|
Articles by John Dallara, MD Films and Scans
Films and Scans EMS brings you a 54 year old who slipped off a wet ladder rung and fell about 15 feet. He is boarded and collared by the paramedics and complains of R hip pain. Vitals are OK, and he complains of pain in his R hip area. “I can stand,” he tells you... Read moreFilms and Scans
Films and Scans
Films and Scans You are asked to see a stable multiple-trauma patient, 26 years old, who has fallen out of a tree (and you thought only kids climbed trees). He is intoxicated, and apparently fell striking his right side. The brunt of the fall was borne by the right arm, and he is unable to move his right elbow. What does the x-ray show? What is your next move? Read moreFilms and Scans 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... Read moreFilms and Scans
Films and Scans  Here 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.Films and Scans  Paramedics 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. Films and Scans  Evening 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. |
|
The story is simple. “My chest is killing me, and that Motrin stuff is
not cutting it,” the patient says. “It really hurts to breathe.” He woke
the other morning with this upper sternal, pleuritic chest pain. There
are no other exacerbating features, no fever or cough. The pain does not
sound cardiac in nature. Vitals are normal, including an O2 sat of 98%
on RA.
“Room 4, old septic guy with pneumonia, a trach, DNR, admitted,” says
your colleague as he hands over the department. “He’s really hypoxic,
but we put in a new trach collar, sats are holding at 90%. I’ve talked
with the family. He fell, so we’re getting a CT of the head and C-spine
that still pending. Would you check it?”
Triage walks back a 42-year-old male who has been stabbed in the left
shoulder by his girlfriend (OK, I admit I am curious why, but first
things first). He has bilateral breath sounds, but is not taking deep
breaths due to pleuritic pain on the left side.
Triage 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. 
Columnists
Recent Comments
