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trauma

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EM@3AM: Morel-Lavallée Lesion

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A 30-year-old female presents after sustaining a motorcycle collision at highway speeds. She was wearing protective equipment, including a helmet, gloves, knee and elbow pads, and riding boots. She denies loss of consciousness but reports severe right lower extremity pain rated as 10 out of 10. Vital signs reveal BP 93/78 mmHg, HR 122 bpm. During the secondary survey, a rapidly expanding mass is noted over the right lateral thigh. The overlying skin is tense and tender to palpation.

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EM@3AM: Systematic Approach to Massive Hemorrhage and Nuances in Special Patient Populations

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A 32-year-old female presents with chief complaint of “abdominal pain”. Her pain started 8 hours ago and became severe within the last 30 minutes. Initial vitals demonstrate a blood pressure of 88/48 mm Hg, HR 122 bpm, Temp 36.4 C, and 20 respirations/min. On your physical exam she has tenderness to palpation in the left lower pelvic region with rebound tenderness. You note her hypotension and perform RUSH exam. During your exam you note free fluid in the rectouterine pouch. As you finish your exam, she is now pale, clammy, and minimally responsive to pain with repeat blood pressure 64/33 mm Hg. What is the systematic approach to a patient with signs of massive hemorrhage?

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EM@3AM: Thoracic and Lumbar Spine Trauma

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A 70-year-old female with a past medical history of osteoporosis, atrial fibrillation, and hypertension presents with acute thoraco-lumbar back pain after a ground-level fall. She is stable, but she does have pain at the T-12/L-1 region of her back.  She has full motor strength and sensory function in the lower extremities. Her patellar reflexes are 1+ bilaterally, no ankle clonus is noted, and she denies any saddle anesthesia or bowel/bladder incontinence. 

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