I posted two day ago about a difficult transfer I was trying to make to another ER. See here. Anyway, the point of the post was to bring up the technical and logistical difficulties in arranging for a LEGAL transfer.
Here it the follow up to this particular case. (which was about a patient who had an apparent partial third cranial nerve palsy – highly suggestive of an intracerebral aneurysm). So I found that after the woman had signed out, her family persuaded her to go to an hospital in an adjoining state (very close) that performed intracranial angiography. The ER doctor there called our ER for official reports of our CT scan. While we were talking, the guy said , “So , did you know what eye drops she was taking?” I said “Yes, they told me she was only taking artificial tears for dry eyes”. Wrong. “Urgggh, I said, what is she on?” “Cyclopentolate” he said.
Of course cyclopentolate DILATES THE PUPILS! It is used for iritis and other ophthalmological cases and to dilate pupils for an easy eye exam! I was so annoyed when I heard this since now, aneurysm is MUCH less likely – (the other ER was doing an angio just in case since she had a headache and vomited), so much so that I don’t think she needed transfer in the first place! I totally wasted about 1-2 hours calling all over the northern part of our state trying to arrange a transfer that the patient would accept!
URGHGHGH! @$@##@%~$~!!!!
Well, at least she was OK – I just wish patients would know the meds they are on!
Been there. I recall one patient with a “blown pupil” who it turns out had been out sailing and took off her scopolamine patch, then rubber her eye. Fortunately, I figured it out before getting the MRA. (I was prompted to think of it by an astute ophthalmologist who I had consulted over the phone.)
Do they not have MRI/MRA capacity where you work? In my life, these have almost totally replaced cerebral angiograms.
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