Friday, January 7, 2011

When Spidey Sense Kicks In

The patient had presented with mid-lower back pain, more in the flank area, rated as maybe 4/10. He felt a little uncomfortable. His BP was a little high, heart rate in the 80's. Dr. CindyLou Hu pounded on the area but the patient said nah, that doesn't hurt, it feels like it is DEEP inside. Hmmm...

Back pain? or something worse?

Dr. CindyLou elected to do a CT instead of sending him home with pain meds. It showed a HUGE dissecting aortic aneurysm (click here to read about it). This would be a bad thing, but there are two types.

One type requires surgery like, yesterday; if it ruptures, it's all over. The other can be treated conservatively with medication. It was an overnight shift so CT's are read remotely by an on-call radiology service with whom the hospital contracts; I believe they exist in bunkers somewhere, perhaps in Antarctica, or in rainforests, possibly connected with the Dharma Project and sharing office space with Keebler Elves while alternating searches for Sasquatch and the Loch Ness Monster. Normally there is a little bit of a lag for readings (hey that happens during the day as well). Fortunately this guy had the NOT IMMEDIATELY FATAL type and was admitted to Higher Level of Care Medical Center where he did well.

As Dr. Cindy Lou and most nurses would say, sometimes you just gotta go with that gut feeling. Not all BAD THINGS slap you in the face and say they are a BAD THING; but experience helps, and sometimes the patient just can't say for sure what is going on beyond (and this includes parents regarding their kids), "there is something that just isn't right".

I once had a 38 year old with nausea who said he just didn't feel right; except he LOOKED like he was going to die, literally, right in front of me. An EKG confirmed that he was having the BIG ONE. Some nurses never develop that sixth sense that prods immediate action, but most do. Gotta trust that Spidey Sense.