Untrue Truism

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Arcan57

Arcan57

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How many of you were trained or have listened to lectures that talk about the low yield of CTs in syncope?

I used to believe that it was a waste of time and money to do CT scans on these folks if they had a normal neuro exam and denied trauma. While it's possible my patient population is just exceptionally bad historians with exceptionally large spaces for the bleeds to expand, I can no longer live the lie.

Syncope + old person = CT
Dizziness + old person = CT
AMS + old person = CT
 
Arcan57 said:
How many of you were trained or have listened to lectures that talk about the low yield of CTs in syncope?

I used to believe that it was a waste of time and money to do CT scans on these folks if they had a normal neuro exam and denied trauma. While it's possible my patient population is just exceptionally bad historians with exceptionally large spaces for the bleeds to expand, I can no longer live the lie.

Syncope + old person = CT
Dizziness + old person = CT
AMS + old person = CT
Click to expand...

Let's face it,

old person = CT
 
WilcoWorld said:
Let's face it,

old person = CT
Click to expand...
It's so seductive to hear that your history and physical are good enough to weed out pathology. In a low protest situation, they probably are. In a high protest population, not so much. Just had a pt pan-scanned s/p t-bone high speed MVC by one of my NPs that was sober as a nun and had a completely non-tender abd exam with nl VS and completely nl trauma labs. Had a grade III spleen and a grade II liver lac. Only c/o was some mild L CVA pain w/o ttp. No free fluid so the FAST would have been negative. I'm pretty sure I would have sent the guy home with just a CXR if the UA was clean had the scan not been ordered prior to my eval.
 
Arcan57 said:
How many of you were trained or have listened to lectures that talk about the low yield of CTs in syncope?

I used to believe that it was a waste of time and money to do CT scans on these folks if they had a normal neuro exam and denied trauma. While it's possible my patient population is just exceptionally bad historians with exceptionally large spaces for the bleeds to expand, I can no longer live the lie.

Syncope + old person = CT
Dizziness + old person = CT
AMS + old person = CT
Click to expand...

What do these formulas all have in common? OLD

OLD = CT
That said if there was a true syncope, I assume there was some level of trauma, maybe just trivial trauma.
Any hint of fall in an old person = CT for me.
 
There a poster here some years ago (I can't remember who it was off the top of my head) who said something to the effect of..

I would rather bankrupt the system with unnecessary CT scans than go through another lawsuit
 
VA Hopeful Dr said:
There a poster here some years ago (I can't remember who it was off the top of my head) who said something to the effect of..

I would rather bankrupt the system with unnecessary CT scans than go through another lawsuit
Click to expand...

Don't even pretend like you don't know who posted that.
 
It was also an opening quote on EM:RAP q long while back during their montage of clips.
 
Why do you feel bad about this, if there is not witness to exclude head injury in a person older then 65 you are not supported by nexus, Canadian or new Orleans; that's pretty rough. Higher incidence of head and c-spine injuries in the elderly as well.
 
I'm not understanding the first post. Old buys you a CT. Everyone has a number. And AMS buys you a CT, too. Falls in elderly get you a CT. Syncope and weakness/dizziness in of themselves, not so much.

Young person with syncope and normal neuro exam? You're going to have to document either a discussion of the risks of radiation, or what it was in the history that made you think it was worth it to image.
 
Hair Police said:
I'm not understanding the first post. Old buys you a CT. Everyone has a number. And AMS buys you a CT, too. Falls in elderly get you a CT. Syncope and weakness/dizziness in of themselves, not so much.

Young person with syncope and normal neuro exam? You're going to have to document either a discussion of the risks of radiation, or what it was in the history that made you think it was worth it to image.
Click to expand...
So you'll routinely get a head CT on a 73 yo that complains of feeling tired without any other corroborating hx or physical?
 
Arcan57 said:
So you'll routinely get a head CT on a 73 yo that complains of feeling tired without any other corroborating hx or physical?
Click to expand...
Actually, this is what I thought your first post was arguing - All of the combinations in your first post included "old".

RustedFox said:
Global fatigue only ? No.
Dizzy/vertigo, AMS, or syncope ? Yes.
Click to expand...
That is what I meant.
 
The initial post said "it's possible my patient population is just exceptionally bad historians" and I think that was (a) key to the humor. That and the vagueness of "old".

If you're a 70 year old Jane Fonda, you have a good story for vasovagal syncope, and your witness is confident that you didn't have head trauma or seizure activity, then no I'm not doing CT.

on the other hand...

If you're a 64 year old Keith Richards and you think you just rolled off the couch after a l'il too much, but all we really know is that you were found on the ground by your neighbor, then heck yes I'm doing a CT.
 
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