Don't make me spell it out for you.
An 85 year old lady presents with left sided weakness, slurred speech, and a room air sat of 85%. She has been very healthy until last week, when she fell and broke her pelvis. She was just discharged from our fine establishment two days ago. Would you work her up for:
A: Nothing. She's just old. Old people have problems. It's the circle of life.
B: A hemorrhagic CVA. CT comes back normal, she must be OK. We'll sit on her in the ER for a bit and then send her home.
C: An ischemic CVA. CT comes back normal, lets's keep her overnight and see what her CT says tomorrow. She needs supportive care anyway.
D: An ischemic CVA, and oh, hey, let's go ahead and check for a PE, because her sats are 85% for no apparent reason, and those obnoxious clots can sure get around.
Sometimes new docs are great.
The ones who listen to their nurses and pay attention to their patients and are only arrogant up to the point where they don't know the answer, and then they turn off the arrogance and work as part of the team trying to fix the patient; I love those ones.
The ones who walk in with the "I'm better and smarter than you because I'm a doctor and you're not" attitude, that don't recognize clinically significant details about patients, but you can't tell them anything, because they know everything; not too fond of those ones.
Not too fond at all.
8 comments:
Nawwww....why on earth would recently healthy old ladies need O2 sats above 90?
I'd have asked Junior if he'd leave his granny sit and win a trip to the funeral home or get her the CT just to make sure she didn't win the PE.
Scary, scary, scary!
Ummm...D?
Was she hemoptysisyzing too? What happened? Doc ignored the 'detail' of 85%? Poor form.
As an RT, I HATE when people diminish the importance of oxygenating! That should be someone's first priority!
Well, I guess I'd assess to see if she needed immediate intubation, give supplemental O2 assuming she was not, do the stat head CT, if normal, then assume ischemic CVA, and then do a CXR to see if she aspirated from the CVA (ie slurred speech--trouble handing secretions). If no, then maybe further investigate with a CT to r/o PE, especially if she is tachycardic, for instance. However, heparinizing someone with PE in the context of acute CVA might be contraindicated anyway...
I was thinking UTI.
Holy crap! I really want to believe that docs are not this egotistical, stubborn, and asshole-like, but I'm wrong, aren't I? I really am ready to give up on the human race.
yay for medblogs because I took a quiz today with a very similar question about a pulse ox at 86%, and I got it right! yay!
~Flo
Oh...yikes...
I am an MSW-social work intern in a cute rehab of a big hopsital. Everyone works as a team.
Well...accept the unit manager who is...um...a...bitch. Seriously, she is just bitchy! Just her nature, I am trying to get over it. At least she is bitchy for the right reasons. anyways.
However, the unit is full of med students, nursing students, PT student, Ot students.... TONS of people un top of regular staff.
However, me...little old SW intern...is asked by Dr. Clueless resident about getting a formalary override approval for one of the 15drugs that a patient was discharged with yesterday. As if me, or any other person, has magical medicaid powers.
We got the paperwork for her, but we knew these things take days, not minutes. She asked us if we can go to the outpatient pharmacy we contract with, and pick it up, and deliver it to the guy.
Um....yeah
(Did I tell you we had a suicidal patient in room 3?)
We very nicely suggested that she can call in a similar RX for the next couple of days.
Now....keep in mind at the end of the story that she called in a fucking OTC. (can you see why we did not spend two hours on this?)
Now mind you, I have been on the floor for a couple of weeks, and she has been here since????? (well, at least July, right?)
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