September 2022: An Unclear Diagnosis

​​"Stroke alert! Unstable vitals. Will be here in three minutes."Those words came from the charge nurse, and the team assembled. I was now on the stroke alert train. Moments later, the patient arrived unconscious on the stretcher. This elderly woman had been well 20 minutes earlier when she vomited and developed an altered level of consciousness. She had a history of hypertension and hadn't taken her medications because she felt sick all day.She had agonal respirations, and I intubated her on the EMS stretcher. The Accu-Chek was normal. We were all thinking it as she left for CT. With that pressure, she had a bleed.Now I was busy riding the stroke alert train. The stroke bundle of orders had to get in. No family had arrived, so I hoped for some help from the old records. A written chart would be needed for the next steps with the stroke neurologist and ICU.And with that, she was back. Then came the calls. First, the neuroradiologist: no bleed. Do you want to send her back for a CTA/CTP? Next, the stroke neurologist: no bleed. Is there any other reason for this?"Hey! Can you come take a look at this?" The primary nurse interrupted my pondering about the best next step for this elderly patient with no further history.She said she had put the woman in a gown and placed a Foley to obtain urine when she noted swelling of the right labia. It was hard and felt funny.She was right! Fornier's gangrene? Was it an incarcerated hernia? Did we miss a fever?...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs