medic25 Posted September 22, 2015 Share Posted September 22, 2015 Let me guess, the GSW was "It is Nothing" triaged to urgent care? Been there before. Had a patient triaged to me in fast track once as a "puncture wound". He was firing an antique rifle which exploded, and felt something hot puncture his neck. Take off the bandage and find a "puncture wound" (aka entrance wound) just lateral to the trachea; shot a quick plain film and sure enough there was a bullet lodged just neck to the hyoid. His fast track visit ended up with a quick couple of lines, and ambulance, and a transfer to the closest trauma center. Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 22, 2015 Share Posted September 22, 2015 a few new ones. abitofchestpain.jpggunsafety.jpg If anyone missed this widened mediastinum you either have to repeat first year of school with a class full of "gunners" or else take PANRE for 3 consecutive years as punishment. For the record, echocardiography is witchcraft in my book aside from the four chamber view (just can't get the hang of it). Quote Link to comment Share on other sites More sharing options...
medic25 Posted September 22, 2015 Share Posted September 22, 2015 For the record, echocardiography is witchcraft in my book aside from the four chamber view (just can't get the hang of it). Come to the dark side; learn to love the echo :) There are a lot of great references online, but I'm finding the best thing is just doing a lot of them. I'll grab echos on stable chest pain and syncope patients, just to get the practice; 4 chamber is nice, but there is a lot more info in the other views. Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 22, 2015 Share Posted September 22, 2015 Don't need the info in a snot/cough gov't job as I wheel my walker, cane, Geritol bottle, and emergency alert button out the door to the Soyent Green factory. 1 Quote Link to comment Share on other sites More sharing options...
Hallcrest Posted October 27, 2015 Share Posted October 27, 2015 You've got it. Dilated aortic root (~6.5cm), with an intimal flap, consistent with a Stanford type A aortic dissection. marfan? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 27, 2015 Author Moderator Share Posted October 27, 2015 subtle finding on one of my patients in Haiti last week. new dx. Quote Link to comment Share on other sites More sharing options...
Reality Check 2 Posted October 27, 2015 Share Posted October 27, 2015 Club feet. Quote Link to comment Share on other sites More sharing options...
cop to pa Posted October 27, 2015 Share Posted October 27, 2015 Looks like extreme pigeon toe. Club foot? *edit* reality check beat me to it. Quote Link to comment Share on other sites More sharing options...
medic25 Posted October 28, 2015 Share Posted October 28, 2015 marfan? No, just old and hypertensive. Good thought though. Quote Link to comment Share on other sites More sharing options...
jmj11 Posted October 28, 2015 Share Posted October 28, 2015 I see the mother is giving you the finger for taking a picture of her baby. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 10, 2015 Author Moderator Share Posted November 10, 2015 identify the fb pictured here: Quote Link to comment Share on other sites More sharing options...
cop to pa Posted November 10, 2015 Share Posted November 10, 2015 Um, the title of your picture shows up. Unfair advantage. Never seen one before, though. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 10, 2015 Author Moderator Share Posted November 10, 2015 Um, the title of your picture shows up. Unfair advantage. Never seen one before, though. woops. I had never seen one before either. they come in a magazine like a nail gun and hold sod in place. guy missed bone and no obvious tendon injury. digital block and just pulled it out. Quote Link to comment Share on other sites More sharing options...
cop to pa Posted November 10, 2015 Share Posted November 10, 2015 Lucky bugger Quote Link to comment Share on other sites More sharing options...
bigdawg1986 Posted November 11, 2015 Share Posted November 11, 2015 Really? It's a stake for a drip irrigation system. That's an unlikely injury right there... Sent from my SM-G900V using Tapatalk Quote Link to comment Share on other sites More sharing options...
bigdawg1986 Posted November 11, 2015 Share Posted November 11, 2015 How about this? Sent from my SM-G900V using Tapatalk Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted November 11, 2015 Share Posted November 11, 2015 Exit wound? Quote Link to comment Share on other sites More sharing options...
bigdawg1986 Posted November 12, 2015 Share Posted November 12, 2015 Exit wound?Yup... Ar15 to the leg. Oops Sent from my SM-G900V using Tapatalk Quote Link to comment Share on other sites More sharing options...
JohnnyM2 Posted November 15, 2015 Share Posted November 15, 2015 Yup... Ar15 to the leg. Oops Sent from my SM-G900V using Tapatalk Is that the entry on the top left? Looks like a lot of bone fragments. Do you think he will be able to use the leg again? Quote Link to comment Share on other sites More sharing options...
bigdawg1986 Posted November 15, 2015 Share Posted November 15, 2015 Follow up x-rays Quote Link to comment Share on other sites More sharing options...
bigdawg1986 Posted November 15, 2015 Share Posted November 15, 2015 Sent from my SM-G900V using Tapatalk Quote Link to comment Share on other sites More sharing options...
JohnnyM2 Posted November 15, 2015 Share Posted November 15, 2015 Ouch. Looks like the middle third of the tibia disintegrated on impact. From the bone debris pattern it seems the projectile traveled down. Looks unsalvageable. Quote Link to comment Share on other sites More sharing options...
bigdawg1986 Posted November 15, 2015 Share Posted November 15, 2015 Ouch. Looks like the middle third of the tibia disintegrated on impact. From the bone debris pattern it seems the projectile traveled down. Looks unsalvageable.Well clearly I'm not the surgeon... But it was ex fixed. We have 8 surgeons in our group and I don't routinely see this one's patients so unfortunately have no follow up information Sent from my SM-G900V using Tapatalk Quote Link to comment Share on other sites More sharing options...
bigdawg1986 Posted November 15, 2015 Share Posted November 15, 2015 We also have a similar one from a 12 gauge which was surprisingly a lot more salvageable due to lower projectile speed and less vaporizing of bone Sent from my SM-G900V using Tapatalk Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 27, 2015 Author Moderator Share Posted November 27, 2015 12 cm x 4 cm lac just distal to knee of 30 yr old morbidly obese diabetic. full of gravel. almost took this one on myself but thought better of it. called ortho. guy spent about 2 hrs in the OR getting all the gravel out and closing it. Quote Link to comment Share on other sites More sharing options...
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