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GSW to the Leg

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History of Present Illness:

  • A 32-year-old male presents to the ED for a GSW to the left femur.
  • He denies any other injury

Vital Signs & Physical Exam:

  • Vital signs are normal except for a pulse of 110, which improved with fentanyl.
  • Physical exam is normal except for an entrance wound to the upper outer left thigh and an exit wound just above the knee
  • Distal neurovascular exam is intact

Initial Diagnostic Testing:

  • CBC and BMP are normal
  • The Knee X-ray is shown below

QUESTIONS:

  1. What does the case image show?  (click two times to enlarge)
  2. What should you do next?  
  3. Where can one get a quick refresher on this topic?  

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ANSWERS:

  1. What does the case image image show?  The image shows air in the joint.  There is also a nondisplaced distal femur fracture.
  2. What should you do next?  Give antibiotcs and consult ortho.   See case conclusion below page-shot tutorial.
  3. Where can one get a quick refresher on this topic?  See yellow highlighted area below from purple book above…

1-Minute Consult on the EM topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

 

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CASE CONCLUSION: We’ll just have to see

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