The Case of the Miniature Muscleman.

[dotcb]

I totally would have discharged that patient on visit #1, possibly with no imaging...

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[RustedFox]

Furthermore, I did the CXR and the T-spine series. No widened mediastinum. No nothing.

 

[WilcoWorld]

Furthermore, I did the CXR and the T-spine series. No widened mediastinum. No nothing.

Not that it's sensitive, or better than a CXR, but did you check bilateral BP's?

I do this pretty regularly, and I admit it's mostly to fend off sharks. I've never caught any pathology as a result, but I wonder if documenting symmetric BP's and a normal CXR is legally protective?

 

[Rendar5]

Furthermore, I did the CXR and the T-spine series. No widened mediastinum. No nothing.

you'd either need an aortic arch dissection or a traumatic dissection to result in widened mediastinum on CXR, at least as far as I was taught in residency.

 

[Arcan57]

Not that it's sensitive, or better than a CXR, but did you check bilateral BP's?

I do this pretty regularly, and I admit it's mostly to fend off sharks. I've never caught any pathology as a result, but I wonder if documenting symmetric BP's and a normal CXR is legally protective?

The incidence of disparate BPs in the same in dissection as in the general population. I think you have to document pulses but I don't think boh arm
BPs is protective and will lead you to a lot of unnecessary work ups (or having a documented abnormality that you ignored).

 

[dotcb]

I think the following things, while clinically meaningless, can buttress your chart
no aortic murmur
symmetric pulses
absence of neuro symptoms
no multiregional pain (chest/back, back/abd, chest/abd)

In patients where I'm not doing any significant testing, I write things like this - freebies - they reflect that you considered the diagnosis. I write analogous things when I consider PE, spinal cord compression, torsion, etc.