Stay Off the Admit Train
A man in his mid-50s with intermittent nosebleeds was sent in by his primary doctor for “abnormal labs.” The CBC sent from the office revealed a hemoglobin of 5.9 mg/dL. He had no past medical history and no sites of bleeding except for nosebleeds. Labs were sent to confirm the anemia as well as for potential admission.
His lab results were WBC 5.5; HGB 5.0; platelets 160; NA 124; K 3.4; Cl 99; CO2 23; BUN 16; Cr 1.8; glucose 71; anion gap 2; calcium 9.3; and albumin 2.1.
What is his diagnosis?
With the pressure on wait times and length of stay, I think much more often we put patients on the "admit ...
Source: Lions and Tigers and Bears - August 20, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Stay Off the Admit Train
A man in his mid-50s with intermittent nosebleeds was sent in by his primary doctor for “abnormal labs.” The CBC sent from the office revealed a hemoglobin of 5.9 mg/dL. He had no past medical history and no sites of bleeding except for nosebleeds. Labs were sent to confirm the anemia as well as for potential admission.
His lab results were WBC 5.5; HGB 5.0; platelets 160; NA 124; K 3.4; Cl 99; CO2 23; BUN 16; Cr 1.8; glucose 71; anion gap 2; calcium 9.3; and albumin 2.1.
What is his diagnosis?
With the pressure on wait times and length of stay, I think much more often we put patients on the "admit train&...
Source: Lions and Tigers and Bears - August 20, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
‘Blood Draining Inside My Head’
Have you ever picked up a chart, glanced at the chief complaint, and immediately thought, "Really! How do they know that?"
If you practice long enough, you will hear chief complaints such as "feels like spiders are crawling inside me," "feels like my muscles are falling off my bones," or something equally improbable. Yes, some might be delusional, but others just may be trying to give you the best clues they can.
"I Feel Blood Draining Inside My Head"
A 19-year-old man with no active medical conditions was brought to the emergency department five days after an assault duri...
Source: Lions and Tigers and Bears - August 6, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
‘Blood Draining Inside My Head’
Have you ever picked up a chart, glanced at the chief complaint, and immediately thought, "Really! How do they know that?"
If you practice long enough, you will hear chief complaints such as "feels like spiders are crawling inside me," "feels like my muscles are falling off my bones," or something equally improbable. Yes, some might be delusional, but others just may be trying to give you the best clues they can.
"I Feel Blood Draining Inside My Head"
A 19-year-old man with no active medical conditions was brought to the emergency department five days after an assault during wh...
Source: Lions and Tigers and Bears - August 6, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Luck or Wisdom?
Some might say it would be better to be lucky than good.
Others might say it is crucial to maintain a high index of suspicion.
In emergency medicine, clearly both are true.
Here is a humbling case of a fortunate diagnosis made by a colleague.
A 42-year-old woman with a history of hypertension and schizophrenia presented to the emergency department with a day of left flank pain. She had a decreased appetite and didn't remember her last bowel movement, but had no fevers, chills, vomiting, or vaginal or urinary symptoms. She had left upper quadrant tenderness, perhaps with some guarding. The urine dip was unremar...
Source: Lions and Tigers and Bears - July 24, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Luck or Wisdom?
Some might say it would be better to be lucky than good.
Others might say it is crucial to maintain a high index of suspicion.
In emergency medicine, clearly both are true.
Here is a humbling case of a fortunate diagnosis made by a colleague.
A 42-year-old woman with a history of hypertension and schizophrenia presented to the emergency department with a day of left flank pain. She had a decreased appetite and didn't remember her last bowel movement, but had no fevers, chills, vomiting, or vaginal or urinary symptoms. She had left upper quadrant tenderness, perhaps with some guarding. The urine dip was unremarkable....
Source: Lions and Tigers and Bears - July 24, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
An Impeccable Exam
Another patient pops up on the electronic medical record tracking board: a 52-year-old man with back pain who had run out of pain medication. A pink box indicates the lowest possible triage severity. A quick look at prior visits reveals that this diabetic, hypertensive smoker with high cholesterol was admitted for weakness and numbness of the right lower extremity just two months ago. His stroke workup, including head CT, brain MRI, and MRA, was normal. A lumbar MRI was also was relatively unremarkable.
With an empty bottle of Tramadol in his hand, the (fully dressed) patient recounted that the pain medicine initially see...
Source: Lions and Tigers and Bears - July 3, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
An Impeccable Exam
Another patient pops up on the electronic medical record tracking board: a 52-year-old man with back pain who had run out of pain medication. A pink box indicates the lowest possible triage severity. A quick look at prior visits reveals that this diabetic, hypertensive smoker with high cholesterol was admitted for weakness and numbness of the right lower extremity just two months ago. His stroke workup, including head CT, brain MRI, and MRA, was normal. A lumbar MRI was also was relatively unremarkable.
With an empty bottle of Tramadol in his hand, the (fully dressed) patient recounted that the pain medicine initially seem...
Source: Lions and Tigers and Bears - July 3, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
