Not too busy today, but I was at the hospital for extended lengths of time... waiting for stuff to happen. My first patient was from the Emergency Department, and older lady with chest pain and decreased O2 sats and a positive D-Dimer, a lab test to check to see if clots are forming. A primary place for clots to end up is in the pulmonary artery... the old "blood clot in the lung" trick, according to Maxwell Smart. Well, the best way to see these clots is to do a CT pulmonary The iodated contrast material that is used is excreted by the kidneys almost immediately... in fact, the original use was as a way to visualize the urinary tract in the early 1920s. The kidneys, however, have to be working reasonably well, or the stuff just sits there and crystallizes. This is not good for the stuff that kidneys are made of. So we have been routinely checking kidney function before we inject this stuff. Incidentally, we've only been doing this routinely for the last year or two. Most of the time and ER patient has already been screened for stuff like this before the test is ordered... there are alternatives to the CT exam, of course, primarily the V-Q lung scan. Not nearly as good, but it can detect defects in larger segments of the lung. So I was almost ready to start the injection when I decided to take an extra minute and check... and her creatinine, the lab test for kidney function, was double what it should be. So, off the table she goes, to wait a coupla hours to get a lung scan. And that's twice this weekend that I've almost made a big mistake with contrast and just barely caught it serendipitously.... One of my partners in CT is working the evening shift, so I haven't been called back since 15:00. Karen and I watched A Beautiful Mind and really enjoyed it. The scenes in the end, the hero looked a lot like BoB Dole, and I thought to myself, "Do all old men eventually look like BoB Dole? Omigod, will *I* look like BoB Dole some day?" If I ever get that old I won't care what I look like... hell, I don't really care what I look like right now, so I guess I won't worry about what I might think later! I do need to get to bed, though, I'm going in at 07:00 next week, I need my beauty sleep.
embolus study, which is where I come in. What we do is inject radiopaque contrast material (the stuff that's made out of iodine that I mentioned yesterday) and take a bunch of highly-detailed CT slices through the pulmonary arteries and the lungs. We occasionally have false negatives due to motion, but we don't have false positives... if we see it, it's there.