It was in the middle of the Chinese new year holiday. I was doing the endless shift which I had a feeling that it would never end…
I am alert but yet the body is darn tired, with years of training, I was able to see patient with reflex but sometimes, the banshee of tiredness would confuse one and eventually leading to a case like the below…
It was late in the night, a middle-aged severe obese lady had presented to ED with her husband. She had complaint of left flank pain. She had noted with stable BP and denied of any past attack nor trauma history. However she had presented with an unusual sign – cold sweating.
I had ordered some routine test and given her some analgesic. The study revealed pyuria and no mild leukocytosis. During the 2 hours in which I attended to wave after wave of patient, I had given her NSAID, Stin, Pethidine as the preliminary diagnosis was left urinary stone. After the result came out, I had diagnosed her as pyelonephritis and told her that she should be admitted. She was still cold sweating ..... I was confuse and unable to find a proper explaination... I did ruled out acute coronary syndrome and hypoglycemia as nothing could be done, I had admitted her to the ward...
I went off on the morning and came back later in the night….. I logged into the system and saw that the patient was admitted to ICU under the dx of renal hematoma.
I was stunned by the record and called up Han for latest update. Han told me that the lady had experienced a BP drop later in the morning. On further inquiry, she had admitted that she was pushed during an argument with her husband and knocked over a closet on her back. She was embarrassed to tell us about the family violence event….
She was lucky as her shock stage was promptly reverted after proper management. As it was subcapsular renal hematoma and no surgery was needed.
If I had done a quick look abd sonography as usual in the ED, the case could have been diagnosed earlier. However I was too tired(frankly said, bad excuse… but my judgment was affected…)
But the weird part was that even with the severe subcapsular hematoma, her urine was still clear and no hematuria was noted.
A missed and I learnt something…
I recalled that was this case many years ago when a male withe head injury later admitted for pneumonia....Just had to more cafeful in the future....
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