Wednesday, May 20, 2009

when do you stop feeling D-U-M-B??

i am taking care of a 14 week old puppy whose head was crunched by a much larger dog. it's pretty terrible. the puppy is disoriented, vocalizes constantly, has a severe head turn (torticollis), rolls like an alligator, and is generally effed up pretty bad.

at the owner's request, i took xrays of the skull. for what it's worth - xray is a crappy way to look for skull fractures. unless it's a humongous, depressed fracture - it isn't going to show up on a plain film. ct scan is much, much better. but much, much more expensive, too.

so anyway, xrays show a "fracture" in the middle of the skull - which would be consistent with all the signs i am seeing in this dog. i diagnose a fracture of the calvarium.

i worked on her all day, and despite that, she is doing horribly. the cherry on the sundae is that tonight - after reviewing stuff on VIN (veterinary inter-network) and in my diagnostic radiology book - it turns out that the "fracture" i saw is really an open suture line (growth plate in the skull). so this fracture isn't really a fracture.

in my defense - the suture line is much too wide - likely due to significant swelling of the brain. it's possible that there is a fracture there too.

when will i start knowing EVERYTHING so i won't feel so stupid all of the time?

oh, right. NEVER.

on the bright side - skull fracture or not - management of head trauma is the same. so my "misdiagnosis" doesn't affect the patient. unfortunately, she's in bad shape. i don't expect her to survive much longer.


Nicki said...

you're right. Never. Bummer huh? All that time and money...

labmom said...

You don't need to know everything, you just need to know where to get the info you don't know.. but you do need to know that you don't know everything, that way you can keep an open mind and keep learning.