A 53-year-old female with a past medical history significant for hypertension presents to the ED with headache and dizziness. Her symptoms have been constant over the last two weeks. She was diagnosed with peripheral vertigo by her primary care doctor and sent home with meclizine which has not provided her with symptom relief.
Triage vital signs (VS) include BP 163/89, HR 78, T 98.4, RR 14, SpO2 98% on room air. On exam, no nystagmus is noted. Her extraocular movements and cranial nerves II-XII are intact, strength of all four extremities is 5/5 without any focal weakness, and there are no appreciable sensory deficits. There is, however, dysmetria of the right upper extremity.
Just a quick post to brighten your weekend. Like many of you I have lost count of the number of times I’ve been challenged about performing a contrast CT for a critically ill/injured patient because we don’t yet know the creatinine level. Despite the evidence for contrast induced nephropathy being dubious, and large observational trials indicating that it is not a factor in subsequent renal failure the challenge has persisted.
Interestingly the challenge has usually been about the absence of a result, with a request to delay the scan until it it is known. In contrast (sic) a patient with known renal impairment and/or high creatinine was a short and satisfying conversation as we already knew what the issue was. Paradoxically, when there is uncertainty, this often led to delay. If we know what the renal function is, even if awful then there is NO delay as a ‘decision’ CAN be made. When we are waiting for a result to come back clinicians feel that there is not enough information to make a decision and so they wait. When you step back and think about it this makes almost no sense at all, but it’s the nature of humans who can comfortably handle an abnormal result, but not uncertainty
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