BS "Admit to Medicine"

[emt30119]

Just finishing up a couple inpatient months and experienced some pretty bogus admissions.

Just for fun, feel free to share your less than convincing "Admit to Medicine" experiences.

Just to get started. Middle aged lady who was having pretty significant bleeding in the OB clinic. They US'd her and found a bleeding fibroid. She got light headed, rapid response called, and I scooped her up and took her to the ER. Hg low, but vitals OK. No other medical problems. OB resident tells the ER resident, this patient needs...."Admit to Medicine". Despite the fact that they have not only a OBG but GYN inpatient service. Hmm, I guess only medicine can give a pack of RBCs...

Bleeding fibroids...Admit to Medicine

---

Members don't see this ad.

 

[DIce3]

To be clear, in the private world, there are no bogus admissions. Every patient is your most important patient that you want to care for immediately, regardless of the incompetence of fellow clincians (i.e. ARNPs and PA-Cs). Better to change one's mindset now so as to ease in to what your life will soon be like. I see nonsense from fellow midlevels daily and am genuinely happy to salvage a patient from receiving substandard care.

 

[anonperson]

Just finishing up a couple inpatient months and experienced some pretty bogus admissions.

Just for fun, feel free to share your less than convincing "Admit to Medicine" experiences.

Just to get started. Middle aged lady who was having pretty significant bleeding in the OB clinic. They US'd her and found a bleeding fibroid. She got light headed, rapid response called, and I scooped her up and took her to the ER. Hg low, but vitals OK. No other medical problems. OB resident tells the ER resident, this patient needs...."Admit to Medicine". Despite the fact that they have not only a OBG but GYN inpatient service. Hmm, I guess only medicine can give a pack of RBCs...

Bleeding fibroids...Admit to Medicine

A lot of specialties can play this game. As an OB resident, if the ED calls us first we will admit, but I have seen a fair amount of times, medicine being the admitting team and then we get consulted.

But medicine punts any pregnant patients fairly routinely. One recent example off the top of my head,

44 year old with family history of CAD who is 12 weeks pregnant with chest pain- I've had medicine refuse this admit and want the patient admitted to OB instead. I don't think it's that appropriate to have OB working up chest pain in a 44 year old, especially this early in pregnancy.

 

[obiwan]

we see a lot of perforated GI tract who are too sick to go to surgery so surgery will want to admit to MICU to stabilize them which unfortunately most of them die

 

[Instatewaiter]

To be clear, in the private world, there are no bogus admissions. Every patient is your most important patient that you want to care for immediately, regardless of the incompetence of fellow clincians (i.e. ARNPs and PA-Cs). Better to change one's mindset now so as to ease in to what your life will soon be like. I see nonsense from fellow midlevels daily and am genuinely happy to salvage a patient from receiving substandard care.

There isa difference between incompetence and wanting someone else to admit your patient. In the world iutside of training you thrive on low hanging fruit but in academic medicine the residents would rather someone else do the work

 

[jdh71]

To be clear, in the private world, there are no bogus admissions. Every patient is your most important patient that you want to care for immediately, regardless of the incompetence of fellow clincians (i.e. ARNPs and PA-Cs). Better to change one's mindset now so as to ease in to what your life will soon be like. I see nonsense from fellow midlevels daily and am genuinely happy to salvage a patient from receiving substandard care.

I was waiting for this post to show up when I first saw the thread. And it showed up post number 2!!

No one in training gives a flying rat's ass what it's like in private practice and with that said . . .YES you still care about bull**** admits, even in private practice. One simply finds it more palatable because it's what you are getting paid to do.

Bleeding fibroid with a low Hgb but otherwise normal patient? EVERYONE knows that patient should be admitted by the lazy as **** gynos, and it's weak sauce.

 

[jdh71]

A lot of specialties can play this game. As an OB resident, if the ED calls us first we will admit, but I have seen a fair amount of times, medicine being the admitting team and then we get consulted.

But medicine punts any pregnant patients fairly routinely. One recent example off the top of my head,

44 year old with family history of CAD who is 12 weeks pregnant with chest pain- I've had medicine refuse this admit and want the patient admitted to OB instead. I don't think it's that appropriate to have OB working up chest pain in a 44 year old, especially this early in pregnancy.

