It’s not just the normal exam, it’s the “I glance at his vital signs. They are totally normal. I walk in the room and he’s sitting on the stretcher eating a triple cheeseburger, smiling and says, “What’s up doc?”

The odds of this patient being in the throes of an AAA leak or dissection are ZERO, as in zilch nada squat zero.

In fact, I’d FAIL you in an exam situation if you justified it as such, because his “emergent” CT is INAPPROPRIATE, period.

That means that you CT *every* 70 yr old with (benign, if the CLINICAL CONTEXT IS TAKEN INTO ACCOUNT) back pain simply to CYA, which contributes to that green glow in the dark I see emanating from over the border to the south.

Be careful of using the medico-legal climate too lightly as an excuse, in this context citing it as the reason simply indicates to me *the doc* is the problem, not the lawyers…

For heavens sake have the balls to put medical decisions where they belong : with MDs, not lawyers.

Doing an emergent CT on this guy was CRIMINAL, if there were any lawyer issues to be debated here, it would be exposing him to unnecessary radiation.

This patient needed a bedside FAST as a screen for an AAA, or at best an OPD U/S via his Primary.

He needed an emergent CT to rule out emergent dissection or leak, as much as I need a brain transplant.

Jmho

I always wished I was working when a baby was born in the ER, although I know it’s an ER doc’s potential nightmare. I remember a young girl had a baby there and stated she didn’t know she was pregnant. I just cannot understand how any woman/girl can not know they are pregnant. ??? Movement of the baby, particularly as it grows. The inability to crunch your large …hard …stomach down in last couple of months, particularly getting out of deep chairs, etc. Tying shoes, even getting panties on with ease – basic stuff. Braxton hicks contractions. Increased frequency of urination, enlarge breasts (can I say the “B” word here:) and so on. But especially …HOW can any woman NOT KNOW they have a LIVING…GROWING BABY in their body?

I’m glad you all made out alright.

That would be one hideous case of constipation and how could she not tell the difference? Weird.