CASE PRESENTATION A 37-year-old male pedestrian was brought in by ambulance to an urban teaching emergency department (ED). He had been struck by a motorcycle traveling at unknown speed. The patient complained of pain in the neck, right forearm, and lower back. Later he said that he had been suffering abdominal pain for two months and that the pain was worse now. He arrived ‘‘boarded and collared,’’ with consistently normal vital signs, and was alert and fully oriented but mildly intoxicated. Witnesses to the event said no loss of consciousness had occurred. However, the patient could not remember events preceding or following the impact. He reported having recently consumed alcohol and acknowledged drinking ten to 20 standard alcoholic drinks per day for many years. He was also a smoker. He denied any other medical, surgical, medication, or substance abuse history. Triage noted swelling and closed deformity of his right forearm, with intact neurovascular function. Radiographs of his arm were ordered by the nurse, and he was triaged to the intermediate acuity area of the ED.
- abdominal trauma,
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