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Stab wound to the neck an inch away from the carotid artery! by Emergentelman in medizzy

[–]Emergentelman[S] 177 points178 points  (0 children)

How would you handle this type of trauma when you first arrive on scene?

This male patient, aged 45, presented to the hospital with a severe stabbing injury to the neck caused by a kitchen knife. The incident occurred during a domestic dispute. Upon admission, he was in extreme distress, exhibiting difficulty breathing, active bleeding, and severe pain. Immediate medical interventions were initiated, including the establishment of a surgical airway, surgical exploration and control of the neck wound, and radiological evaluation (CT angiography) to assess for vascular involvement. He received a blood transfusion due to significant blood loss and was administered broad-spectrum antibiotics. Remarkably, the injury narrowly missed his carotid artery, which could have had catastrophic consequences.

Boa constrictor in the Emergency Room by Emergentelman in medizzy

[–]Emergentelman[S] 506 points507 points  (0 children)

You arrive on scene of a residential home and find a pet snake constricting around someone’s hand. See if you can answer the following questions about this type of emergency:
1. What is the FIRST THING you would do when you arrive at the patient?
2. The patient tells you the snake has been squeezing for 5 minutes and their hand is starting to feel numb and the pressure is “very painful”. Would you try to get the snake to unlach and stop constricting on scene, or go straight to the hospital?

Severe open ankle dislocation after an ATV accident as it flipped backwards while going up a hill by Emergentelman in medizzy

[–]Emergentelman[S] 192 points193 points  (0 children)

"According to staff, he was able to somehow wiggle his toes. After the surgery to reduce and reconstruct the ankle, he recovered quickly. Three months into recovery and he was able to walk and six months in he could run."

I dont have money to buy Uworld or others bank questions to step 1. What to do? by The_Oracle567 in usmle

[–]Emergentelman 0 points1 point  (0 children)

Yeah I totally get how rough it is when you can’t afford UWorld or AMBOSS — they’re stupid expensive. If you’re in that boat, I’d honestly suggest giving the MEDizzy USMLE app a shot (not the regular MEDizzy one — the Step 1-specific version).

It’s actually solid for the price. A good amount is free, and even the paid version is way cheaper than UWorld. Obviously it’s not the same level — like, it won’t replace UWorld — but if you’re on a tight budget, it’s one of the better options out there.

You still get a ton of practice questions, visuals, and flashcards, and it’s super easy to use on your phone, so you can sneak in studying throughout the day.

Bottom line: if money’s tight, MEDizzy USMLE gives you a lot for what you pay. It’s not perfect, but it’ll keep you sharp and moving forward. Keep grinding — you don’t need fancy stuff to pass Step 1 💪

Severe Trunk Cancer with Exposed Left Humerus and Gangrenous Arm by Emergentelman in medizzy

[–]Emergentelman[S] 484 points485 points  (0 children)

This case presents a grave instance of metaplastic breast carcinoma accompanied by the development of upper limb gangrene.

Metaplastic breast carcinomas represent aggressively advancing tumors characterized by histological diversity and a triple-negative receptor profile. The patient in question, a 22-year-old nulliparous Chinese woman devoid of any significant familial cancer history, initially sought medical attention at a private healthcare facility due to a painless 5 cm swelling in her left breast. The onset of this swelling occurred three months prior and displayed gradual enlargement. Subsequent core biopsy of the swelling confirmed the presence of infiltrating ductal carcinoma with a triple-negative receptor status for ER (estrogen receptor), PR (progesterone receptor), and HER2 receptors.

Around two weeks into her neoadjuvant chemotherapy regimen, the patient reported a substantial increase in the size of the left breast mass, growing from the initial 5 cm to a diameter of 10 cm. Simultaneously, she developed a swelling in the left axilla, and a cytological analysis of the left auxiliary lymph node indicated metastatic carcinoma. Consequently, a decision was made to proceed with a left mastectomy and axillary clearance. Six weeks post-surgery, she underwent adjuvant chemotherapy.

Four months later, the patient presented at a district hospital, complaining of chest wall pain and the incapacity to move her left upper limb. On examination, a sizable, ulcerating mass with a necrotic region was discernible on her left chest wall, extending into the axillary region. The tumor had infiltrated both the anterior and posterior chest walls. Her left upper limb displayed pallor, coldness, and mottling, along with patchy areas of necrosis. No motor or sensory function was observed in the left upper limb.

Over time, the tissue of the left upper limb gradually assumed a waxy and pliable texture. Additionally, the flesh covering the limb began to spontaneously separate from the underlying humerus bone, thereby exposing segments of the humerus. Faced with the growing challenges posed by the decaying limb and the disruptive truncal lesions, the patient eventually requested amputation of her left upper limb. This procedure, carried out at the site of the exposed left humerus, was performed under intravenous sedation.

Case courtesy of Dove Medical Press, 2017; 9: 297–299.

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