Test your clinical knowledge with the daily Case in Point program, which gives you the opportunity each weekday to work through a subspecialty case.

CASE OF THE DAY

A 13-year-old girl presented to the tertiary care hospital via air ambulance after sustaining a close-range single shotgun wound to the right upper extremity and thorax. The patient had been intubated in the field and was hemodynamically unstable upon arrival. As such, cross-sectional imaging was delayed until the patient was stabilized. Portable chest and upper extremity radiographs revealed numerous shotgun pellets throughout the right hemithorax and mediastinum as well as an extensive comminuted fracture of the right upper extremity. The patient underwent emergency surgery to repair a tracheal injury, right upper extremity vascular injuries, and external fixation of the right humerus. After 3 days of close monitoring in the pediatric intensive care unit, the patient’s Glasgow coma scale slightly improved and the clinical team determined the patient was now stable enough to undergo cross-sectional imaging. A CT scan of the head, neck, and right upper extremity was requested to further characterize the patient’s thoracic injuries and assess for possible hypoxic ischemic encephalopathy.