What The Heck? Bicycle Trauma

regionstraumapro:

You figure it out. As usual, you get limited information up front.

An early teenage male was doing some crazy stuff with his bicycle. Unfortunately, he slipped, striking his abdomen on the handlebar.

Using this image alone, figure out the problem. Comment below or tweet your guesses! More tomorrow and Thursday.

image

This is why I should have payed more attention in radiology class… 

I’d say that he’s ruptured his anteriolateral abdominal wall musculature causing bowel to herniate as the gas in the bowel loop appears to be just underneath the skin.  

Q:Hey, thanks! I'm probably one of a handful of Rads that takes an interest in ECG rhythms haha would you mind explaining to me how you knew it was a single chamber ventricular paced rhythm? Cheers, Jamie

thenext3years

No problem, it’s actually very simple and you mentioned how I know it’s ventricular paced in your first post. Ventricular pacing occurs just before the QRS complex and causes a broad complex as you noticed. That’s because the complex travels along the myocardium instead of using the efficient conduction system of the heart the impulse takes longer to move around the heart. It also gives a pattern very similar to bundle branch blocks as that is a similar situation where the conduction pathway is blocked and the impulse has to travel around the heart through the myocardium instead. Along with the broad QRS you also get a tall ST segment that is always in the opposite direction to the deflection of the largest wave in the QRS complex. A atrioventricular or atrial paced rhythm would have a spike occurring just before the QRS complex and as the impulse would use the conducting fibers of the heart it would be narrow complex with normal QRS complexes. We’re touching briefly on pacemakers there which are an interesting topic in it’s own right and you might want to read about those but they are more complicated that you may think at first! Whilst this ECG shows pacing spikes throughout sometimes they are only programmed to fire when the heart rate drops below a certain figure or if the ventricle doesn’t respond to an atrial contraction then the pacemaker kicks in for a bit. All good fun! Thanks, Alex. 

Had my finals written SAQ paper today. Made a number of very stupid mistakes many of which from not reading the question. Perhaps I’m dyslexic? I read 7 as 27 weeks pregnant which meant I discussed antepartum haemorrhage management rather than miscarriage management… I also read MMSE rather than MSE meaning for both of those questions whilst I wrote correct answers, they were correct for a different question…

I also got basic stuff wrong which I really should have known better but perhaps glossed over thinking I knew it… I find out in a week if I am required to sit further papers if I’m not yet a ‘clear’ pass. 

On top of feeling bummed about how it went I have to sit an MCQ / EMQ paper tomorrow. But regardless of how I do in that exam it won’t make up for a poor result in todays one.

Finished my medical school clinical exams yesterday.

Four patients the first two went very well, PCKD and Sleep apnoea, I felt I knew a lot about those diseases.

However, I had a bad third case of some form of peripheral neuropathy that was a bit atypical with a horrible examiner and a confusing history from the patient. So that put me in a bad mood for my last case of OCD and my head obviously wasn’t in the right frame of mind as I forgot some pretty major questions in the history, I did say in the questioning after that I should have asked XYZ but I’m not sure if that makes up for the omissions in the first place… 

It’s stressful and I won’t find out if I’ve passed until the 28th of June. Horrible wait. 

Written papers are in a week and a half and I’m less stressed about them but I don’t want to be complacent. 

Medical school finals

2 of 8 finals patients down! Two more tomorrow, then the four next week. 

The cases went well yesterday I was pleased, maintained my composure and answered the questions adequately during the viva part after seeing the patients. 

First case was a gentleman with UC and subsequent ileostomy formation and had to examine the abdomen/stoma. Anticipated all of the questions afterwards and had it nailed.

Second case was a paediatrics case who had episodes of dizziness and blackouts. I’d managed to ascertain that it was a cardio problem rather than a neurological problem so asked to examine the heart, whereas the three other students asked to do a neurological examination and were directed back to do a cardiac examination so that was good.

I’ll be honest as it was a finals case I didn’t come up with the obvious diagnosis of vasovagal fainting but did say it sounded like it was something that was causing her blood pressure to drop on standing like orthostatic hypotension. I managed to get the main causes of LOC in children and the things that you need to rule out so at least I came across as safe. Felt a bit stupid though when the examiner said “tell me what you know about vasovagal attacks” and the penny dropped that it was that simple and could describe them and how they are caused by varying degrees of hypotension and bradycardia. 

Now to focus on the remaining 6, I actually enjoyed them yesterday so not too stressed now.

Found out the hospital I’ll be working in from August!

Nice little DGH on the South coast so I’ll be sure to make the most of the beach. 

First rotation is ‘Acute rehab’ so your guess is as good as mine but I’m guessing post stroke/head injuries or massive trauma. Should be a nice gentle introduction to life as an F1. 

After that it’s respiratory and then general surgery. After my F1 year I’ll be moving to South London. Now I need to look for accommodation, exciting!