OK, time for a round of "Are You Smarter Than the ER Attending?"
A guy has right shoulder surgery and immediately afterward, he gets a right shoulder nerve block for post-op pain management. He presents to the ER 12 hours later (at 3AM) with complaints of continued decreased sensation in his right arm. He denies any shortness of breath/chest pain/headache. He is still able to move his right arm but it is weaker than his left. Do you:
A. Order a head CT
B. Order a neck CT
C. Consult the ortho resident to rule out compartment syndrome
D. Ask the ortho resident to admit the patient for observation
E. All of the above
If your answer was F--reassure the guy that this is what is supposed to happen when you get a nerve block--then congrats, you are smarter than the ER attending. You are also equally smart to my sister, who was able to get the answer even before she heard all the options. You are also equally smart to the patient, who correctly predicted that was what was going on but just wanted to make sure because he didn't realize it was going to last that long. I don't fault him for going to the ER, although I think he probably just could have called the surgeon or the anesthesiologist and gotten an answer as well as decreased radiation exposure.
I would say the two hardest parts of that consult were dragging my butt out of bed and down to the hospital at 3AM and trying to explain to the ER doc that this was totally normal and I didn't need to bring the guy back to the OR for some sort of nerve exploration. Finally I said to him, "you know, we see this every now and then. Patients have nerve blocks and then they come back to the ER because they're surprised it lasted as long as it did."
My ortho attending thought it was kind of funny, but he wasn't the one who had to deal with it at an unG-dly hour of the morning.
Go go modern medicine.