How should I have managed this patient?

[SomethingFishy]

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Ok, this was a medicine clinic patient, came in for pre-op. Got an EKG, compared with his last, there were some new T-wave inversions (he had a few in other leads before, but these were new ones). He is asymptomatic. Should I have sent him straight to the Emergency Room or referred to Cardiology for further testing?

 

[smq123]

Ok, this was a medicine clinic patient, came in for pre-op. Got an EKG, compared with his last, there were some new T-wave inversions (he had a few in other leads before, but these were new ones). He is asymptomatic. Should I have sent him straight to the Emergency Room or referred to Cardiology for further testing?

If he's asymptomatic, why would you send him to the ER? I guess my question is: what would you hope that the ER would do for him?

 

[SomethingFishy]

I guess I was thinking that if he's having ischemia now, he could progress to infarction and would need to be ruled out with troponins and then maybe stressed?

 

[SomethingFishy]

Also isn't the progression of an acute MI t wave inversions, st changes, q waves?

 

[Droopy Snoopy]

Ok, this was a medicine clinic patient, came in for pre-op. Got an EKG, compared with his last, there were some new T-wave inversions (he had a few in other leads before, but these were new ones). He is asymptomatic. Should I have sent him straight to the Emergency Room or referred to Cardiology for further testing?

Don't you staff your patients? It's July, and right now there's no such thing as a dumb question. Take advantage of this and use the in-real-life experts around you.

 

[smq123]

use the in-real-life experts around you.

Good point.

OP - you've posted in the past that you were a new intern last year. Hopefully your program is such that you would feel comfortable running such questions by your attendings, as a PGY-2.

 

[SomethingFishy]

I took some time off to have my baby. Still have a few months left.

 

[smq123]

I took some time off to have my baby. Still have a few months left.

But still, your attendings at your program should still know you, and you should still be getting precepted when seeing patients in the clinic....but you don't seem very comfortable asking your attendings these questions? 😕