Reply #15: Sometimes it's hard because [View All]

[Heddi]

1) I know this person doesn't have insurance (they've told me) so this test will really add to the bottom line that honestly, they're probably not going to pay anyways (I'm okay with that, really)

2) I know, and my coworkers know, and the MD knows, that in reality this test isn't needed. Yes, they fell, but they didn't break open their skull, they don't have a head bleed, they don't have any kind of brain injury

HOWEVER...they may. And let me tell you a story:

A lady came in and had broken her leg b/c she fell off a ladder while painting.

She was alert, oriented, all of that. She said she clipped her head on the washing machine as she was hitting the floor. No headache. Neurologically intact.

She was admitted to my unit, she was going to get surgery on her leg the next morning.

A few hours after admit, she complained of a headache. Still neurolgoically intact. They didn't do a CT in the ER because she just nicked her head, nothing serious, we'll do one in the AM before surgery.

Well, as the night goes on she's getting worse and worse, just headache, worst headache of my life. I give her pain meds and she starts projectile vomiting---big deal, people vomit after dilaudid all the time.

SO the doctor is at her bedside, see's all this. I ask him if he wants us to do the CT tonight? no, we'll do it in the morning as planned, she just hit her head, no big deal.

Well, about 4 hours later she was unresponsive, pinpoint pupils. She finally got the CT and had a massive bleed in her head, was at that point basically brain dead and died.

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Moral of the story---sometimes you don't know if it's useful or useless until you do the test. I agreed with the MD that she probably didn't need the scan until the next AM. The signs she was displaying: headache, vomiting, are a hallmark sign of brain injury, but I was too new an RN to know this. (now I know and will never forget!)

So now, because of this woman's case, any report of head injury, no matter how minor, gets a CT at that hospital.

Another story:

Patient is confused, falls out of bed, Found on side of bed. Pt denies hitting head. Is neurologically intact. NO bruises or bumps. Patient is put back to bed. Found dead the next morning because of massive head bleed that occured when he fell.

New policy: All hospital falls, unless they are WITNESSED BY STAFF, will get head CT's, even if pt denies hitting head.

90% of the time is unnecessary. 10% of the time is necessary. Don't know until you do it.