Index Title: RROQUE’s Medical anecdotal Report [04-5]

MAR Title: “Gray zone of observation”

Date of Medical Observation: July, 2004

Narration:

RA a 30-year-old male came in with multiple stab wounds in the neck. He presented with hypotension and tolerable dyspnea.

By physical exam, he sustained 2 punctured wounds in the anterior neck bilaterally, with associated subcutaneous emphysema.

After prompt resuscitation, his symptom improved and was admitted for observation with an impression of probable airway injury.

No hard and soft signs of vascular injury were noted. Ancillary imaging diagnostics (plain and contrast radiographs of the neck) showed no contrast extravasations and the only finding was a widened mediastinum.

Patient underwent tracheostomy for intermittent dyspnea. His symptoms became worse and later expired.

Thinking retrospectively, “Will I be faulted if I explored the patient without clear cut indications?”. Could I have saved him if I had made the right decision?”

Insights (Discovery, Stimulus, REINFORCEMENT):

Patient Management Process is dynamic.  It has a stimulus and an action.  A point in between this stimulus and action exist a zone.  This zone may reflect the margin of safety of a surgeon, maturity, and knowledge.

Actions of surgeons must be borne out of anticipation and not a mere reaction to a stimulus, otherwise it’s either the surgical plan was inadequate or totally wrong.

Our actions must be dynamic; we should search and rethink our actions until we have achieved our goals in our patient.

• LIVE PATIENT

• SATISFIED PATIENT

• NO MORBIDITY/MORTALITY

• NO MEDICO-LEGAL SUIT