Saturday, March 13, 2010

Now That's some Real Back Pain

And I thought I had some bad back pain.
Patient- 90some year old man who gets admitted for uncontrollable back pain. Upon some work up, it is found out that he is bacteremic (bacteria in his bloodstream) but no source and a UTI. When someone gets an infection, the source has to be identified and in this case it proved to be difficult. his chest x-ray was normal, his MRI found a severe compression fracture but no cause of infection. We ordered an abdominal CT scan, and low and behold, bilateral psoas abscesses. That would definitely be the cause of a blood infection. Ok what next? They have to be drained. This is done by an interventional radiologist under the guidance of CT. I followed the patient to radiology and was in the room while he was transferred from his bed to the CT table. This might have been one of the most heartwrenching things I have been apart of since starting school. This very elderly gentleman who has a severe compression fracture of his spine and two abscesses in his back which are painful, has to be laid on his side on a hard surface. The process of moving him was just awful. He kept yelling out in pain and saying things like "Please don't leave me in here alone." The procedure went relatively smooth and the dr was able to drain a lot of puss.

On a side note, this guy had been prescribed a Fentanyl patch which is a strong pain medicine that is constant since it's attached to the body. When the nurse went to go change the patch Thursday night, the old one was gone, which means that his pain had not been adequately controlled for a few days.

I'm pretty attached to this patient, so I hope when I see him on Monday, he will be either discharged or a lot better. 

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