And you're correct about your case. I'd make the argument that ANY patient who had CAD and chest pain shouldn't be anywhere near an OB team - something you also seem to recognize. But what's going on in the OP is a bit different

The case in the OP.
1. Fibroid (bleeding)
2. Low Hgb
3. All other system a-ok nrormal.
4. ZERO other past medical history.

EVEN you guys can handle that.

Which part of this lady needs an internist?? Are you guys not the lady parts and pregnancy doctors??

 

[anonperson]

And you're correct about your case. I'd make the argument that ANY patient who had CAD and chest pain shouldn't be anywhere near an OB team - something you also seem to recognize. But what's going on in the OP is a bit different

The case in the OP.
1. Fibroid (bleeding)
2. Low Hgb
3. All other system a-ok nrormal.
4. ZERO other past medical history.

EVEN you guys can handle that.

Which part of this lady needs an internist?? Are you guys not the lady parts and pregnancy doctors??

No part needs an internist. But if the medicine service is willing to get dumped on, what can you do.

At my hospital, it entirely depends on who the ED calls initially. Sometimes it's GYN or it's the medicine service. And if it's the medicine service, I'm not going to go begging to take the patient off of their service so I get stuck with a discharge summary etc.

 

[jdh71]

No part needs an internist. But if the medicine service is willing to get dumped on, what can you do.

At my hospital, it entirely depends on who the ED calls initially. Sometimes it's GYN it's the medicine service. And if it's the medicine service, I'm not going to go begging to take the patient off of their service so I get stuck with a discharge summary etc.

Well. That's true enough. I don't go looking for trouble either.

 

[MedicineDoc]

I think part of it at least in non teaching hospitals is that they try to always have someone on in house on the medicine service so if things go south quick there isn't a couple of nurses who don't have a clue as to how to deal with something bad paging a specialist who calls back 2 hours later if that. Also, specialists typically dont have much time for digging a little deeper and scanning an extensive medical history when all the money is made in the OR. If its a slow ball it doesn't bother me so much. I just try not to waste too much time on the stable fracture patient and may not be in a hurry to see it. Every now and then the **** will hit the fan out of nowhere and I don't mind being on top of that as the nocturnist. That's why hospitals subsidize the medicine hospitalist team despite operating at a loss. As for the above post about sitting on a perforated bowel until the patient is dead If I was the attending I would be on the phone trying to ship that patient or stating things like poor prognosis even with surgery but it appears surgery is best option in the chart. Having said that I've never encountered a surgeon like the ones you describe. Most of them are straight shooters who are kind on no nonsense once you get past the resident level.

 

[Bostonredsox]

A lot of specialties can play this game. As an OB resident, if the ED calls us first we will admit, but I have seen a fair amount of times, medicine being the admitting team and then we get consulted.

But medicine punts any pregnant patients fairly routinely. One recent example off the top of my head,

44 year old with family history of CAD who is 12 weeks pregnant with chest pain- I've had medicine refuse this admit and want the patient admitted to OB instead. I don't think it's that appropriate to have OB working up chest pain in a 44 year old, especially this early in pregnancy.

My malpractice insurance does not cover obstetrics. The pt should be admitted to you and you should consult me to work up the chest pain. If anything goes wrong with her or that baby and I'm listed as the primary I'm toast. I have yet to meet an internist who will admit a pregnant woman or child under the age of 16. It's medicolegal.

 

[jdh71]

My malpractice insurance does not cover obstetrics. The pt should be admitted to you and you should consult me to work up the chest pain. If anything goes wrong with her or that baby and I'm listed as the primary I'm toast. I have yet to meet an internist who will admit a pregnant woman or child under the age of 16. It's medicolegal.

You aren't practicing obstetrics though.

 

[rokshana]

No part needs an internist. But if the medicine service is willing to get dumped on, what can you do.

At my hospital, it entirely depends on who the ED calls initially. Sometimes it's GYN it's the medicine service. And if it's the medicine service, I'm not going to go begging to take the patient off of their service so I get stuck with a discharge summary etc.

fair enough, but the OP's example had the OB resident tell the ED to admit to medicine...that just being lazy...and in the end its not like medicine can say no when the people who SHOULD be taking care of the patient don't want to...

 

[rokshana]

You aren't practicing obstetrics though.

its not like the baby is a separate entity and if something were to go wrong...

one of the hospitals i worked at as a hospitalist couldn't decide on what kind of patients the hospitalists were to admit...the ONLY thing they could decide on was ...no pregnant patients...

