Wednesday, October 19, 2005

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.

Just kidding!

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)!
I have always felt that we learn more from our mistakes than we ever do from success, and I know I'll be much less inclined to dismiss a potential diagnosis because it doesn't meet "by-the-book" criteria in the future.

You can never be too old or too experienced.

Live and learn.


6 Comments:

At 10/19/2005 06:40:00 PM, Blogger Heather said...

Humble pie is sometimes hard to swallow, but we have all been there. It's great that you are open enough to learn from the situation and share with us!

 
At 10/20/2005 05:20:00 AM, Blogger Dr. Deborah Serani said...

Love the part where you say to ask and listen. So much can be learned by asking a simple question!!!

~Deb

PS: It took me 3 times to get the word verification right...what's up with me?

 
At 10/20/2005 05:42:00 AM, Blogger kenju said...

Don't beat yourself up about it. I had a broken elbow from a fall down some steps and it didn't show up on xray for 3 weeks afterward. My doc was embarrassed when it did show up - he swore it wasn't broken.

 
At 10/20/2005 06:20:00 AM, Blogger unicorn said...

no signs at all? just pain? that is rather unusual for a fracture.

Just make a hot cup of coco, lie down and read "chicken soup for the nurse's soul" maybe that helps a bit.

best wishes
unicorn

glad you liked my last post :D

 
At 10/21/2005 07:45:00 AM, Blogger Rita Schwab - MSSPNexus said...

Enjoyed your post. We need Emergency Department nurses, and I don't think you could have lasted 27 years in that hectic, emotional enviroment without such a great sense of humor!

Rita
http://msspnexus.blogs.com/mspblog/

 
At 10/21/2005 11:19:00 AM, Blogger Third Degree Nurse said...

I'll bet you asked. It would be LIKE YOU to ask because you are the kind of nurse who listens to your patients. Perhaps she was crying at the time?

Whatever. The most important thing is that she got an accurate diagnosis. Isn't that why it's called the health care TEAM?

 

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