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em photo quiz( occasional series)


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  • 1 month later...
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1 hour ago, jmj11 said:

I've looked at a lot of brains but not abdominal CT in years. But I see a significant contusion of the liver's right lobe ... unless my own brain is seeing a Rorschach.

nope, you got it. Multiple grade 3 liver lacs. Transferred to facility with IR for embolization. 

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  • 1 month later...
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38 minutes ago, ohiovolffemtp said:

Pre & post reduction films of an open and comminuted distal R tib/fib fx.  Don't know what the radio-opaque material that overlaid the distal fib on the 1st plain film is.

Was the achilles tendon transected?  Gastronemius looks shortened.

medics had applied a tourniquet appropriately for bleeding they could not control with standard maneuvers. Their ambulance looked like they killed a pig back there.  On arrival she was still bleeding despite the tourniquet. I gingerly placed quikclot trauma gauze in the wound and applied 4x4s and a tight ace wrap around the wound and placed her leg up on several pillows. I removed the TK and bleeding did not return. The initially cyanotic leg(expected with TK) pinked up right away. Then I got the first film above. The reduction was quite easy. Inline traction and push the bone back in.  The pt is elderly and has neuropathy. They required no meds for the reduction. They were then lifeflighted to the regional trauma center for a washout and x-fix. I get all my ATLS points for remembering abx and tdap 🙂 achilles and gastroc looked ok, but it would not surprise me if they find partial tears in the OR. 

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On 7/8/2022 at 9:42 PM, EMEDPA said:

medics had applied a tourniquet appropriately for bleeding they could not control with standard maneuvers. Their ambulance looked like they killed a pig back there.  On arrival she was still bleeding despite the tourniquet. I gingerly placed quikclot trauma gauze in the wound and applied 4x4s and a tight ace wrap around the wound and placed her leg up on several pillows. I removed the TK and bleeding did not return. The initially cyanotic leg(expected with TK) pinked up right away. Then I got the first film above. The reduction was quite easy. Inline traction and push the bone back in.  The pt is elderly and has neuropathy. They required no meds for the reduction. They were then lifeflighted to the regional trauma center for a washout and x-fix. I get all my ATLS points for remembering abx and tdap 🙂 achilles and gastroc looked ok, but it would not surprise me if they find partial tears in the OR. 

Eric, once again you do us all proud.

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  • 8 months later...
Fast Track patient - right upper arm pain following a night of heavy drinking, patient couldn't recall details from the night but was sure she fell and landed on her right shoulder. Physical exam unremarkable. Xray negative for fracture, mild soft tissue swelling noted over posterior elbow and medial humerus. What was the etiology?
image.gif.e8806eb2af34949effcdf8232c61f55f.gif
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