Unusual trajectory of a bullet from the shoulder to the brain: an emergency department perspective on finding a missing bullet.

Terminal ballistics continues to struggle with bullet trajectory reconstruction and interpretation. This is a case of a young man presented with a very unusual trajectory of a bullet from the left shoulder to the brain parenchyma. The single wound and altered mentation prompted a CT head and neck scan, which revealed a retained bullet in the brain parenchyma, traversing from the left shoulder, across the neck and into the brain without causing significant damage to vital organs. We managed the patient conservatively. Emergency physicians dealing with gunshot injuries should thoroughly search for the bullet in cases where only a single wound is present and the bullet is missing, and they should have a basic understanding of the ballistics to understand the mechanism and injury pattern sustained by the bullet. This atypical ballistic trajectory scenario emphasises the need to exercise vigilance in accurately predicting the trajectory when the ballistic route is unknown.

Sigmoid colon perforation secondary to blunt abdominal trauma from cow hoof.

INTRODUCTION: Abdominal discomfort is one of the most prevalent complaints presented to the emergency department. When making a clinical diagnosis, blunt trauma with substantial visceral injuries requires a high index of suspicion. CASE PRESENTATION: The patient went to the emergency room after experiencing lower abdomen discomfort and a fever for two days. He was 40 years old. He says he was injured two days earlier when a cow foot landed on his stomach, causing mild blunt injuries. When examined, he is delicate all the way down in his lower belly. Results from the lab indicated a higher-than-normal total leucocyte count. Echogenic bowel thickening is seen on point-of-care ultrasonography (PoCUS) of the lower abdomen. Abdominal CT with contrast revealed oedema, heterogeneous enhancement, and a focal stretch of thickened circumferential mural including the sigmoid colon and peri-colonic fat stranding. Biopsy results from a sigmoidoscopy revealed significant sigmoid colon constriction and localized areas of active inflammation. Stricture development after a Sigmoid hole caused by a cow foot injury is an extremely unusual occurrence. DISCUSSION: This case emphasizes the need of a thorough history and physical examination, especially in a high-pressure emergency scenario, and the value of using ultrasonography at the bedside to make a definitive diagnosis and improve patient care. CONCLUSION: Regardless of the severity of abdominal damage caused by cattle collision, early imaging should be explored since delaying action might result in poor results.

Need of Point of Care Ultrasound Training in Pediatric Emergency Medicine Practice: A Wake-Up Call for the Low-Income Countries.

POCUS is the acquisition, interpretation, and rapid clinical integration of ultrasonographic imaging performed by the treating physician at the patient's bedside. It is used in the field Emergency Medicine to assist in diagnosing and managing various clinical conditions ranging from undifferentiated shock, respiratory failure, and cardiac arrest, which have shown a positive impact on clinical decision-making, resulting in a decreased emergency department and hospital length of stay. POCUS is also a valuable diagnostic tool in managing pediatric patients for whom radiation exposure is a significant concern. It is used to aid in diagnosing and managing various pediatric medical and surgical emergencies. Despite the evident literature regarding the utility of POCUS in Pediatric Emergency Medicine (PEM) practice, there is a lack of specialized training for pediatric emergency physicians, especially in low-income countries. Therefore, this comment emphasizes the need for POCUS training in PEM.