SAEM Clinical Image Series: Fishing in Papua New Guinea
History of Present Illness: A 33-year-old male went river fishing with a homemade spear and diving mask in Papua New Guinea. He felt sudden pain and tugging to the right lower extremity. He was near shore and grabbed a tree root. He held on for dear life as he was being pulled back into the water. It felt as if his foot had been torn off. He did not let go of the tree root and eventually the pulling force ceased. He got out of the water and walked 2 miles unassisted before finding help and hospital transport.
A 32 year old woman arrives in your emergency department after being in a motor vehicle collision where she was the seat-belted driver. She undergoes chest CT imaging despite a negative chest x-ray because of her ongoing anterior chest wall diffuse tenderness. You discover a small 10% pneumothorax (PTX), but no other associated thoracic injuries. Should you place a tube thoracostomy (chest tube)? Should this patient be admitted to the hospital? A 2019 Annals of Emergency Medicine paper by the NEXUS Chest research group tackles these questions.
Emergency Medicine (EM) residents are expected to be familiar with and competent in performing a wide number of procedures, including rare ones such as performing an escharotomy in a patient with severe burns. Unfortunately, there is a paucity of readily available simulation models to facilitate practice of this rare yet potentially life-saving skill.
Welcome to Leg Day #2 of the 