Prognostic Indicators

Anyone who has been in emergency medical care for some time is aware of those clinical findings that herald instability; prognostic indicators that typically point toward a more stormy course of care when they’re present.

For instance, there’s the infamous “two word dyspnea,” in which the patient has to pause for breathe between every two words:

“I can’t – *pant, pant* – breathe.”

When you see that in your COPD or CHF patient, you know that the chances are high that your patient will be undergoing the PVC challenge* very soon.

Poor prognostic indicator.

On the other hand, if they say, “Well I can’t breathe and it’s been going on for three days now and it really gets worse at night and I’ve tried Vick’s Vapo Rub and a humidifier and I’ve been coughing up this green nasty stuff and I even tried my cousins inhaler and nothing seems to help and I think I may have pneumonia or Legionnaire’s Disease because I Googled it and it matches my symptoms perfectly…“

…and they can do it without even pausing for breath, then you know that they’ll probably be discharged before you can complete your paperwork, or they’ll sit in the waiting room long enough to grow roots before they ever see a doctor. You just give them a little supplemental oxygen and a ride, and you try your best to keep the eye rolling to a minimum.

Positive prognostic indicator.

Well, I have discovered another prognostic indicator that we’ll dub “two whimper pain.”

If your patient has pain to such a degree that they must groan or whimper at least twice between every word of their history:

AD: “What’s wrong, Ma’am?”

Patient: “I – *groan, moan* -be hurtin’.”

AD: “Where?”

Patient: “My – *whimper, sniffle* – chest.”

AD: “What’s your name, anyway?”

Patient: “Sh’aronapathia – *whimper, yelp* – Smif.”

AD: “Uuhhh, can you spell that?”

Patient: “S – *moan, groan* – H – *whimper, moan* – apoxcrafee – *whimper, moan* – …”

…then they are more than likely full of shit. The more agonized groans and whimpers inserted between every word, the more full of shit they are.

Just call that a helpful tip from your Uncle Ambulance Driver, kiddies.

*endotracheal intubation