It is another busy night in ED. The ‘Bat-Phone’ rings, gently pricking the ear to attention in anticipation of the next code…

We are bringing in a 60 year old lady with profuse diaphoresis, hypotensive with a systolic of 70 and altered conscious state…

Initial examination confirms an unwell lady, drained of colour, drenched in sweat taking short shallow breaths. Following application of oxygen, comprehensive non-invasive monitoring, IV access and analgesia you decide to perform a rapid bedside abdominal USS (even though you are by no means an expert in wielding the mighty sono sword)…but it is late, the really clever sonoboys are all tucked up in bed…so it’s all up to you – SonoMan^®

Through the vagaries of shadows that are beholden to the sonographic snowland you think you see a cave-like compressible opening around 5-6cm in diameter…but lets face it – the howling blizzard you just demonstrated on the sono-machine-thing hasn’t really helped you refine your differential diagnosis

So you send your patient to the ‘Donut of Death’ for a dose of real radiation

Now what Doc?

Abdominal CT scan

Additional images (for @scanman)

Acalculous Cholecystitis

Acalculous Cholecystitis

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

From time to time little things get lost. Whether you are playing billiards naked in the dark; counting money with your tongue; battling with an electric rolling pin….or just ‘slipping’ whilst in the shower….you may be unlucky enough to find yourself in the emergency department desperately trying to manifest a more tangible excuse for foreign body concealment.

These are my top 10 foreign bodies.

10 Not the tastiest treats in the cupboard

Can you identify all the objects – and spot the odd one out…

Ingested Abdominal Foreign Bodies

9 Toxic Ingestions

Iron tablets are among a select group of preparations which are radio-opaque. An X-ray can be a great way of determining the exact number of tablets ingested of this potentially lethal substance.

Iron Tablet Overdose

Fortunately mercury thermometers are going out of fashion. Don’t sneeze when your temperature is being taken…

Mercury Ingestion from shattered thermometer

8 Mmm that looks yummy Mummy

Ear-rings, paper clips, screws and spoons are not liable to degrade quickly upon ingestion…

7 Money in the Bank

6 Mea culpa

Sometimes cavity penetration occurs through no fault of the patient…

Right Main Bronchus (RMB) Intubation

Right and Left Bronchus Nasogastric Intubation

5 Not the Full 8-ball

Warning: Playing billiards, naked, in the rain…at night – may result in serious injury

4 Beware the Button Battery

3 The Classics

Who knew there were so many varieties of electric rolling pins?

2 Serial Offender

Iron deficiency may be a reason behind the ingestion of some metallic objects.

Can you guess how many objects were ingested?

MMmm – Surgeons in Rotterdam in the Netherlands were flabbergasted when X-rays showed 78 different items of cutlery in the 52-year-old woman’s stomach.

Ingestion of 78 pieces of Cutlery!

MMMmmm Shiny

1 “Can’t Beat the Feeling!”

This is my favourite, mainly because of the inventive excuse used to explain the placement of a 375mL effervescent drink bottle. As a result of the alleged causative event the team at Life in the Fast Lane issue the following warning.

Warning: Narrow necked bottles should not be used to collect urine specimens

Feeling Thirsty?

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

A long-term inpatient from a Psychiatric hospital presents to the Emergency Department with gradual onset of abdominal swelling over four weeks and acute generalised abdominal pain over the last 24 hours.

Can you spot what might be causing his discomfort?

Faecaloma or fecaloma

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Life in the Fast Lane Medical Blog - Emergency Medicine education blog

How many foreign bodies can you identify?

abdominal foreign bodies

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Life in the Fast Lane Medical Blog - Emergency Medicine education blog