 

[Bostonredsox]

You aren't practicing obstetrics though.

Any medicine I give that pt that could potentially hurt the kid will fall on my head. Not a risk I would ever take. I will consult and order labs, recommend imaging if warranted, and recommend meds if needed. I do not know the pregnancy safety rating of medications and I doubt " we'll I looked it up on epocrates and it says category B" will hold up in court. She goes on the OB service here and well consult for the severe dyspnea with positive aa gradient, sinus tach and a trop of 1.1 and make the pe diagnosis, recommend you start heparin. But the final decision making will fall on the doctor who has formal training in delivering medications to pregnant women, not me.

At my shops the Ed docs know better than to call the hospitalists for anything related to a pregnant woman. The call always goes to OB. Then they call for consult if needed.

GYN is different. I don't care about admitting severe symptomatic anemia for fibroids and memorrhagia. Ill admit, give them blood, and consult the pajingo doc on call to come do whatever the hell they want to for treatment. Which is usually, give blood, ill see them in the office next week.

 

[MedicineDoc]

its not like the baby is a separate entity and if something were to go wrong...

one of the hospitals i worked at as a hospitalist couldn't decide on what kind of patients the hospitalists were to admit...the ONLY thing they could decide on was ...no pregnant patients...

I would refuse to admit a small bowel obstruction or an incarcerated inhumanly hernia or anything that could be characterized as an emergent surgical case by definition no matter what the hospital told me to do. Cholecystitis with "cool off the gallbladder" more realistically saturate the rest of the body with with antibiotics prior to surgery as antibiotics aren't going to penetrate the gallbladder per surgery recommendation maybe.

 

[Bostonredsox]

I would refuse to admit a small bowel obstruction or an incarcerated inhumanly hernia or anything that could be characterized as an emergent surgical case by definition no matter what the hospital told me to do. Cholecystitis with "cool off the gallbladder" with antibiotics per surgery recommendation maybe.

Agreed. I take septic shock gallbladders and have IR put in a perc drain to buy the surgeon time until the shock state cools down. I take the partial SBO/ileus constantly. But complete obstruction, appendix, stable GB pt that just needs a LC, any form of trauma, incarcerated hernia....that Shiite is going to general surgery all day. People forget medicine can be a consulted service too.

 

[dozitgetchahi]

Oh man, can we talk about bull**** social admissions too?

About a week ago, we got conned into admitting this ~80 y/o woman who claimed to be 'short of breath' and 'weak'. She had some chronic medical issues, but really nothing acute...chest pain workup is stone cold normal. Vitals normal. Initial labs normal. Apparently the woman is being kept up too late by her relatives playing video games in her apartment...after a good night's sleep, her weakness/SOB are magically 'gone'. We roll her out that day.

Next admitting day, the ER cons us into admitting a couple who apparently were brought in by ambulance from a 'filthy' apartment...wife misdosed insulin, went hypoglycemic...ER argues that they can't go home now because the apartment is 'filthy', and oh yeah we think the husband is demented too...talk to husband, do MMSE etc, not really demented. They don't even want to be in the hospital and leave AMA before I can finish the discharge summaries.

Fortunately we switched attendings the day of the 2nd incident, and our current attending pushes back a lot harder against the bogus BS the ER tries to admit...but still. I'm rotating at our program's county hospital right now, and 'social admits' easily account for 10-20% of our team's patient load.

 

[MedicineDoc]

Oh man, can we talk about bull**** social admissions too?

About a week ago, we got conned into admitting this ~80 y/o woman who claimed to be 'short of breath' and 'weak'. She had some chronic medical issues, but really nothing acute...chest pain workup is stone cold normal. Vitals normal. Initial labs normal. Apparently the woman is being kept up too late by her relatives playing video games in her apartment...after a good night's sleep, her weakness/SOB are magically 'gone'. We roll her out that day.

Next admitting day, the ER cons us into admitting a couple who apparently were brought in by ambulance from a 'filthy' apartment...wife misdosed insulin, went hypoglycemic...ER argues that they can't go home now because the apartment is 'filthy', and oh yeah we think the husband is demented too...talk to husband, do MMSE etc, not really demented. They don't even want to be in the hospital and leave AMA before I can finish the discharge summaries.

