What's your most surprising clinical find? A few of my colleagues and I were chatting about epic triage fails the other day and decided that there should be a "Waiting room to ICU plaque" somewhere in the department especially for patients triaged to sit in the waiting room who end up in ICU, I am sure this happens in wards as often. Also, we were trying to figure out the best "VS" triages. Not just ED but all nurses, please add your biggest unexpected surprise diagnoses / discoveries.
Here's mine- not my triages thankfully but no doubt I'll have one eventually.
Diagnosis- dodgy sex injury resulting in dislocation of several cervical spine- straight to ICU.
Triage- "Epigastric pain / syncope while doing situps (25yM)" CAT 3, ramped for 3 hours in acute (anxious young man and a bit um, snobbish and a little bit rude).
Diagnosis- Aortic dissection- straight to theatre, survived.
Triage- "Requesting prescription for endone, L) leg pain drowsy" CAT 5, waiting room.
Diagnosis- Rhabdomyolysis- fasciotomies, renal failure straight to ICU, had injected endone and been lying in same position for 2/7.
Triage- "High speed MVA, sternal pain" (19yM) CAT 3, seated in acute with his aunty, patiently waiting for half an hour for team leader to read his chart. Four of his friends from the same accident brought in with ambulance service 1/12 hours earlier, all being admitted for various injuries. Pt. was driver- team leader almost had her own MI.
Diagnosis- Sternal fracture and cardiac contusions, HDU.
Triage- "Onset headache post sneezing" CAT 4, waiting room.
Diagnosis- Some sort of intracranial bleed which ended in burr holes.
Now for the VS
Face VS Concrete, Shampoo bottle VS Rectum, Alcohol VS Oesophagus, Lawnmower VS Foot, Tablesaw VS Hand, Tree branch VS Eyesocket, Cat VS Testicles, Flu VS Wimp, Pseudo seizure VS Trainee paramedic, Demented pt. VS Sundown, New intern VS Sensible, come up with something better for us.
