physician here!
couple clarifications, which I cannot hold in after spending tens of thousands of hours in the library
- No good doctor would ever order an MRI for a "waist-down" thing, unless this was an absolute medical mystery that had been serially investigated with equivocal findings, and even then... MRI is rarely used because of its massive list of cons, though it was quite promising when first introduced. Serial CT scans generally come before MRI, and CT is also not first imaging.
- XRAY and USS = much quicker, cheaper. Always first-line in the ER for any bony or soft tissue abnormalities. CT is NEVER the first imaging anyone would order, for any organ...UNLESS:
- UNLESS: your patient had
head trauma (i.e. fell off a horse, motor vehicle accident, surfing accident, facial trauma/surgery...). This is to rule-out a brain bleed, studies show CT is most sensitive early on. Noncontrast CT head is a standard order for every ER patient who says "yes" when we say "did you hit your head when you fell?" (and for those with reduced consciousness/encephalopathy/obvious head bruising or laceration, obvi)
- last point: the "non-maleficence" do no harm principle. Doctor's have the responsibility to protect our patients and their health information, including prisoners. We are bound to deny even a LE request if not medically necessary, because exposure to radiation and contrast is doing harm for no medical reason. This became a huge discussion in WWII when American doctors happened across wounded Nazi soldiers, and when they wanted to treat the injuries, they were told not to treat an injured enemy. What would you do?
- So again, for that reason, no good doctor would order a CT on anyone who did not have a medical indication for one
...but again... anyone who comes in with recent head trauma would get one to rule out a slow subdural hematoma, and police mayyyy be very happy to provide this caring service for her post-surfing accident head injury, considering the CT will also show evidence of any recent bone fracture and stages of healing - time-sensitive imaging information.
sorry for the rant. fun part for me!
and yes, must point out that it has not yet been confirmed this specific imaging was done on KA. blood alcohol test was weird too...not a standard order. A urine drug screen is very standard and wasn't mentioned. hope we get to see what they produce.