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28 January 2013

The gut was right.

The US TV drama NCIS, the 'Gibbs Gut' is always trusted.
The same goes for our job, if it doesn't feel right it isn't.
This instinct or intuition generally comes with experience and an open mind.

17M - Horsing around with his twin and stuck his arm through a glass door panel. one large lac with muscle exposed but it appears no tendon or nerve damage. It's going to need a surgical washout.
25M - Horsing around with other backpackers and dislocated his shoulder, 20mg of Morphine got him up off the floor and walking down the twisting convoluted stairwells of this backpackers and on his way to hospital.
52M - Who was out celebrating the Bucks Night of one of his sons and when trying to stop a fight between strangers got pushed backwards and suffered a minor scalp injury.
28M - GHB OD
86M Angina resolved declined Tx.

27F - Fainted, a very common job. We arrive and while she's LL on the floor she's talking so I sit her up then to her feet and as she appears steady we walk outside the restaurant for a sit down examination.
Physically she is a fine healthy young lady but there is a scared/fear in her eyes and she says that she doesn't feel right. At first there seems to be confusion to questions but it didn't seem right so investigated further it's more an aphasia but even then it depends on the way your phrase the question;
Whats you DOB? no answer just a struggling look.
When's your birthday? the something of the something 19something, straight off no problem.


No drugs, trauma, over exertion, fatigue, illness, recent overseas travel, medical Hx and appeared clean, sensible, well presented, high functioning and not seeking attention.

There had been a previous syncope today that they put done to heat in the middle of the day, but I would like her to see a Dr tonight because I can't convince myself of any obvious cause for this.

While at first Triage was doubtful of my concerns after talking to the pt and witnessing another syncope and adding incontinence to the presentations some sort of seizure is looming.
A tumour larger than a golf ball in her frontal lobe region was found on CT.
It appears very aggressive as symptoms continued.

I hope they can do something, she's a very lovely girl.    

Be Excellent to Each Other and See You at the Big One!


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