New Technology: The Bruise Suit
Here’s an interesting new product. It’s called the “bruise suit”, and it was designed by some students at the Imperial College of London. The purpose of the suit is to visually indicate that enough force has been applied to potentially cause injuries.
It was initially designed to help Paralympic athletes detect when they’ve encountered enough force to cause injuries that they are unable to feel. It uses a pressure-sensitive industrial film developed by Fuji that changes color based on the compressive force applied. It gets darker as the force increases.
This product is currently in the concept phase, meaning that it will be some time before it hits the market. However, it’s a great idea that has implications for athletes playing contact sports and rescue professionals, to name a few. We’ll see how it develops!
To summarize: stab to the back, prone position, stable vitals, awake and alert and breathing easily. The patient had a chest xray which showed some likely hemothorax. He was sent to CT (prone) and the image obtained looked like this:
They key points to note are:
- The injury is completely above the diaphragm. No need to worry about an intra-abdominal problem.
- The amount of hemothorax is moderate. It is not enough to mandate a thoracotomy. At least for now.
- There is a significant pneumothorax. You can’t see it due to the windows used, but the lung has separated from the chest wall by about 3cm.
- The track of the knife was directed laterally.
- No significant vascular structures were involved, and there is no contrast extravasation.
Final management: The patient was returned to the ED, and the knife was deftly removed and processed properly as evidence. The patient was then turned supine and a 40 Fr chest tube was inserted using procedural sedation. About 400 cc of blood was drained and reinfused. A repeat chest xray was obtained, which showed some residual hemothorax and near resolution of the pneumothorax. He was then admitted for frequent vital signs and drainage measurements for two shifts. Afterwards, he was placed in our chest tube management protocol. The tube was removed and he was discharged two days later. There were no complications.
I’m currently in Montreal, and just finished some presentations at McGill University / Montreal General Hospital on pediatric trauma. I’ll be wandering around the city today and will finish the stab to the back case tomorrow. Looking for fans!
So yesterday, we found that our patient was hemodynamically stable, with a knife in his back, positioned prone. An initial chest xray shows the knife (plainly) and haze in the right side of the chest. Obviously, this is a hemothorax.
Key points to note are that the amount of blood present is modest and the knife point is relatively medial, as is the entry seen on the outside. Combined, these data points indicate that you have time to gather more information.
My choice was to go to CT to get the ultimate anatomic information. What, you say, the patient is prone! Well, the scanner doesn’t care. As long has his torso AND the knife fit through, it works. Here’s the representative scan result:
What do you do now? Where do you do it? Answer tomorrow. Tweet or comment your decision!
Yesterday, I presented a case of a young man with a knife in his back. He was brought to your ED in the prone position. The question was, what to do next?
With any trauma patient, regardless of size, shape, or position, the first question is always, “does this patient belong in the ED?” And usually, that question is answered by checking hemodynamic stability.
This patient stays prone while you quickly assess vital signs. If vitals are abnormal, he needs to get rolled to the operating room immediately, while still prone. There is no time to figure out how to reposition, or if the knife can be removed. Get him out of your ED.
But let’s say he is hemodynamically normal and talking to you. You need more information. So start with a physical exam. With him in the prone position! It works. In this case, there are no other puncture wounds, and the anterior part of the body can be examined by carefully logrolling him onto his side. Breath sounds are decreased over the right chest, otherwise there are no other anomalies.
So now what? Well, let’s get some more info! How about a chest xray? Best position? Prone! It’s the easiest, because the patient does not need to be held up next to an xray plate, which would also have to be held manually. The lateral view doesn’t add anything but hassle. Here’s the result:
Now what? What do you see, what do you do? Tweet or comment; more to follow tomorrow.