Wednesday, July 27, 2005

Syncope

915 am, seeing consults in the cardiac surgical ICU:
40 year old patient with a history of AML, status-post chemotherapy with resultant interstitial lung disease, having undergone bilateral lung transplantation last week. I was being consulted for post-operative hyperglycemia.
As I was about to go in to check the patient out, my beeper goes.
Damn. ER? Why are they calling me??
Me: Hi, this is Dr. K, endocrinology. I was paged.
ER Lady: Yea, Dr. K, I think we have something here that belongs to you...
Me: Huhhh? (Thinking: Oh man, some crazy pregnant woman claiming to be carrying my kid??? Or did they find my stash of junkfood?)
ER: Do you know an Amelia Earhart? (Name changed to protect identity)
Me: Err, yea, that's my medical student. She's supposed to be in unit XYZ seeing a patient (?).
ER: Well, seems that she fainted (twice) while checking the patient out. They brought her down here to be checked out. Perhaps you wanna come down here when we're ready to release her...
Me: !!!
When she was ready to be dismissed, I drove her home. Had to give her the royal treatment as she was a family member of one of my bosses. Although she said she was well enough to return to work, I was afraid he'd fire my ass if I didn't send her home!
Perhaps it was the sight of the multiple lines, or the 2 chest tubes, or the long midline scar running down that guy's chest after having undergone a 2-vessel bypass (LIMA to LAD, saphenous vein graft), or maybe she just skipped breakfast.
Fairly classical; started feeling queasy, some nausea, minutes before she fainted. Then some sweating, and then boom... she was gone.
Popquiz for the med students out there: What kind of syncope do you think this is likely to be?
Since no one took up the challenge:
Answer: Vasovagal syncope. Diagnosis made mainly by history and the negative physical exam. Could consider doing a tilt-table study if in doubt.

1 Comments:

Anonymous ariel said...

Hee, Dr. K(ildare) to the rescue :P

4:18 AM  

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