EM Diagnosis?

[Paws]

I know we're not supposed to try and diagnose things on the forums but over in allo we are trying to figure this one out. We are all over the place in our guesses and I thought you guys would know for sure.

http://forums.studentdoctor.net/showthread.php?t=248486

I am halfway through my second year, just far enough to realize I know so little, and I have a long way to go. Do you guys have any ideas ... ? It's sort of like playing Clue around the holidays, a mystery game.

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[docB]

I'm not trying to be annoying but from an ER perspective this guy should have been admitted a long time ago. Since the guy had a pulmonary angio we should know if he has a PE or not. And if the guy's been here long enough for us to get culture results shouldn't someone have done at least one troponin?

 

[basementbeastie]

we should have the pathology report by now!!!

 

[Seaglass]

I posted my reply over there. At least at my institution this person would not have gotten enzymes and would have been unlikely to get angio or even a dimer. He has NO criteria for Wells assuming that anything not mentioned is negative and given his fever his most likely dx is going to be infection.

 

[Paws]

Hey guys, thanks for even looking at the case. I looked again tonight and people are still all over the map with diagnosis. We haven't heard back from the OP so I am wondering what the real situation is with this "case."

I would like to know where this case came from and what was the outcome!

 

[12R34Y]

Ahhh...come on now. I think this guy deserves at least one set of enzymes. He's a smoker with a family history of cardiac dz. He's also got a technically abnormal 12-lead (although non-specific and probably nothing).

I've been burned multiple times as have many on this board I'm sure of with the "too young for MI" guy/gal that "can't be having an AMI" who DOES in fact have an MI.

a couple of my young 20's MI's have been crack cocaine induced. We don't really have a drug history on this guy, but can you really trust any patient's history?

I'd give him one set of enzymes while you're getting your obligatory CBC, chem, CXR, 12-lead type of work up.

just my opinion though.

later