Traumatic Pancreatitis

I recently had a patient that we decided had traumatic pancreatitis. The attending physician had mentioned he hadn't seen a case of this in a long time, and I'm thinking I haven't seen a case prior to this. That sort of made me think, was it more common years ago? This phenomenon isn't something I see even on occasion, or that I can think of.

Our patient had no external signs of injury and the trauma workup was essentially negative. There was some "haziness" at part of the pancreas on CT scan (can't remember if it was the head or tail), but no injury called on the read. The only thing was the patient had elevated pancreatic enzymes. In looking at some research, traumatic pancreatitis is frequently the result of trauma to the epigastrum, such as impact from a steering wheel or handle bars. If I remember, our patient was assaulted/kicked, but to the back, not abdomen.

The process is thought to involve the rupture of minor components of the pancreatic duct system, consequently releasing the enzymes. This would account for our patient's elevated levels. Management is non-operative and it will resolve naturally. From my experience, this isn't something encountered everyday, nor is it something of major concern. However, it was something new that I thought I'd share. Maybe someone else will have a case of traumatic pancreatitis soon.

Penetrating Trauma

I'm pretty sure I haven't covered this topic. I think I was about to go into impalements in my foreign objects blog, but realized it deserved it's own sections. Alas, here it is! A recent patient reminded me of this topic, as she was impaled in the eye with a pole that extended into the brain. At my trauma center, blunt trauma is far more common than penetrating trauma, so these cases are always of interest to me.

Although we do see gunshot wounds (GSW) to the head, which seem to come from Mexico with a bad story behind it, I have to say a nail gun to the head is far less frequent. But apparently it happens. In one such case, the nail hit a cerebral vessel that I don't remember anymore, but I found the case very interesting. In order to remove the nail, the patient had undergone a balloon study to determine if the patient could survive without blood flow through that vessel. The patient passed the test, so went on to have the vessel coiled, which essentially blocks blood flow permanently (which is why they had to make sure the patient could tolerate such a procedure). THEN, the nail could be removed. Quite interesting.

Speaking of GSW to the head though, sometimes they are self inflicted. A memorable example of that was a patient that shot himself in the temple, realized he was "unsuccessful" for suicide, and shot himself in the other temple. Unfortunately, this resulted in severing the optic nerve and rendering the patient blind (but the brain was completely unharmed).

In other case, a girl fell several stories onto a iron fence, impaling her vagina. I didn't see this patient, so not sure the extent of the injuries, but the mechanism was certainly enough for me to remember.


This photo avove isn't from our center, but this sort of neck trauma isn't all that rare. I've had several cases of severe neck lacerations, including injury to major vessels. Sometimes, although much less, there can be tracheal injury as well. This isn't impalement, but certainly penetrating trauma. If you get them soon enough, they actually do pretty well. It's really all about the clock-stop the bleeding in time.

Most common to our trauma center are stab wounds. I know I've seen on TV-trauma telephone poles go through torsos, but I've never had a case with that. Nonetheless, we have so many car crashes, falls, and assaults that even stab wounds are different and interesting. And anything more is just plain exotic!

A decision has been reached!

Well, as some of you might remember, I mentioned going back to school for a PhD. The grueling application process is over, and I recently made my official decision on which offer to accept. It was actually far more taxing than I anticipated! I only applied to 4 schools, but it turned out to be far more work than I expected when I started! I'm trying to remember if it was this much work to apply to go to school before, and I'm pretty sure it wasn't. Nonetheless, that part is over and that's a relief. Although I do realize, this is really only the tip of the iceberg! Now it's on to four years of school!

This also means a move across the country...again. I moved for school on the east coast twice, and looks like I've committed to doing the same for my PhD. It's already feeling more complicated at this age. Wish me luck in selling my house!

Regardless of the obstacles, I am excited. I look forward to the work ahead of me, even though I know it won't be easy. This will probably change my focus here, as well. When I first started this, I wanted to try make sure it wasn't only for NPs. That is hard at times, and I know I also tend to favor "trauma topics." I can't help it. But with my soon-to-be academic focus, I'm sure you will notice a change in topics again...but not until Fall!