The Contusion That Wasn't
The only person NOT unhappy in this old Parke-Davis ad is the nurse! The kid looks upset, the mother looks hostile and the doctor looks like he is watching to make sure the nurse doesn't mainline the immunization. This pretty much sums up nursing: scared patients, hostile families and grumpy old doctors who can't let a nurse swab an injection site without ordering it done in a clockwise direction.
Humility is a noble trait. My humility gene got a kick in the pants this week. Here's the scenario:
Female patient, 36 hours post forearm-injury secondary to a sport. No swelling. No deformity. No decrease in range of motion. No bruising. No point tenderness (and I was all over that arm like white-on-rice, looking for point tenderness). Was able to continue playing after injury. Chief complaint: it began hurting again after initial improvement. Nurse-With-Overarching-Pride-In-Assessment-Skills (aka: me) tells ED MD that it just sounds like a contusion. ED MD evaluates patient and orders x-ray. "What???" I say incredulously. "You have got to be kidding!" ED-MD-With-Patience-Of-Saint assures me he is not joking, that (1) patient requested an x-ray and (2) there is an area of point tenderness where ball met forearm (an area I had palpated rather thoroughly). To make a long story short:
The patient had a fracture. There it was. In all three views.
I had a red face.
No freakin' way!!! Uh....yes freakin' way!! I picked up my jaw and returned my humbled self to the triage room.
So what did I learn?
- Fractures are one of the most commonly missed diagnoses in the ED.
- DOH! Before smooshing around looking for point tenderness, ask the patient where it hurts the worst and work your way around from there. It's amazing what you discover when you actually listen to the patient.
- Doctors are doctors for a reason. I am not a doctor, although I will occasionally play one in my mind.
- Nobody's perfect (sniff)!
You can never be too old or too experienced.
Live and learn.