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Discussion

CASE STUDY??? Anyone interested in an interactice one??

I'm wondering if there would be any interest in a "case study" that would take a patient from presentation and through treatment. There would not be any right/wrong - just an exchange and hopefully an opportunity to improve all of our abilities to critically think and be able to work through patient complaints, history and interpret the data. Also, we can look at treatment - so anyone up for it??

Brief example:

You are working in adult ED triage 74 year old female patient presents ambulatory with minimal assistance to the ED at 1500 c/o fever and feeling bad. Patient has 2 very concerned daughters and this is the 4th ED visit this week - (the other visits were at other ER's - but, the family volunteers that they were idiots working in the other ED's --- so we came here instead). Pt does not appear in acute distress.

Patient is alert but confused. (Family states this is near normal for her).

Vital Signs:

BP 104/64 HR 104 RR 22 SaO2 95% on RA Oral Temp 100.6F

History:

Hypertension

AMI 3 years earlier - placed 2 stents.

GI bleed 5 years ago -required 6 unit transfusion

NIDDM

GERD

Osteo-Arthritis/Chronic Pain

Hysterectomy at age 43

Basal cell carcinoma removed 2 years ago

Medications:

NKDA (does "break out" from adhesive tape)

Lisinopril

Atenolol

Prilosec

Plavix

Baby ASA

Duragesic Patch

Metformin

Now what? How do you proceed? Questions?

Anyone interested in participating in case studies?

Just leave a yes or no response.

Just a thought?? Anyone??

Featured Replies

Sure, I'm up for interactive case studies. In this case I would suggest a UA & CS to start.

I think case studies are a good idea. Drawing electrolytes and CBC with diff would be a good start too.

Sure, I'm up for interactive case studies. In this case I would suggest a UA & CS to start.

:yeahthat:

I'm up for this.

I agree with the above...might as well add blood cx, ekg, possibly start fluids, what are lung sounds like?

Count me in!

I'm interested.

I would talk more with the daughters and get a recent history, find out what the ERs diagnosed with her previously this week and also get a glucose level.

I'm wondering if there would be any interest in a "case study" that would take a patient from presentation and through treatment. There would not be any right/wrong - just an exchange and hopefully an opportunity to improve all of our abilities to critically think and be able to work through patient complaints, history and interpret the data. Also, we can look at treatment - so anyone up for it??

Good idea. You can count on me.

What a great idea! I love reading Mike's on flightweb!

Anyway, the other posters have some good initial thoughts. I'd want a CBC, Chem 8, UA c&s, 12 lead, talk to the daughters (tell them "thanks for choosing to have your emergency this week here with us"....j/k!) and find out a more detailed hx. What was the impression from other ERs?

Sats are good on RA, how are the BBS? Heart tones? Bowel sounds? has she had any difficulty voiding or with bowel movements?

I agree with all the others suggestions. Don't think I have anything to add. I do have a question what is a chem 8, I usually draw chem 7 (lytes, glucose, bun and creat.) ?

I agree with all the others suggestions. Don't think I have anything to add. I do have a question what is a chem 8, I usually draw chem 7 (lytes, glucose, bun and creat.) ?

sorry, a little slang term there. we usually say a chem 8 when it's to include mg+ level, but yeah, a chem 7 is our routine panel.

i'm in......define feeling bad

May do all over the above, chemistries, UA and C&S... Taking a through history of home care may help as well. Are daughters competent to deal with care? Hydration? ADL's?

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