You are evaluating a multiple trauma patient who sustained a substantial head injury, was intubated and is non-communicado.  On the secondary survey you note some left knee swelling.  The extremity is neuro-vascularly intact, and the knee is stable to stress testing. There is an effusion present...

altTriage walks back a 45-year old Hispanic man with chest pain.  “He said ‘dolor’, and pointed right here,” says the triage nurse, indicating on himself a mid-sternal location.  “Good enough for me. I brought him straight back.”  Your Spanish is a little thin, but you get the high points – “nausea, vomito, mucho dolor,” the patient says, making good eye contact.

altHere is a fun case for the 50% of you who are still reading your own plain films after hours (me too!). An elderly gentleman arrives with a dry cough and shortness of breath for several days. Family reports him to be “a little confused.” There is no history of trauma.
altParamedics bring in an elderly female who fell at the nursing home.  By report, she slipped on something and fell forward, landing chin-first on the edge of a coffee table.  She complained immediately of neck pain and was immobilized by EMS.  Vitals are P 75, BP 180/105, RR 20, sat 95% RA.  She is alert and appropriate.  General exam reveals only a small contusion/laceration on the chin.  Her neurologic exam is intact. 
altYou’re working at a teaching hospital ED in Houston one evening when one of your residents presents a case of back pain. The patient is a 57-year-old African-American female with a history of Hepatitis C diagnosed in 2000, questionable cirrhosis, macrocytic anemia, GERD, and chronic back pain for five years.
altEvening shift. All the rooms are full and there’s an unspeakable number of patients in the waiting area. Triage calls with a simple request. “I have this fellow here,” he narrates, “who says he was hit with a bat in the left chest. 
Wet Readings 
 
EMS calls a trauma alert for a gentleman injured from a shotgun blast about 20 minutes ago. 
  
As the patient rolls to CT, you review the plain films.  What do they show?  What actions do you anticipate? 
 
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You are called to ED triage to evaluate a 30-year-old with stomach pains. “I think he has a kidney stone,” his mother volunteers by way of introduction. “You know his father had them also, and he just won’t settle down.”  
 
 What do you see in this CT scan. Read the case HERE.
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 A 29-year-old female presents late in the evening to your rural emergency department, accompanied by her husband, with a chief complaint of right flank pain for approximately 3 days. It’s busy and she’s been waiting in triage for over two and a half hours, probably because she looks so good.
 
What does this transabdominal image show? Read the case HERE.
This case, originally published in May of 2009, sparked a lively debate online. Here are some highlights. Continue reading for the final analysis. 

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