Saturday, August 13, 2016

Seeing it was amazing

So.... up next is another clinical experience....

The BIG case we had was a patient who was brought by ambulance as a stroke alert which means that CT tech is notified so that by the time that the patient arrives, they are at the hospital and the CT scanner is ready for the patient to be scanned. 

When the patient arrived, she could barely wiggle her left toes, had trouble lifting her left arm and sensation was drastically affected on her left side. Her pupil on the left side was sluggish as well. Her facial expressions were asymmetrical and she had a slight slur (ambulance personnel said that it was quite pronounced when then arrived) and grip was unequal bilaterally (less on left side). 

I immediately put her onto telemetry which showed A- fib (every other VS was within defined limits)– however the physician wasn’t concerned. I was baffled. I don’t understand why no one is ever concerned when they see this. I put in two large bore IVs (one in the AC and the other in the hand; on the same arm) and drew labs. 

Then she went to CT. It was clear which meant that she did not have a hemorrhagic stroke and if she had an ischemic stroke there was no evidence of that at this point. By the time that she had returned from CT her condition had changed, she was starting to be able to move her left side more freely. She was able to life her left arm almost entirely and slowly, but steadily she was able to raise/move her left leg & toes. Her left pupil was now reacting briskly. 

Upon return from the CT I did her EKG which still showed A-fib, however the physician struck this out and wrote out stable rhythm with occasional PVCs which I don’t agree with considering the A-fib was also showing on the strip rhythm. But as a student I don’t feel comfortable speaking up and disagreeing with a physician. I asked my preceptor about it and she said that she didn’t understand it but didn’t do anything further about it. 

We switched gears a bit to get the paperwork in order to give to the new hospital, give report but also still take care of our patient who thankfully every time we did another assessment was improving. By the time we transferred her to a stroke hospital, she was able to move all her limbs, her grips were strong and equal, her eyes were PERRLA, and expressions were symmetrical. 

I spent a lot of time with her and the family alleviating their fears and explaining things after the physician as well as answering many questions.  What I learned had to do with the last one. It was amazing to see a person with a stroke (a TIA is how the physician was classifying it given that her symptoms were dissolving right in front of our very eyes) and to see how the symptoms of it were evaporating slowly but surely, little by little. 

It was hard for me to reserve not telling this family that this event probably occurred because of her A-fib and that this physician simply ignoring this fact and not telling the family about it. I just wanted to yell it out loud!!!!!  Ugh so frustrating. 

I loved being there for this patient and for the family though through such a difficult time in their life. I could absolutely work in the ER and enjoy it for the rest of my life if I dealt with situations like this day in and day out!

It was also neat to see a stroke patient at that point and watch the symptoms disappear b/c coming from a neurology unit where we see the patients AFTER their symptoms have resolved or when their symptoms are more permanent. Frankly I thought it was awesome to see her symptoms resolve little by little. 

I think if I could do pediatric ER that would be awesome!!!! But we'll see how things pan out.

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