I have seen this twice.
The first time, 10 years ago, I was a medical SHO in CT-less
Orpington Hospital. 18 year old chap presented 3 days after onset of
a headache which had taken all his strength away. Fully conscious no
focal neurological signs. BP 150/100, low pulse. I don't think he had
neck stiffness. I only just passed the trial by telephone viva and
the neurosurgical registrar grudgingly accepted the patient.
Subsequent investigation revealed *two* berry aneurysms which were
clipped. The chap made an uneventful recovery.
At the beginning of August one year (about 5 years ago), an A&E SHO
asked me for advice about a 33 year old chap with a severe headache
that had started while he was carrying his child on his shoulders. He
thought the child had kicked him on the head but his headache had not
gone away. He too was minimally hypertensive and bradycardic, with
nil else to find. I told the SHO that I didn't like the sound of the
headache and advised her to refer him to the medics. The medical SHO
(first year) sent him home. Three days later he was brought in
comatose from a sub-arachnoid bleed. He has not made a good
neurological recovery and legal proceedings were taken against the hospital.
Medical teams, especially inexperienced and unsupervised SHOs try
very hard to resist admitting patients like these. It can be
extremely difficult to pass the trial by telephone that our
colleagues sometimes impose on our SHOs. Whilst we canback up our
juniors when we are in the department, cases like these worry me
about what can happen when our backs are turned.
--
Helen D. Vecht ############# WARNING! ############
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