There is maybe nothing I hate more than calling the ED with imaging results and finding out the provider has not even seen the patient….
Me choosing to fix a typo in my radiology template every single time I use it, rather than taking the 4 seconds it would take to fix the template itself, is a great way to sum up what is fundamentally wrong with me as a person.
This is all I can think about after I just read the fifth negative CTA H&N on the same patient within a one month span…..
I am convinced that the most dangerous thing you can do after the age of 65 is get up to go to the bathroom in the middle of the night.
Can someone please tell me how many points “patient feels floaty” is worth on the NIH stroke scale?
Cause apparently it’s enough to get a CTA…..
Me, a telerad who works from home and hasn’t seen a patient in 3 years, going to get my annual PPD for hospital credentialing….
Me: Hi I see you ordered a brain MRA to “evaluate the cavernous malformation…” ?
Hospitalist: yes the neurosurgeon wants to see the flow rate.
Me: ….The flow rate…. In the cav mal….By doing an MRA….?
Them.: Yep
Me:
ER: Hi, you didn’t mention the pts left ear on your head CT report. He complains of “nodules”
Me: the history i was given was “headache”…. So no I did not mention his normal ear skin
ER: Well can you addend it?
Me: Nope. If you want specific reports, give specific histories
Can an ED doc somewhere, anywhere, please explain how:
Patient transferred in with a known, nonruptured MCA aneurysm and an NIHSS of 0, gets a full STROKE ALERT head ct, cta, and perfusion?
What I think should happen when someone orders a head & neck MRA on a patient who just had a completely normal CTA.
How I wish I could write my reports:
Impression
Shockingly, this patient with no new focal neurological deficits has no vessel occlusion. The cta is unchanged from cta done 9 days ago, which was unchanged compared to the cta 1 month before that, and the one 6 months before that
You might think you’re having an easy night as an ER rad… but I promise that you’re really always just one post-op, post-radiation, head and neck cancer with active bleeding, emergent trach, and disease progression away from being 45 minutes behind.
Whenever I read a prior radiology report and think “wow, what idiot said that?”…. There’s about a 75% chance that I, myself, was that idiot.
Just another fun example of this job instantly humbling me on a daily basis.
It should be illegal to order a CTA for “dizziness” without first calling the radiologist to specifically tell them why you hate them so much.
But seriously, please stop with the CTAs.
Me calling the ER:
Me: hi, this patient has a large brain bleed and is herniating and has hydrocephalus
ER: ok. Do you think they need an mri or a cta?
Me: umm… I think they need a neurosurgeon.
Does anybody know the actual stats on how many old people fall on a nightly basis?
Anecdotally, as a radiologist, my guess is that it is all of them.
Got an entire “stroke alert” last night for the indication: “the patient doesn’t know todays date”
General rule of thumb, if the radiologist reading the scan has the same symptom as the patient, it’s probably not a good enough reason to call a stroke alert.
#NIHSSzero


