As usual, just when my night ER call coverage is about to expire at 8 am, I get a call at 7:55 am for a patient who walked in complaining of backpain. Great! "Can you send him to be seen in the office? we open at 8:30?" Nope, once they are registered for ER they have to be seen in ER. DARN IT@!
I go in and it was an obese patient, young guy in his 30s. I have seen so many people coming to the ER for pain meds and it has made me suspicious of everyone. "what happened sir? How can I help you?" I asked.
"I jumped off the back of my truck and when I landed I had severe mid back pain. I always have back pains and see an orthopedics regularly but now it hurts". And that my friends, is the typical pain med scenario. They have had back pain forever, seen many specialist, nothing works....etc etc etc.
"Do you have any medical conditions?". No nothing except for Ankylosing Spondylitis (AS). Now that perked my ears up. For us in the medical field, when we prepare for the boards, we learned that AS=Bamboo Spine. I have seen a few of these patients during my sports med rotation. Their spine x-rays look like large Bamboo stick. "Is that why you see orthopedics often?" yes.
I examined his back, there was no swelling, no skin redness or bruising. He pointed to his mid back and when I touched his spine at that spot, he squirmed in pain. I called radiology and had them take him for x-ray of spine. It took us a while to fit him on the x-ray table due to his large abdomen and his pains but we did it.
I went to my office to check my computer and see what time my first patient was coming in and then returned to the x-ray department.
His x-ray looked normal, not sure I could call it to a bamboo spine but right at the very top of the x-ray, the disc looked like it was split open, to the outside but it was very faint and difficult to see. I had them get a radiologist for me and he confirmed that finding and requested that I get a CT scan of the spine as that looks like a CHANCE FRACTURE. A what? he explained that a chance fracture is a fracture through the spinous process and vertebrae. Meaning that there is a serious risk for paralysis. OH NO. My patient was walking around without any spine protection.
I ran back to the ER and the patient was not there! I called and the nurses had brought him up to the nurses station so that they could do their morning sign outs. He was standing around waiting for me.
I literally had to force him into the bed and immobilize him, then called around to several spine centers in Minneapolis and found a spine surgeon who accepted him as a patient to operate on. I shipped him out that morning.
Apparently people with AS have very brittle bones and their spine is fused and not flexible so a simple fall can lead to devastating fractures. But he walked in to the ER by himself so I was not suspecting much. My definition of a chance fracture? its a chance that you can become paralyzed.
Here are some pictures that I found on the internet:
http://img.medscape.com/fullsize/migrated/545/253/ajr545253.fig4.gif
http://img.medscape.com/pi/emed/ckb/radiology/336139-386639-1998.jpg
No comments:
Post a Comment