In the ED, their vitals/exam are as above. Unclear etiology of the patient’s symptoms given description of symptoms by patient’s daughter but differential includes persistent urinary tract infection, deconditioning, metabolic etiology, anemia, or medication side effect. Lower suspicion for ICH, infarct, mass, or seizure given history of present illness. We will proceed as below. – […]

In the ED, their vitals/exam are as above. Differential is very broad and includes infection (such as UTI, PNA, meningitis, or viral encephalitis), intercranial process (such as ICH, CVA, mass), cardiopulmonary processes, electrolyte abnormalities (such as hypoglycemia, hyperglycemia, hyponatremia, hypernatremia, hypokalemia, or uremia), polypharmacy, intoxication/overdose, withdrawal syndromes. Lower suspicion for a primary psychiatric process, hepatic […]

In the ED, their vitals/exam are as above. Given the patient’s altered mental status and GCS of 8 or less, the patient was intubated upon arrival. Differential is very broad and includes infection (such as UTI, PNA, meningitis, or viral encephalitis), intercranial process (such as ICH, CVA, mass), cardiopulmonary processes, electrolyte abnormalities (such as hypoglycemia, […]

The patient is declining IV, labs, and imaging against medical advice. The patient demonstrated good understanding and was able to verbalize in their own words the risks of refusing labs and IV and including, death or permanent disability. While I do not agree with their decision, their thought process is goal directed. Their speech is […]

The patient states they want to leave because “***”. The risks of leaving against medical advice without further workup were explained to the patient. The patient demonstrated good understanding and was able to verbalize in their own words the risks of leaving up to, and including, death or permanent disability. While I do not agree […]

In the ED, their vitals/exam are as above. PO H1 blocker/PO H2 blocker/steroids were given immediately. Given history, I doubt an active PNA or infection as patient afebrile. I doubt PE as patient without pleuritic CP, no LE signs of DVT including edema/unilateral swelling or calf pain. Also, low likelihood of PE by Well’s criteria. Doubt imminent airway […]

In the ED, their vitals/exam are as above. IM epi (0.01mg/kg, max dose 0.5mg) in anterolateral thigh/IV H1 blocker/IV H2 blocker were given immediately, in addition to steroids, IV fluids, and pain medication. Given history, I doubt an active PNA or infection as patient afebrile. I doubt PE as patient without pleuritic CP, no LE […]

In the ED, their vitals/exam are as above. The differential for AKI includes 1) pre-renal etiologies (decreased circulating volume: dehydration from poor PO intake/diarrhea/vomiting/diuresis, sepsis, cardiorenal syndrome, hepatorenal syndrome, bleeding, salt wasting; afferent dysfunction: constriction from NSAIDS/contrast OR dilation from ACEi, ARB; large vessel disease: renal artery stenosis, thromboembolic), 2) intra-renal etiologies (tubular/interstitial: ATN, AIN, […]

In the ED, their vitals/exam are as above. I am concerned for imminent airway compromise due to *** given patient’s past medical history and {Airway Signs & Symptoms:43078}. *** concern for active bacterial infection given patient is ***febrile. Given this, will proceed as below – Labs/Tests: VBG plus, Lactate, CBC, CMP, PT/INR, T&S. Consider procalcitonin, […]

In the ED, their vitals/exam are as above. Patient with AICD firing likely due to ventricular tachydysrhythmia (including rapid VT/VF) most likely due to electrolyte abnormality vs. volume abnormality (such as hypervolemia/hypovolemia) but we will evaluate for inappropriate ICD function and acute cardiopulmonary etiologies (such as infection, ACS, CAD, valvular disease, myo/pericarditis, endocarditis, DVT/PE) as they are on […]