Fortunately we switched attendings the day of the 2nd incident, and our current attending pushes back a lot harder against the bogus BS the ER tries to admit...but still. I'm rotating at our program's county hospital right now, and 'social admits' easily account for 10-20% of our team's patient load.

The thing about refusing them is if they are planning on admitting the patient a lot of times it's a half ass if even that story and you really never know a lot of times unless you go look at it and do all the research what you are really refusing and usually their note isn't finalized and who knows what it will ultimately say. Also, a lot of times if sending them home is making them uncomfortable even if they can't put a finger on it there winds up being something there. A lot of times not as well.

 

[dozitgetchahi]

True. The only admit that we've truly blocked so far was somebody whose only issue was florid psychosis...rather than admitting them to the psych unit at this hospital, for unclear reasons they tried to dump them on us...we were like wtf are we going to do with a violently psychotic pt on a general medicine floor?

But I totally agree that most of the time the ER workup is disturbingly half assed...like when they pushed us to admit somebody with a GI bleed whose first CBC wasn't even back yet...just kinda ridiculous.

 

[MedicineDoc]

A couple of months ago I had the same ER doc try to admit a diabetic COPD with shortness of breath to me without a troponin. Nope. Call me back when you have the troponin. Oops NSTEMI. EF is just above 15 percent. Two days same ER doc later tries to admit an altered mental status with no CT head. Nope. Call me back when you have the CT head. Oops intracranial bleed and no. Neurosurgery. Shipped out of ER. About a week later tries to admit a non compliant diabetic with "old burns" on chest from smoking with oxygen for COPD exacerbation that she didn't come to the hospital for. Nope have surgery see it first and if they say its okay and consult on then I will take it. Oops has a wet gangrenous foot from redting it against a space heater and as per surgery will die if not taken directly to surgery. One and a half months later discharged to NH minus one foot.

 

[jdh71]

OMG it's a lady with KNOWN CAD with chest pain. Are you guys even real doctors?

 

[surge55]

A couple of months ago I had the same ER doc try to admit a diabetic COPD with shortness of breath to me without a troponin. Nope. Call me back when you have the troponin. Oops NSTEMI. EF is just above 15 percent. Two days same ER doc later tries to admit an altered mental status with no CT head. Nope. Call me back when you have the CT head. Oops intracranial bleed and no. Neurosurgery. Shipped out of ER. About a week later tries to admit a non compliant diabetic with "old burns" on chest from smoking with oxygen for COPD exacerbation that she didn't come to the hospital for. Nope have surgery see it first and if they say its okay and consult on then I will take it. Oops has a wet gangrenous foot from redting it against a space heater and as per surgery will die if not taken directly to surgery. One and a half months later discharged to NH minus one foot.

...I don't see what's wrong with the first one. you can't order the tropinin and treat CHF/NSTEMI?

 

[MedicineDoc]

...I don't see what's wrong with the first one. you can't order the tropinin and treat CHF/NSTEMI?

It's the job of the Er to get on top of heart attacks. Not let them sit in the ER with a bogus diagnosis and wait for a bed for 3 hours and then another 45 minutes to an hour for the nurse to call and let you know the patient is on the floor. You ever hear of minutes to pci if indicated. Same goes for strokes.

 

[jdh71]

Any medicine I give that pt that could potentially hurt the kid will fall on my head. Not a risk I would ever take. I will consult and order labs, recommend imaging if warranted, and recommend meds if needed. I do not know the pregnancy safety rating of medications and I doubt " we'll I looked it up on epocrates and it says category B" will hold up in court. She goes on the OB service here and well consult for the severe dyspnea with positive aa gradient, sinus tach and a trop of 1.1 and make the pe diagnosis, recommend you start heparin. But the final decision making will fall on the doctor who has formal training in delivering medications to pregnant women, not me.

At my shops the Ed docs know better than to call the hospitalists for anything related to a pregnant woman. The call always goes to OB. Then they call for consult if needed.

You guys are a bunch of ****ing cowards and I'm ashamed to hear this attitude form you.

 

[Bostonredsox]

You guys are a bunch of ****ing cowards and I'm ashamed to hear this attitude form you.

