Recently, I responded to a call at a local plant. It was dispatched as dizziness. I immediately thought this would be a ploy to get out of work. When I walked in the nurses station, I was immediately taken aback by the patient's presentation. In a cool room, he was pale and very diaphoretic. My initial thought was cardiac etiology. The patient did not complain of chest pain. This is possible in some heart attacks, so I obtained a 12-lead. It was pristine. Next I continued to query the patient as to what medical history he had. This provided no useful information. As we moved the patient to the cot he became violently ill. All other vitals where normal. Lung sounds, temp, blood sugar, BP....all inconclusive. I gave prophylactic zofran to stabilize him enroute to the hospital. I continued to talk to the patient. What he told me next took me aback, and put all the pieces of the puzzle together. With the simple phrase, "my ears started to plug up before this happened," it became clear.
His nausea and vomiting where caused by a failure of his Eustachian tubes to drain the fluid built up and caused pressure on the cochlea in his ear. A simple cause of inflammation due to allergy exacerbation. However, the secret was not in the 12-lead, or the physical exam, or even the past medical it was in the telling of a simple phrase. If I had not asked the right questions, I would have arrived without a working diagnosis and could have caused a greater amount of time to occur before the patient condition was improved. The lesson here is that the secret can sometimes be found in the telling.
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