This week was really cool at my acute care clinical because my clinical instructor and I caught a red flag on a patient who had been admitted for a GI bleed! As we were going through their history they started to tell us how they were completely independent until about two weeks ago – when they began falling frequently and required help with bathing and dressing. They stated that they were also losing sensation down their right leg, feet and around their perianal region and that they had become incontinent. Mind you, none of this was in their chart.
We tested their sensation and it was indeed diminished, mostly in their RLE L5 dermatome. They also had very weak dorsiflexion in their right ankle (2- MMT). I wish I would have had my reflex hammer with me at the time so I could have checked those too.
My CI called the patient’s MD and the first thing the MD says is “You know you’re calling me about a GI bleed right?” *rolls eyes* so my CI says yes, and proceeds to tell him about our findings. He then says, “Wow, it looks like we need to get an MRI.” UMMM YEAAAH!! YOU SAID IT, NOT US haha. Fast forward, the patient’s MRI results showed that they had cauda equina syndrome caused by severe spinal stenosis and they needed immediate surgery! The MD ended up calling my CI after receiving the MRI results to thank us for catching that. My CI and I were both felt super proud and I thought it was really humble of the MD to call back just to thank us. I think it was also another a reminder for me, to ALWAYS listen to your patients, NEVER put anything past any patient and to always be sure to check EVERYTHING when something does not seem right.
If you have any interesting patient stories, please comment below!!!