Patient X was by mauling (intentional).
Patient Y was by stabbing (accidental).
Patient Z was by a broken glass bottle (accidental).
Patient X and Y undergone expensive ancillary examinations that turned out unremarkable (with normal findings).
Patient Y and Z were discharged against medical advise (DAMA).
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Patient X was a 58 year old male who was hit by a wooden 2x2 stick on the face and by a rock on the right side of the head. He came in to ER because of dizziness.On physical exam, there was an L shape lacerated wound over the bridge of the nose, two subgaleal hematomas on the right side of the head (occipital and parietal areas), and abrasions on both knees. Wounds were washed, cleaned and dressed. Then a cranial CT scan, chest XRay, facial XRay and cervical spine XRay were done. These ancillary procedures amounted to 8,000+ pesos. And the results were unremarkable except of course for superficial soft tissue swelling. Steri-stip was applied to approximate the laceration over the bridge of the nose. Approximate total bill was 11,000 pesos.
Patient Y, a female was accidentally stabbed with a kitchen knife while trying to stop a fight between two individuals. Physical examination of the wound revealed a 1 cm in length with 1-2mm in depth at the left lower back, i.e, Lumbar 1 to 2 area.
Patient came in 2 hours after the time of incident for further evaluation with concern if there is internal bleeding. Wound was then washed and cleaned. Patient was advised to have a renal stonogram (a CT scan) to rule out renal parenchymal injury. This ancillary examination costs 7890 pesos (the cheapest specific CT to check on abdominal/retroperitoneal organ injuries versus abdominal CT).
With vital signs being stable, history reviewed, and wound exploration done, I personally did not consider doing any more ancillaries. I considered it to be minor and that the wound should be closed and patient be advised to go home. However, my superiors advised a CT scan to rule out internal bleeding. Our patient's scan result showed no solid organ injuries, no psoas muscle asymmetry, no accumulation of fluid, not even submucosal injury... otherwise, and in simple terms, there were normal findings, well of course, except for skin injury
With the scan results being normal, could I've done the right decision to forego with the ancillaries if I were the attending? Maybe and probably not. According to them, sometimes we could miss this seemingly minor cases. I was being concerned with the expensive procedure, and I thought it should be requested if there are already signs that would indicate the need to but on second thought, I think they were right when they say 'obtaining normal results instead of abnormal expected results doesn't mean the procedure done was unnecessary' because that was the point of the doing it... to rule out the possibility of.
The plan then was to close the laceration by primary intention (suturing the wound) however, patient opted to be discharged against medical advise. Approximate total bill: 9,000 pesos.
Patient Z, on the other hand was a male who accidentally dropped a bottle that broke then lacerated the left foot, below the medial maleolus. Patient went to a hospital because bleeding was not controlled, however patient transferred at our institution because patient was not attended to. Wound was gaping with length and depth of 5cm and 3mm, respectively. After assessment, wound was cleaned, and dressed. Ideally, the wound should be closed by sutures (primary intention). Patient agreed with the plan however, when his gay friends went over, they said they do not agree that it needs stitching and asked the patient to be discharged against medical advise.
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Wala lang naman, ang weird lang parang nasayangan ako sa CT scan ni patient Y. Tapos di rin pala papasuture ng sugat. Nasayang sa ancillary yung pera, sana sa treatment nalang.
Si patient X naman, gustong gusto na madischarge para gumanti na, papatayin na daw niya si kuya Rudy. hehe. screen name yan.
Si patient Z naman, mashadong under the saya naman sa mga kaibigang bading. May pambayad naman sha eh. Sayang lang ang pagpunta at pagbayad sa ER fee. Sana sa bahay nalang sha nagpatigil ng pagdurugo. At nakuh, talaga naman, nagnenok pa ng apat surgical instruments ang mga bading na yun. Mahal kaya yun.
Wala lang naman, ang weird lang parang nasayangan ako sa CT scan ni patient Y. Tapos di rin pala papasuture ng sugat. Nasayang sa ancillary yung pera, sana sa treatment nalang.
Si patient X naman, gustong gusto na madischarge para gumanti na, papatayin na daw niya si kuya Rudy. hehe. screen name yan.
Si patient Z naman, mashadong under the saya naman sa mga kaibigang bading. May pambayad naman sha eh. Sayang lang ang pagpunta at pagbayad sa ER fee. Sana sa bahay nalang sha nagpatigil ng pagdurugo. At nakuh, talaga naman, nagnenok pa ng apat surgical instruments ang mga bading na yun. Mahal kaya yun.
