Monday, December 13, 2004

Tales From the Trauma Service II......
Or trauma as chronic disease. 40'ish male pedestrian struck by a motor vehicle. He is "agitated" at the scene with no motor function in his lower extremities. He has no sensation below the nipple. Lax rectal tone, but good motor function of his upper extremities. He has a BAC of 256. Radiographs as follows:

That's going to hurt!! Here is a CT reconstruction:

And for you MRI fans:

And he had an open tibial plateau fracture to boot:

So fairly straightforward case. His FAST exam was negative as was the remainder of his spine films. He began to manifest spinal shock and required a central line and Dopamine. He underwent anterior fusion by the neurosurgeon on HD#2. When I went to the office to put in his charges I discovered that he and the trauma service had crossed paths before.
Two months ago he was admitted for a concussion after a motor vehicle collision. He was intoxicated at that time as well.
Eighteen months ago he was stabbed just below the right nipple. He was found to have a pneumothorax and underwent laparoscopy. A small liver injury was found which had stopped bleeding.
Trauma:the gift that keeps on giving!!
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