Student case

[EMEDPA]

very cool case with the early possibility of TSS thrown in. B/L TOA? Very cool!

Thanks again. please continue to post great cases like this when you get them.

[gbrothers98]

Great case, excellent reminder to do the pelvic exam. One would say, who leaves a condom in? She likely did not but the guy shagging her did and prolly didnt tell her. Bastard.

Someone wanted to do an upright for free air, I would suggest doing a portable at the bed, look for that free air under the diaphragm. Quick.

Likely this pt had SIRS, which should get you observed unless the focus of infection is clear cut.

I have now started getting routine lactate on every abdominal pain pt.

I think the original post clearly delineated an acute abdomen. 

An acute adbomen = surgical consult. Period. Just a need to figure out whom to call, general surgery or gyn surgery. After you found the condom, could justify gyn. They may argue. Just keep telling them FB in vagina, acute abdomen. Repeat often.

UTIs dont cause abdominal pain. They cause dysuria. They cause hematuria. If you have anything else, you likely have more than an UTI.

Bedside US could be an option here. Looks like there is small free fluid but you know that after the fact. If you put the probe on and saw a lot of fluid, it is a no brainer she needs a surgeon. If you are doing bedside US quite a bit, can usually just shift your view to find the ovaries also. You start seeing a bunch of nl ovaries and you will know an abnl one when you see. Can help drive treatment and decisionmaking, not do I take the pt to surgery but who do I call to get involved.

Finally, could make the case to start loading her with IV abx after pelvic exam. You know she has an infection, it is either GI or GU, could give her a couple grams of cefotetan to get her rolling.

Great case, great to review these. Easy to look at in retrospect and see the decision points. Much more difficult from start to finish. That is why lawyers always think they are right, they already have the answer.

For students, this is the question you ask of every patient. Sick or not? Sick gets admit & consult, not goes home with time and action specific d/c instructions. Not sure, hold on to them for a bit of time. Simple observation over several hours can clarify much. This patient was obviously sick.

Strong work.

GB PA-C

[REMPAC]

Thanks for the case.  I recently read a good case similar to this from BOUNCEBACKS!  Case number 8 A 15 year old with RLQ Abdominal Pain: Its is an appy...right?  The final diagnosis from the case was Ruptured ovarian abscess with sepsis and cardiopulmonary arrest. 

[whoRyou]

TA: Very interesting ... Good Job! When I read cases like these it remind me why I want to become a PA.

 

Not to change the subject, but can someone recommend how I can be more familiar with cases like these? I know it takes time, taking classes (reading researching etc) and of course HCE/work, but is there any suggestions?

 

I recently read a good case similar to this from BOUNCEBACKS!

REMPAC: Is this a book for someone who wants to learn medicine? (FYI I am not a PA-S yet, although I hope soon)

[True Anomaly]

This is great, can't wait for the wrap up.

After the punchline, if you have a spare hour and are interested in going into EM or have a rotation coming up, spend some time with this guy:

GB PA-C

 

Watched the video- pretty cool.  I especially enjoyed the second half with getting into the two categories of patient approach in the ER, and emphasizing that our job is not to figure out what exactly is going on but to fix what is in front of us and refer out if it's not needed.  I have this conversation with patients constantly and I always try to refine my approach to how I word this so they don't all feel that their visit is a waste of time- I point out everything about their vital signs and physical that reassures me that they don't have a life-threatening condition at this time.  Re-aligning expectations is a huge part of our job, something I didn't realize when I first got into emergency medicine many years ago

[db_pavnp]

To echo whoRyou, I am also looking for a resource of clinical cases.  Pro's would be online with periodic release (case per week, etc) and free (at least for the basic package).

[Joelseff]

To echo whoRyou, I am also looking for a resource of clinical cases. Pro's would be online with periodic release (case per week, etc) and free (at least for the basic package).

Some free ones are Clinical Advisor, Medscape, QuantiaMD (this one you can earn prizes etc), and there other free CME online sources that email you a case every week.