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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.

 

 

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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,

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  • Moderator

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....

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  • 1 year later...

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.

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