Posted: 4/3/2014 4:08:21 AM EDT
| Let's say you're an ER doc and you have a 77 y/o male patient come in. You have access to the patients EMR and he has been a patient at your facility multiple times. During the patients visit you can tell that he is somewhat confused, I would say foggy myself. He is presenting with intense lower back pain, family said he had a temp of 102.1 at home, and he's on 3 litres of oxygen. Aside from treating the back pain, would you look at the patient's record to find out what chronic ailments he might have to help better treat him, or just look at the back pain? |
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Let's say you're an ER doc and you have a 77 y/o male patient come in. You have access to the patients EMR and he has been a patient at your facility multiple times. During the patients visit you can tell that he is somewhat confused, I would say foggy myself. He is presenting with intense lower back pain, family said he had a temp of 102.1 at home, and he's on 3 litres of oxygen. Aside from treating the back pain, would you look at the patient's record to find out what chronic ailments he might have to help better treat him, or just look at the back pain? History AND Physical. Not History OR Physical. |
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History AND Physical. Not History OR Physical. Quoted:
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Let's say you're an ER doc and you have a 77 y/o male patient come in. You have access to the patients EMR and he has been a patient at your facility multiple times. During the patients visit you can tell that he is somewhat confused, I would say foggy myself. He is presenting with intense lower back pain, family said he had a temp of 102.1 at home, and he's on 3 litres of oxygen. Aside from treating the back pain, would you look at the patient's record to find out what chronic ailments he might have to help better treat him, or just look at the back pain? History AND Physical. Not History OR Physical. Yea, i'm pretty disappointed in this situation. The doc ordered a xray of his back and that was it. No blood panel or anything. Had doctor looked at patient's H&P he may have noticed that he has diabetes and stage 4 renal failure. |
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Snip... Yea, i'm pretty disappointed in this situation. The doc ordered a xray of his back and that was it. No blood panel or anything. Had doctor looked at patient's H&P he may have noticed that he has diabetes and stage 4 renal failure. This was in the ER, correct? The ER isn't necessarily a 'treatment' facility....they're looking for acute issues (fractured spine, etc....not my field, I'm a Foot Dr.) that need to be handled immediately, and will then get him to the proper (Nephrologist, Endocrinologist, Internal Med Doc) physician for longer term treatment. Did they do a finger stick, take his temp, etc. when he showed up? Nursing intake sheet at the triage area? From the ER docs I know...more might have been checked than you are aware of. AFARR |
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Back pain and subjective fever in a 77year old should get a workup. Chem 7, CBC, urinalysis at the minimum. Probably a CT scan also. Differential would include, urinary tract infection, kidney stone w/obstruction, and spinal abscess right off the top of my head.
A physical exam may help as well. 
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Back pain and subjective fever in a 77year old should get a workup. Chem 7, CBC, urinalysis at the minimum. Probably a CT scan also. Differential would include, urinary tract infection, kidney stone w/obstruction, and spinal abscess right off the top of my head. A physical exam may help as well. That's a pretty broad differential Yes, his history should be taken. An EMR is not necessary. It takes about 2 minutes to ask the patient or others with him, "Hey, dude, you got any medical problems?' In our ER, a diabetic has a glucometer done by nurses long before I see the patient, but they are just wonderful like that. |
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I understand that the ER is for treating acute symptoms. However, the man who's missing half of one of his feet and the other is swollen should be a good identifier. I wasn't with my dad when he was triaged or when the doc checked in on him. I was in my office in the same building while all that was going down. I told my mom to hunt down the doc and tell him that dad was in stage 4 renal at which point the doc decided to do a blood workup.
I'm frustrated in part because the doctor has a button he can click in his dashboard that will bring up the H&P in 5 seconds, and at the top of that is a list of chronic issues from his most recent visit. On my part i'm going to make sure that dad has a printed and laminated list of current meds and I guess a card of some sort that has a brief summary of his conditions and hope that they will read that next time. |