More Land mines

07/10/2009 at 5:42 AM Leave a comment

A few more land mines. ( situations that dont look dangerous to a lay person, but if you know what you are doing the claxons and alarms should be going off.

Clavicular lymph node. It is a swollen node  in a specific area just above the clavicle. The only time you can feel this node is when you have lung cancer. One of the few clear unequivocal rules in medicine. This is not something that you send the to the ER,but it is not the usual situation( with almost every other enlarged node) where you treat it with antibiotics for a few weeks and see if they go down.

A mild infection of the skin of the hand is treated as a severe infection and a potentially life threatening infection. If that very same infection is a few inches up the arm, no big deal. But the hand is a dangerous place. it has so many structures and compartments that it doesnt react normally to what is a mild skin infection. I am not talking about a small cut and the slight redness that surrounds the cut as it heals. The next step up is when the infection starts spreading , around the finger or around the hand, away from the intial point. this needs to be treated agresively and watched closely with your finger on the trigger, ready to send them to the hand specialist.

For any girls 15sh or older with any of the common side effects of pregnancy: nausea, vomiting, malaise, belly pain,dizzyness. They are pregnant until proven otherwise. The teens and parents pleas are insufficient. I will need a urine or blood pregnancy test that is negative. Otherwise we will be chasing the wrong thing.

The most dramatic case was this 16 year old with severe belly pain. She claimed she was a virgin. I walk in the room and see a 7 month pregnancy. I did not see a fat girl. I  mention the pregnancy and there are stares and denials. No she is not pregnant, she has just put on alot of weight in the last few months. ( and how dare you mention it!)

I begin to feel like alice. I am the only sane one in the room. But instead of getting into a shouting match I go and get the doppler, find the mothers heart beat. We can all hear it at around 70 beats,then I find the babys at 130. I am done. The girls finally admits to that one New years eve tryst, lots of tears came out. diagnosis made. referals made.


Entry filed under: Uncategorized.

The Power of Fear You call that a good outcome?

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