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Ever seen a patient with constipation? No, I mean some SERIOUS constipation? I have. This is kinda how it went for me....
Help. Help! I need something for the pain! I hear a woman wailing from Emergency Department room 4.
Whats that all about? I ask Veronica the nurse. I guess I need to see that one first, dont I?
No. She says shes got constipation and no other problems. You need to see room 7 first, which is a 70-year-old male with back pain, hypertension and a family history of abdominal aneurysm. He might have an actual emergency, answers Veronica.
Definitely, and thanks for letting me know, I say, as I walk in to see the possible abdominal aortic aneurysm (AAA) patient. I glance at his vital signs. They are totally normal. I walk in the room and hes sitting on the stretcher eating a triple cheeseburger, smiling and says, Whats up doc?
What brings you in here today, Sir? I ask.
Oh, nothin. My back hurts. I think I pulled a muscle, he says.
Have you ever been told you have an abdominal aneurysm? I ask.
Out of room 4 and into my ears, blast some more primordial screams, Oh. Oh! Ooooooohhh!
No, Ive never had one, but my dad died of an aneurysm. Ive got high blood pressure, though. You better go see that lady, doc, he says. Ill be fine. You go check on her.
Let me feel your abdomen, I say. I cant feel any pulsating mass. I push a little deeper: still nothing. I feel his radial, femoral and foot pulses: they are all normal. I finish my exam and put in an order for a CT aortogram, along with the rest of his workup. Sir, I need you to put the cheeseburger down, until we get this checked out, okay? We need to keep your stomach as empty as possible until we know whats going on, alright?
You got it, doc, he answers.
I move on to room 4. Oh. Oh! Heeeeeelp! I need a laxative. Please, something for the pain, screams an obese 42 year-old Caucasian woman.
That should be no problem. Just tell me a bit more about whats going on, maam, I ask as she paces the room, obviously very uncomfortable and anxious out of proportion to a case of constipation.
Its been about a week since I had a bowel movement. I feel r e a l l y bloated, she says. Whoa. Whoa! Whoa! she moans, then takes a few slow, deep breaths. It feels like Ive got an 8 pound ROCK stuck down there binding me up. Please! Give me a laxative, an enema or something. Stick your hand up there and take it out, I dont care what youve go to do. Just do something for the pain. Im begging you, please!
Where is your pain? I ask her.
Right here, she says pointing to her lower mid abdomen.
When was your last menstrual period? I ask.
Oh, geez. Oh geez! she says, as she stops pacing and lies down on the stretcher. She lies on her side and gets into a fetal position. Just give me an enema. Ive been disimpacted before. Just do it. Do it!
Okay, Ill have to do a rectal exam. If there is an impaction, Ill try to remove as much as possible and then we will give you an enema. It will be very uncomfortable, but youll get tremendous relief. Okay? Veronica hands me some gloves and some lubricant. I lean over to do the rectal exam and she lets out her loudest scream yet.
I think its coming out! Arrrrrrrrrrrrrrrrrrgggggghhhh! she screams. I lean over again to do the rectal exam and.....(read more)
Help. Help! I need something for the pain! I hear a woman wailing from Emergency Department room 4.
Whats that all about? I ask Veronica the nurse. I guess I need to see that one first, dont I?
No. She says shes got constipation and no other problems. You need to see room 7 first, which is a 70-year-old male with back pain, hypertension and a family history of abdominal aneurysm. He might have an actual emergency, answers Veronica.
Definitely, and thanks for letting me know, I say, as I walk in to see the possible abdominal aortic aneurysm (AAA) patient. I glance at his vital signs. They are totally normal. I walk in the room and hes sitting on the stretcher eating a triple cheeseburger, smiling and says, Whats up doc?
What brings you in here today, Sir? I ask.
Oh, nothin. My back hurts. I think I pulled a muscle, he says.
Have you ever been told you have an abdominal aneurysm? I ask.
Out of room 4 and into my ears, blast some more primordial screams, Oh. Oh! Ooooooohhh!
No, Ive never had one, but my dad died of an aneurysm. Ive got high blood pressure, though. You better go see that lady, doc, he says. Ill be fine. You go check on her.
Let me feel your abdomen, I say. I cant feel any pulsating mass. I push a little deeper: still nothing. I feel his radial, femoral and foot pulses: they are all normal. I finish my exam and put in an order for a CT aortogram, along with the rest of his workup. Sir, I need you to put the cheeseburger down, until we get this checked out, okay? We need to keep your stomach as empty as possible until we know whats going on, alright?
You got it, doc, he answers.
I move on to room 4. Oh. Oh! Heeeeeelp! I need a laxative. Please, something for the pain, screams an obese 42 year-old Caucasian woman.
That should be no problem. Just tell me a bit more about whats going on, maam, I ask as she paces the room, obviously very uncomfortable and anxious out of proportion to a case of constipation.
Its been about a week since I had a bowel movement. I feel r e a l l y bloated, she says. Whoa. Whoa! Whoa! she moans, then takes a few slow, deep breaths. It feels like Ive got an 8 pound ROCK stuck down there binding me up. Please! Give me a laxative, an enema or something. Stick your hand up there and take it out, I dont care what youve go to do. Just do something for the pain. Im begging you, please!
Where is your pain? I ask her.
Right here, she says pointing to her lower mid abdomen.
When was your last menstrual period? I ask.
Oh, geez. Oh geez! she says, as she stops pacing and lies down on the stretcher. She lies on her side and gets into a fetal position. Just give me an enema. Ive been disimpacted before. Just do it. Do it!
Okay, Ill have to do a rectal exam. If there is an impaction, Ill try to remove as much as possible and then we will give you an enema. It will be very uncomfortable, but youll get tremendous relief. Okay? Veronica hands me some gloves and some lubricant. I lean over to do the rectal exam and she lets out her loudest scream yet.
I think its coming out! Arrrrrrrrrrrrrrrrrrgggggghhhh! she screams. I lean over again to do the rectal exam and.....(read more)
