Hello, med students. My name is Zach Olson and thank you for downloading this week's episode of the EM Clerkship podcast.

We are still on our trauma series. I know you're probably getting pretty burned out on all this trauma right now, but we're almost done.

If you stick with me, you're going to be all over these cases, not just as a student,

but as a resident too. So just hang with me. Here's this week's case.

University Hospital's Ambulance 48 in route to you with a trauma alert.

Got an 18-year-old male was a competitor at a bull riding competition, was thrown off,

landed on the top railing on the fence on his abdomen.

His complaining of 9 out of 10 pain and positive for rebound tenderness.

We are going to do an ultrasound in a minute here. I just wanted to

give you a quick call. We're still about 20 minutes out. Currently BP is 100 over 60 pulse of 140. Respirations

are at 28 right now. We do have them on 15 liters of 2 via non-re breather. We have two large

bore IVs started. Parents are also with us. We're going to do an ultrasound. We'll give you a call back and update you.

Now think closely about this EMS call. This is clear, obvious abdominal trauma. Easy. This patient's

probably going to need surgery. That's not the point of today's episode. What I want you to remember

today is mechanism exam imaging. Mechanism exam imaging. Because here's the deal. Unlike all of Exam. Imaging.

Mechanism exam imaging.

Because here's the deal.

Unlike all of these other injuries we've talked about,

abdominal injuries, specifically blunt abdominal injuries,

are never straightforward.

We don't have fancy decision rules that we can use to determine what to do. Even the CT scan, the gold standard imaging study for abdominal pain is nowhere close to 100%.

And everybody knows it.

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