Thursday, October 29, 2009

hey, remember that patient...

I read about the effects of this phrase on emergency physicians at, but I'd never really seen its effects.  I've been working in emergency while my life in on hold, and I saw one of the attendings from last week in the office, so I said:

"hey, remember that patient from last week?  Jeremy Smith?"

and I could visibly see him work through the algorithm in his head...

"no, remind me again?"

"85 year old, went into resus for hypotension;  from a nursing home, acute on chronic renal failure..."

"oh yeah"

"anyhow, she had a hemicolectomy and is doing well.  A save."

"not just a save, a resurrection!"

Although calling it resurrection may be hyperbole, the dood was ASA 5E, surviving a condition with 50-90% mortality.  and I owe it all to Bongi and one line in that blog post, which made me think of the right diagnosis a year later.


  1. wow!!! thanks for the kind words, but i think he was luck to get you at that moment. well done.

  2. Thanks for all the kind words.

    Bongi, perhaps he was lucky to have someone interested in surgery as his casualties doctor. But without you telling me that phosphate can be elevated in ischaemic gut, I would never have known this; it's not taught in our medical schools.

    The case in question: abdo pain, black vomit, black diarrhoea. AAA/DM/CKD stage IV-V. Gas: acidosis, phosphate high. I initially put it all down to the renal failure. Scanned (no contrast) to see if the worsening tenderness was the AAA (only 4cm). I look at the calcified aorta, the oedematous bowel, and the phosphate, and the idea pops into my head. Gastro accept him, but I say I'd like a surgical review anyhow. Surgeons confirm diagnosis (belly is quite peritonitic by the stage they get there) and take him to theatre pretty quickly. Five days in intensive therapies, and then did well.