Indexing Title: NALUDINOs Medical Anecdotal Report [07-02]

MAR Title: The Value of the Ancillary Procedure

Date of Medical Observation: February 2007

Narration:

I had my share of trauma patients. Some survived while some others did not. This is about a patient who survived. He was a man of heavy build. He came on his own to the emergency room. He was stabbed in the chest with a bladed weapon.

 He had stable vital signs. We diagnosed the patient with pneumohemothorax and inserted a chest tube.  We were able to evacuate blood from this man's thorax. There was no indication for a thoracotomy. After a while, the patient started complaining of epigastric pain and difficulty of breathing. I attributed the difficulty of breathing to post operative pain.

            I was concerned about the abdominal pain. I requested for a FAST.  It yielded a negative result. The abdominal pain however, was increasing in severity. I requested for a repeat FAST, which was also negative. I was becoming more concerned about the possibility of an abdominal injury.

The patient was now in severe pain and showed a drop in blood pressure. Despite the negative results of the ancillary procedure we decided to operate on the patient.

Intraoperatively we noted multiple intraabdominal injury and a significant amount of hemoperitoneum.

Insights (Physical, Psychosocial, Ethical) (Discovery, Stimulus, Reinforcements):

In this modern age, with the advent of newer diagnostic modalities, we find ourselves faced with a multitude of options in the diagnosis of a disease.

Just how accurate can these examinations be? Literature would enumerate sensitivities and specificities of the different modalities.

Knowing the limitations of these different procedures, there is still tendency for us to be complacent and rely too much on them instead of our clinical eye.

With this patient, I almost fell into that trap. I admit, I was stubborn.  I did not initially recognize the fact that this patient had an abdominal injury.

We must be vigilant. We must know the limitations of the instruments we are using and be able to recognize that fact.

There is no one solution to the diagnosis of a disease. All must be taken into consideration.