Proper Workup in Young Hypertensive Tachycardia Patient
There were a couple of comments to the last post on Semantics that made me question whether or not it was proper to do a large workup on a young patient with tachycardia. So I decided to create a poll to get everyone else’s opinion. Assume that the patient’s use of K2 was disclosed. In a 17 year old (i.e. “young”) patient with persistent tachycardia unresponsive to treatment who uses synthetic marijuana, what testing should be performed? Note: There is a poll embedded within this post, please visit the site to participate in this post's poll. (Source: WhiteCoat's Call Room)
Source: WhiteCoat's Call Room - August 16, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Medical Topics Source Type: blogs

Semantics
A 17 year old patient comes in by ambulance for chest pain and tachycardia. His heart rate was in the 130s. He was hypertensive. He was sweating. He had a history of ADHD and was on Adderall. No other medications. No alcohol or drugs. His exam was unimpressive and all the testing came back negative, but the patient still remained tachycardic. So we gave him a couple doses of Ativan, thinking he may have taken a little too much Adderall. Still no better. Then we started doing some additional tests to rule out the less common reasons for his symptoms. D-dimer normal. He denied alcohol or drugs, but we checked for them anyway...
Source: WhiteCoat's Call Room - August 13, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

Healthcare Update Satellite – 08-06-2013
Look for more updates at my other blog at Dr.Whitecoat.com Naked West Virginia patient steals ambulance from emergency department parking lot, goes on joy ride and then crashes into three vehicles – requiring more ambulances to take injured patients to the hospital. Hopefully this time they locked the ambulance doors. And I’m not sure I’d be wanting to sit on the driver’s seat without a plastic cover until after the seat gets washed down. Use of chest x-rays in asthma patients increasing between 1995 and 2009. According to a 2005 study cited within the post, most xrays in children with asthma are deemed “unne...
Source: WhiteCoat's Call Room - August 6, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Pain Predicament
A family doctor calls to give us a heads up about a patient coming to the emergency department. He was obviously upset and sounded frustrated. He started in with the story … I used some lidocaine a pair of tweezers, and some small scissors to remove a small lesion from a patient’s tongue. There was a little bleeding afterwards, but that seemed to stop with pressure. Then the patient said that it felt like her tongue was swelling. I thought it was from the lidocaine, so I kept her in the office and watched her for a half hour, then sent her home. They wanted some pain medication. She was allergic to codeine, so I presc...
Source: WhiteCoat's Call Room - July 31, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

Healthcare Update Satellite 07-29-2013
Look for more health care stories from around the web at my other blog at DrWhitecoat.com InQuickER has some competition for violating EMTALA in the “reserve a spot for my emergency department visit” market. Massachusetts hospital using service called “ResERved” and another company called ER Express is also filling this niche … at least until malpractice attorneys realize that EMTALA violations and decisions from hospital administrators to utilize these services aren’t subject to state malpractice caps and also bring in another set of “deep pockets” when patients suffer an injury. Brazilian man dies when co...
Source: WhiteCoat's Call Room - July 29, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Clear!
I got a few e-mails asking whether I’m still blogging. Short answer is “yes.” The number of posts has been a lot less than usual, which sometimes is a sign of a blog on life support. Have had several things that have required my time over the past couple of months but now most of those things have … stabilized. I’ve got a few days off now that I’m dedicating to putting all the scraps of paper on my desk into posts. Even have a few guest posts that I’m looking forward to putting up. For the few of you out there who are still reading, thanks for sticking around. Now to get back to ha...
Source: WhiteCoat's Call Room - July 29, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs

Thanks For Watching
Its been a rough few weeks. The stories keep piling up on my desk. This one keeps coming to mind, so I figured I’d try to post it from my phone.* An elderly patient came in by ambulance after tripping over a curb. She fell and hit her face, causing a nasal fracture and a periorbital contusion. But she was also having an increasing headache and she had proptosis. That’s a bad sign. We got the CT scan of her brain and it confirmed our fears. She had a retrobulbar hematoma, meaning that there was an expanding blood clot behind her eye which was pushing her eyeball outwards against the eyelid. Because the lids push...
Source: WhiteCoat's Call Room - July 20, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

