Saturday, January 02, 2010

What Would You Liike Me To Do?

An interesting shift; not as busy as I thought it might have been...

There is,as many of you will know, an ongoing struggle for us in the ED to convince our Specialist brethren that once in a while, we know what we're about.

I saw a young woman yesterday, with a long, complex history; the sort of history that makes life difficult for you - a mixture of physical and psychological, God-given and self afflicted. She has had many admits with belly-ache, and mostly managed with difficulty.

Yesterday she presented a week after taking a substantial overdose of tramadol, complaining of abdominal pain and an inability to open her bowels. So far, so constipation; except that her pan was uncontrollable (which may represent real pain, or simply a desire to obtain more morphine...) her pulse racing, and her lactate sky-high.

Her belly was tight, exquisitely tender, and I called for a surgical consult. The first surgeon I spoke to me told me he thought it all sounded "very soft". You can interpret that any ay you want, but I'm a stickler for tradition, and like my patients examined before their complaints are dismissed as "soft"

The next surgeon's input was limited to asking me what I was doing about the tachycardia?

Well, I've tried agressive fluids, enough morphine to kill a horse, and antibiotics in case she's perfed... I'm kind of stuck; so what I did was... call you.

1 comment:

Anonymous said...

I agree.

If I where to get a beep asking me to see a patient I'd likely assume that whomever it was,a trained professional, called for a good reason! And individuals not examining patients for themselves really drives me bonkers.

ps To the enevitable comments; yes, sometimes you don't NEED to examine a patient to know what's going on but in this case it would have been an excellent idea.