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SAMPLE EMERGENCY ROOM CASES
  1. 31 yo stab wound left chest
    S: Reportedly had some rib injury several weeks before. Walked into ER about 1 hr after knife wound left chest after domestic dispute. Has been drinking alcohol. Has had tetanus series.
    O: alert, strong alcohol odor, breath sounds present bilaterally, 2 cm SW left 5th ICS, near sternum. good peripheral pulses
    LABS - ECG ST 123, Chest x-ray possible fluid/infiltrate left base.
    Course - see DATA FLOWSHEET. 1900 cc blood removed from left chest, 4 units packed cells given. Trauma unit at ______ accepts (Dr_______). They will bring 4 units of blood.


  2. Chest pain, acute MI.
    S: 75 yo male, with known glaucoma and on Zocor for elevated cholesterol. Chest pain began about 90 minutes PTA while mowing lawn. Goes into left arm. Has not had this before. Went to PMD, brought to ER by his physician.
    O: alert, chest pain level 5, no JVD, lungs clear, heart sounds normal, Abdomen soft, femoral and pedal pulses present. No edema
    LABS: ECG showed 5 mm ST elevation anterior leads. chest x-ray normal.
    Course - see DATA-FLOWSHEET. Given tPA, Heparin, aspirin, Lopressor, nitro,
    transferred to ____________________


  3. Multiple injuries in 8 y/o from 4 wheeler accident
    S: 8 yo, along with 4 others on 4 wheeler, ran into stopped tractor, about 1 hr PTA. Complains of left knee pain, left upper chest and face/jaw pain. No known LOC
    O: alert, oriented to person, talking and following commands. 2 cm laceration left jaw, loose right lower teeth, mandible stable, but tender swollen right jaw. tongue lacerated. Airway clear (talking) lungs clear, bilaterally, heart sounds normal. Abdomen soft, no masses/tenderness. Extremities -moves all, left grip weaker than right. Gaping laceration below left knee.
    Skin - 3-4 cm burn left elbow and right heel.
    Course - See DATA-FLOWSHEET.
    X-rays - C-spine ok C1-6, below this not visualized Fx left clavicle
    Chest - suggestive small pneumo-mediastinum Transferred to ____________Dr. _______accepts. Intubated by Dr. ________anesthesia.

Harold D Cross MD
Emergency Medicine Physician
E-mail address:
 hdcross@islc.net
Mailing address:
 2809 W. Royal Oaks Drive
Beaufort, SC, 29902
843-524-0959