Tuesday, April 23, 2013

A missing lung.

This may be an obvious one, but still, what are your guesses? MOI? Alive or dead? 


This patient presented to our services for a completely unrelated complaint to his obviously demolished L lung. The patient was a self-inflicted GSW from a shotgun to the L chest over TWENTY years prior... that is correct... the following patient is alive & well 20+ yrs after attempting to shoot himself.

A couple of you picked up pretty quickly on the discrepancy between his CXR and the lack of radiographic life support apparatus such as ET tube, chest tube, etc... if this patient presented acutely, the CXR would have contained ALL of the above & more.

So the lessons out of this:
1) Always look at your patient & not just your monitoring or diagnostic equipment... if the patient is flatline on the ECG but is talking to you... it is probably not asystole. If the patient is BLUE & not breathing, but his sats appear to be 98%, you should probably still bag him.

2) The human body is a very fragile AND a very resilient thing... I have seen ricochete 22s kill a man... and you have now seen a man missing an entire lung on a CXR with over a dozen pellets still in him be alive and fine 20yrs later. This is why we WORK some trauma patients that may still have a pulse, but yet may appear unsalvageable to us... this patient is a living testament to that. The initial scene of his shooting would have probably been quite gruesome & I can only imagine being the medic responding to that... my initial thoughts would have been that this pt will not make it... but alas.

When I post medical material... whether it be an ECG, an xray, a write up or something else... it is almost always a patient or a case that I had direct interaction with and because it caught my eye for some reason. Many of you subscribe to dozens of medical sites that recycle the same medical themes over & over... as cool as an AMI may look like on a 12-lead, it does tend to look near about the same anywhere else... I will not waste your time with the obvious.

Thanks for following & feel free to share anything I post, and as always message me with feedback or any questions!

~EMSDoc911

1 comment:

  1. I'm not a doctor, but I can say that there's something wrong with the x-ray. Do you think it was caused by faulty medical equipment? Medical equipment should be run through quality assurance for them to operate effectively.
    - PhoenixDeventures.com

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