December 20th, 2011 by ChristopherChangMD in News
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According to Boston News, in early December 2011, a carpenter accidentally discharged a nail gun and embedded a 3.5 inch nail in the bottom of his neck. Based on the CT scan included here, it appears the nail entered the neck dead center given the clear appearance of the windpipe.
Based on the location, the anatomic sequence of nail piercing is as follows:
Skin –> Thyroid Gland –> Trachea –> Esophagus Back Wall –> Cervical Vertebral Body
The damage to skin, thyroid, and trachea is not a big deal… In fact, one can consider this a mini-tracheostomy. Minimal bleeding would be expected.
However, the hole between the trachea and esophagus is another matter which may heal well… or not. The esophagus Read more »
*This blog post was originally published at Fauquier ENT Blog*
December 16th, 2011 by GruntDoc in Opinion, Research
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I read this headline and said, “Wow!, finally I won’t need to CT all those patients’ heads!”
FDA permits marketing of the first hand-held device to aid in the detection of bleeding in the skull
Helps to determine if immediate CT scan is needed
The U.S. Food and Drug Administration today allowed marketing of the first hand-held device intended to aid in the detection of life-threatening bleeding in the skull called intracranial hematomas, using near-infrared spectroscopy.
via Press Announcements > FDA permits marketing of the first hand-held device to aid in the detection of bleeding in the skull.
But then, wait, said I, is it any good? Read more »
*This blog post was originally published at GruntDoc*
October 28th, 2011 by DeborahSchwarzRPA in Research
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Lyall A. Gorenstein, MD, FRCS (C), FACS
A recent study funded by the National Institutes of Health found that CT screening reduced deaths from lung cancer by 20%. While it may seem intuitive that screening would help to detect lung cancers and reduce deaths, until now, that had not been definitively proven.
“This is a landmark study,” said Lyall A. Gorenstein, MD, Director of Minimally Invasive Thoracic Surgery at NewYork-Presbyterian/Columbia University Medical Center, who lauded the study’s design and its clear implications for treating patients at risk for lung cancer. Lung cancer is the leading cause of cancer-related deaths in the United States, but the merits of screening — whether or not it actually improves patient outcomes – has been a topic of debate for the last 30 years. Dr. Gorenstein believes that Read more »
*This blog post was originally published at Columbia University Department of Surgery Blog*
September 24th, 2011 by Shadowfax in True Stories
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A hard thing about being an ER doctor is that I know a little, sometimes very little, about a lot of things. When I am faced with a particular condition, I often need to call the specialist for that organ, who knows way way more about it than I ever will, and they all think I’m an idiot because I don’t know as much about their organ as they do. There’s a huge asymmetry of knowledge, and it can create some tension and conflict.
I’m OK with it, because I can ignore their condescension and I am secure with what I do know, and its limits. But sometimes I get perplexing instructions from the specialists. The emergency medicine dogma can be overbroad and a little hidebound and what the specialists will do in the real world often radically diverges from what the Emergency Medicine textbooks say to do. It’s often an interesting learning opportunity for me, especially when it’s a condition I don’t encounter that much. But I also have to work to maintain a flexible and open-minded attitude when I call a consultant and my side of the conversation consists of “Really? I didn’t know you did that for this…” You need to know and trust your colleagues in other specialties, and know when to call BS on them and push to do something else, which is really hard to do when you are talking to someone who is so much more of an expert than you are.
So I saw this guy recently, an urban hipster who was perhaps a bit too old to be riding his longboard on the hilly streets of our fair town. He didn’t seem to be too good at it, judging by the collection of crusted abrasions and aging ecchymoses he was sporting. He had been falling a lot recently — we only get about a month of sun here, so I guess he was making the most of the summer weather practicing his new hobby. He had a variety of complaints from Read more »
*This blog post was originally published at Movin' Meat*
August 25th, 2011 by Shadowfax in Research, True Stories
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Well, this is satisfying. Over the years, in our ER we have mirrored the nationwide trend and have significantly increased the utilization of CT scans across the board. The reasons are manifold. Some cite malpractice risks, and indeed in our large group we have had one lawsuit for a pediatric head injury and another for a missed appendicitis which probably did contribute. But, in my opinion, there have been many other drivers of the increased use. For one, CTs have gotten way, way better over the last 15 years, which quite simply has made them a better diagnostic tool. They’ve also gotten way faster. As the facilities have invested in CT scanners, they have increased their capacity and increased their staffing, so the barriers to their use have rapidly diminished. I am so old that I remember when ordering a CT involved calling a radiologist and getting their approval! No more of that, I can tell you.
But a couple of years ago, we really started paying attention (perhaps belatedly) to Read more »
*This blog post was originally published at Movin' Meat*
