Just a post to dump some of the links that have been sitting in my Inbox (and were probably forgotten while I was hovering of death's door the week before last).

First up is from Trusted Places (recently the Times 'website of the week') - I've mentioned them here before, they are a website that lets you submit your own reviews of your favourite places. It's run by some really lovely people, and they are currently running a competition.

Just write a review and you have the chance to win a rather posh looking hamper.*

*Disclaimer - they are sending me a hamper, but for previous support, not for mentioning this link.

The Open Rights Group, of which I am a proud member, have just published their two year review - it shows what they have been up to for the past two years. They are good folks and fight on important battles. If you live in the UK and use the internet then you should be donating to them. I do, and I'm poor.

Unless of course you want to see corrupt e-voting and more corporations taking away your rights.

Seriously worth every donation.

There is a newish police blog up - and he has just posted about his experience with the LAS. I have similar feelings when I'm trying to sit on an aggressive patient and they screech round the corner. The comments are good as well.

All emails have been answered - if you were expecting an answer from me and haven't got it - I'd send that email again.

Patients can be tricky little buggers sometimes - they like to trip you up.

We were sent to a middle-aged woman experiencing difficulty in breathing. We arrived and I did my usual examination and history taking.

Here is what I learnt.

• She had difficulty in breathing.
• She had a cough.
• She had a fast pulse.
• She was coughing up a bit of frothy white sputum.
• Her lungs sounded clear, no sign of infection.
• She'd recently had a long haul flight.
• She was a smoker.
• She wasn't on the contraceptive pill.
• She didn't have a high temperature.
• She had a pain in her chest that wasn't made worse by her breathing.
• She had a fairly low oxygen saturation.
• She had deep 'S' waves in lead I.

All of which made me think that there was a possibility that she could be having a pulmonary embolism - this is a life-threatening emergency and needs rapid treatment at a hospital.

So we carried her downstairs, did an ECG (where we discovered the deep S waves - something that is one third of the changes that occur in a pulmonary embolism), and 'blue lighted' her into hospital.

After some investigation she was found to have a kidney stone.

A kidney stone?

Now, I've seen a lot of kidney stones in my time. None of them ever presented like this. With a kidney stone you get abdominal pain, back pain, you tend to writhe around on the trolley. You don't have a cough, chest pain, reduced oxygen levels and an altered ECG. There was nothing, absolutely nothing, about her condition that suggested a kidney stone.

But it just shows you how easily you can be 'tricked' by the examination and history of the patient. It's why I have a fairly low benchmark before I 'blue light' a patient to hospital. Even if it's just something that my subconscious has picked up I'll 'blue' them in - I can always find a justification to the hospital as to why I've done so.

"Treat for the worst, hope for the best", it's how I get to sleep at night without worrying that I've let someone die because I haven't treated them seriously.

I'm sure everyone who works in healthcare has a similar story about how an atypical patient presentation has tripped them up. Feel free to tell me about it in the comments.

Four days off work - that I shall spend answering emails and doing writing type work. I swear, this blogging/writing lack is like having a second job. This is a problem as I am naturally lazy. So if you are expecting a reply to an email and don't get it today, then your best bet would be to send your email again as it's disappeared into the ether.

Thanks for all the comments on my last post. I don't think that my father disappearing really did affect me in any way - pretty much as soon as he left we treated the whole thing as a joke.

One day I should tell you about my half-uncle, my only other male relative (besides my brother) who is also an amusing pillock...

Right...To work!