
It seems that in throes of a passionate recreational activity, a couple’s handcuff key fell into a heating vent. Having not been able to retrieve said key, an embarrassed pair decided (perhaps after Googling advice from others who have shared this predicament) that the police were the best bet for assistance. Despite the Internet’s assurance of "universal" handcuff keys, the officers could not free the fettered lovers, but they were able to provide transportation to the emergency department...
Source: Lions and Tigers and Bears - December 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The Situation
Shortly after starting my night shift, a nurse motioned me into the med room whispering, “We have a situation.”
It seems that in throes of a passionate recreational activity, a couple’s handcuff key fell into a heating vent. Having not been able to retrieve said key, an embarrassed pair decided (perhaps after Googling advice from others who have shared this predicament) that the police were the best bet for assistance. Despite the Internet’s assurance of "universal" handcuff keys, the officers could not free the fettered lovers, but they were able to provide transportation to the emergency department.
...
Source: Lions and Tigers and Bears - December 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Uncorked
An elderly, "hyperventilating" man with no past medical history was brought by EMS to the emergency department because he had been feeling sick and weak for at least a week. A venous blood gas with critical care panel, an Accu-Chek, and an EKG were obtained.
Accu-Chek: 110
Venous blood gas: pH 7.23, bicarb 7, potassium 9.4
As expected, this patient was in renal failure, and impressive renal failure at that, with a BUN of 278 and a creatinine of 32.5. The kitchen sink of temporizing measures were thrown at him, and a procedure was performed.
Which procedure? Dialysis? No, he had a Foley c...
Source: Lions and Tigers and Bears - November 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Uncorked
An elderly, "hyperventilating" man with no past medical history was brought by EMS to the emergency department because he had been feeling sick and weak for at least a week. A venous blood gas with critical care panel, an Accu-Chek, and an EKG were obtained.
Accu-Chek: 110
Venous blood gas: pH 7.23, bicarb 7, potassium 9.4
As expected, this patient was in renal failure, and impressive renal failure at that, with a BUN of 278 and a creatinine of 32.5. The kitchen sink of temporizing measures were thrown at him, and a procedure was performed.
Which procedure? Dialysis? No, he had a Foley catheter pl...
Source: Lions and Tigers and Bears - November 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Boxer's Fracture
It's Saturday night, and the next patient in the rack has hand pain. A young man watching the game at a local bar hit a wall when an argument broke out. One glance at the swelling of the lower lateral aspect of his dorsal hand, and the diagnosis is virtually certain. He has a boxer's fracture. Clearly, the force of the fist against an immovable object caused the proximal fifth metacarpal to break.
Shockingly, the expected fracture was missing on the first film. The metacarpals were completely intact! The lateral and oblique gave the answer, however.
This patient has a fracture of the body of the hamate ...
Source: Lions and Tigers and Bears - October 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Boxer's Fracture
It's Saturday night, and the next patient in the rack has hand pain. A young man watching the game at a local bar hit a wall when an argument broke out. One glance at the swelling of the lower lateral aspect of his dorsal hand, and the diagnosis is virtually certain. He has a boxer's fracture. Clearly, the force of the fist against an immovable object caused the proximal fifth metacarpal to break.
Shockingly, the expected fracture was missing on the first film. The metacarpals were completely intact! The lateral and oblique gave the answer, however.
This patient has a fracture of the body of the hamate and a fo...
Source: Lions and Tigers and Bears - September 30, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Low-Tech Solution to Diagnosing a Serious Problem
An elderly patient was brought in short of breath.
The x-ray finding was not seen on first glance. A colleague mentioned that his mentor recommended always rotating the film to the left and right as a better way to see a pneumothorax on plain radiographs. It seems human eyes are better at seeing horizontal lines than vertical ones. In fact, that simple maneuver seemed to make the pleural line pop. A dark viewing room makes the line stand out even more.
The patient was sent for CT to confirm the finding and to evaluate for adherence to the chest wall. Remember that ultrasound has been shown t...
Source: Lions and Tigers and Bears - September 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Low-Tech Solution to Diagnosing a Serious Problem
An elderly patient was brought in short of breath.
The x-ray finding was not seen on first glance. A colleague mentioned that his mentor recommended always rotating the film to the left and right as a better way to see a pneumothorax on plain radiographs. It seems human eyes are better at seeing horizontal lines than vertical ones. In fact, that simple maneuver seemed to make the pleural line pop. A dark viewing room makes the line stand out even more.
The patient was sent for CT to confirm the finding and to evaluate for adherence to the chest wall. Remember that ultrasound has been shown to have gre...
Source: Lions and Tigers and Bears - September 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Just Gave Out
This elderly patient fell after his right knee gave out while walking. Besides impressive calcification of the popliteal artery, what is wrong with his knee?
He has a comminuted tibial plateau fracture. The biggest radiographic clue is the meniscal line on the cross-table lateral. This is blood and fat in the joint. Fat droplets would be floating on top if you drained this effusion and placed the blood in a basin. You should always assume there is a fracture if you see this.
Another subtle clue includes an abnormal increase in density at the top of the tibia, which can come from an overl...
Source: Lions and Tigers and Bears - August 3, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Just Gave Out
This elderly patient fell after his right knee gave out while walking. Besides impressive calcification of the popliteal artery, what is wrong with his knee?
He has a comminuted tibial plateau fracture. The biggest radiographic clue is the meniscal line on the cross-table lateral. This is blood and fat in the joint. Fat droplets would be floating on top if you drained this effusion and placed the blood in a basin. You should always assume there is a fracture if you see this.
Another subtle clue includes an abnormal increase in density at the top of the tibia, which can come from an overlying fractu...
Source: Lions and Tigers and Bears - August 3, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
