You’re dealing with some type of eye problem/injury in the ED. How do you know when to call the eye doctor? What problems need emergent attention? Which ones require a phone call only? Which ones can just be sent to the ophthalmologist’s office in a few days?
The link below provides a set of guidelines for you to use to help figure this out. As always, it’s a good idea to apply your own expert judgment as well.
Yesterday I posted an image of an unusual chest CT. The patient had been involved in a motorcycle crash weeks ago, and presented with new onset chest pain and weakness.
Exam of the chest showed a hint of diffuse swelling on the left side and moderate tenderness. Chest x-ray suggested a mild effusion on the left. I showed one slide of the CT yesterday, which showed a large amount of complex material in the chest wall. This is most likely a mixture of blood and clot.
Here is another slice of the CT that is more revealing:
Now you can see that there are multiple rib fractures present. While comparing the original and the recent scan, it is apparent that the fractures are more displaced on the recent one. Upon closer questioning the patient admits that he did fall down the day before the new pain and swelling occurred.
And by the way, he forgot to mention the fact that he had developed deep venous thrombosis and was taking warfarin! And also by the way, his blood pressures were becoming a bit soft.
I would consider this life-threatening bleeding! Crystalloid and blood resuscitate immediately. Reverse the anticoaguation quickly, using prothrombin complex concentrate (PCC, preferably 4-factor). Then send him to interventional radiology to see if there are any active bleeders that can be embolized. Finally, it’s off to the ICU to finish up the resuscitation and restore him to normal!
Here’s another one for you to figure out. Of course, I’ll give you minimal information and see what you can do with it.
A middle-aged male presents to your ED from home with left chest pain and weakness. There is a history of a motorcycle crash 6 weeks ago. Ultimately, a chest CT was obtained and here is a representative section:
Here are my questions:
What’s going on?
What should you do about it?
Leave a comment below or tweet your guesses. Answers tomorrow!
The Trauma Professional's Blog provides information on injury-related topics to trauma professionals. It is written by Michael McGonigal MD, the Director of Trauma Services at Regions Hospital in St. Paul, MN. Regions is a Level I Adult Trauma Center, and has partnered with Gillette Children's Specialty Hospital to become the first Level I Pediatric Trauma Center in the Upper Midwest.