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Good choice to let ortho handle that one. When I worked ER locums I had a guy come in with a 20 cm laceration to lower leg from having a ski-doo fall off the trailer onto his leg in the lake. The doc I worked with said go ahead and clean it up and suture. I had a med student with me who helped and did some of the work. It was a beautiful repair but a disaster overall. There was a tiny seashell that was imbedded that didn't get irrigated out. Initially when I saw the guy I considered calling surgery on call and wish I would've listened to gut. The guy was ok but got bad infection,dihescense of wound,IV antibiotics and surgical fix later. Happened on a July 4 holiday with ER crazy and everyone stressed. A good lesson learned to not let the pressure of getting patients in and out and then making a mistake like that. I had night mares for months afterwards and it was one thing that made me consider to stop working at that particular facility due to the pressure ..it was a toxic environment overall and I was too young in my career to figure out how to handle the personalities at that facility. But I learned a lot too and documented that the SP approved and delegated the repair to me and med student. It saved my buttons.

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{style_image_url}/attachicon.gif dirtywound.jpg

 

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.

Two hours for that? I'm in ortho and that just doesn't sound right... Considering that in 500 cases I've only had a longer than 2 hour case maybe less than 5 times. Even if there's a tendon lac that just sounds waaaay off.

 

Sent from my SM-G900V using Tapatalk

 

 

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Two hours for that? I'm in ortho and that just doesn't sound right... Considering that in 500 cases I've only had a longer than 2 hour case maybe less than 5 times. Even if there's a tendon lac that just sounds waaaay off.

 

Sent from my SM-G900V using Tapatalk

you can't appreciate it from the picture but there was LOTS of embedded gravel that didn't irrigate out and needed to be removed a piece at a time. no tendon lac. that's why I was considering doing it myself.

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  • 1 month later...
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I guess the cxr didn't copy well. there is a 10-15% ptx L upper lobe. spontaneous. admitted for obs. no chest tube felt needed by surgery.

anyone want to tell me specifically why the bp 70 and pulse 70 in the trauma pt with the head bleed( notice the lack of ventricle and midline shift)?

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  • 2 weeks later...
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Would expect low pulse d/t Cushing's, but would also expect elevated BP.  If trauma, was there other major bleeding?  What meds were the patient on - any anti-hypertensives, particularly beta blockers?

good. yes, brady due to head injury...hypotension makes you look elsewhere....like the belly where you find most of their blood volume and an h+h of 7/21.

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  • 3 weeks later...

Just to clarify what I'm seeing in the video.  Anterior traction is placed on the extended arm while the thumbs are pushing along the lateral border of the scapula?  Is that what they were doing?

 

E, when you did the reduction was it similar to how it was presented in the video?

 

That's pretty wild.

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Just to clarify what I'm seeing in the video.  Anterior traction is placed on the extended arm while the thumbs are pushing along the lateral border of the scapula?  Is that what they were doing?

 

E, when you did the reduction was it similar to how it was presented in the video?

 

That's pretty wild.

longitudinal traction on the affected arm by assistant. force applied to inferior aspect of the scapula straight up with both thumbs produced reduction. pretty much just like the video. IM dilaudid only for pain control. the guy said when he gets procedural sedation folks generally also dislocate his shoulder in the process.

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  • 2 weeks later...
  • 2 weeks later...

I had that same (well similar) elbow last week.

 

that appears to be a thoracic aneurysm (descending).

 

I had a pt last year that dropped 300 lbs on his chest and had a traumatic dissection of his ascending aorta involving the brachiocephalic artery. Not to mention pneumo, and multiple broken ribs as well as the sternum.      

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