Ventilation-Perfusion Scan (V/Q scan)
- high probability scan for R. sided pulmonary embolism
- almost absent perfusion to R. lung, with normal ventilation
Paracetamol Toxicity Normogram
- ~40% of self-inflicted poisoning is due to paracetamol
- can cause severe liver damage if >150mg/kg is taken (>12g or 24 tablets)
- damage is from accumulation of NAPQI (metabolite of paracetamol)—> liver and renal damage
- "High Risk Patients" = alcoholics, malnutrition, HIV, enzyme inducing medications, cystic fibrosis (lower threshold for Rx)
- Symptoms - nausea, vomiting, abdominal pain + hepatic tenderness, jaundice
- Treatment - plot plasma paracetamol on graph, if above treatment line —> N-acetylcysteine, initially rapid infusion 150mg/kg, then 50mg/kg over 4hrs, and 100mg/kg over 16hrs
- INR = most sensitive measure of liver damage
- Monitor U&Es and urine dip as risk of acute tubular necrosis
- ?Transplantation - use the Kings College Criteria (pH, INR, Creatinine, encephalopathy)
This image shows gas embolism and air bubbles inside the meningeal vessels in a drowned diver due to sudden decompression.
Is this subdural or extradural blood? It isn’t quite crescent shaped and it isn’t quite lens shaped. So how can you tell?
Well shape isn’t everything. This is subdural blood because it is crossing the lambdoid suture. Extradural hemorrhage is contained by the periosteum of the inner table of the skull and therefore does not cross cranial sutures. Handy little fact to remember.You can see the suture for yourself on the bone window CT image here:http://radiopaedia.org/cases/subdural-haemorrhage-3
Useful to know…
Me: *casually looking through someones notes whilst I wait for my patient to get back from a scan*
Doctor: Oh you don’t want to go near him
Me: Really? Why?
Doctor: He is what we call a “triple P”
Me: A what?
Doctor: A “Piss Poor Personality”
De-gloving of the foot I guess…but I can’t imagine what could have caused it. Eh…never mind. Motorcycle injury. The source site says: Please wear high quality bike boots when riding. As seen below, trainers just aren’t suitable footwear.