Patient’s fall

Thursday, October 19, 2006

Weekly journal assignment

Week 4

Patient’s fall

This week, my assigned patient went to home when I arrived at the clinical day. The RN assigned me another one which is in the same bed. Without preparation, I started to take care of the patient. It went well. It also gives me some confidence for clinical patient care as real (without prep). This patient’s diagnose is not really clear yet. I have some thought about it.

The admission reason was “post fall”. Patient felled when he was walking his dog. He has an ICD in place, ER admitted him to PCU for evaluation of the ICD, and to find the reason of this fall.

Patient has history of CAD, A-fib, multiple stroke, hypertension, hyperlipidemia, diabetes and so on.

The reason for fall is “syncope” as the doctor’s H&P stated. But patient does not remember the event, did not feel dizziness and so force. There is no newly developed weakness, language difficulties and thought process disorders after the fall. Based on this, they basically ruled out stroke, and focused on “syncope”.

The cause for syncope has multiple reasons: it could be sudden onset arrhythmia, acute hypotension, hypertension crisis, hypoglycemia; they all can lead to temporary cerebral dysfunction and result to syncope and fall.

With a history of a-Fib and CAD, it is almost guaranteed that life threatening arrhythmia could happen. But with an ICD in place, the possibility became too little to be worried of, unless the ICD does not function well. Then, check the ICD is necessary.

The result is the ICD functioning perfectly. So this can rule out of cardiac syncope. And the blood sugar showed on the high side in ER.

But patient felled. And don’t remember the event. That is the key I think. I would like to order an EEG to see if there were any epilepsy event (with multiple stroke, there is very possible to have secondary epilepsy); I also would like to at least have a brain CT to see if there were any new changes if I were his doctor. Some mini stroke could make patient “pass out” without leaving marked signs and symptoms.

I am wondering why the doctor did not order these tests yet. Well, patient is in the hospital only one day, probably the doctor is going to order those tests later. This just are some my thoughts. I sure appreciate the opportunity I got to learn and think.

Thanks for being so patient to read my thought.