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Case presentation 96.04.24 Intern 黃毓琦

Case presentation 96.04.24 Intern 黃毓琦. Personal profile. Name : 簡 X 涵 Gender : female Age : 49 years old Chart number : 23506199 Arrival date at ED : 96/03/22 Time : 07:42 am. Injury mechanism. She fell down from stairs (3~4 steps) this morning (7:00am)

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Case presentation 96.04.24 Intern 黃毓琦

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  1. Case presentation96.04.24Intern 黃毓琦

  2. Personal profile • Name : 簡 X 涵 • Gender : female • Age : 49 years old • Chart number : 23506199 • Arrival date at ED : 96/03/22 • Time : 07:42 am

  3. Injury mechanism • She fell down from stairs (3~4 steps) this morning (7:00am) • Left foot pain without initial loss of consciousness was noted • CC: Left foot pain

  4. Pre-hospital evaluation and management • sent to KMUH ER • Head :ILOC, dizziness, headache, nausea/vomiting, amnesia, vertigo • Neck: pain, stiff, soreness • Chest: pain, dyspnea • Abdomen: pain, discomfort • Limbs and skin : left foot pain, swelling, deformity

  5. AMPLE history • Allergies: denied • Medication: nil • Past illness: • DM:(-) • HTN:(-) • Hepatitis B carrier (-) • Other systemic diseases: denied • Operation history: C/S • Last Meal :last night (21:00)

  6. Initial evaluation (KMUH) A (airway) / B (breathing): • Collar fixation: (-) • Airway: speech: normal respiration: smooth • airway obstruction sign foreign body in the mouth • Trachea • Breathing sound

  7. C (circulation): • Rate: brachial a. , carotid a., femoral a. , dorsalis pedis a. • Cuff BP : 136/86 mmHg • Skin condition: appearance, temperature, humidity

  8. D (disable): • GCS: E4V5M6 • Pupil response: od: ? os: ? E ( exposure ) : • left foot pain, swelling, deformity

  9. Secondary evaluation (KMUH ER) • Left foot x-ray AP & lateral view

  10. UpToDate

  11. LearningRadiology.com

  12. LearningRadiology.com

  13. Left foot Lisfranc fracture-dislocation (tarsometatarsal ; TMT joint ) 96/03/22 08:03AM

  14. Plan • Consult orthopedics for surgical intervention

  15. Lab data (96/03/22)

  16. Lab data (96/03/22)

  17. Chest x-ray

  18. Tentative diagnosis • Left foot Lisfranc fracture-dislocation

  19. Operation • Sent to OR at 11:20 • CRIF and short leg splint

  20. Post-op x-ray • 96/03/22 18:57 Impression 1) Status after internal fixations for fracture dislocation at the tarsometatarsal joints of left foot with improved alignment. 2) Status after splint fixation for left foot.

  21. After admission • Admission to 13ES66-02 • Pain relief agents and rehabilitation was done • Close observation of post operation condition • MBD on 96/03/26

  22. Thanks for attention

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