M&M - Dr. Reyner

Missed Foreign Bodies in Wound

• Litigation - wound repair is a big issue - make sure to document (and have) discussion with patient about possibility of retained foreign body, document pre and post exam.
• Plain films usually first line but will miss organic material.
  
• US by ED docs better than XRAY; look for comet-tailing with glass and metal.

Stenoclavicular Dislocation - 

• Mediastinal structures at risk for damage here - need CT to evaluate for vascular damage. 
  

Chest Pain 
Pt seen with normal 12 lead ECG. D/C'd home. Returned within 12 hours with a STEMI.

Core concept - LISTEN TO YOUR PATIENTS - history is everything - no amount of clinical decision rules can trump this. 

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