1/37. Blunt thoracic aortic injuries: initial evaluation and management.In at least one large study, the average time from arrival at the emergency department to arrival in the operating room was nearly 6 hours. That 30% of survivors will die in the same amount of time underscores the need for rapid diagnosis and treatment. In blunt thoracic aortic injury, beta-blockers have been shown to reduce the incidence of rupture, and their use is rarely contraindicated. A working knowledge of the mechanisms of injury likely to produce this lesion, commonly associated injuries, clinically relevant and easily recognizable chest film findings, and appropriate use of beta-blockade can have a significant impact on mortality. Any physician responsible for evaluation of trauma patients should be familiar with this information.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/37. Traumatic testicular dislocation: a case report and review of published reports.Testicular dislocation after blunt scrotal trauma is a rare event. Its diagnosis depends on the awareness of the physician of its possible occurrence. It is usually a late finding during treatment of a motorcyclist brought to the emergency room because of multitrauma injury and is sometimes demonstrated in an abdominal computed tomography scan. We describe a typical case and discuss the chain of events leading toward the correct diagnosis and treatment based on a review of published reports.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/37. Blunt pancreatic trauma: a difficult injury.The diagnosis and initial management of hemodynamically stable blunt pancreatic trauma should include a high index of suspicion when a patient has sustained a severe force vector in the anterior-posterior direction of the abdominal cavity. patients who are hemodynamically stable should have physical examination, computed tomography (CT) of the abdomen, and serial determinations of serum amylase levels. If CT shows any suggestion of injury to the pancreas, such as fluid between the splenic vein and the posterior border of the pancreas, follow-up endoscopic retrograde pancreatography (ERP) should be done. In patients with a significant retroperitoneal hematoma, ERP should be followed by noncontrast CT for the evaluation of extravasation of contrast material. If ERP shows ductal disruption or follow-up CT shows extravasation of contrast, operative management is indicated. The astute physician should always remember that the most difficult aspect of pancreatic injury is timely diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/37. Serial bedside emergency ultrasound in a case of pediatric blunt abdominal trauma with severe abdominal pain.We present a case of a teenager with isolated left renal laceration with perirenal hematoma. The patient had presented with severe left upper quadrant (LUQ) pain following blunt abdominal trauma (BAT) sustained during a sledding accident. A screening bedside focused abdominal sonogram for trauma (FAST) rapidly excluded free fluid on two serial examinations, 30 minutes apart. It provided the pediatric emergency physician with a measure of diagnostic confidence that the patient could be safely transported to the CT suite for detailed delineation of his injury. Moreover, narcotic analgesia was liberally administered early in his illness course, without the fear of unmasking potential hypovolemia when it was known that he did not have gross intra-abdominal bleeding on his bedside ultrasound (US). It also provided a working diagnosis of the primary organ of injury. Our hospital, like many pediatric hospitals around the nation, does not have in-house 24-hour radiology support. We suggest that the use of the bedside US be extended to the stable pediatric patient in severe abdominal pain following BAT. It can serve as a valuable, rapid, noninvasive, bedside, easily repeated, fairly accurate triage tool to evaluate pediatric BAT with severe pain.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/37. Imperforate hymen: congenital or acquired from sexual abuse?Imperforate hymen diagnosed beyond the newborn period may present a dilemma for the physician. Three case studies are reviewed in which children with the diagnoses of imperforate hymen presented for evaluation of suspected sexual abuse. Clear descriptions of genital anatomy documented at well-child visits may be critical to later interpretations of findings encountered during examinations for suspected sexual abuse.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/37. More than tears in your eyes (exophiala jeanselmei keratitis).PURPOSE: To describe a patient with exophiala jeanselmei keratitis. methods. CASE REPORT: One patient with persistent corneal infiltrate that developed several days after a minor ocular trauma from an onion slice. RESULTS: culture plates from corneal scraping showed a growth of the yeast exophiala jeanselmei, a rare causative agent of ocular infection. CONCLUSIONS: Whenever a corneal abscess does not improve with the usual antibiotic treatment, a thorough ophthalmic history should be taken to determine whether there was a recent ocular trauma. If the trauma was caused by a plant material, the physician should raise the possibility of an unusual fungal infection.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/37. Craniofacial trauma in children.Craniofacial trauma is relatively uncommon in children, but the potential involvement of the structures at the base of the skull and the intracranial space makes it important for physicians to understand the potential dangers presented by such injuries. This report delineates the different types of injury that can damage the upper facial skeleton and the brain of a child. The author reviews initial management and diagnosis of such injuries and examines the approach to definitive reconstructive surgery using three case studies as examples for discussion.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/37. Traumatic tricuspid insufficiency--a case report.Traumatic tricuspid insufficiency following blunt chest trauma, although an uncommon entity, has been reported more frequently over the past 2 decades. Increased physician awareness of the possibility of myocardial trauma accompanied by proper clinical evaluation and follow-up are the keys to a successful outcome regardless of whether a medical or surgical approach to treatment is initially selected. Early surgical correction has become the preferred treatment in most instances and may be influenced by clinical status and other associated comorbid conditions. A patient with a combination of myocardial contusion, valve laceration, and papillary muscle rupture is presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/37. Endovascular management of blunt traumatic renal artery dissection.PURPOSE: To describe the importance of accurate diagnosis and successful emergent endovascular repair of intimal injury to the renal artery from sudden deceleration. CASE REPORT: A 22-year-old man was evaluated after jumping head first out of a fourth floor window. Gross hematuria was detected at the initial assessment. Contrast-enhanced computed tomography (CT) revealed diminished uptake in the right kidney. Arteriographic examination of the renal artery demonstrated 2 areas of intimal disruption, which a team of physicians decided to treat with angioplasty and stent placement owing to the associated intracranial injuries. Two balloon-expandable stents were successfully deployed to exclude the intimal defects. Once the associated injuries were also addressed, the patient made an uneventful recovery. CONCLUSIONS; Management of blunt traumatic injuries to the renal vasculature involves timely assessment to maximize preservation of renal function. In the setting of multiple concomitant injuries, recent experience supports the consideration of endoluminal intervention for traumatic renal artery dissections.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/37. Optic neuropathy resulting from indirect trauma.Minor blunt injury to the head and face may result in optic nerve contusion with secondary optic atrophy. The resulting visual loss is devastating for the individual. We report an uncommon but important complication that may result from an apparently trivial injury. Early identification and initiation of appropriate management may restore the individual's vision. Emergency physicians are often the first to see patients at risk of this complication yet there is little discussion of this injury in the emergency medicine literature.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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