If you're looking for a stupid patient story, you'll be disappointed by this update, and I apologise in advance. If you're looking for a really cool picture, you're in the right place.
If you were in a car accident 25 years ago, chances are very good you have a little scar above your belly button where the trauma surgeon performed a DPL - Diagnostic Peritoneal Lavage. A small incision was made, a catheter was inserted into the abdomen, and a liter saline was instilled. That saline was then immediately drained out, and if blood, bile, or stool came out with it, you would have gone straight to the operating room for an exploratory laparotomy where the surgeon makes a much larger incision to get into the abdomen to take a look around. A very large number of these operations turned out to be unnecessary, because if it was the spleen or liver bleeding (which it usually is), that bleeding almost always stops by itself (over 90% of the time).
The trauma world has been vastly changed in the past 20 years by the advent of CT scans. "CT" stands for "computerised tomography", and it's essentially a cross-sectional X-ray. In the 1990's, a CT scan of the head alone used to take about 30 minutes, since the machine was only able to take one picture at a time. But we were able to see inside the head for the first time. These days, a full body scan only takes about 20 seconds because the machine takes 64 or 128 pictures at a time. The best part is that the really fancy (read: expensive) machines automatically reformat the raw data into 3-D pictures. But CT scans aren't just for looking at the brain or the guts. They are also great at finding broken bones, and they are much more sensitive than regular X-rays. Plus, the pictures just look cool.
In case you don't believe me, here's some proof. This is an actual 3-D rendering of a patient of mine this past week who was jumped by a gang of misfits who punched and kicked him repeatedly in the face:
In case you don't see it immediately, look at the mandible (that's the jaw bone) on the lower left side of the picture just behind the last molar. There's a second fracture on the right lower side of the picture just next to the midportion of the mandible.
Getting all these scans may be a bit more expensive (ok, a LOT more expensive), but it has also enabled us to find a lot of injuries that plain X-rays just can't see. It has also saved patients from a lot of unnecessary operations. If I see a bleeding liver or spleen, I know that patient will most likely not need surgery.
Hey, wait a second...I'm operating less than before because of these damned CT scans! But I love doing surgery! I'm supposed to hate that, right? But I just can't...they're just too cool.