The Value In Listening To The Patient

Dr. Rui Amaral Mendes, associate editor of BMJ Case Reports, writes that doctors need to listen carefully to their patients and build a timeline of what happened rather than relying heavily on scans and tests. This is in response to a British patient whose partial dentures got stuck in his throat during surgery and weren’t discovered for eight days. The BMJ is a weekly peer-reviewed medical journal and one of the world’s oldest general medical journals. Originally named the British Medical Journal, the title was officially shortened to BMJ in 1988, and then changed to The BMJ in 2014.

The patient went to the emergency room because he was having a hard time swallowing and was coughing up blood. ER doctors ordered a chest X-ray, diagnosed him with pneumonia and sent him home with antibiotics and steroids. Over the next several weeks, he returned to the hospital four times with episodes of coughing that produced blood. Doctors then discovered that the man had a torn artery in his neck near the area where the dentures had caused tissue damage. The patient required another emergency surgery, along with several blood transfusions.

Earlier in 2019, the journal Case Reports in Surgery described a 50-year-old man in Turkey who apparently swallowed his dentures during sedation before surgery. Ingestion of Partial Denture after General Anesthesia Induction and Ventılation: A Rare Case, Hakan Akelma et al, Case Reports in Surgery, Volume 2019, published 29 May 2019.

Most anesthetists work from the mouth. To prevent perioperative dental damage and complications, it is important to determine the dental status of the patient and identify any sensitive teeth or soft tissues and the anesthesia risk factors associated with these in a full preoperative evaluation. Nowadays, many patients have dentures which are more fragile than the natural teeth. The increased use of partially fixed dentures in the elderly increases the possibility of swallowing prostheses. This possibility is often overlooked. If it is not noticed that the patient has partial dentures, there is a possibility that the denture will be pushed into the oesophagus and swallowed during ventilation with positive pressure following preoperative induction. … Complications of prosthesis ingestion include necrosis, perforation, penetration of adjacent organs, bleeding, and obstruction.

Emergency medicine specializes in the treatment of acutely ill and injured people. The emergency medicine doctor has completed complex training which typically lasts three to four years. Litigation in emergency medicine may involve allegations of missed or delayed diagnoses of life-threatening conditions, mismanagement of acute illness, and inappropriate discharge from the emergency department. Contact Elite Medical Experts to retain a hand-selected emergency medicine expert witness with the credentials needed in your case.