Severely mangled extremity after high energy trauma | Figure 1

Severely mangled extremity after high energy trauma

45f female ran over by bus, prehospital care was provided, arrived to my hospital’s ER, where we initiated ATLS protocol, immobilized the leg with plaster splint after thorough examination and irrigation of tissues with sterile saline, took her to have proper X-rays taken (only relevant shown). Upon arrival MESS 9.

We amputated above the knee due to the extensive soft tissue damage.

Diagnosis added by author

Open tibia fracture with extensive soft tissue damage and neurovascular affectation.

WARNING: Very Graphic. This is by far the worst trauma case I have ever seen in a living patient. Arm was completely crushed, she had her arm outside the car and got T-boned by a truck. Luckily we found some vessels and blood supply and didn't have to amputate. 9 hours later no biceps left. Debrided a lot of tissue.

This 17 y.o. was driving a golf cart with no shoes and his foot hanging out of the vehicle. He got too close to a curb. His friend managed to get the cart back to the roadway and put a makeshift tourniquet on the leg along with direct pressure from a bystander helped save his life. When we arrived the golf cart looked like a murder scene. He was very pale and actively bleeding upon our arrival. I applied two tourniquets to stop the bleeding. I estimated at least one pint of blood loss. The wound was bandaged and splinted. Two IV's were started and he was aggressively resuscitated for stabilization. He was given pain meds and zofran once his blood pressure was up. He was flown to a level one trauma center. He had multiple fractures, missing tissue, ligaments, and missing dorsalis pedis artery. The were able to save the food and toes but he will require multiple surgeries. He posted these pics to FB.

40 yrs old gentleman/ MVA / not Wearing helmet. Presented to ER with gcs of 3/15. Having stridor, gasping. Pupils unequal, not reactive. Abdomen tense and distended. Anal tone ABSENT. Puncture wound on right thigh. 5 minutes on arrival, pt became Brady and Asystole. CPR 3 cycles- ROSC. Image 2 shows morrisons pouch on arrival and image 3 taken 1/2hr later. what would be your management for this patient? Will update on challenges we faced and pitfalls for this case.

Dispatched to Traumatic Injury. While responding we were advised that the patients foot was cut by a push mower. Arrived on scene to find a 40’s y/o male bleeding controlled and the wound care already completed by firefighters. The remaining toe parts were retrieved and bagged on ice by firefighters upon our arrival. IV was established and pain management was started. The patient was transported by ground to a local trauma center for treatment. When asked what happened the patient stated that he was backing up with the push mower and backed into a post causing him to lose his balance and his left foot went into the back of the mower deck. The patient was wearing gym shoes.

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?