In the interest of something medical…

OK, really, my enthusiasm has not returned. I’m just letting my bitterness and cynicism simmer for awhile. I’m focusing on becoming faster, more efficient, making quicker (better?) decisions. The more patients I see, the more practice I get. You’d think at some point it would become rote.

Today, I saw a 2 year old boy who hit a car. That’s right, the car didn’t hit him, he hit the car. He ran out into the road, and hit the side of the car as it was moving. He hit his noggin, got thrown back on the ground, passed out, then woke up crying. A short helicopter ride later, he was an hour and a half from home in my emergency department. Imagine trying to take a history from a 2 year old whose parents are en-route over an hour away!

So I did the basic advanced trauma life support workup. No brainer for most of it…labs, c-spine, chest, pelvis films. Other studies are at the discretion of the examiner. He had a big bump on his noggin, and had passed out. Easy enough…CT Head. But what about his belly? He had a scrape on his right lower rib cage, didn’t look too bad. He’s not crying, he’s stable, but…he’s not a very good historian. I waffled back and forth while he was getting his plain films done. If he was a 22 year old drunk acting the same way (but age appropriate)I’d probably get a CT of his belly, but somehow, I enjoyed the simplicity of a workup including just the barest of essentials. He’ll have to be admitted, I reasoned, for observation anyway. They can scan him later if he gets worse.

Well, sometimes I just need a kick in the can to do what’s right. Radiation to babies bodies aside, sometimes it’s just better to scan it all. I sent my attending in to see him. “I’ve missed too many liver lacs,” was his conclusion, “scan his belly.” I thought it was a wild goose chase. But wouldn’t you know it. Not just one, but TWO liver lacs! Man, my boss is smart!

  1 comment for “In the interest of something medical…

  1. carl
    September 6, 2004 at 8:53 pm

    I agree that it is nice to be able to say that he has two liver lacerations, but does it change the care at all. If the child remains hemodynamicly stable after 24 hours of observations are you going to do anything different?? Your 22 year old would be told to take it easy with on contact sports for 6 weeks, but have you ever tired to do this with a 2 year old. In the old days we use to get a lot of trauma operations for postive DPL’s to find liver lacerations that had stopped bleeding, that now days we just follow. The only advantage of doing the CT of the belly was that if it and the head CT were normal, with parents that you could trust one could make the argurment of discharging the patient. Over all the best rule of thumb in trauma is that the patient has it unless you have proved that they don’t.

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