Thursday, September 2, 2010

Did I miss it?

That is what I kept asking myself over and over as I was seeing the pt in front of me. She had come in the day before with a stab wound to her back. Bill had seen her initially, but had to do a Csection, so asked me to follow up with her. Anytime there is a stab wound you worry about the knife penetrating into the lung cavity causing a pneumothorax or a collapsed lung. When I see her she is saturating 100% on room air, has breath sounds on both sides and in no respiratory distress. I explore the wound, don't feel it going into her lung cavity, don't see any bubbles coming out, so I sew her up. The chest xray confirms that she has lung markings on both sides and no pneumothorax. She isn't from our area, so I couldn't admit her, but asked her to come back in the morning to be checked again. When I see her in the morning, she is saturating 99% on room air, but does not have breath sounds on her L side. I listen and listen again, yep definitely no breath sounds. I get a chest xray and sure enough her lung is collapsed on the L side. She, thankfully, wasn't in respiratory distress, but she needs a chest tube to reexpand her lung. As I am looking at the CXR, I keep asking myself what I really saw yesterday and if there was a pneumo that I missed or not. So I asked Judy, one of our clerks, to find the CXR so I can see if I missed something. Nope, still with lung markings on that side. So it seems I didn't miss anything yesterday, and thankfully had the pt come back today and found something that needed attention.