upstairsfromreality (![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
upstairsfromreality) wrote2023-07-28 07:44 pm
upstairsfromreality) wrote2023-07-28 07:44 pm
Thumb
Patient Name: Hatherly, Victor Ignatius
DOB 1/17/1998 Age 25 Y Sex:M
Preferred Pronouns: He/Him
Chief Complaint: traumatic amputation of left thumb
Patient presented to A and E accompanied by an employee of the London Underground. Underground employee left at start of consultation.
Tachy at 120 bpm. BP 90/54, O2 98%, resps 25, temp 36.8,
Pale and diaphoretic.
Saline IV started upon arrival.
Patient stated that his left thumb had been cut off at work in a deliberate attack by a client. He state LOC for an undetermined time following the attack. Thumb did not arrive with patient.
Upon examination, left hand distal and proximal phalanges of the first digit were missing, with a single, full depth laceration through the joint. No fracture observed, confirmation by plain film x-ray required. Tourniquet applied to wrist in the field, replaced in the A&E.
Sterile dressing placed.
Orders:
Imagining: x-ray left hand, three views
Labs: CBC, chem-7
Orthopedic consult to determine immediate vs urgent surgery.
John Watson.
DOB 1/17/1998 Age 25 Y Sex:M
Preferred Pronouns: He/Him
Chief Complaint: traumatic amputation of left thumb
Patient presented to A and E accompanied by an employee of the London Underground. Underground employee left at start of consultation.
Tachy at 120 bpm. BP 90/54, O2 98%, resps 25, temp 36.8,
Pale and diaphoretic.
Saline IV started upon arrival.
Patient stated that his left thumb had been cut off at work in a deliberate attack by a client. He state LOC for an undetermined time following the attack. Thumb did not arrive with patient.
Upon examination, left hand distal and proximal phalanges of the first digit were missing, with a single, full depth laceration through the joint. No fracture observed, confirmation by plain film x-ray required. Tourniquet applied to wrist in the field, replaced in the A&E.
Sterile dressing placed.
Orders:
Imagining: x-ray left hand, three views
Labs: CBC, chem-7
Orthopedic consult to determine immediate vs urgent surgery.
John Watson.
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Are you in the medical field, or do you just write it very well?
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I worked in a hospital file room for a bit, back in the dark ages of paper charts, but no, all my medical knowledge is from TV.
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I actually wasn't trying to be funny there, even though I'm glad you thought it was. Everything else (except the pronouns) was important to both 1889 Watson and 2023 Watson. I wanted to add a detail that matters now and not then: the possibility of reattachment.
For 1889 Watson, of course, reattachment is a pipedream. For 2023 Watson, what matters is the condition of the thumb:
Yes, thumb is in great condition. Let's do this!
Vs
No, thumb was crushed by whatever tore it off.
No, thumb was damaged by something dumb the patient did to preserve it, like putting it directly on ice. (Sadly, this happens.)
Or as here,
No, we don't have the thumb.
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(When the U.S. made the push to refer to the Emergency Room as Emergency Department with the abbreviation ED, I snickered because ED also is an abbreviation for erectile dysfunction. And I still smile to myself when I see SOB even though medically it means shortness of breath, which is certainly no laughing matter.)
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I also worked for a while doing customer service for Medicare D prescription insurance. (I know, further proof of American healthcare dysfunction, that even government insurance felt the need to add a corporate middle man.) Premium bills were constantly messed up do to miscommunication between our company and Medicare itself. The catchphrase there: Social Security Administration. There's a reason they abbreviate it ASS backwards.
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