Meh. I generally agree with you on most topics, but not here. My malpractice insurance does not cover me for obstetrics or pediatrics. No one in the group I joined admits a pregnant female. None. If I was a family doc with some OB training under my belt sure, but I'm not. i havent touched a pregnant pt other than my wife since midway through third year of medical school. i am not being the primary on a pregnant female anymore than I am on an intracranial hemorrhage. Admit to neurosurgery. Can consult me to manage the vent and other stuff.

 

[jdh71]

Meh. I generally agree with you on most topics, but not here. My malpractice insurance does not cover me for obstetrics or pediatrics. No one in the group I joined admits a pregnant female. None. If I was a family doc with some OB training under my belt sure, but I'm not. i havent touched a pregnant pt other than my wife since midway through third year of medical school. i am not being the primary on a pregnant female anymore than I am on an intracranial hemorrhage. Admit to neurosurgery. Can consult me to manage the vent and other stuff.

BUT you're NOT doing obstetrics when you deal with a chest pain in woman who has CAD and also happens to be pregnant. I don't understand how this is confusing. A woman with chest pain and CAD needs an internist to manage the case not an obstetrician.

And I've admitted plenty of head bleeds in my time. Admitting an intracranial hemorrhage does not mean you're doing neurosurgery.

 

[anonperson]

Any medicine I give that pt that could potentially hurt the kid will fall on my head. Not a risk I would ever take. I will consult and order labs, recommend imaging if warranted, and recommend meds if needed. I do not know the pregnancy safety rating of medications and I doubt " we'll I looked it up on epocrates and it says category B" will hold up in court. She goes on the OB service here and well consult for the severe dyspnea with positive aa gradient, sinus tach and a trop of 1.1 and make the pe diagnosis, recommend you start heparin. But the final decision making will fall on the doctor who has formal training in delivering medications to pregnant women, not me.

At my shops the Ed docs know better than to call the hospitalists for anything related to a pregnant woman. The call always goes to OB. Then they call for consult if needed.

I could maybe see this in a case with a viable pregnancy and you needed to monitor the fetus acutely, but some of this $hit happens at 12 weeks of pregnancy when there isn't a damn thing any OB can do for the embryo. That's my main issue.

Otherwise I feel it just delays the appropriate care the patient should be getting.

And the whole medicine/pregnancy thing seems bogus. What happens when pregnant patients end up in the unit? Our unit is closed and the ICU team manages them with MFM/OB as consultants.

 

[gutonc]

My malpractice insurance does not cover me for obstetrics or pediatrics.

So now, as a medicine R3, in addition to difficult airways you're an expert in medmal?

 

[MedicineDoc]

BUT you're NOT doing obstetrics when you deal with a chest pain in woman who has CAD and also happens to be pregnant. I don't understand how this is confusing. A woman with chest pain and CAD needs an internist to manage the case not an obstetrician.

And I've admitted plenty of head bleeds in my time. Admitting an intracranial hemorrhage does not mean you're doing neurosurgery.

I had to admit a head bleed (putamenal) with some herniation 3 weeks ago as it "was not amenable to surgery" And the hospital i am currently working at has neurosurgery coverage. The neurosurgeon was seeing the patient in the ER and I got the nurse and said get an order sheet. She tried to hand it to me and i said no and pointed to the neurosurgeon. I did write some preliminary vent orders before consulting pulmonology and neurology. I remember his orders i think mannitol .25 mg/kg IV q 6 hours? with q4 hour bmp with call NS for plasma osmolarity greater than 315 with renal failure being the concern. Although in reading about it I think it is supposed to be 300 for the serum osmolarity.

 

[VA Hopeful Dr]

I could maybe see this in a case with a viable pregnancy and you needed to monitor the fetus acutely, but some of this $hit happens at 12 weeks of pregnancy when there isn't a damn thing any OB can do for the embryo. That's my main issue.

Otherwise I feel it just delays the appropriate care the patient should be getting.

And the whole medicine/pregnancy thing seems bogus. What happens when pregnant patients end up in the unit? Our unit is closed and the ICU team manages them with MFM/OB as consultants.

What my internist wife's hospital does is medicine would admit said pregnant lady, get a plan in place... then call OB and say "Here's our plan, is everything here baby-kosher?".

As an FM intern, I called the local MFMs a few times with questions about can I do this or that on pre-viable pregnant patients and their response was always "Do what you have to do for the mom... if she dies, baby doesn't really matter anymore".

