A Good Story

​That was the chief compliant. Right away, I was skeptical because it seemed rare that something was actually stuck in a patient's throat.Long ago, I had moved away from plain x-rays to CTs for this complaint. Direct visualization was fraught with problems. I just didn't do it enough to feel confident that I would be able to see an embedded fishbone among the glistening saliva. It was possible that it could be so buried in soft tissue that I could not see the top.I thought I had already seen the future path before I drew back the curtain.Lying comfortably on his side was a 22-year-old man with rock solid vital signs, an entirely normal physical exam, and no previous medical history. "So you have something stuck in your throat," I said flatly, more as a statement than a question. He replied just as flatly, "No." Now he had my attention. "Where?" He pointed to his sternum right between the nipple line."What happened?"He told me that he had been eating sesame chicken when it had gotten stuck. He knew the uncomfortable feeling because he had had it before. Like those times, he would "fill up" and "vomit spit" every few minutes. Every time before, it eventually passed, he said. It could not have been a more classic description of a food impaction.With nothing but that description, I called GI at 8 p.m. on a weekend. An hour or so later, the endoscopy suite was opened, and he left the ED. Another hour went by, and I was ...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs