Trauma
Pneumomediastinum After Cervical Stab Wound
DOI: https://doi.org/10.21980/J87P79Anteroposterior (AP) chest X-ray showed subcutaneous emphysema of the neck, surrounding the trachea (red arrows), right side greater than left, and a streak of gas adjacent to the aortic arch (white arrow). Computed tomography angiogram (CTA) of the neck showed air outside of the trachea, positive for pneumomediastinum (blue arrows).
Laceration Repair for Emergency Physicians
DOI: https://doi.org/10.21980/J8TP7KBy the end of this educational session, the learner will: 1) understand indications and contraindications for suture repair of lacerations, 2) compare when various types of wound repair are appropriate: such as sutures, staples, tissue adhesive and tissue tape, as well as what size of suture material is appropriate depending on the location of the laceration on the body, 3) list the appropriate types and sizes of suture for various locations and types of lacerations, 4) understand the definitions of the three types of wound closure (primary, secondary and delayed primary) and when they are appropriate, 5) understand the basics of local anesthetic including which anesthetic to use and the maximum dose for each, 6) understand when sutures should be removed, 7) list various suturing techniques and their indications, and 8) improve comfort levels in performing various suturing techniques including: simple interrupted, horizontal mattress, vertical mattress, and corner repair. If desired, instructors can individually assess the learner sutures using the attached complete validated suture checklist to show proficiency in these techniques. Please see the brief wrap-up section at the end of the manuscript.
Open Book Pelvic Fracture
DOI: https://doi.org/10.21980/J8CK7HThe initial radiograph of the pelvis shows an open-book pelvic fracture deformity with pubic symphyseal dislocation, left greater than right sacroiliac diastases, and fractures of the left superior and inferior pubic rami, right inferior pubic ramus, and left acetabular anterior column. The additional inlet and outlet radiographs of the pelvis after application of a pelvic binder also show an open book fracture with significant improvement of the widened pubic symphysis.
Realistic Chest Tube Simulator Using Pork Belly with Skin
DOI: https://doi.org/10.21980/J8R03JBy the end of this instructional session learners will be able to: 1) discuss the indications, contraindications, and complications associated with chest tube thoracostomy, 2) competently perform chest tube insertion on a simulator, and 3) properly secure chest tube.
Open Pneumothorax
DOI: https://doi.org/10.21980/J88036A large chest wound was clinically obvious. A chest radiograph performed after intubation showed subcutaneous emphysema, an anterior rib fracture, and a right-sided pneumothorax. He was then taken to the operating room for further management.
K-9 Police Dog Bite
DOI: https://doi.org/10.21980/J8B88GThe photograph is of the anterior compartment of the right lower leg demonstrating multiple deep lacerations with exposed and torn muscle. X-ray showed no foreign body.
Lunate Dislocation
DOI: https://doi.org/10.21980/J86K56Plain film of the right wrist showed the classic “spilled teacup” consistent with a lunate dislocation. There is a loss of the normal articulation between the distal radius and lunate.
Traumatic Aortic Injury
DOI: https://doi.org/10.21980/J85P4JThe initial chest x-ray showed an abnormal superior mediastinal contour (blue line), suggestive of a possible aortic injury. The CT angiogram showed extensive circumferential irregularity and outpouching of the distal aortic arch (red arrows) compatible with aortic transection. In addition, there was a circumferential intramural hematoma, which extended through the descending aorta to the proximal infrarenal abdominal aorta (green arrow). There was also an extensive surrounding mediastinal hematoma extending around the descending aorta and supraaortic branches (purple arrows).