I have caught several vascular occlusions over the years masquerading as sciatica or benign extremity complaints. This is why it is incumbent to examine patients with back or extremity pain in a bed, undressed, with shoes off. As more and more ED’s move to the flawed “vertical flow” process that involves shuffling patients to chairs instead of beds, this becomes more challenging and these misses will become more frequent.
Yep. Unfortunately this is not the first case I've heard of in which a vascular occlusion was mistaken for sciatica. Always frustrating when people come in for back/leg pain and you go in the room and they've got their shoes laced on tight and a pair of skinny jeans on.
Good case! It reminds me of a case when I had a patient who called into my clinic asking for medications for what he thought was a gout flare of his toe. When he came in for the exam he had a blue colored toe and PVD causing his pain. Unfortunately it has become very common for patients to send mychart messages for treatment of symptoms without a physical exam, which is vital.
I have caught several vascular occlusions over the years masquerading as sciatica or benign extremity complaints. This is why it is incumbent to examine patients with back or extremity pain in a bed, undressed, with shoes off. As more and more ED’s move to the flawed “vertical flow” process that involves shuffling patients to chairs instead of beds, this becomes more challenging and these misses will become more frequent.
Yep. Unfortunately this is not the first case I've heard of in which a vascular occlusion was mistaken for sciatica. Always frustrating when people come in for back/leg pain and you go in the room and they've got their shoes laced on tight and a pair of skinny jeans on.
Good case! It reminds me of a case when I had a patient who called into my clinic asking for medications for what he thought was a gout flare of his toe. When he came in for the exam he had a blue colored toe and PVD causing his pain. Unfortunately it has become very common for patients to send mychart messages for treatment of symptoms without a physical exam, which is vital.
Good catch! Patients aren't actively trying to sabotage us but it sure feels that way some times.