Keywords: C-Spine Clearance, altered mental status (PubMed Search)
Keywords: blunt trauma, pneumothorax, CXR supine, ultrasound, seashore, stratasphere (PubMed Search)
(Please note the prior version of this pearl was incorrect with respect to the images referenced. This version is corrected.)
Patient s/p blunt chest trauma. CXR (image 1) vs. lung ultrasound (image 2), do you see any inconsistencies?
Lung ultrasound in traumatic pneumothorax: The "Stratosphere Sign"
Written by Dr. Michael Allison.
For advanced sonographers:
1. Blaivas, M. et al. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Academic Emergency Med. 2005 Sep;12(9):844-9.
2. Lichtenstein D et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med. 2005 June;33(6): 1231-8.
Keywords: Apical cap, dissection, blunt aortic injury, chest xray, radiology (PubMed Search)
44 y/o female restrained driver s/p motor vehicle crash complaining of chest pain and shortness of breath.
Answer: Left pleural apical cap.
The Apical Cap
An apical cap is a unilateral or bilateral irregular density over the apex of the lung, generally less than 5mm. The lower border is often sharp but undulating.
Fabian TC, Richardson JD, Smith JS Jr, et al. Prospective study of blunt aortic injury: multi-center trial of the American Association for the Surgery of Trauma. J Trauma 1997;42:374-383.
McLoud TC, Isler RJ, Novelline RA, et al. The apical cap. Amer J Rad 1981; 137:299-306.
Rivas LA, Fishman JE, Munera F, et al. Multislice CT in thoracic trauma. Radiol Clin North Am2003; 41:599-616.
Keywords: Epinephrine, Lidocaine, Fingers, (PubMed Search)
Lidocaine with Epinephrine and it use on Fingers and Toes
It has been taught for a long time that Lidocaine with Epinephrine should not be used on fingers, toes, ears and nose [There has to be a kid's song in there somewhere] due to the risk of vasoconstricition/vasospasm and possible digitial infarcation.
The short story is that this practice is not supported by the literature, and there are now numerous publications that have shown that lidocaine with epinephrine is safe for use on the finger tips. It turns out the the original case reports were submitted with procaine and epinephrine and not lidocaine with epinephrine. Most of the cases of digital infarction where with straight procaine that is now thought to have been contaiminated or too acidic pH close to 1 when injected.
The effects of epinephrine last approximately 6 hours. This time is well within the accepted limit of ischemia for fingers that has been established in digitial replanation.
So why use Lidocaine with Epinephrine:
Thomson CJ, Lalonde DH, Denkler KA, Feicht AJ. A critical look at the evidence for and against elective epinephrine use in the finger. Plast Reconstr Surg. Jan 2007;119(1):260-266.
Keywords: Seatbelt Sign, Abdominal, Trauma (PubMed Search)
Keywords: Ankle, Maisonneuve, Jones, Fracture (PubMed Search)