Thursday, January 24, 2008

Outcome?


















What do you think would happen if I pointed a 12 gauge shotgun at my foot and pulled the trigger? Well, now the patient has a BKA and now he knows what would happen.

28 comments:

  1. note for you non-medical blog junkies out there.

    the second view shows the radiology tech's hand holding the patient's toes to allow the film to be taken. if you look where the ankle should be you will see dark areas inside light areas... two areas are kinda on top of each other on this film. this is air, and, erdoc85 will correct me if i'm wrong, but from the film it looks as if the blast almost amputated the ankle and that it was pretty floppy- hence the need for someone's hand in the film.

    the white dots are shotgun pellets, and, if i'm not mistaken, this film was taken with the patient on a backboard.

    the backboard was only necessary to transport the patient without his leg falling off. the backboard is the straight line on the second film behind the 'ankle'.

    i bet there was not spurting blood contrary to what you might suppose. the high pressure vessels supplying the foot probably contracted immediately after the blast, and while the foot was a hamburger-y, bloody mess, he probably did not need a tourniquet or BP cuff to staunch the bleeding.

    just some guesses. one more guess... alcohol was involved.

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  2. Clarifying that "BKA" = "below knee amputation" might be helpful too.

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  3. That's about how my feet feel at the end of a shift these days.

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  4. 911doc and sue-thank you for explaining it for me. You saved me some time with Dr. Google.

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  5. 911: I actually think the hand is the guys own and he's just stretching out his hamstrings.

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  6. Thanks for the explanation, 911 and Sue. I was scratching my head over the techie talk. Great post, though the thought of any limb being "hamburger-y" make me want to yak.

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  7. "hamburger-y"

    I just threw up in my mouth a little...

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  8. etotheipi,

    I laughed so hard at the hamstring comment that I stooled myself. And I am not going to clean myself up.

    CAT

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  9. 911 is correct. The foot was nearly amputated at the ankle already. The rad tech needed to hold it up to get the lateral.

    It wasn't too bloody surprisingly. In fact, the dorsalis pedis pulse was still present! Also surprisingly, no alcohol involved...just a sub-porcine IQ.

    This was impressive....and impressively stupid.

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  10. Sub-porcine IQ? You people slay me.

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  11. What an idiot! He should have used a 20 gauge.

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  12. Emergency medicine: saving the world from natural selection. Awesome films. :)

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  13. Not that it matters, but what size was the shot? (It did the damage) That's kinda neat that he had a dorsalis pedis but like you said-pretty much self cauterized the wound! I think I would have drunk some likker or just pored some on me to make it look like a better accident! Porcupine IQ- LOL

    Excellent Post..thanks for sharing.

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  14. Actually, porcine is piggies, not porcupines. But maybe porcupine would have worked better? Pigs are actually really smart--smarter than most dogs, in fact.

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  15. Either animal could have kicked this guy's ass at checkers!

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  16. ok, this may be a stupid question...

    but was their subcutaneous empheseyma in the foot?

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  17. yes. non issue as he has deep-tissue emphysema and they took the foot off. the sub-cutaneous emphysema was the least of his problems but would be a problem if this were not such a devastating jury.

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  18. Ah, cool, thanks for the prompt answer.

    I wasn't sure if you could get it in somewhere other than the chest/neck. I guess it makes sense though, it's just friggin' air in the flesh...

    I should probably think before I ask a question.

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  19. no worries! you are probably on the trauma side. sub-q emphsema is bad in chest/neck trauma but we also see it outside trauma with 'gas gangrene', there the air is from bacteria in the soft tissues which make gas, clostridium difficile is the classic bug WWI and shit. Sub-q emphysema with skin infection is, perhaps worse than sub-q emphysema from trauma.
    toodles.

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  20. Ahhhhhhhh.

    Thanks so much, that makes perfect sense.

    My faveorite part "clostridium difficile is the classic bug WWI and shit." HAHA!

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  21. I am guessing that the sub-q emphasema is not air, but rather, combustion gasses injected into the soft tissues from the (rather close) muzzle at discharge (of the gun, not the patient). However, as noted earlier, this is a matter of academic curiosity with no clinical relevance. There is no foot or ankle left to save.

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  22. There were certainly injected gasses from the muzzle blast, but the wound was mostly open, so there was plenty of room air in there as well.

    You're right, it's academic since it's in a bucket somewhere with one of Etotheipi's colleagues contemplating what kind of stupid fuck shoots his own foot off!

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  23. I really wish the radiographer had used something else rather than their hand directly in the beam. That's not very ALARA.

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  24. Man, if the AAHA (american animal hospital association) saw one of my tech's hands like that on one of the radiographs in our hospital, we would lose our accreditation faster than a cat can make me sneeze!

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  25. I have seen many an ankle xray.. Even a few status post GSW. But I have never seen one quite like that. Must have been something to see in person.

    The entire joint is just vaporized. Everything is gone. I can't even tell where the calcaneus should be.

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