I'm approaching the end of my Ortho prac, and have been taking on a more varied patient load, partly due to my supervisors request and also due to the lack of straight forward patients. As such I received a male who had sustained some fractures to his vertebrae, and I was asked to conduct a S and O on the patients (who had reported no Neurological deficit). He had been taken by ambulance to another hospital, then transferred to the hospital were I am completing my placement. Previously today he had had a number of images taken of his upper and lower limbs, as well as his upper thoracic and cervical vertebrae. When I went to see the patient he was reporting pain in his lower back, which he had not experienced before the imaging. This pain was reported by the patient as worse then any pain that he had experienced following his accident. On further assessment there was no motor deficit noted, although he did have some altered sensation. Based on what I had seen on the assessment, I discussed the patients comments with my supervisor, who in turn advised me not to attempt to mobilise the patient, and instead to confer with the medical officer managing the patient. I did so, and it appeared that the medical team were also questioning his presenting complaint, I was advised to cease treatment and informed that further investigations would be made on his lower back. In addition to this it was found that xrays had been taken at the initial hospital, but they were unavailable on the pacs system.
During all of this I was unsure whether or not I was being too cautious with the patient, as I have had limited experience with patients who have received a spinal injury. I feel that I made the right call by being as cautious as I could, even though I also felt that it could make me look less than confident in my final week of my placement. However I also decided that I would rather have looked less confident and then had to justify it, as opposed to mistreating a patient.
It should be noted that I don't know what the results of the xrays were, I'll find out tomorrow. However, I think that if I encountered a similar problem next time, I would still be cautious, although due to my lack of significant experience with spinal patients, my cautiousness may have been exaggerated. I don't think cautiousness is actually a word...
1 comment:
I think what you did in this situation was 110% spot on. I think you can never go past your gut instinct, something that you can't really explain, but just feel should be done (not very evidence based I know, but most of the time it is a saving grace for patients, as a few of my supervisors have mentioned).
As students, it is hard for us to determine whether we are unsure or if this is a gut instinct telling us to do/not do something, but as we become experienced, this will become easier. Plus, I beleive, when it comes to the health of a person, always err on the side of caution, and seek advice if not sure. That is what I (and am sure anyone) would expect from a health professional.
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