Prinzka t1_j246fnk wrote
Reply to comment by Earthguy69 in TIL of Dick Roth, a swimmer who was diagnosed with appendicitis shortly before the men’s 400m individual medley in the 1964 Tokyo Olympic Games. He refused an immediate operation and instead swam in the finals, winning a gold medal. by alexjpg
>In my hospital we wouldn't do an ultrasound,
Really?
For me they did ultrasound and x-ray.
And my appendix turned out to already have been perforated.
Earthguy69 t1_j247omu wrote
If it's an uncomplicated appendicitis doing an xray is really unnecessary. It's lots of harmful radiation to a young person.
If the person has gone with it for days, have highly elevated inflammation markers or peritonitis, then yes doing an xray is indicated to see if there is any complications that could affect surgery.
ost123411 t1_j248duf wrote
I don't think the concern with doing a single xray for possible appendicitis is radiation exposure..
Earthguy69 t1_j25a0f0 wrote
It certainly is. You are doing a CT scan. 1/200 statistically get a cancer later in life that can be attributed to the scan.
ksdkjlf t1_j25d9u5 wrote
You're off by an order of magnitude. Per the FDA:
"A CT examination with an effective dose of 10 millisieverts [an abdominal CT averages 8] [...] may be associated with an increase in the possibility of fatal cancer of approximately 1 chance in 2000. This increase in the possibility of a fatal cancer from radiation can be compared to the natural incidence of fatal cancer in the U.S. population, about 1 chance in 5 (equal to 400 chances in 2000). [...] If you combine the natural risk of a fatal cancer and the estimated risk from a 10 mSv CT scan, the total risk may increase from 400 chances in 2000 to 401 chances in 2000."
400 in 2000 to 401 in 2000 is a change of 20% to 20.05%.
One abdominal CT is not "lots of harmful radiation".
ost123411 t1_j2932xo wrote
Much higher chance of dying during appendectomy than developing cancer from a single CT scan
Earthguy69 t1_j2978ji wrote
Not at all. You have a higher risk of dying driving to the hospital than doing the surgery
ost123411 t1_j297gkm wrote
You are drastically overestimating the level of risk involved with a single CT scan
Prinzka t1_j248jr0 wrote
My point is that your comment was like "oh you know immediately that it's appendicitis no need to check just start cutting".
And that's just not the case.
Both the x-ray and the ultrasound were to find out what the actual problem is.
Earthguy69 t1_j25aahg wrote
No, that is literally how it is.
An ultrasound can never say it's not appendicitis. Most often an ultrasound doesn't show it.
Doing a CT scan is just giving a young patient a lot of unnecessary radiation.
The medical legal climate in the US might be different but in most places they do not do a CT scan because the presentation is so obvious.
How long have you worked in the ED?
Prinzka t1_j25bz8i wrote
I know you're trying to argue from a position of authority so that you can go "hah see I've worked in X profession longer!".
I never said that I do this in a hospital.
I have no clue what an ultrasound can show in these cases.
What I'm saying is that after MY appendix perforated they did not know what it was.
All the tests they did included doing an ultrasound and an x-ray.
They didn't tell me what each test would specifically look for.
Just making the point that it's not an automatic cut and dry "oh that's acute appendicitis".
Especially if you've got someone with high pain tolerance.
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