Healthcare Update Satellite — 07-09-2013
More updates available tomorrow on my other blog at DrWhitecoat.com Why does an $11,596 emergency department visit cost $1,100? A spokesperson for the California Hospital Association says that it is because of government regulation. I want to know what doctor ever gets paid $4,242 for a Level 4 emergency department visit. California attorneys are trying to raise the cap on damages under California’s Medical Injury Compensation Reform Act. Caps are currently $250,000 and haven’t been raised in more than 35 years. The article says that many attorneys won’t take medical malpractice cases in California because they are t...
Source: WhiteCoat's Call Room - July 9, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Dragonisms
I’m not sure if I’ve had a stroke and am slurring my speech or if the Dragon NaturallySpeaking voice recognition engine is just messing with me, but lately I’ve had to triple check my charts to make sure some bad transcriptions don’t get finalized into the record. Earlier this month, I tweeted about one case where part of my discharge instructions to a patient suffering from GERD symptoms included: “Bland Diet.” The Dragon NaturallySpeaking program translated that to: “Plan to die”.I could only imagine those instructions hitting the front page of our local newspaper if I hadn...
Source: WhiteCoat's Call Room - June 30, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Funny Random Thoughts Source Type: blogs

Healthcare Update Satellite — 06-26-2013
See more HealthCare Updates at my other blog at http://drwhitecoat.com. UK Accident and Emergency Department criticized for multiple failures after going into “crisis” mode from January through March due to a surge in patient volumes. Of course, all the investigators go and pick through the hospital’s policies four times in April after things have calmed down, rather than going and trying to address the problems in real time while they’re happening. Want to see me faint? Give me a story about an inspector going to a hospital during a crisis, and making a specific real-time recommendation on how to improve the ...
Source: WhiteCoat's Call Room - June 27, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

The Orthopedist’s Favorite Footwear
“Come ON! You’ve gotta be KIDDING me!” the orthopedist yelled into the phone when I called him for the third fracture of the morning. Meh. Wasn’t the phone calls. He’s always in a bad mood. First, it was a patella fracture. Then, it was a hip fracture. Now, it was an open ankle fracture. What was the common theme running through all of the fractures? The orthopedist’s favorite footwear: Flip flops. The first patient’s flip flop caught on a curb and caused her to hit the concrete full force with her knee. The second patient’s flip flop broke while she was trying to run to catc...
Source: WhiteCoat's Call Room - June 20, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

The Last Doctor is Always the Smartest
Twice recently, I’ve been privy to patient complaints about emergency department “misdiagnoses” when patients have gone to follow up appointments with their physicians. One case involved a young girl who had a rash. The rash was preceded by a low grade fever in the days prior, began on the chest and spread outward, and had the classic appearance of a viral exanthem. The girl’s parents weren’t happy with that diagnosis. They believed that the girl was suffering from an allergic reaction and that she needed antihistamines and steroids. The doctor explained that the rash was not an allergic-type ...
Source: WhiteCoat's Call Room - June 17, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

Healthcare Update Satellite — 06-15-2013
This study showed that there was a 1 in 50 chance of a significant finding. Some people had bleeding in their cerebellum, some had hydrocephalus, some had cancers. When patients received a follow up MRI, 13% of patients had significant findings – most of which were strokes that had gone undiagnosed on the initial CT scan. I’m betting that if the testing was negative, certain groups of people [cough cough Consumer Reports hack cough] would label the tests “unnecessary” and state that the testing shouldn’t have been performed. What would you want if it was your family in the emergency department...
Source: WhiteCoat's Call Room - June 15, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Healthcare Update Satellite — 06-06-2013
More HealthCare Updates from around the web are at my other blog at http://drwhitecoat.com. Remember the case where hospital administrator Bruce Mogel allegedly planted a gun in a doctor’s car then called the police to frame him because the administrator didn’t like the doctor’s criticisms of the way the hospitals were being managed? The doctor sued the hospital and won $5.7 million. Well a judge just threw out that judgment. Employers can’t be liable if the employee/officer’s actions are not reasonably related to the job or reasonably foreseeable. Patients gone wild. Combative New Jersey patients gets beat down...
Source: WhiteCoat's Call Room - June 7, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

I Can Hear You …
I  think I’ve discovered what elderly patients feel like when everyone thinks that they’re too senile to understand the conversations around them and just talk about them as if they aren’t there. Like this … In one emergency department, the nurses regularly talk about me in loud voices as if I’m either deaf or unable to comprehend. Nurse 1 [to the ceiling]: This patient’s been ready to go for 6 milliseconds. Where are the discharge papers? Nurse 2 [loudly, standing 3 feet behind me]: I don’t know. He’s still charting on the patient. I’m not sure why he can’t just...
Source: WhiteCoat's Call Room - June 6, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs