case 2

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case 2 - July 19, 2007 3:36:25 PM

Dr.Wagner

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13 year old lacrosse player is hit with a lacrosse ball. You are at the sideline acting as the ATC, PT. You see the picture below. The patient states he is "ok" and wants to play. What would guide your decision making.

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RE: case 2 - July 19, 2007 4:19:50 PM

Tom Reeves DPT ATC

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Any abdominal rigidity, rebound pain, vomiting. could have ruptured his spleen.

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RE: case 2 - July 19, 2007 6:29:24 PM

FLAOrthoPT

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From: West Palm Beach
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was there a tick there prior? lol..kidding:
breathing without pain?
Valsalva without pain?
how tender to palpation?
Rebound pain?
any naseau/vomitting?
any discolortion in his urine (if he happened to go to bathroom)?

I have been hit by many a lacrosse ball, and know that our goalie rarely wore anything when we were hucking ballas as fast as 90mph at him, and never got very injured. Sooooo, knowing the sport some, A)why no rib pads?B)unless something there in the symptoms to make me be flagged, not going to be as concerned about a LAX ball hit

so on the surface, looks like the pic but no other real symptoms, go play...

but will wait to hear answers to our questions first... must say i have seen a street hockey puck cause a splenic injury hit right about there as well, so will go with, waiting tohear more info first route

< Message edited by FLAOrthoPT -- July 19, 2007 6:35:55 PM >

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RE: case 2 - July 19, 2007 9:41:55 PM

jma

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Yes, any breathing difficulties, positive rebound test, positive blumberg sign, Kehr's sign for the spleen?

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RE: case 2 - July 20, 2007 8:26:47 AM

Dr.Wagner

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Joined: January 24, 2003
From: Indianapolis
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Grade III splenic laceration.THis is first diagnosed on an Ultrasound, which is readily available bedside in the ED. This prompts a CT scan.

ON exam, rebound tenderness MAY NOT be found early, therefore LUQ tenderness and mechanism of injury may be the only initial findings. Vital signs will be stable early.

"Blumberg sign" is a seldom used term for peritoneal signs over the appendix.

Question: What vital sign would be abnormal earliest in the exam?

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< Message edited by Dr.Wagner -- July 20, 2007 8:30:36 AM >

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RE: case 2 - July 20, 2007 8:47:43 AM

Tom Reeves DPT ATC

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my guess would be blood pressure(decrease) or heart rate(increase) due to volume loss and shock.

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RE: case 2 - July 20, 2007 10:34:37 AM

jma

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Might show signs of shock. Tachycardia, increased breathing rate.

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RE: case 2 - July 20, 2007 4:26:42 PM

Dr.Wagner

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The first vital sign to show irregularity is Heart Rate. In Stage II of hypovolemic shock (15-30% blood loss) tachycardia with stable blood pressure is found.

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Dr. Wagner DO
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RE: case 2 - July 21, 2007 9:55:57 AM

jma

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From: NY
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That was a interesting case. Please do not hesitate to post more. They are very informative.

(in reply to Dr.Wagner)

Post #: 9