Monday, April 21, 2008


Before today, I had never seen the effects of a gunshot wound before, much less a self-inflicted one. I was unsure that the bullet would be easily visualized on the x-ray, but the outline was clearer than a rabies virus capsule. It's true what they say about the identities white opaque things on CT: blood, bone, bullet, or "bontrast" (contrast).

Medicine loves acronyms and mnemonics. Give a poorly spelled and nonsensical acronym that serves as a mnemonic to any medical student and they will write it down and regurgitate it back to you like a highly trained machine. We like crazy sentences and mnemonics full of sexual innuendo. For example, for the brachial plexus, we have "SMI LPM MARMU" and "Randy Travis Drinks Cold Beers." Okay, there was no sexual innuendo. To the untrained eye.

For an assessment of a teenager's psychosocial history, we use HEADSSS (my pet peeve is when they add multiple "invisible" repeats of a letter in the mnemonic), which stands for "Home, Education, Activities, Drugs/Alcohol, Sexual History, Suicidality, and Safety." I underestimated how important HEADSSS can be as a "tool" to cover the basics until my patient was an adolescent with a self-inflicted gunshot wound. Suddenly, the mnemonic was a way to get inside his HEAD(SSS).

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