Do any of you have any bounceback cases that you will always remember or learned something from?
One of mine was a bounceback several years ago which was a 50’ish old lady with radicular neck pain for a few days. She said because she was limping from the gout in her toe that her PCP diagnosed earlier (later found out clinically). she was tilting her head forward to continuously gauge not stepping the wrong way. No fevers, IVDU, headache, dissection signs, weakness etc. I ended up CT’ing her(not sure why) which was negative. neuro exam was good. gave her some meds and ensured outpatient follow-up with return precautions. Came back a couple days later still in pain. one of my partners saw with benign exam, modified medication regimen and i think added some steroids. sent home. came back a couple days later and this time obviously admitted. Had MRI of the c-spine which showed some diskitis and osteo. During the hospitalization the "gout" was discovered after needle aspiration to be a septic toe which seeded to her neck. Luckily she was eventually discharged without long term sequelae or need for any rehab etc. i learned to never ever trust any diagnosis that a patient tells you that comes from out of hospital provider unless you can confirm the methods that came to that diagnosis. Obviously i dont go down the list of everyone's medical problems and ask how they were diagnosed, Im only referring to something thats part of the case or presentation.
One of mine was a bounceback several years ago which was a 50’ish old lady with radicular neck pain for a few days. She said because she was limping from the gout in her toe that her PCP diagnosed earlier (later found out clinically). she was tilting her head forward to continuously gauge not stepping the wrong way. No fevers, IVDU, headache, dissection signs, weakness etc. I ended up CT’ing her(not sure why) which was negative. neuro exam was good. gave her some meds and ensured outpatient follow-up with return precautions. Came back a couple days later still in pain. one of my partners saw with benign exam, modified medication regimen and i think added some steroids. sent home. came back a couple days later and this time obviously admitted. Had MRI of the c-spine which showed some diskitis and osteo. During the hospitalization the "gout" was discovered after needle aspiration to be a septic toe which seeded to her neck. Luckily she was eventually discharged without long term sequelae or need for any rehab etc. i learned to never ever trust any diagnosis that a patient tells you that comes from out of hospital provider unless you can confirm the methods that came to that diagnosis. Obviously i dont go down the list of everyone's medical problems and ask how they were diagnosed, Im only referring to something thats part of the case or presentation.
