Tuesday, July 01, 2008


Don't you love it when nothing else is wrong, but there is one thing, one symptom, one minut finding that make you sit back and go, "Self, something is totally fucked up about this." You look at your patient, who looks fine, whose vitals are stable, but that one finding, that one thing is signifigant enough that your gut is screaming at you. I had that the other day. A young pt who had pain in inspiration "right here" and he pointed to a point on his chest on his right side. "A rubbing sharp pain?" I ask. "
"Yep. Excatly."
Pluresy. His vitals are ALL stable. Normal Sinus on the EKG, 99% SPO2 on room air, I put him on a canulla. respirations 16 non labored. Not fighting for oxygen at all. I listen to his lungs with my handy dandy stethescope. High tech little tool we have, not really, but very important peice of equiptement on the ambulance. So I instruct him to take a deep breath and hear very clearly breath sounds on the Left, but nothing on the right. Whaaayayayyttt? Okay do it again dude, Deep breath. And again, nothing on the Right. I look at the monitor and everything is normal. So ONE more time, deep breath, and once more....nothing on the right. But still vitals stable and pt not working to breath. I ask again any shortness of breath. No. None. Just a sharp pain and he can put his finger on it. He doesnt want to go to the hospital. I explain that I can't hear air moving on the right side, thats strange. I have a gut feeling that something is funky. But how do you explain to someone about gut feelings? I convince him to go. and we take a easy ride to the hospital.
When we get there, I tell the staff. "I know I sound like a crazy person, his vitals a completly stable, SOP2 is 99-100%, respirations are 16, and he denies SOB. But I swaer his has almost no lung sounds on the right. I know all I have in the feild is a stethescope, not exactly a chest xray. But I swear, I listened 8 times, my partner listened. neither of us could hear. So we brought him to ya'll. So you tell me...can this be a spontanous pnuemo even though no other signs and symptoms piont to one?"
The doc told me that I was thinking the more deadly Tension Pneumo, a small bleb wouldn't show up so seriously. SO I did what I could do in the feild and brought him to the hospital. So good job. They would do a chest xray and figure it out. He wouldn;t try an diagnose a pneumo in the feild.
Yesterday, I stopped by the ER, it was not only a pnemo, but a big one. Needing a chest tube.
This my friends is what you find when you do a good assessment.
Listen to Lungs, know what the sounds mean, do the 12 lead on that 78 year old whose only complaint is weakness ( I found a huge anterior MI once that way, again, pt was very stable, vitals, only complaint was weakness x 3 days, but there it was staring back at me plain as day). I have had several medical mysteries recently, where the patient was absolutly stable, but something told me, put them on the monitor and then caught the 2 degree heart block or the stable Vtach (yep, had that too) don;t put them with you EMT basic partner, as competent as he is, he can't give amiodarone or interpert a 12 lead. CHeck the drunks BGL. Oh shit it's 567. Thats why he altered. Yes there are times that sometimes a fall is just a slip and fall. Listen to your patient. They can tell you many things. And also listen to what they are NOT telling you. Sometimes that can tell you more.

1 comment:

Anonymous said...

It usually pays to listen to your gut. In some cases my "pucker receptors" are activated and I always listen to those too.