A 15 yo hockey "phenom" (Wayne Fretsky) comes to you after a recent Minnesota Boys State Hockey Tournament loss. In addition to his ego being bruised, he also sustained this injury to his abdomen. While skating at full speed he was "checked into the boards by a THUG" and somehow "my stick jammed into my gut." However, being the tough stoic player that his family, coaches, and community have come to expect...he shook off the injury and kept skating. He awoke this morning with some pain in his left upper abdomen and flank. Following breakfast he became lightheaded and nauseous. Upon thorough review of systems he denies headache or neck discomfort, but says "my shoulder is really bothering me."
His vital signs are normal for age. His abdomen mildly tender in the LUQ. The above bruise is noted. No palpable focal tenderness in the shoulder with normal range of motion.
What should you do?
A. Reassure him, get his autograph, (hoping it might be worth something in 10 years)?
B. Perform bedside ultrasound: FAST exam
C. Xray his shoulder
D. CT his abdomen
E. Call Children's and continue your job search for a high paying medical consultant gig.
What if he were 6 years old and had been "thrown from his bike"? In other words, What other injuries should you consider in a younger patient with serious blunt abdominal trauma?
Who, in your opinion, is the biggest Hockey THUG of all time?
I would start with B (us/FAST) and would consider either a CT or admit to surgery with serial exams and serial hg. Worried about splenic injury and duodenal hematoma for which CT is not very sensitive. Either way he will be admitted for serial exams it just depends if they want CT first to evaluate spleen/kidney.
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