 

[LoudBark]

My malpractice insurance does not cover obstetrics. The pt should be admitted to you and you should consult me to work up the chest pain. If anything goes wrong with her or that baby and I'm listed as the primary I'm toast. I have yet to meet an internist who will admit a pregnant woman or child under the age of 16. It's medicolegal.

The practice of internal medicine is not exclusive of taking care of pregnant patients with internal medicine problems. Not sure if you have taken your ABIM exam, but you may even see a few questions on there regarding pregnant patients with medical issues.

In regards to your malpractice insurance, as long as you are not practicing obstetrics and are practicing medicine on a pregnant patient, you are fully covered. If you don't think so, call your malpractice carrier and they will tell you that.

If a woman is early in pregnancy with no complications of pregnancy and has chest pain, no reason they should be admitted to OB. Any concerns regarding meds, procedures, etc. on a pregnant woman can and should be discussed with pharmacy or the OB with you as admitting.

 

[Gastrapathy]

We're such fleas we can't even keep a decent venting thread going without degenerating into an actual medical discussion.

 

[rokshana]

So now, as a medicine R3, in addition to difficult airways you're an expert in medmal?

sorry, gotta agree with the R3 here...and that ob stuff last 18 yrs...my malpractice isn't going to cover ob related issues and is gonna say settle...

say the 12 week pregnant woman IS treated by IM as the primary...and then loses the pregnancy...bet your bottom dollar shes gonna sue the IM doc as well as the OB doc...sure it MAY get dismissed, but in some states just getting named in a suit is just as bad as losing a suit...

 

[NewYorkDoctors]

At my place, neurology lost its service, so all patients admit to medicine. But the bright side is the patients are usually medically stable, neurology is a consult service but they do all the work, and I just type in orders like a monkey...



but I do get to see some pretty interesting neuro cases that I wouldn't otherwise see.

 

[michaelrack]

The practice of internal medicine is not exclusive of taking care of pregnant patients with internal medicine problems. Not sure if you have taken your ABIM exam, but you may even see a few questions on there regarding pregnant patients with medical issues.

.

I have taken and passed the ABIM certification and recertifcation exams. Yes, there are questions about pregnant patients- but that is irrelevant to the issue of which service should be the primary service. One could argue that the ABIM exam has questions regarding pregnant patients because internists are expected to be able to be knowledgeable consultants for these patients.

 

[michaelrack]

"Do what you have to do for the mom... if she dies, baby doesn't really matter anymore".

And if she lives but the baby has an adverse outcome, all docs involved are facing a huge lawsuit.

 

[jdh71]

I really can't believe what I'm seeing in this thread.

 

[jdh71]

And if she lives but the baby has an adverse outcome, all docs involved are facing a huge lawsuit.

No they are not. This is stupid.

 

[pseudoknot]

You ever hear of minutes to pci if indicated. Same goes for strokes.

NSTEMI is not an indication for emergent PCI.

 

[MedicineDoc]

NSTEMI is not an indication for emergent PCI.

Whether the patient gets a cath and a stent or is started on a heparin drip or just gets aspirin or whether the patient has a NSTEMI or STEMI or the ER either got an EKG or didn't even get an EKG or got an EKG and ignored 4 mm depressions (which also happened at the same place the patient was emergeny transferred for a CABG) it's their job to do the initial workup and start the patient down the right road not waste time and wait for the hospitalist to figure out whether the patient actually has an emergent condition after hearing some half ass story from the Er doc hence the word emergency medicine. Which is the reason you question the ER doc and don't accept half ass ER workups before accepting the patient because once you accept that patient you own them even if they are sitting in the Er for a few more hours. If you want to be both the ER doctor and the hospitalist I am sure they will be happy to oblige. Also NSTEMI can get an emergent cath and pci if the cardiologist deems the risk and cath findings warrant it.

 

[Bostonredsox]

Nstemi with unrelieved chest pain and/or hemodynamic instability is/are indications for emergent pci. Chest pain free, stable vitals, EKG clean, doesn't matter if trop is 30, they usually wait till the following morning for cath. Unless there are no elective cases going on. I have very rarely seen a chest pain free nstemi go right to the lab. But nearly every active, unrelieved chest pain nstemi I have seen has gone straight to the lab.

 

[redy]

No they are not. This is stupid.

I hope you are right. Unfortunately I fear you are wrong. Anyway In this scenario I would admit to medicine/telemetry as the primary issue is CP and she just happens to be pregnant. Ob can be consultants. Having said that there is nothing wrong with admitting under OB service and medicine consulting, is there?

