Patients can be tricky little buggers sometimes – they like to trip you up.
We were sent to a middle-aged woman experiencing difficulty in breathing. We arrived and I did my usual examination and history taking.
Here is what I learnt.
- She had difficulty in breathing.
- She had a cough.
- She had a fast pulse.
- She was coughing up a bit of frothy white sputum.
- Her lungs sounded clear, no sign of infection.
- She'd recently had a long haul flight.
- She was a smoker.
- She wasn't on the contraceptive pill.
- She didn't have a high temperature.
- She had a pain in her chest that wasn't made worse by her breathing.
- She had a fairly low oxygen saturation.
- She had deep 'S' waves in lead I.
All of which made me think that there was a possibility that she could be having a pulmonary embolism – this is a life-threatening emergency and needs rapid treatment at a hospital.
So we carried her downstairs, did an ECG (where we discovered the deep S waves – something that is one third of the changes that occur in a pulmonary embolism), and 'blue lighted' her into hospital.
After some investigation she was found to have a kidney stone.
A kidney stone?
Now, I've seen a lot of kidney stones in my time. None of them ever presented like this. With a kidney stone you get abdominal pain, back pain, you tend to writhe around on the trolley. You don't have a cough, chest pain, reduced oxygen levels and an altered ECG. There was nothing, absolutely nothing, about her condition that suggested a kidney stone.
But it just shows you how easily you can be 'tricked' by the examination and history of the patient. It's why I have a fairly low benchmark before I 'blue light' a patient to hospital. Even if it's just something that my subconscious has picked up I'll 'blue' them in – I can always find a justification to the hospital as to why I've done so.
“Treat for the worst, hope for the best”, it's how I get to sleep at night without worrying that I've let someone die because I haven't treated them seriously.
I'm sure everyone who works in healthcare has a similar story about how an atypical patient presentation has tripped them up. Feel free to tell me about it in the comments.