Case presentationCase presentation

96.04.2496.04.24 Intern Intern 黃毓琦黃毓琦

Personal profilePersonal profile

Name : Name : 簡 簡 X X 涵 涵 Gender : femaleGender : femaleAge : 49 years oldAge : 49 years oldChart number : 23506199Chart number : 23506199Arrival date at ED : 96/03/22Arrival date at ED : 96/03/22Time : 07:42 amTime : 07:42 am

Injury mechanismInjury mechanism

She fell down from stairs (3~4 steps) She fell down from stairs (3~4 steps) this morning (7:00am)this morning (7:00am)

Left foot pain without initial loss of Left foot pain without initial loss of consciousness was notedconsciousness was noted

CC: Left foot pain CC: Left foot pain

Pre-hospital evaluation and Pre-hospital evaluation and managementmanagement

sent to KMUH ERsent to KMUH ER Head :ILOC, dizziness, headache, Head :ILOC, dizziness, headache,

nausea/vomiting, amnesia, vertigonausea/vomiting, amnesia, vertigo Neck: pain, stiff, sorenessNeck: pain, stiff, soreness Chest: pain, dyspneaChest: pain, dyspnea Abdomen: pain, discomfortAbdomen: pain, discomfort Limbs and skin : Limbs and skin :

left foot pain, swelling, deformityleft foot pain, swelling, deformity

AMPLE historyAMPLE history

Allergies: deniedAllergies: denied Medication: nilMedication: nil Past illness:Past illness:

– DM:(-) DM:(-) – HTN:(-)HTN:(-)– Hepatitis B carrier (-)Hepatitis B carrier (-)– Other systemic diseases: deniedOther systemic diseases: denied– Operation history: C/SOperation history: C/S

Last Meal :last night (21:00)Last Meal :last night (21:00)

Initial evaluation (KMUH)Initial evaluation (KMUH)

A (airway) / B (breathing):A (airway) / B (breathing): Collar fixation: (-)Collar fixation: (-) Airway: speech: normalAirway: speech: normal

respiration: smooth respiration: smooth airway obstruction sign airway obstruction sign foreign body in the mouth foreign body in the mouth Trachea Trachea Breathing soundBreathing sound

C (circulation):C (circulation): Rate: brachial a. , carotid a., Rate: brachial a. , carotid a.,

femoral a. , dorsalis pedis a. femoral a. , dorsalis pedis a. Cuff BP : 136/86 mmHgCuff BP : 136/86 mmHg Skin condition: Skin condition:

appearance, temperature, appearance, temperature, humidityhumidity

D (disable):D (disable): GCS: E4V5M6GCS: E4V5M6 Pupil response: Pupil response:

od: ? od: ? os: ? os: ?

E ( exposure ) : E ( exposure ) : left foot pain, swelling, deformityleft foot pain, swelling, deformity

Secondary evaluation (KMUH ER)Secondary evaluation (KMUH ER)

Left foot x-ray AP & lateral viewLeft foot x-ray AP & lateral view

UpToDate

LearningRadiology.com

LearningRadiology.com

96/03/22 08:03AM

Left foot Lisfranc fractLeft foot Lisfranc fracture-dislocation (tarsoure-dislocation (tarsometatarsal ; TMT jointmetatarsal ; TMT joint ) )

PlanPlan

Consult orthopedics for surgical Consult orthopedics for surgical interventionintervention

Lab data (96/03/22)Lab data (96/03/22)

Lab data (96/03/22)Lab data (96/03/22)

Chest x-rayChest x-ray

Tentative diagnosisTentative diagnosis

Left foot Lisfranc fracture-dislocationLeft foot Lisfranc fracture-dislocation

Operation Operation

Sent to OR at 11:20Sent to OR at 11:20 CRIF and short leg splintCRIF and short leg splint

Post-op x-rayPost-op x-ray

96/03/22 18:5796/03/22 18:57ImpressionImpression1) Status after internal fixations for 1) Status after internal fixations for fracture dislocation at the fracture dislocation at the tarsometatarsal joints of lefttarsometatarsal joints of left foot with improved alignment.foot with improved alignment.2) Status after splint fixation for left 2) Status after splint fixation for left foot.foot.

After admissionAfter admission

Admission to 13ES66-02Admission to 13ES66-02– Pain relief agents and rehabilitation was Pain relief agents and rehabilitation was

donedone– Close observation of post operation Close observation of post operation

conditioncondition MBD on 96/03/26MBD on 96/03/26

Thanks for attention