 

[Gastrapathy]

No they are not. This is stupid.

Sure they are. If anyone gets sued, everyone gets sued. Can't live your life in fear of it but should understand it. I don't think the "primary service" question really matters for protecting you from a suit before viability.

 

[jdh71]

Sure they are. If anyone gets sued, everyone gets sued. Can't live your life in fear of it but should understand it. I don't think the "primary service" question really matters for protecting you from a suit before viability.

Any of us can get sued at any time for anything. Doesn't mean we all do get sued at anytime for anything.

Though I can guess that if you treat a patient like a leper is this is translated to the family and bad things happen you have a higher risk of being named in a lawsuit.

 

[dozitgetchahi]

OMG it's a lady with KNOWN CAD with chest pain. Are you guys even real doctors?

I'll one up ya...today dealt with admitting a dude with known PRINZMETAL'S ANGINA with two weeks' worth of chest pain that coincidentally started at the same time he ran out of his verapamil because he couldn't afford a refill.

Did ED refill the script and send him along? Of course not - even though he had a cath a couple months ago that showed no CAD.

Full CP workup and admit to our service.

 

[jdh71]

I'll one up ya...today dealt with admitting a dude with known PRINZMETAL'S ANGINA with two weeks' worth of chest pain that coincidentally started at the same time he ran out of his verapamil because he couldn't afford a refill.

Did ED refill the script and send him along? Of course not - even though he had a cath a couple months ago that showed no CAD.

Full CP workup and admit to our service.

That's garbage. We used to see and then discharge those patients directly from the ED

 

[LoudBark]

I'll one up ya...today dealt with admitting a dude with known PRINZMETAL'S ANGINA with two weeks' worth of chest pain that coincidentally started at the same time he ran out of his verapamil because he couldn't afford a refill.

Did ED refill the script and send him along? Of course not - even though he had a cath a couple months ago that showed no CAD.

Full CP workup and admit to our service.

Why did you admit him? Negative cath 2 months ago?

You and your attending should have scripted him his verapamil and sent him home then and there. Just because the ER offers you an admit doesn't mean you have to accept it.

You just cost the health care system another $1800 with your serial cardiac enzymes, over night admit, and tele monitoring.

 

[Instatewaiter]

A couple of months ago I had the same ER doc try to admit a diabetic COPD with shortness of breath to me without a troponin. Nope. Call me back when you have the troponin. Oops NSTEMI. EF is just above 15 percent.

I think I remember you posting in a critical care thread about how you were so good at critical care a week or so ago and how you had such brass balls and could hang with the critical care folks... would you like to take that back? 'cause you probably should

Also NSTEMI can get an emergent cath and pci if the cardiologist deems the risk and cath findings warrant it.

First, emergent cath is such a nebulous term. There's kinda emergent and EMERGENT. Really unless your pounding on the guys chest, an NSTEMI isn't the last. It is very rarely emergent either.

And you should be the guy who knows when to activate the cath lab for an NSTEMI if you're a hospitalist. Unless the guy is hemodynamically unstable it doesn't need to go right to the lab. Almost all of the people we get who are having "unrelieved" chest pain become chest pain free once you anticoagulate them, put them on a nitro drip and effectively beta block them. I agree though, if after the good college try despite an appropriate map and HR they're still having chest pain, we'll pull the trigger and take them to the lab.

 

[MedicineDoc]

I think I remember you posting in a critical care thread about how you were so good at critical care a week or so ago and how you had such brass balls and could hang with the critical care folks... would you like to take that back? 'cause you probably should




First, emergent cath is such a nebulous term. There's kinda emergent and EMERGENT. Really unless your pounding on the guys chest, an NSTEMI isn't the last. It is very rarely emergent either.

And you should be the guy who knows when to activate the cath lab for an NSTEMI if you're a hospitalist. Unless the guy is hemodynamically unstable it doesn't need to go right to the lab. Almost all of the people we get who are having "unrelieved" chest pain become chest pain free once you anticoagulate them, put them on a nitro drip and effectively beta block them. I agree though, if after the good college try despite an appropriate map and HR they're still having chest pain, we'll pull the trigger and take them to the lab.

You are either really dense or a straight up troll. Either way I got mothing to say to you.