Believe it or Not!

[Apollyon]

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We had a GSW (gunshot wound) yesterday, through and through L bicep, entered the lateral chest wall just anterior to the axilla, then we couldn't find the bullet. My colleague thought he felt it at the chest wall, but it wasn't. So we got the stat chest and abdomen films - see it in the abdomen. Get lateral and decub films - it appears to be in the lumen of the stomach. Surgery is getting ready to roll the guy to the OR.

Then, one of the most incredible things I've seen since I started med school (sarcasm here, and funnin'): the rads resident came out of the box, went to the trauma room, and, incredibly, touched the patient. He was palpating for the bullet, but couldn't feel it. True to life, though, wasn't it something but the bullet was in the rectus abdominus - the bullet tracked subQ and ended up in the abdominal wall.

If he would have felt the bullet, right then and there, I would have bowed down.

Believe it or not.

 

[Leukocyte]

I believe everything you said except the radiology resident touching the patient part. That part is just pure fiction.

 

[Annette]

The radiologist lived in the light long enough to get to the patient, let alone TOUCH him???!!!!?!?!?

 

[Whisker Barrel Cortex]

Ah, misperceptions abound. I have personally examined many patients in the ER when the imaging findings are unclear. In fact, I saw several patients before the ED docs since they have the triage nurse automatically order films whether its needed or not. I saw a teenage football player in the ED waiting room since he already had his elbow films (and a previous elbow fracture and ORIF).

And geuss what, while doing procedures, we spend a lot of time with the patient too. We do pelvics and perform hysterosalpingograms, we perform biopies (general radiologists, not interventional), we do paracenteses and thoracenteses, we do GI studies where we palpate the patients abdomen and move the loops of bowel while following under flouro. Oh and we see much more sunlight than any other specialty since we also get out of the hospital while the sun is still up. 😀

 

[Whisker Barrel Cortex]

Oh and you should have gotten cross table lateral film of the abdomen. Decub will not help you at all unless its in the peritoneum and mobile.

 

[lowbudget]

Slam. WBC, you rock.

 

[docB]

I actually had a tough case the other day and rads really helped me out. I had a 450 lb guy with an INR of >17, Hct of 12 and no IV access. Huge risk for a bleed if I did a subclavian, guy has a 30 inch neck so not crazy to do an IJ, both femoral sites were caked in yeasty badness. Rads did'nt want to do a PICC because they said he could get a compartment from a deep stick so WTF. The rad actually went a got their sonosite (we don't have ER US where I am) and the rad personally came over and found a vein and held the US while I stuck it. Worked out best for everyone. Thanks rads.

 

[Apollyon]

Oh and you should have gotten cross table lateral film of the abdomen. Decub will not help you at all unless its in the peritoneum and mobile.

That's just it - we did get a cross-table lateral (I mentioned that in the OP), and then the decub, and it did appear to move. However, the chief (trauma) was telling our med student that the plain films are only about 65% specific (so there was a 1 in 3 chance that it wasn't in the belly).

As for you, lowbudget, if you notice above, this post was in jest, playing to stereotypes about rads. So there! 😉 Our rads guys (and women) are my buddies.

 

[Annette]

Hear! Hear! 😍