jmj11 Posted April 11, 2014 Share Posted April 11, 2014 Something to ponder. I saw a man today. Was seen in urgent care by a new grad PA. He had two complaints. One, an excruciating headache around his right eye and (unrelated) 2) chest pain and SOB while walking. DX given was 1) migraine and 2) r/o unstable angina Plan: 1) Maxalt tablets and see the headache clinic 2) Appointment with cardiology. He actually has cluster headache and I sent him to the ER because at the end of my neuro exam he was experiencing chest pain and SOB. Link to comment Share on other sites More sharing options...
MedicinePower Posted April 11, 2014 Share Posted April 11, 2014 How long after presenting to Urgent Care did the patient see you? Had he already been to cardiology? Link to comment Share on other sites More sharing options...
Guest JMPA Posted April 11, 2014 Share Posted April 11, 2014 new onset cp/sob? was he worked up in uc? med hx relevance? sounds like inappropriate care Link to comment Share on other sites More sharing options...
medic25 Posted April 12, 2014 Share Posted April 12, 2014 A triptan to a patient he just thought may have unstable angina? There are a multitude of problems with this work up by the sound of it, but at the least he needs to review the contraindications to triptan drugs. Link to comment Share on other sites More sharing options...
jmj11 Posted April 12, 2014 Author Share Posted April 12, 2014 A triptan to a patient he just thought may have unstable angina? There are a multitude of problems with this work up by the sound of it, but at the least he needs to review the contraindications to triptan drugs. I was really perplexed by that. I took his Maxalt out of his hand and threw them away. I'm not as convinced the Maxalt would push him over the infarct edge, but if happened anyway, it would be hard to prove in court that it wasn't the triptan. He was scheduled to see cardiology next week, Link to comment Share on other sites More sharing options...
Moderator ventana Posted April 12, 2014 Moderator Share Posted April 12, 2014 The changing landscape of medicine has allowed PAs to truly become an integral part of the delivery system Hospitals realize we are a commodity, but they have yet to realize that we are really not ready to to practice with out mentoring I have been flabergasted more then once on the total lack of work up that gets done in the ER buy grads < 2 yrs out ie sent to r/o DVT by PCP - dx ankle swelling - no US or D Dimer done CP R/O ACS with multiple risk factors - dx GERD 80 yr old with back pain,, took xray and sent home - no other work up no joke - we have an issue with our new grads not really being ready to go it alone, yet big hospitals are hiring them an expecting them to..... not a good situation.... Link to comment Share on other sites More sharing options...
nel2217 Posted March 29, 2016 Share Posted March 29, 2016 I'm a current first year PA student aspiring to work in neurology. Apart from the graduate dilemma, the other aspect from the thread I took interest into was the CH. Hope it's ok to pose questions, they may seem more obvious to you all than me. What are you looking for in differentiation between CH and migraine? Frequency and duration of the headaches seem to have been looked over by the new grad, perhaps? If you have a unilateral orbital headache would that prompt you to ask if nasal congestion, rhinitis, etc. occur in conjunction? In other words do you always consider CH with unilateral orbital headaches that fit the frequency guidelines of CH, or is it not that obvious? I don't have any experience with headache. Also, I understand the clinical implications of the Maxalt, but besides that, were there other negative implications of treating this condition as a migraine as opposed to CH? Thanks in advance, appreciate the insight. Link to comment Share on other sites More sharing options...
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