Today I have come to the guard at the Health Center a 62 years old, attached to a companion of EAP, with malaise, generalized aching expressive, sweating, pallor and intense nervousness. Nothing strange in an emergency with one caveat: it is deaf. After trying to calm her
(seizing his hands, looking into his eyes, taking a picture of calm), I had to step up my resources of persuasion to convey that I will do everything possible to understand it (active listening, empathy).
She tried to express all their symptoms through gestures and sounds and cries issuing high-sounding (remember you do not hear and you can not modular) that produce to those who are close to her obvious discomfort.
noticed that I did not read lips, so I took the gesture as a form of communication. I issued no sounds or raise my voice to hear me (something impossible that would have produced more alarm in the waiting room)
His HC was pretty bland, hiatal hernia, depression and other old episodes of no great importance except " Postmenopausal Osteoporosis "the 51 years with a T-score of -2.2 (?) and" Scoliosis Malignant learned "from 52 years without a radiological test (¿?). I have no clear neither the beginning nor diagnosis nor complementary examinations. The first is foreign to this age without a premature menopause (which is not included in the story), why he was given a DEXA at \u200b\u200b51? Why diagnostic T-score \u0026lt;-2.5?, And the second home is usually in childhood or tumor (no symptoms). Know if you have been treated (brace or surgery) at the time, if it has not been effective or if she has rejected. None of this is reflected in its history
Ordering symptoms showed clinical signs of lower respiratory infection and a severe back pain. And would take about 10 minutes of consultation when I taught a report of emergency 6 days before, came on the same box, and after blood count, urinalysis and chest X-ray (reporting of fused vertebrae but not in cardiac and lung disease) was discharged with a diagnosis of musculoskeletal pain vs . Colic renouretera l. I can not find plain abdominal radiography and abdominal Eco. The patient was upset with the service and expressed his contempt for the information contained in the report.
Once I got to communicate and understand problem, I relaxed a little. I thought, "now comes easier exploration" ...
Lo and behold, after exploring oral cavity and neck (without problems) I'm back with a severe scoliosis and left with a huge hump floor. On auscultation there was a decrease of buzz in the hump and the rest normal. The renal percussion was positive on the left side abdominal tenderness and pain showed a tour of the ureter. Throughout this phase, the patient was very helpful and informed me of their pain adequately. However, through my head was about the idea of \u200b\u200b how can I explain what colic?
A strip of urine confirmed the microhematuria, proteinuria and pyuria. It was clear to the diagnosis and treatment, my problems were again the media until I found out who could read (" course!, How will not know if their main form of communication") I explained everything asked and I mentioned the desirability of outside normal consultation with your doctor. We parted with a handshake.
Communication problems are always present in health emergencies, but in patients with neurosensory disabilities, much more. Imagine
the patient came to our usual consultation being of our quota, "what else should we do?
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