good cases

11 year old football player comes in with his ring finger angled at about 70 degrees across the top of his middle finger, with the knuckle pointing towards the pinky. X-ray confirms a simple fracture with rotation and angulation. Ortho was in surgery, so I called them with my plan…hematoma block, manual reduction, splinting, follow-up in clinic. The resident thought it was a great idea. It’s amazing what they’ll let you do if you have a good plan and sound like you know what’s going on. (Plus, he didn’t have to come down and see it!) I have a feeling that wouldn’t have worked with my next case when I called the neurosurgeon…

70 ish year old lady with one week of headaches, one episode of left leg weakness is sent from OSH (outside hospital) with an MRI report of a mass, but no films! SO we repeated a cat scan of her head which showed a fairly big tumor, with necrosis (cell death) in the middle, an enhancing ring and edema (swelling) around it, all causing swelling and shift of the brain to the opposite side. Can you imagine? One week of headaches, and suddenly, you’ve got a brain tumor! (now don’t all go rushing off to your doctors…she also had focal weakness, dizziness that was all unresponsive to initial treatments, so her PCP ordered the initial imaging study)…

Finally, an 11 year old girl with a previous brain tumor (resected) now with dizziness and balance problems. We do a head CT (normal) and an Lumbar puncture, which despite my best efforts and plenty of lidocaine, was still painful for her, also normal. Finally, dad says to me, “by the way doc…she’s had foul smelling pus coming out of her right ear…do you think that could have anything do to with her balance problems?” ARRRGHHH! Here’s some ear drops, sir…

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