4.21.2010

Trauma Rads

First up after registration is a Radiology Review. Frankly CT scans and Ultrasounds look like Rorschach's tests to me. I can see something when the doc or the CT tech points it out, but on my own I'm never quite sure what I'm looking at. Oh, I can spot a brain-bleed and a broken leg most times but not much more than that. 

Radiology review seems like it primary designed for the providers -- the panel is two radiologists and two surgeons. They argue enough for me to realize that I'm not the only one who has trouble picking up on the difference between a subtle pneumo and a skin fold. 

We get to see some impressive sternal fractures and one of the radiologists gives us tips on how to spot them by the high density blood behind the sternum.  Apparently these are often found as seatbelt injuries. 

The subject changes to unexpected Pulmonary Embolisms -- the majority of which are incidental. 

One of the surgeons on the panel says that fractures damage the bone marrow, which of course is full of ebolitic material. There is also a spike in the coagulation factors right after a trauma. Studies have shown that hypercoagulability is highest in the 24 hours after the traumatic event then decreases over a period of about three days. So why do some patients throw a PE after a simple pelvis fracture and die while others suffer no ill effects? "Genetics" explains the other surgeon.  This is the "Cave Man Bonus" -- a trait that probably helped save our ancestors from the saber tooth tiger bite, but these days can cause major problems.

We look at lungs and how to tell when what appears to be a wide mediastinum is a bad thing. 
We learn the trick for finding pneumos ... look for a thin, white line with black on both sides. People have gotten chest tubes for skin folds that look like pneumos. Yikes.
We learn that fallen lung sign is a bad thing.
We see great images of chest tubes is all the wrong places. Yikes!

I've been here only a few hours and here's our first open book fracture images -- yup, that will keep me from buying a motorcycle for another few years. Poor dude lost a testicle. Note: blood at meatus = no foley, but you already knew that.

Kidneys, Spleens.

Oh, and for the record, most Rorschach images look like CT scans to me, so what do I know.

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