If you do a job do it properly
When I was working as a locum Nurse Practitioner I came across a patient that had fallen and hit her head. I actually saw her on her fourth presentation to the same emergency department.
When she first came she was examined and had a wound to her head which was closed with sutures and a CT head scan as she was on blood thinners, which was normal.
Before I saw her I could hear the nurses moaning about her saying it was 'ridiculous' that she had been in so many times for the same problem and kept getting sent away after being assured everything was ok. They had her marked as a time waster.
I have learnt from experience to brush those sorts of comments off as there is usually a reason why people keep coming back. She said that every time she goes to bed the wound started bleeding again then by the time she got to A&E the wound had stopped bleeding. She described a bed as being ‘covered in blood’.
On examination her hair which was long was heavily matted in dry blood. I was unable to see the wound at all. I asked for her permission to cut the hair so that I could get a good view of it. To my surprise the sutures that had been used to close the wound were not even in her skin they were in her hair. The wound was still gaping with a large blood clot in the middle keeping it from closing. I had to evacuate a large blood clot from the wound in order to close the wound sufficiently.
When the patient walked to the treatment room for me to suture she almost collapsed on me and went very pale. I ordered some blood tests and found her to have a haemoglobin of 50 which is less than half of what it should be. She has bled out over half of her bodies reserves of blood from a head wound over the last few days.
Im sure if I had been the fourth one to send her away it could have been a life threatening situation and Ive no doubt as the last one to see her it would have been all my fault.
My advice would be to have a low threshold for further investigations for a returning patient. Always seek a senior opinion on a returner and document everything. Be even more thorough than you would normally be. Dont listen to idle chit chat from colleagues and form your own opinions without any bias.
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