pulling apart cases from the ED...
The Case.
A sunny Saturday morning in Sydney and your 56 year old patient was just outside doing some gardening when they feel a rather sharp bite on their right hand (on webspace between thumb and index finger).
He arrives to the ED distressed and very anxious. His vitals signs are normal and he has localised pain only.
He then hands you this saying “this is the bugger that bit me !!” …..
Where do you go from here ??
The case:
A motorcyclist is minding his own business, stationary at a set of lights and is rear-ended by a car at ~60-70km/h. He is thrown 10 meters or so from his bike and lands on his left side. Remarkably he is systemically well, except for significant left lateral chest wall pain !!
You think he has reduced air-entry on the left side, but is he’s not dyspnoeic, nor hypoxic. The remainder of his primary survey is unremarkable.
This is his supine CXR…
EFAST showed no evidence of free intraperitoneal fluid, but this is what I saw on the chest….
