A 31-year-old male presented to the ER after falling from a 3-meter wall. He fell on his face and is complaining of face pain and body aches. He isn’t sure if he lost consciousness. GCS 15/15. Not much history was taken from the patient as he was in excruciating pain. Vitals HR: 105 bpm, RR: 19 bpm, BP: 106/59, Ox. Sat: 100%, Temp: 36.9.
This case is a kind of unusual. Having this amount of depression of the skull and showing almost no neurological abnormality is not happening very frequent.
We hope that you also recognized the air inside in the right image.
To learn more about how to read the CT scan, see the chapter below.
How to read head CT by Reza Akhavan
You may also see below infographic showing a mnemonic about reading head CT in the ED.
56 years old male known case of HTN, presented to ED with chest pain. The onset was 2 hours ago started gradually. It is a constant and worsening pain. Location: Anterior central chest epigastric. Radiating to Central back” middle of the back.” The character of the pain is heaviness and tightness. The degree at onset was 3 /10. The degree at maximum was 6 /10. The Exacerbating factor is leaning forward. The relieving factor is rest but not leaning forward, eating, antacids, oxygen, nitroglycerin, and morphine sulfate.
Do you recognize the problem in the chest x-ray?
To learn about management, please read chapter below.
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In case you didn’t encounter a 6-year-old patient who swallowed a coin today!
In case you didn’t encounter acute altered mental status and right side weakness today!
In case you didn’t encounter an elderly with altered mental status today!
A 69-year-old male was brought to the ED by EMS because of altered mental status described by relatives. He hardly communicates and is not oriented. He has a motor weakness on the left upper and lower extremities 2 and 3 out of 5, respectively. BP: 183/88 mmHg. Other vitals are in normal range. CT scan image is given. What is next?
In case you didn’t encounter another trauma today!
You are working in a rural hospital. A 55-year-old female was brought to the ED by EMS. She was found at home, lying on the ground, in front of the stairs. She is vitally stable but unconscious (GCS: E1, V:2, M:3). You applied trauma surveys. After inline stabilization, you intubated the patient. The facility does not have a CT scan, and you order standard X-ray series for trauma including c-spine.
What are abnormal findings in this x-ray?
Facet dislocation? Unilateral or Bilateral?
In case you didn’t encounter a sudden severe headache today!
A 46-year-old female patient presented with severe headache. BP: 178/88 mmHg, HR: 103 bpm, RR: 22/min, T: 37, SpO2: 98% in room air. She has no history of disease. She is unconscious (GCS E1, V3, M4). No obvious lateralized motor deficit. Bedside gluco-check is normal. You intubated her to secure airway and send her to the CT (above image). What is your next action?