Masking Histories

Sometimes patients can be awkward buggers, all their signs and symptoms point to one thing, and it is only a bit later, with a bit more investigation that you find out what is actually wrong with them.

Today was a case in point, I got called to a 40 year old male who had been suffering from chest pain for the past two hours.  I turned up and started my examination of him.  He had fallen down the stairs the day before, his chest was painful when I pushed on it, and he had no symptoms leading me to believe that the problem was anything to do with his heart.  I immediately thought that the pain was muscular in nature, rather than a more serious cardiac problem.

The only thing was that his pulse felt ‘funny’, a strange little ‘thrumming’ sensation that was a little like a double heartbeat.  So I thought that if I hooked him up to my cardiac monitor I’d have a better idea what was going on – but the leads on the monitor weren’t working, so I would have to wait until the ambulance turned up.

It was a little embarrassing because the patient and his wife were both doctors (probably working in research)  Both were happy with their treatment and the ambulance soon turned up.  The patient was connected to their monitor and we found out that he was in SVT which is a rythmn problem with the heart, causing it to beat too quickly.

So the actual ‘Chest Pain’ was probably related to the fall, being either a bruise or a muscle strain.  While the patient’s real problem was hidden from a cursory examination.  It is only because we have the capability to electrically examine the heart that the patient was sped into hospital rather than taken in normally.

I’m wondering if the fall somehow caused the arrythmia, it’s probably not outside the realms of possibility.

Knowing what the patients problem was also meant that the ambulance crew didn’t look embarrassed after handing the patient over to the nurses at the hospital.

Tomorrow I have a special learning day – learning how to ‘maintain personal safety’, how to defuse aggressive situations and how to escape from grapples and the like…

Then on Wednesday, I have a plan for something a little bit special – that will either be fun, or really tedious.

5 thoughts on “Masking Histories”

  1. obvious cause does not always lead to the same obvious result: 'tis why being a medico be so difficult. A good dose of ESP be needed also: dungbeetle stercus fimus.

  2. Controll and Restraint or C&R as us Nurse Types call it. and Breakaway Techneques. It's brillient fun training (or a welcome excuse to hurt your anoying colegues) But if you have to use it in real life I sujest you forget all that training and RUN RUN RUN as fast as you can.

  3. Heh, oh yes – I've done it four times before when a nurse (if only because male nurses were expected to be 'security' in my old A&E), and while the physical stuff is a laugh, I think it'll mainly be 'defusing the situation'. Something I don't often have aproblem with as I leave my ego at the door.And yes…running is good – it's why I don't wear my stab vest, it'd only slow me down as I run away.

    And an unexpected kick in the testicles also discourages pursuit.

  4. “And an unexpected kick in the testicles also discourages pursuit.”

    I think that tends to discourage most activities other than ‘scrabbling in the dirt’ and ‘gasping for breath’!Ithika.

    The Broken Hut

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