Sunday, April 24, 2016

If the symptom is life threatening, monitor the patient...monitor the patient...monitor the patient...

He was a known de-compensated chronic alcoholic liver cell disease patient who gets admitted to the ward regularly for peritoneal tap to relieve difficulty in breathing. One day his complain was different. He complained of per rectal bleeding.
Variceal bleeding in alcoholics is not uncommon. But in that particular patient had undergone colonoscopy within last 6 months & had been normal. His PR bleeding also was only 1 episode in early morning & seemed it has stopped after that. Unfortunately he has eaten beet-root day prior which sometimes gives red color stools.
He was nicely walking here & there. No abdominal pain. Since one episode of PR bleeding, he worried & got admitted. On examination he was not at all pale. Blood pressure pulse also normal. No hemorroids or any masses were found. Ok..what to do..With the reassuring clinical findings, he wanted to go home. But he was admitted by the junior doctor & blood pack was preserved in case if needed. His blood investigations also were sent. It was around morning 10 am. In the evening around 4 pm , the patient was lying on the bed & talking with the bystander. Suddenly he has become unresponsive & immediate CPR started. When transferring the patient from the bed to trolly, they have seen massive amount of blood has soaked the garments of the patient.

Lesson- By the time of examination, patient may be stable. But symptoms which can be life threatening, these patients can go bad at any time. Therefore monitor the patient. Atleast keep them in near by nursing station & order a monitoring chart.
  
If the symptom is life threatening, monitor the patient...monitor the patient...monitor the patient...

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