Tuesday, March 02, 2004
Well it seems the ex is vindicated by my faulty memory and unscrupulous bank staff. okay, well good.
feeling : terrible, after work. a 58 yr old chap I admitted with a hx of RTA, and next to no signs but a hx earlier in the day of headache, suspicious to me of a small SAH then suffered a massive bleed a few hours later on the medical ward.
I actually re-read my notes, and I wrote :
Dx : SAH / ICH, ? SOL (mild signs), RTA - no head injury evident, ? LOC
Plan : refer medics for admission +/- CT
his only sign had been a mild tongue deviation to the right. which the medical SHO had been unable to reproduce when she saw him.
I dunno why but I feel terribly guilty. If only he could have had his urgent CT tonight, although he was table for 4 hours in A&E with a GCS maintained at 15/15 and b/p normal, HR normal.
If only I had pressed the point of SAH more firmly - except the taking over medical SHO had agreed with my Dx, and her clerking even exaggerated many of the things I had written (sudden onset (R) frontal headache became Sudden onset headache "like punched")
Perhaps if I had told the family that although his signs were minimal he might bleed again, like he did. Instead I told them that he might have had a small bleed or stroke, but he didn't have much in the way of signs which was a good thing, and that we would probably CT in the morning (which was exactly what the medics decided to do).
Fortunately, the medical SHO said exactly that to the family.
So perhaps the only thing wrong this time around was the system. Perhaps we should just CT everyone with a moderate clinical suspician, at 2 in the morning. Perhaps radiologists should get off their bums and wake up out of their bed, to turn on their computers and view the tele-conference linkup of the CT scans.
Perhaps many unnecessary CT scans that cost heaps of time, staffing and money are better than the odd CT scan that isn't quick enough - and only because ultra-quick when it's too late.
sigh.
feeling : terrible, after work. a 58 yr old chap I admitted with a hx of RTA, and next to no signs but a hx earlier in the day of headache, suspicious to me of a small SAH then suffered a massive bleed a few hours later on the medical ward.
I actually re-read my notes, and I wrote :
Dx : SAH / ICH, ? SOL (mild signs), RTA - no head injury evident, ? LOC
Plan : refer medics for admission +/- CT
his only sign had been a mild tongue deviation to the right. which the medical SHO had been unable to reproduce when she saw him.
I dunno why but I feel terribly guilty. If only he could have had his urgent CT tonight, although he was table for 4 hours in A&E with a GCS maintained at 15/15 and b/p normal, HR normal.
If only I had pressed the point of SAH more firmly - except the taking over medical SHO had agreed with my Dx, and her clerking even exaggerated many of the things I had written (sudden onset (R) frontal headache became Sudden onset headache "like punched")
Perhaps if I had told the family that although his signs were minimal he might bleed again, like he did. Instead I told them that he might have had a small bleed or stroke, but he didn't have much in the way of signs which was a good thing, and that we would probably CT in the morning (which was exactly what the medics decided to do).
Fortunately, the medical SHO said exactly that to the family.
So perhaps the only thing wrong this time around was the system. Perhaps we should just CT everyone with a moderate clinical suspician, at 2 in the morning. Perhaps radiologists should get off their bums and wake up out of their bed, to turn on their computers and view the tele-conference linkup of the CT scans.
Perhaps many unnecessary CT scans that cost heaps of time, staffing and money are better than the odd CT scan that isn't quick enough - and only because ultra-quick when it's too late.
sigh.
