A 25-year-old patient presents with recurrent lithium button battery ingestion. She had been admitted with the same presentation 3 week before and had undergone urgent endoscopic removal of the button battery. It was noted on the operation note, that the oesophagus had “significant erosions” at approx. 23 cm and evidence of early stricture formation. On…
In the blunt trauma patient, where we are considering a pan-scan, is there a role for the log roll, the FAST scan or the rectal examination any more? Case The ambulance phone rings: “ETA 15 minutes. We have a 25 year old male involved in a high speed motor vehicle accident. He has come off the…
Trauma in pregnancy is a much more complex topic than simply, ’tilt them on their side’. Trauma in the obstetric patient is a leading cause of non-obstetric mortality. The complexity of the obstetric trauma scenario relates to: Alterations in maternal anatomy and physiology The sensitivity of the foetus to hypotension and hypoxia. Issues of radiation…
Head injury with fixed dilated pupils: Are we done? We have looked at the pupillary response before on this blog in terms of the Doll’s Eye Reflex in brainstem death and the oculocephalic reflex. However, what if the pupils are fixed and dilated? We seem to learn quite early in our medical careers that fixed…
In recent blogs I suggested that clinically significant C spine injuries can be excluded by CT scan in the intoxicated patient and Luke Lawton raised the suggestion that the hard collar may not be as efficacious as we were led to believe in our youth. One of the questions that the C spine blog attracted…
In preparation for EMCORE Hong Kong 2018, I took some time to sit down and revisit how and why we do one of the oldest rituals in trauma medicine – applying a rigid c-collar. I still remember as a junior doctor being taken through the rigorous method of application….measure up properly, hold the head steady,…
The most commonly used c spine clearance rules exclude or mandate imaging in the case of the “intoxicated” patient, and there is debate as to whether a normal CT C spine is adequate to clear the neck of the intoxicated patient in blunt trauma.(1,2) Many clinicians advocate either waiting for intoxicants to clear before clinically…
A Maisonneuve fracture is caused by pronation and external rotation. It can be difficult to find, even if we get fixated on the ankle. The patient may present with a complaint of rolling their ankle and ankle pain. Be vigilant for this type of injury. It is made of two main components: A spiral fracture of…
Introduction What if we had a tool that allowed identification of haemorrhage source, in trauma patients with no obvious primary source or with potentially multiple sources of bleeding? Who would gain the most from this?…..The sickest and most unstable patients obviously. Well we do have such a tool!…….It’s the CT Scanner. Who are the sickest…
Introduction Airbags have had a significant effect on decreasing fatalities in high speed motor vehicle collisions. However they are also responsible for injuries, in most cases minor, in approximately half the cases where they are deployed. Not wearing a seat belt and sitting less than 25cm from the bag, predicts a subgroup of patients that…
Pelvic fractures are most often associated with massive trauma. In terms of skeletal injuries they account for about 3% of all injuries. However they have the potential to result in haemodynamic instability, leading to significant mortality. Approximately 10 years ago the mortality from multi trauma with pelvic ring disruptions and haemorrhagic shock approached 60% (J…
Here is a 3 minute video on the Whistler technique for putting in hips. Its quick and easy and really doesn’t allow you to hurt yourself. You use your legs to give you the traction. Just watch and see. Try it for yourself. I call it the under-over technique: I put my arm UNDER the…
