By the end of this instructional session learners will be able to: 1) discuss the indications, contraindications, and complications associated with chest tube thoracostomy, 2) competently perform chest tube insertion on a simulator, and 3) properly secure chest tube.
A large chest wound was clinically obvious. A chest radiograph performed after intubation showed subcutaneous emphysema, an anterior rib fracture, and a right-sided pneumothorax. He was then taken to the operating room for further management.
The photograph is of the anterior compartment of the right lower leg demonstrating multiple deep lacerations with exposed and torn muscle. X-ray showed no foreign body.
Plain film of the right wrist showed the classic “spilled teacup” consistent with a lunate dislocation. There is a loss of the normal articulation between the distal radius and lunate.
The initial chest x-ray showed an abnormal superior mediastinal contour (blue line), suggestive of a possible aortic injury. The CT angiogram showed extensive circumferential irregularity and outpouching of the distal aortic arch (red arrows) compatible with aortic transection. In addition, there was a circumferential intramural hematoma, which extended through the descending aorta to the proximal infrarenal abdominal aorta (green arrow). There was also an extensive surrounding mediastinal hematoma extending around the descending aorta and supraaortic branches (purple arrows).
The left Achilles tendon had a defect on palpation, while the right Achilles tendon was intact. When squeezing the right (unaffected) calf, the ankle spontaneously plantar flexed, indicating a negative (normal) Thompson test. Upon squeeze of the left (affected) calf, the ankle did not plantar flex, signifying a positive (abnormal) Thompson test. The diagnosis of left Achilles tendon rupture was confirmed intraoperatively one week later.
Keywords: radiology, trauma, normal, suprapubic, FAST exam, videos, ultrasound, US
Keywords: radiology, normal, renal, Morrison’s pouch, trauma, liver, ultrasound, video, FAST exam
