Below is a kid s/p Road Traffic Accident (RTA) with a broken L humerus and dislocated elbow. These were overlooked initially, though in the rush to pay attention to his R shoulder laceration that bisected the deltoid and exposed the rotator cuff, but left the joint capsule intact. Because he couldn't afford surgery and was above 5 yo (for free/reduced cost care), we closed him in the ED after an attempt to reconnect segments of his delt. Days later, he's adducting that arm ok, but a tissue defect remains...
Interesting sono here-- this woman had so much ascites that her pelvic organs (uterus, tubes & ovaries) are outlined beautifully floating in the fluid in her stomach (this is normally not the case!). Just had to take a picture of the sono screen.
Hmmm, oh, here are a couple TB cases. The first is a woman coughing up blood and with R chest pain for a while. There's a small density with some central clearing on the upper right close to the lung periphery. Not much else causes a "cavitary lesion." There's also a guy who was cachectic (ie skeletal) and had had cough for several months. His nodular infiltrate is pretty good for advanced TB, and he was begun on meds.
So a few others will wait. Got called out of conference to do a pericardial centesis on the floor (so, how many of these have you done, Doctor?) and continue to see a lot of "end-stage NOS" A woman came in the other day with complaints of no urine output for a week and on sono had the worst bilateral obstructing hydronephrosis I'd ever seen (retroperitoneal fibrosis due to TB?), and another woman presented with hepatosplenomegaly and enormous kidneys (medical renal disease --> HIV nephropathy? HELP!!!). So it's been interesting. But, for the most part the kids bounce back, so that's good. Oh, one last bit. Remember, when you're working in an international setting, even when the patients do bring in their medicines, it's not always helpful...
All good things,
--aws
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