From the monthly archives:

November 2008

The Family Doctor

I recently saw this on ER Stories .
If anybody can find out who this family doctor is, let me know his phone number. 
I want him for my primary physician.
 

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To CT Scan or not to Scan

 Q:

Dear ER Doc,

 I recently brought my 8 year old son into the ER because he was having stomach aches.  The ER doctor did blood tests and an exam, and then sent us home.  We were told to get rechecked the next day.

My son got worse, and we went back to the ER and another doctor ordered a CT scan.  This showed appendicitis and my son needed an operation.  Why didn’t the first doctor order the CT scan?

Beth

Dallas, Texas

 A:

Dear Beth,

Without knowing all the details of what happened, it is hard to completely answer this question.  However, I can tell you that a good ER doctor will not order a CT scan on everyone.  Besides being a very expensive test, CT scans expose patients to some radiation.  In children, it is advisable to limit the number of xrays and CT scans to decrease their chances of getting cancer.  Most doctors feel that we should avoid doing unnecessary CT scans, and instead we should rely more on our clinical judgement.  I often send patients home with instructions to get rechecked, as was done in this case.  This helps sort out which patients need a CT scan, and which patients can avoid the radiation and expense.

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Barbara Bush perforated ulcer

Q:

Barbara Bush was just hospitalized with a “perforated ulcer.”  Is this a life threatening condition?

A:

Absolutely!  Peptic ulcer disease is inflammation, ulceration, and usually excessive acid in the upper digestive tract (stomach, duodenum, etc.).  A perforation, or hole, can occur when an ulcer becomes severe enough to erode through the wall of the stomach or intestine.  Then, intestinal contents can spill into the abdominal cavity.  This is very bad.  Patients often feel intense pain, and then can get an overwhelming infection.  Usually, surgery is recommended for immediate cleaning of the spilled intestinal contents and repair of the hole.  The sooner the condition is diagnosed, the better.  Older patients in particular are at high risk of death from perforation.

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Nailed it… Himself to the wall that is

 wonder where Jim is. . .?

A carpenter came in recently with a chief complaint of a nail puncture to his thumb.
This is certainly not an unusual injury, but I noticed that the time he was hurt was 3 hours prior to arrival. The patient had shot a 16 penny nail all the way through his thumb with a pneumatic nail gun.
“What took you so long to get here?” I asked him.
The carpenter looked a bit sheepish at that question, and then admitted he had nailed himself securely to the house he was building.
No one was on site to pull the nail out, and he couldn’t reach his hammer.
Fortunately, he had his cell phone in his pocket, so he called his wife. She was not at all squeamish about using his hammer to pull the nail out of the 2X4 framing, but she let me take the nail out of her husband.

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Acetaminophen Overdose

Q:

I just found out that 2 days ago my daughter had a fight with her boyfriend and she took a handful of acetaminophen pills.  Should I have her stomach pumped?

A:

First, I am sorry that you and your daughter are going through what must be a very difficult time.  Unfortunately, intentional drug overdoses like these are common.  There are a couple very important things to think about with an overdose of any medication.  First, you should get evaluated in an emergency department right away to find out if the medicine is causing any serious bodily harm.  We don’t usually “pump the stomach” these days, but there are many things we commonly do to prevent and treat toxic effects of medicines.  Acetaminophen can have some very significant toxic effects when taken in high doses, in particular liver damage.  I would strongly advise that your daughter be evaluated immediately.

Second, if it is clear that no adverse medical effects are happening as a result of the overdose, we always consider why the patient took the pills in the first place.  Usually, a crisis worker or other psychiatric professional will talk to the patient and family in detail to determine if the patient remains suicidal.

I have found that young people sometimes overdose on pills as an impulsive act, or as a call for attention, not necessarily to kill themselves, but they often underestimate the potential danger.  Quite a few patients have unfortunately died as a result of taking acetaminophen pills, thinking they were completely safe.

To learn more about suicide prevention, visit the American Foundation for Suicide Prevention .

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