The man with the croaky voice

A 42 year old male presents following having been punched to the throat.

He is sitting comfortably in a chair, writing in a journal. No-one is really concerned. I’m asked to see him because he has a croaky voice? Hmmmm…I’m interested. On examination there is nothing to find, except his croaky voice. No stridor, nil else. Nothing to see on mouth opening.

He states that the voice change occurred immediately after he was punched to the throat. He has experienced difficulty in drinking water since.

Ok, what do you think?

Well at this point I was more than concerned, primarily about a fractured larynx. This could be an airway nightmare![…]

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Beware of making the diagnosis of renal colic!

Sometimes a little knowledge can be dangerous. Beware of just knowing the percentages, know to apply them in the clinical context.

I was recently handed over a patient who had presented with abdominal pain. The patient was reported as having some left sided abdominal pain and pain on left kidney ballottement. The diagnosis of renal colic colic had been made. The patient was being treated with oral analgesia with a view to going home when pain was under control.

The past history the patient gave was a hysterectomy a few years prior, with a complication of hernia, and a further complication of infection, post hernia repair. She had also had a secondary in the lung for which she had had a lobectomy. She did give a history of left renal colic some 19 years previously […]

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