Second Chance on Bladder US

“If you are given a second chance in life, don’t blow it,” you advise your eager resident. It has been an overwhelmingly busy day in the department. Interspersed between the motor vehicle collisions, hypoxic and hypotensive CHF exacerbations, and patients with florid sepsis, your team is trying to see and help all of the ankle pains, throat pains, and dysuria that have also walked through the waiting room doors. The neighborhood clinics are completely overbooked, and your department has been dealing with the overflow all week. Your resident has three charts in her hand and has just finished presenting the two sicker patients to be seen. Her third patient is a 60-year-old, otherwise healthy male, who was just here last week for nausea, dysuria, and “feeling unwell”. He was diagnosed with a UTI at that time, and given a prescription for cephalexin. Per his records, he had reported some unprotected intercourse also, so he was empirically treated with azithromycin and ceftriaxone for gonorrhea and chlamydia. The patient went home and his dysuria did not improve with the antibiotics. He couldn’t afford the co-pay to be seen in our clinic, so he returned to the ED. On exam, the patient is sitting comfortably in bed, in no acute distress. He has his hospital gown on backwards with the ties and opening in the front—a sure sign that he’s not your typical ED frequent-flier. He’s happy to talk to you about his persistent symptoms, and does not appear angry or disenchan...
Source: EPMonthly.com - Category: Emergency Medicine Authors: Tags: Uncategorized Source Type: news