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Hey Guys,
Thought I’d post this as I feel it was a mistake on my part, though fortunately no harm came from it.
50 year old guy this past Saturday (which was a ridiculous shift full of drunks and unhelmeted mopeds and motorcyclists with some very sick people) who was an unhelmeted moped rider going reportedly 60mph and wrecked while drinking alcohol and somehow managed not to make their way to Rm 9.
BP: 125/73. HR: 86. RR: 18. O2 saturation: 91% on room air. Temp: 97.6 F (oral)
A&Ox3, c/o shortness of breath and diffuse chest tenderness. Not really any obvious bad looking signs of trauma and had been log-rolled prior to my eval (triaged about 1hr 45min before I saw him).
I saw him, in no respiratory distress, maybe some expiratory wheezing on my exam, but with breath sounds on both sides and no crepitus that I could feel to his anterior chest. I finish my eval and just order a MAN scan based on his Hx and due to his drinking alcohol (EtOh 292)
Patient is taken to CT at 23:05 (about 2 hrs after I ordered them) and the nurse grabs me after the scan and tells me I need to look at his chest CT (only his C-spine images were up at the time which showed me all kinds of SubQ emphysema).
Just a lesson learned; when it’s super busy like that shift was is when we need to be the most cautious and really think critically about the things we need to do, and not be in a hurry when we’re putting orders in.
The guy is doing well so far (and not intubated) and in THIS case no harm was done, I put a chest tube in without difficulty. But I really should have gotten a CXR to start.
His injuries included Bilateral 1st-6th Rib Fx’s, Pulmonary Contusions, Mediastinal Hematoma, Manubrium Fx, C7 Fx, T4, T7 Fx.
Not criticizing you Adam personally because I’ve seen a lot of people doing this. But for the education of the interns I would hedge to say that if you think the patient is in rough enough shape to get a man scan maybe they should be rolled to room 9 so you can get it. If your suspicion for serious injury is low you probably aren’t or shouldn’t be scanning them or your scans should probably be more focused. But the man scan from the department, especially during a busy shift….i mean there could be a change in moons before you get it done and read. I’ve done it plenty of times before too so I’m just as much to blame. But I can recall somebody that was put in the drunk tank and as soon as I met him I knew was more than drunk, blood from the ear, throwing up, ended up with a subarachnoid. I had him moved out of the corner and ordered a man but what I really should’ve done is taken him to 9 (come to think of it, he was on a moped too) But that’s what the purpose of Room 9 is at times (resource utilization, get an immediate CXR, get your blood done and back in timely fashion, go straight to scanner, bump the rest of the ED). Now that can and will be a pain in the $%^ when the last thing you want to do is spend 30 min in Room 9. But honestly the patient above easily could’ve coded with a CT such as above.