Worst CT ever?

[EMEDPA]

Presented SOB with new afib w RVR. Rate controlled with 20 mg diltiazem. CXR whited out L chest. CT below. Nice guy. No family or friends.  Trying to arrange hospice. 

[ohiovolffemtp]

Probably the worst conversations to have in the ED.

[ChrisPAinED]

These ones are always so hard. I try to get patient admitted so they have better access to social work. In my ED we have social workers but not many and non that show a lot of sympathy. 

[jmj11]

Sad. What a shocker for him. I wonder if, retrospectively, he had noticed symptoms weeks or months earlier.

I saw a patient in the ED once with something similar (no heart involvement) but came in after a chiropractor could not help his arm numbness after six months. A DO had come down to help out (Air Force ED) during his lunch. Nice guy but not a good doctor. He had ordered a neck and chest xrays and told me he was ready to discharge after I looked at the films, dx "pinched nerve." I saw the films (had not seen the patient yet) and he had huge lesions in his lung with mets throughout his cervical and thoracic spine, and clavicle with associated pathological fractures. I walked in to see him and had him take his coat back off. He had extreme wasting of his right arm, an obvious deformed clavicle (which he said broke as the chiropractor was adjusting him the previous day) and he was right handed. To make a long story short, was able to have him admitted at the local civilian hospital. I called on Monday (saw him on a Friday) to check on him. He was a quad on a vent and the family had been called in to consider end-of-life care.

If you get the chance and if it is easy, it would be interesting to see that CT. Glad he was in compassionate hands like yours.

[TheFatMan]

shit