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Cerebral infarction case

By regional commission of inquiry into incidents and calamities SHR/DDDB

The wife of a 59-year-old man calls the HAP at 06:00. Her husband had trouble getting up to go to work. Since 03:00 last night he was very dizzy. Then he couldn’t get up to go to the toilet for a while, but that was gone after that. On the way to the toilet, he had to hold on and staggered from side to side, sometimes seeing black in front of his eyes. He also repeatedly complained of cold legs. Gentleman had had a headache the day before, but that was also gone now. Then the gentleman himself comes on the phone and can give an adequate answer. Repeatedly reports that some complaints have disappeared. The triage comes out to a U2. The triage nurse consults with the night doctor and the urgency is adjusted to U3. Patients are advised to go to their own GP in the morning and a clear safety net is agreed.

Gentleman is going to the next morning to your own doctor. On the basis of this consultation, it will be agreed that the gentleman will be examined in the hospital later in the day. Patient goes back home while waiting for the appointment at the hospital. Then it will be Gentleman unwell later in the morning and goes to the hospital by ambulance. One cerebral infarction is diagnosed.

Had Could this have been avoided if the gentleman had been sent in immediately by ambulance? That is, of course, the big question of this patient’s loved ones. The The Commission of Inquiry has investigated this incident and has raised a number of questions reviewed. This is how the question arose: whether there was ‘dizziness’ in the entry complaint the NTS is asked a follow-up question about dropout symptoms. This is evident from not to be so. This should of course be included in the exploratory part of your conversation. The problem with this case is that there is no visible symptoms of failure. Patient also indicated that it was not possible for a while getting up is also gone. At the time of the visit to your own GP who In the morning there are again no signs of failure.

The NHG standard Dizziness indicates urgency only in neurological deficit and refers to the standard Stroke. The NHG standard stroke goes out of focal loss symptoms. There didn’t seem to be any focal Loss of function. Our own GP assessed this later that morning and has not found any signs of failure. An assessment on the The out-of-hours GP service had therefore not led to a different conclusion.

It answer to the question whether this cerebral infarction could have been prevented by It is difficult to give the answer to  the gentleman earlier. However, we can say that if there has not (yet) been a cerebral infarction, a scan should not be to see if there is an imminent cerebral infarction. We have to do it then with the information that the patient and his relative gives us and thus remotely with using the NTS, score the best urgency. This case study shows how It is valuable to triage on urgency. This does not mean, however, that the outcome was avoidable. What’s left when fate takes its toll is a good and timely explanations to the patient and his relative in order to to bring its original expectation to the health care system. put. Gentleman is currently undergoing a rehabilitation program.

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