What are some physical exam findings when you lift the covers?
As a member of the venous thromboembolism prevention committee at Happy's Hospital, I try and remain aware of thrombosis prevention and prophylaxis at all times. In fact, I once had a patient with a GI bleed in which a partner of mine didn't order anything for prophylaxis. Of course anticoagulation
is not indicated in a GI bleeder. But sequential compression devices are.
Thinking it was an over site on the part of my partner, I went ahead and ordered them, then I went into the room to talk with the patient. I discussed the plans for the day and left.
Shortly after, the nurse informed my that my patient was a bilateral AKA (above the knee amputation).
Learning Point of the Day: Always lift the covers.
This reminds me of a patient of mine years ago who had a glass eye. Every subspecialty service was documenting pupils equally reactive to light. If you are a medical student and you document equally reactive to light on a patient with a glass eye, you might as well quit that rotation and start kissing some major ass. If you are an attending, God help you.
What's your biggest physical exam mistake?
I once tried to assess pedal pulses on a pt. with both legs amputated at the hip... the blankets were bunched up, and the previous shift had forgotten to mention it in their report. It was kinda hard to pass that one off as "oh, ummmmmm, just straightening your blankets!"
ReplyDeleteI've seen plenty of nurses document strong, bilateral pedal pulses in a patient with a BKA.
ReplyDeleteI also had a patient with extremely obvious unequal pupils, secondary to scopolamine, that everyone was charting equal pupils on. Did they even look?
Finally, a patient got transferred to us from another floor with sepsis of unknown origin. Patient was obese and completely immobile. We turned him, and his entire backside was pretty much necrotic. Epic fail.
Not mine, but the previous shift on my OB floor was charting normal fundal heights on postpartum TAH/BSO pt. OOPS!
ReplyDeletePattie, RN
OTOH, there's getting all concerned when your pt presenting with weakness and dizziness has a dilated and non-reactive pupil - and then she says, oh, I've been blind in that eye since i was a child.
ReplyDeleteSimilar case. I checked off "all extremity pulses equal" on a patient with an AKA. I guess you could argue the AKA side had a normal femoral pulse!
ReplyDeleteIf anyone can beat this you earn an apple. One of my partners was rounding in the palliative unitand went to see a patient who was admitted to inpatient Hospice. The patient had no complaints, and then my partner left the room and sat down to chart. As he was writing that the patient was comfortable and and no unusual physical findings, the nurse asked my partner if he was going to fill out the death certificate since the paitent had died a half hour earlier.
ReplyDelete...trying to assess upper extremity function and the Cincinnati Stoke scale by asking the pt to put their arms out in front of them and being slightly worried when I saw only one arm rise. The pt only had one arm, but they were wearing a sweater that had two arms... the best part was passing the pt off to the new RN with the report of deficit and watching her!
ReplyDeleteHad a paramedic student tell me the breath sounds were present, clear, and equal bilaterally on a patient with a prior pneumonectomy.
ReplyDelete