Identification and triage of a Morel-Lavallée lesion using point of care ultrasound

Introduction A Morel-Lavallée lesion is a relatively rare, closed, degloving injury. Polytrauma and severe injuries through to seemingly innocuous trauma can distract the clinician from thorough assessment of the affected site. Missed or misdiagnosis of the closed lesion is reported from both a clinical and imaging perspective. Case report A 46-year-old male is discharged from accident and emergency with a shoulder injury following a cycling accident. Ten days post trauma, an advanced practice physiotherapist suspects a lateral thigh Morel-Lavallée lesion during a telephone assessment (Covid-19 restrictions). A face to face appointment with imaging the following day confirmed the suspicion. Discussion The aetiology, imaging and clinical management of a Morel-Lavallée lesion is discussed. The addition of diagnostic ultrasound skills to clinical assessment in this case report may have improved patient care and experience by offering a ‘one stop shop’ to care. Formal training in musculoskeletal ultrasound imaging is emphasised. Conclusion Thorough history taking, clinical reasoning and subsequent application of robust imaging led to the identification of a Morel-Lavellée lesion and, in this case, highlights the value of a point of care ultrasound model in a triage setting.

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Understanding the “Empty Toe” Phenomenon: A Rare Case Report

Journal of the American Podiatric Medical Association ◽

10.7547/19-190 ◽

2021 ◽

Vol 111 (2) ◽

Author(s):

Nicholas V. DiMassa ◽

Erik K. Monson ◽

Kimberly S. Cravey

Keyword(s):

Case Report ◽

Rare Case ◽

Medical Literature ◽

Review Of The Literature ◽

Detailed Review ◽

Soft Tissue Envelope ◽

Degloving Injury ◽

Rare Case Report ◽

Closed Degloving Injury ◽

Closed Degloving

Closed degloving injury involving a toe represents a rare phenomenon in which the bones of the toe dislocate but the soft-tissue envelope remains intact. It has been described sparingly throughout the medical literature, and outcomes have been poor. This article presents a case report of the unique injury while also investigating trends through a detailed review of the literature.

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A Rare Cause of Septic Shock Secondary to Trauma: Morel Lavallée Lesion - Case Report

10.21203/rs.3.rs-718480/v1 ◽

2021 ◽

Author(s):

Mehmet Gunay ◽

Baran Mollavelıoglu ◽

Kaan Ali Fuat Gok ◽

Mehmet Ilhan ◽

Cemalettın Ertekın

Keyword(s):

Septic Shock ◽

Case Report ◽

Fluid Collection ◽

Rare Presentation ◽

Multiple Rib Fractures ◽

Degloving Injury ◽

Closed Degloving Injury ◽

Closed Degloving ◽

Fluid Collections ◽

Gcs Score

Abstract Introduction Morel Lavallée lesion is a hemolymphatic collection in between muscular fascia that can be caused by the separation of soft tissue and muscular fascia in degloving fashion. Morel Lavallée lesion is an infrequent lesion but should be known for medico-legal reports Morel Lavallée is a rare presentation that can cause life-threatening septic and hemorrhagic shock. Case PresentationIn this case report we are going present Morel Lavallée lesion which can present with septic shock and bleeding and can be mortal. Our patient, fourty seven years old male, arrived at the emergency department with an ambulance 1 hour after an extravehicular traffic accident. Apart from a right hemopneumothorax with multiple rib fractures, grade 2 laceration in spleen and bilateral kidneys, zone 2 fracture of sacrum, computer tomography (CT) revealed a closed, degloving injury of the pelvis , also known as a Morel-Lavallée lesion. On CT, Morel Lavallée lesion appear as well-defined, encapsulated fluid collections that occasionally show fluid fluid levels .. Heavy fluid collection was detected in control CT which was actually a collection infected hematoma in the operative setting. Patient was diagnosed in the first 12 hours and necrotic tissues were debrided. Patient was considered deceased after 15 days without any improvement in his GCS score.ConclusionsThere is one report that describe mortality after Morel Lavallée lesion in the autopsy setting. Early diagnosis and treatment are essential to decrease severity of necrosis and sepsis though our patient has deceased due to complications of sepsis

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Case Report: When all claims that it is necrotizing fasciitis but Point of care ultrasound (POCUS) proves the opposite!

POCUS Journal ◽

10.24908/pocus.v3i1.13310 ◽

2018 ◽

Vol 3 (1) ◽

pp. 13-14

Author(s):

Hadiel Kaiyasah, MD, MRCS (Glasgow), ABHS-GS ◽

Maryam Al Ali, MBBS

Keyword(s):

Emergency Department ◽

Critical Care ◽

Case Report ◽

Soft Tissue ◽

Necrotizing Fasciitis ◽

Soft Tissue Infection ◽

Critical Care Unit ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Soft Tissue Infections

Soft tissue ultrasound (ST-USS) has been shown to be of utmost importance in assessing patients with soft tissue infections in the emergency department or critical care unit. It aids in guiding the management of soft tissue infection based on the sonographic findings.

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145 Point of care lung ultrasound in patient triage: integration of ultrasound into a streaming pathway for COVID-19

Emergency Medicine Journal ◽

10.1136/emj-2020-rcemabstracts.27 ◽

2020 ◽

Vol 37 (12) ◽

pp. 839.1-839

Author(s):

Dominic Craver ◽

Aminah Ahmad ◽

Anna Colclough

Keyword(s):

Point Of Care ◽

District General Hospital ◽

Training Programme ◽

Service Evaluation ◽

University Hospital ◽

Junior Doctors ◽

Point Of Care Ultrasound ◽

Face To Face ◽

Point Of Care Diagnostics ◽

Audit Data

Aims/Objectives/BackgroundRapid risk stratification of patients is vital for Emergency Department (ED) streaming during the COVID-19 pandemic. Ideally, patients should be split into red (suspected/confirmed COVID-19) and green (non COVID-19) zones in order to minimise the risk of patient-to-patient and patient-to-staff transmission. A robust yet rapid streaming system combining clinician impression with point-of-care diagnostics is therefore necessary.Point of care ultrasound (POCUS) findings in COVID-19 have been shown to correlate well with computed tomography (CT) findings, and it therefore has value as a front-door diagnostic tool. At University Hospital Lewisham (a district general hospital in south London), we recognised the value of early POCUS and its potential for use in patient streaming.Methods/DesignWe developed a training programme, ‘POCUS for COVID’ and subsequently integrated POCUS into streaming of our ED patients. The training involved Zoom lectures, a face to face practical, a 10 scan sign off process followed by a final triggered assessment. Patient outcomes were reviewed in conjunction with their scan reports.Results/ConclusionsCurrently, we have 21 ED junior doctors performing ultrasound scans independently, and all patients presenting to our department are scanned either in triage or in the ambulance. A combination of clinical judgement and scan findings are used to stream the patient to an appropriate area.Service evaluation with analysis of audit data has found our streaming to be 94% sensitive and 79% specific as an indicator of COVID 19. Further analysis is ongoing.Here we present both the structure of our training programme and our integrated streaming pathway along with preliminary analysis results.

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