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docB

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I've had several weird chief complaint - diagnosis patients lately. 65 yoF with worst HA of life, Dx USA with trop of 5. Pt with ankle pain, Dx pregnancy (and ankle sprain). I heard of a patient with syncope that wound up with a Dx of heel osteo (syncope w/u = new onset diabetes = foot ulcer = osteo).

Others?
 

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When I was 12 years old I went to the emergency room for a broken wrist. I ended up leaving with a cast on my arm and a splint on my ankle. I still have no idea why I needed the splint on my ankle. Maybe it has something to do with the osteopathic "whole body" approach. ;)
 

the END.

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Originally posted by JPHazelton
When I was 12 years old I went to the emergency room for a broken wrist. I ended up leaving with a cast on my arm and a splint on my ankle. I still have no idea why I needed the splint on my ankle. Maybe it has something to do with the osteopathic "whole body" approach. ;)

Keeps you from running around and breaking your other wrist.
 
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DrQuinn

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Thing isn't that big a stretch but as I left today I think I was pretty close to diagnosing a pheochromocytoma. Initially was triaged with a migraine, similar to previous episodes, migraine was relieved iwth mag/benadryl/reglan, but continued to stay hypertensive and tachycardic............................. for several hours. cardiac history/workup was negativo, and upon further quesitoning, her history was pretty classic....... unfortunately we don't get the VMA levels in the ED, so I'll never really know.

Q, DO
 

beyond all hope

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Especially in the ER, when histories are erratic.

Recently

CC: abscess on right side.
Dx: empyema
Saw the pt was cachetic and tachypnic so did CXR - found empyema that extended through the chest wall into the skin. Never done thoracocentesis without a needle before...

CC: CP
Dx: pelvic abscesses

CC: CP
Dx: psychosis, malingering
first time I ever got spit on or threatened by a patient.

CC: fell down + 'my urologist injected something into my penis'
Dx: early pneumonia causing delirium - pt developed fever and rales within a few hours.

CC: ALOC (per other MD)
Dx: GBS Miller-Fischer Variant causing dysarthria and pupillary dilation. Pt couldn't talk and could barely see, so other MD assumed he was altered. I did Hx with pencil and paper in Spanish. Nice guy.

CC: hemiparesis
DX: MI
Don't know why - not shocky, no physical findings except weakness on one side with sparing of face.

CC: rib pain
Dx: osteo of hip
A real pain in the ass (pun intended)

CC: med refill
Dx: HTN urgency/emergency, DKA
assymptomatic pt presents to urgent care with sugar critical high or BP 250/130 + spilling protein in urine. Seen many, many times.

CC: any
Dx: hungry
Very common

etc
 

Homunculus

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Originally posted by DrMom
I got chewed out in the ED once for giving a homeless pt some cereal. :rolleyes:

if you feed them, you reinforce their behavior. not only that, but intermittent reinforcement makes behavior persist even longer.

give the cereal to a kid who really needs it :)
 

edinOH

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Originally posted by DrMom
I got chewed out in the ED once for giving a homeless pt some cereal. :rolleyes:

Don't feed stray cats outside your apartment.

Don't feed stray dogs outside your front door.

Don't feed stray homeless people inside your ED.
 

DrMom

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Originally posted by edinOH
Don't feed stray cats outside your apartment.

Don't feed stray dogs outside your front door.

Don't feed stray homeless people inside your ED.

I know, & I knew you guys would post this :), but he already was a regular (for years) without having been fed, so I seriously doubt that it made any difference. Anyways, it was a resident who actually got the cereal & the brunt of the nurses...it was just me who mentioned it to the resident. I imagine I'll feel differently about this later. :)
 

beyond all hope

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I, like most ED folk, have mixed feelings about homeless who come to the ED just for food and a bed.

It is an incredible drain on the system to call 911 just to get a meal. It ties up EMS and the hospital so that truly sick people can't get help, and it is a terrible abuse of the system. It also makes more work for me having to figure out which complaints are bullsh*t and which are real.

However, it's hard for me to refuse a hungry person food. Many of these people are mentally ill, are unable to get work, and have a very hard life on the streets. I usually end up feeding them, and telling them not to call 911 for food. They ignore me, of course. My only condolence is that if they don't come to our ER, they'll go somewhere else.

My most memorable malingering patient was a nasty old guy with a RUL lung mass, who had been admitted many times to the hospital for a workup but always signed out AMA as soon as he'd had enough to eat and was tired of refusing blood draws. He was really sick, usually drunk, and because he was sick we were EMTALA required to work him up every time he came to the ER.
He called 911 one morning after having AMAed from our ER only hours before with a new BS complaint. He started bellowing for food in the middle of the ER. I was about to feed him when my senior told me not to. I was conflicted, but in the end I went with my senior - CC was belly pain, which I knew was BS, but that's a good reason not to feed any patient. He kept demanding food and I kept telling him no. He signed out AMA, and as far as I know didn't come back for awhile. He probably died on the street, or found another ER that was more receptive to his crap.

Did I do the right thing? I don't know. There's no good answer. This is one of the things I really hate about EM.

That being said, I went into EM partly because we give medical care to anyone, regardless of ability to pay. I am happy and proud to give care to deserving, sick patients who can't afford it. This is just the other side of the coin.
 

jashanley

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Originally posted by QuinnNSU
unfortunately we don't get the VMA levels in the ED, so I'll never really know.

Q, DO

You could follow up or is that above and beyond the EM resident's duties. I love looking up cases from the previous nights to see what has transpired since I admitted them. Our computer system makes it easy.....all notes are typed in and all labs are reported in the same system
 

beyond all hope

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I never do it because I'm lazy, but I'm convinced followup is the key to good training and good medicine in EM. I know a PD who follows up on all of his patients (but he only works 1 shift/week). We have manditory f/u at our program, but most of us just dry-lab it because half of the phone #s that patients give are false or disconnected.
 

docB

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Originally posted by beyond all hope
I never do it because I'm lazy, but I'm convinced followup is the key to good training and good medicine in EM. I know a PD who follows up on all of his patients (but he only works 1 shift/week). We have manditory f/u at our program, but most of us just dry-lab it because half of the phone #s that patients give are false or disconnected.

When I was a resident we have to follow up on 10% of all of our patients. We had to fill out these little forms that asked:
Chief Complaint, Diagnosis, Is the patient better?, If not why not?, Did the patient come back with in 72 hours?
They were based on making phone calls but the CPR patients fit in really well too:
Chief Complaint: Dead
Diagnosis: Dead
Is the patient better? No.
If not why not? Dead
Did the patient come back with in 72 hours? No

One follow up done.
 

Scrubbs

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We have to followup 10 patients per month in the ED... I started doing things like x-ray followup 1 month, GC/CT followups another month, etc. Ok, maybe its not TRUE followup, but at least I'm doing a little self Q&A... ;)
 

DrQuinn

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Had a patient a few days ago, main complaint was pain in the legs, very nonspecific. Nurse told me this patient is a pain in the ass and I need to hurry up and see her to D/C her.

Well, I diagnose thyroid storm and admit with PTU therpay started in the ED.

Q, DO
 
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