Archives for July 2012

Bit of a yarn

Now for something a little different.

A story from theare. I was assisting with a lap appendix. when a theatre nurse came into theatre and feel the ground laughing.

After a considerable time she was able to calm down enough to tell me this story.

The orthopaedic theatre next door was performing an IM nailing for a extracapsular NOF. Pt had be taken to theatre pretty promptly as was found on floor but no concerns with U+E and space on acute list.

The operation had gone smoothly with the consultant supervising a registrar. Then as the registrar began hammering the nail it stopped. So he hit a little harder. He was then dressed down by the boss for being “a little girl” after which he hit a little harder. Then the consultant took over. after much hammering and swearing a larger hammer was requested, same result. At this time the medical student at the back of the theatre said very meekly “I think this patient might have had her knee replaced”

Pin-drop silence.

Said nurse had to make her speedy exit to our theatre to avoid life threatening orthopedic rage.

Radiology was called for and showed the reason for the nail stopping. The cemented Total Knee replacement… Sometimes even if your only tool is a hammer and you can use it well, its worth checking where the nail is going.

Rufus Arthur Johnson Syndrome

Anyone who gets the reference above im impressed as its obscure, moving on.

Patient 52 y/o presented to ED with abdominal pain.

Had been doing sit ups with a friend and had acute onset abdominal pain. no nausea, vomiting. afebrile.

Past medical history of AF on warfarin.

Exam showed small area of ?bruising on anterior abdominal wall associated with local tenderness.

Discussion with surgeons lead to CT abdomen. Shown here:

CT showed, Findings consistent with a left lower rectus abdominous haematoma.

Check Hb normal. D/C home, warfarin stopped for 5 days.

So to explain the reference as i feel i need to.

Rufus Arthur Johnson is better known as Bizzare from D12 he rapped the famous line.

“50 told me to do sit-ups to get buff. Did two and a half and couldn’t get up”

essentially the patients presenting complaint.

There you have it the first patient with Rufus Arthur Johnson syndrome.

Patient with seizures

57 y/O female presents to ED with numerous seizures over preceding days.

Patient reports seizures started following traumatic head injury 5 years ago(MVA) . Nothing before this time. Seen by neurology as an outpatient and initiated on sodium valproate with minimal effect. dose pushed untill side effects and trailed dual therapy with carbamazepine.

Gets some warning, husband describes her knocking on the window when hes outside. When he comes in, on floor unconscious. Regains consciousness after few seconds. usually a bit groggy when she comes around.

Her exam was unremarkable.

ECG (sorry I didnt scan) Was sinus brady 50 BPM.

Patient was admitted to the ward for observation and treatment of prolonged seizures.

Whilst on the ward patient reported feeling one coming on. See trace below.

So I arrived to her looking a horrible shade of pale with the alarms ringing. Her husband was arguing with the nurse as she was trying to put pads on her. “shes fine give it 30 seconds she will be ok” “This happens all the time”

By the time I got to the bedside patient she was responsive and said to me “I guess I had another one?”

Discussion was had around when is ventricular standstill, asystole?

Here is the patients strip post treatment. Follow-up at 3 months, seizure free.