Choke...

I had this old lady who came ED present with chest discomfort 4 days ago. She was already resting on the bed when I saw her. The lady told me that her stomach might have been "hurt" after eating eating her lunch. "hurt your stomach" is local taiwanese way of saying I eaten some irritating food and also it could mean anything... When the patient presented with such complaint, I would always asked deeply as it could be anything. When I asked her to specify her problem. She told me that she had 'choke' and vomited. She had also complaint of some dizziness. The rest of hx was unremarkable and a quick PE did not give me any hint, the gag reflex was ok. The vital sign was ok(sl elevated BP of 145/89mmHg) but I was not feeling easy with the word 'choke'. I ordered a brain CT and some blood test.

I then proceeded to 175 for a rest. 10+ min later, I got a call and the nurses wanted me to the resus area. I was surprised when I saw the lady being bagged. The nurse told me she had passed out on the way back from CT room before I asked. Another nurse than sticked her head into the resus room and told me that the radiographer said ICH was noted. I left the room and opened the PACS - a five star pentagon shape hyperdense line noted over the skull base - the bomb in the lady skull had detonated - aneurysm rupture. 

 
I intubated the lady and consulted our neurosurgeon...  we both agreed that the prognosis is poor and either vegetative or heavan. The family had however wanted a transferred. No NSICU was available in the 4 major hospitals... but however they opted to go to one of the hospital and waited in the ED...
The word 'choke' save my ASS -- if the brain CT was ordered after she had passed out the family might had made noise claiming that we had missed the diagnosis...