Hello everyone,
It is great to have you in my page today.
Since you are here, let us learn something new or perhaps refresh your mind on something you already know, are you in?
Ooh, I can see your hands so let's proceed😂
So today was the consultant clinic and as usual, patients were already in the clinic waiting for his arrival.
He arrived at exactly 9am and we started calling in patients.
I will only be talking about the last patient we saw.
What Brought Him To The Hospital?
According to Mr. Stanley our patient, he had an accident.
He is a driver who had an accident along Enugu - Onitsha Express way; he lost consciousness and was rushed to the hospital by the Federal Road Safety Corps' members where he got admitted.
Many tests were done after he was resuscitated and an X-ray was taken also.
This happened on Wednesday, May 4, 2022.
He woke up and was very active, walking around like nothing happened and was looking all strong. He did not sustain much external injuries and I think that was what gave him assurance that all was well whereas all was not well.
The X-ray result came out and he was referred to the unit I was, CTU [Cardiothoracic Unit] by the doctor on call at the A&E [Accident and Emergency] ward alongside with his X-ray result.
At CTU Clinic
Not long after he came to the clinic, it was his turn to see the consultant.
The consultant asked him what the problem was and the extent he could remember before he lost consciousness.
Mr. Stanley said the last he could remember was when he was hit from behind by a bus and then that was it.
Looking at the patient, Mr. Stanley, you will never believe that there was anything wrong with him as there were no much external injuries until the consultant brought out the chest X-ray result.
You can take a minute to have a look on the well aligned chest x-ray photograph below and can also explore more from anywhere you want just to see what X-ray of a healthy human looks like.
but then, this was the X-ray of Mr. Stanley
Did You See Anything?
You will likely find it difficult to notice anything if you have not checked on the normal chest X-ray but then let me help you see what you missed.
- If you can see the yellow arrows I made; trace it on those ribs bearing them and you will observe a break there.
Medically, it is said to be,"Fracture of the ribs with minimal displacement"
You just learnt a medical term😄
You can now see that not all that glitters are gold indeed, Mr. Stanley looked strong and well on the outside but internally, he had a fracture but thanks to advanced technology that always help us out with this as it is not a diagnosis to be done just by physical examination without the X-ray photograph backing it up as a confirmation.
There is also something else to observe in this chest X-ray, did you know?
- If you follow my red arrow ( don't mind my freehand sketch 🤦), you will notice that it was well aligned on the left side but the right has lost it's alignment ( using anatomical position) because of the multiple rib fractures.
That is A Flail Chest.
It has not finished yet, something is still left, did you notice?
- It is very easy to notice also that the right side of the lungs seems to be shadowed by something; it looks as if it is incomplete.
Just see the space I gave there.
Yes, the lungs was meant to extend a little bit down there but something is covering it.
Recall that the driver was hit from behind by a bus, so it is very possible that he hit his chest on the steering of his own bus;
This lead to the accumulation of the air you saw that is covering some parts of the right lung,
Medically,"we call it Pneumothorax which means air in the lungs".
Treatment
The patient was first given intercostal nerve block, a pain killer, to reduce the pains he was experiencing as a result of the fractures whenever he tries to breathe.
The aim of the treatment is to get the air out of the thoracic cavity and this involved draining it with a tube and we call this type of surgery, Thoracostomy.
Worried about the broken ribs?
Or you forgot he had multiple rib fractures?
- Well, they heal on their own in a space of 2 or 3 months or more depending on the individual.
The patient just needs to take a break from exercise and also avoid wrapping anything tightly around the ribs while they are healing and he will be fine.
Do your best to drive safe always as we pray for God's protection anytime we are travelling.
I hope you learnt something new??
PS: The pictures not sourced are taken with my phone*
Also posted here