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Fri Aug 31 13:55:45 BST 2007

Dr. Roentgen MIGHT be as patient with my ineptitude as you.  With
radiologists it's a crapshoot.

The SQE is sadly obvious now that you point to it.

Thanks for letting me play.  This is interesting.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of SJASMD at aol.com
Sent: Friday, August 31, 2007 8:51 AM
To: trauma-list at trauma.org
Subject: Re: GSW TO RIGHT CHEST. WHAT IS THE WORKUP OF THIS CASE

In a message dated 8/31/2007 2:47:51 P.M. W. Europe Daylight Time,  
pbjorn at emh.org writes:

Something like ninety per cent of penetrating chest trauma is  treated
with a single chest tube.  Start there.  He's got a  pneumo on the
right.

Question is, do you wait for a CXR given his  history, or insert the
tube
first and save on the extra film?

I'm  doubtful that the little circle in his mediastinum is a bullet.
Doesn't  look dense enough, and it's too symmetrical.  Looks more like a
button  (or a spent casing, end-on).  And so as to prove conclusively
that I  have no aptitude for radiology: his stomach silhouette looks odd
to  me.  Any chance the trajectory was downward?

No doctor, me.   And the world is better for it.

Pret

pret dr roentgen would be most impressed. 

the metallic object is the connector of the monitor leads on the chest. 

what no one has mentioned is the subcutaneous air on the LEFT side of
the  
neck, subtle but definitely visible on the original  image.

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GSW TO RIGHT CHEST. WHAT IS THE WORKUP OF THIS CASE