The cause for this patient’s chronic nosebleeds became more apparent when the patient wasn’t able to blow her nose and the resident was unable to insert a sponge into the patient’s nostril to stop the bleeding.
A history of chronic headaches and of more recent vision changes prompted the resident to order a head CT.
A large brain mass which had invaded the patient’s nasal passages and had eaten through the patient’s nasal septum, completely occluding the nasal passages.
Sad case.
Very sad.
Not good. Any idea what type of tumor?
BTW… is everybody who ever treated this “chronic nosebleed” patient contacting their malpractice carriers? I’m sure some of the legal minds out there are thinking “if only someone would have done a CT scan she could have been saved”. Then recruit some charismatic “physician” to parrot the line, and voila… routine CT for every nosebleed becomes the standard of care (whatever the term “standard of care” means).
After all, eroding brain tumors are a cause of nosebleeds — there have been 154 cases since 1951 of meningiomas presenting as nosebleeds. So, an estimated less than 10% of the population/year visit the ER for nosebleeds, (let’s use 5% or roughly 15 million visits at say, $1000/ scan = $15 billion/year for CT alone. That would be 15 billion/year over 59 years… but of course we have only had CT for about 30 years…
… well you get the picture.
Real tort reform is coming. Not insurance reform of capped payouts (like California as our esteemed scholar Matt points out) but real reform. And not just for medmal.
It has to.
Indeed, I’d be intrigued by Matt’s thoughts on this one, since he clearly knows everything about doctoring.
What kind of tumor was it? A SNUD or esthesio?
Actually Density, if you’ll read my posts, you’ll see where I have said multiple times that I know next to nothing about doctoring. Unlike the physicians here, I don’t make many recommendations about fields I know little about.
Read more carefully before you reach conclusions. You’ll find you make more sense that way!
HMMM. Yet over and over you seem to think that bad outcomes could be prevented only if the right protocal or guideline was available and followed, of if the doctor just had the smart lawyer looking over his shoulder. That is why you continually look like an a** Matt
Is the patient’s head tilted? I’m wondering why her left eyeball is so prominent on the scan when “bulging eyeball” isn’t listed among the symptoms that provoked the resident to order the CT.
Patient’s head is tilted in the machine. You can tell by the different amounts of bone on opposite sides of the scan. The bulging eyeball was just because the CT image was taken directly through the center of one eye (you can actually see the lens in the front of the eye) and was taken through the very top of the other eye.
That poor patient. That has to be a sickening feeling to see that, and then have to tell them.
I feel so sorry for the patient.
GBM?
Lost to follow up. She was visiting from out of town and refused admit.
At 28 years old, my Brother-in-law was diagnosed with a sinus tumor.
He had been going to a doctor for a year complaining about nasal congestion. The doctor kept prescribing antibiotics for “chronic sinusitus”.
When he started to lose vision in one eye, he panicked and scheduled a visit to an EN&T doctor. By this time the tumor was so big, the doctor could see it just by looking is his nose.
None of the doctors in our region would operate. Proton Laser treatment saved his life and his vision.
4 years clean, we just celebrated his son’s 2nd birthday on Saturday (another miracle)
I’m no physician, but what does that mean? it’s not treatable?