Radiologist saves a patient from midlevel mismanagement

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Originally posted on Reddit. Lightly edited for grammar and clarity.

Radiologist here with a little anecdote of an interaction I had a while ago with a midlevel in the emergency department.

I come into work for my shift and open up my first case. Late-20s female presents to the ED with abdominal pain and a syncopal episode at home. Pt is post-operative day #1 status post-cholecystectomy. I scroll through the study and I see a huge hemorrhage with active extravasation. I immediately call the ED to convey the findings to the provider (an NP). I then went back and finished dictating the study and proceed to work on a few more cases.

About an hour goes by and something told me to check on the patient. I look at the chart and there is nothing ordered for the patient. No fluids, no type and cross, no consult, absolutely nothing. Now I’m curious as to what’s going on. I call the ED again and speak to the NP to see what’s going on. She tells me that she’s waiting on the surgeon who performed the surgery to come and examine her. I asked how long that’s going to take. She tells me she doesn’t know. I told her that the patient needs to be wheeled into the OR or interventional radiology immediately. It’s a large-volume hemorrhage with active extravasation, which means it’s a pretty rapid bleed.

She proceeds to tell me that the patient is clinically stable, she just has some vague abdominal pain. I again tried to stress the gravity of the situation. I said that young patients can appear relatively stable clinically but they may be minutes away from crashing.

I kind of got the impression that she still wasn’t phased by my warnings. I decided to call IR myself and have them examine her.

They brought her down immediately for an embolization.

This was one of the rare occasions that I actually didn’t need her to correlate clinically.

Fortunately this story has a happy ending.