Sunday, October 21, 2007


Last night a young man came to the ER in police custody. He had been found down, was arrested for public intoxication, and was here for medical clearance before being taken off to jail.

I examined him, finding him to be minimally responsive and complaining of pain in his wrist. He was handcuffed to the bed rail, and the cuff was pinching him, causing his hand to swell. I asked the officer to remove the cuff, after which the pain subsided. Otherwise he was less conscious than might be expected given his blood alcohol level (about half again the legal limit), but the police, who knew him, said that this was a typical event for him and I found no other evidence of injury.

Outside the room I spoke with the staff physician, who asked me whether I thought we should perform a CT scan of the man's head. On the one hand, he was found down and there was no way to know whether he had hit his head or sustained internal injuries. Perhaps he was semi-conscious because of an intracranial bleed. On the other hand, he had been found in this state many times by the police, who usually took him home to sleep it off. It was a busy night, and we had lengthening wait times for all of our patients needing CT imaging. What to do?



At October 22, 2007 at 6:47 AM , Blogger Tom said...

I would prefer to defer to the Bethanizer on this one but as she hasn't commented yet I say do the CT scan. Better safe than sorry.

At October 22, 2007 at 11:03 AM , Anonymous Kate said...

When I worked in the psych ER, my attending's motto was "how would it look written up in the new york times?" There's defensive medicine for you. Given that that's my background, and given that I'm pretty risk-averse in general, I'd vote for the CT.

At October 22, 2007 at 11:29 AM , Blogger Melinda June said...

I think this happened on ER once and Luka got sued.

At October 30, 2007 at 6:53 PM , Blogger photomark2006 said...

yes, i too would scan this man's head. 4 of 4 bloggers say scan him!

no but seriously.

can you believe there are only 197 of us who blog and are into EM?

anyways, good luck c the residency search and all that.


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