It's Not What You Think....

Recently I've had a string of patients with ordinary complaints that turned out to be something entirely different. I think I have good assessment skills, both verbally in interviewing patients and in physical assessments. I've been labeled a "sh!t magnetic" in the past, meaning that if I was working on your shift that day, our ER would receive a lot of critical patients. Now the term defines me in a way that we will get strange situations.

Patient's complaint: simple cough. Diagnosis: ischemic stroke.
     The patient denied all questions regarding some type of infection. Once I dug a little deeper while triaging him, he answered some questions which revealed he had some tongue numbness and the weakening of his writing hand. "I can't write things anymore." Boom!

Patient's complaint:  knee pain from a fall  Diagnosis: third degree heart block
     The patient didn't want to be there. His wife just wanted his knee checked out because he had problems with it before.

Patient's complaint:  possible urinary tract infection  Diagnosis: PSVT (paroxysmal supraventricular tachycardia) meaning a very fast heart rate.
     While the patient was receiving some antibiotics, she mentioned feeling like there were bubbles in her throat. I threw her on our cardiac monitor and her heart rate was in the 180's.

Patient's complaint:  follow up visit from an infected animal scratch. Diagnosis: nonSTEMI (heart attack without ECG changes).
     Who could have guessed this?! The patient felt really sore from an injection - it was actually atypical symptoms of chest pain.

Patient's complaint: feeling bad all over and a cough that over the counter cough medicine won't get rid of.
Diagnosis: Stage 4 lung cancer with metastasis.

Patient's complaint: partial facial paralysis, already diagnosed with Bell's Palsy. However, his hearing and vision on the affected side had diminished. Diagnosis: Ramsay Hunt syndrome.
     This was a new syndrome for me. I did notice a rash on the side of his ear and his pupils were unequal. I didn't know the diagnosis, but I knew something other than Bell's Palsy was occurring.

Patient's complaint: leg pain of unknown cause. Diagnosis: leukemia
     Now the mom of the kid told me he wasn't eating as well, felt really tired lately and he had an enlarged lymph node. I was seriously hoping this would not be the diagnosis.

It's always interesting to hear about a complaint and dig a little deeper. Sometimes a cough is just a cough and then, sometimes it's not.