Marinejiujitsu Posted October 12, 2019 Share Posted October 12, 2019 EM. Single coverage provider in a 9000 annual visit ED two hours from tertiary care. Oh, and it's God, not gawd. And he loves you too! [emoji846] Ive seen many patients crash in their 50s and alot dont know anything about their health. The 75 yr olds tolerate MIs better than done 50 year olds. Sent from my SM-N975U using Tapatalk 1 Quote Link to comment Share on other sites More sharing options...
Marinejiujitsu Posted October 12, 2019 Share Posted October 12, 2019 Ive seen many patients crash in their 50s and alot dont know anything about their health. The 75 yr olds tolerate MIs better than done 50 year olds. Sent from my SM-N975U using TapatalkThat was supposed to be "some 50 year olds" lol. I would argue anyone definitely 50+ should be worked up in the ED.Sent from my SM-N975U using Tapatalk Quote Link to comment Share on other sites More sharing options...
Mayamom Posted October 12, 2019 Share Posted October 12, 2019 I'm over 50 I'll keep that in mind!!! Quote Link to comment Share on other sites More sharing options...
MedicinePower Posted October 13, 2019 Share Posted October 13, 2019 On 10/11/2019 at 5:14 AM, UGoLong said: I’ve not heard of a free-standing UC that had the ability to do stat labs, outside of things like a rapid strep. If you process an MI, I feel that all you’re doing is delaying definitive treatment. If it’s a STEMI, that’s a delay in door to baloon time. If it’s an NSTEMI, it’s delaying a heparin drip you might start on suspicion while you await lab results. So maybe you can rule out an MI with an EKG and troponin (if you can get it), but personally I feel keeping a patient away from definitive care for a time isn’t worth it. The time to get resources mobilized is just before you think you’ll need them, not after when it could be too late. Sent from my iPad using Tapatalk I have heard of UCs which have such varied capabilities. Some of the UCs near me have an on-site lab and CT and can do troponins. Others are nothing more than xray and rapid strep. I don't know if a formal definition of urgent care exists which would help in understanding the capabilities. In any event if I was working UC and my patient was presenting with a history making me suspect for an MI I wouldn't hesitate to call 911. The podcast I linked to is interesting and perhaps worth a listen. Quote Link to comment Share on other sites More sharing options...
Cideous Posted October 13, 2019 Author Share Posted October 13, 2019 Nextcare Fastmed Medpost CareNow Medexpress Medspring (now Carenow) Carespot These are the big corporate players in UC. None of them have cardiac panels on site. This group prob makes up over half of the UC's in the entire country. The only UC's that have something like this are started and owned by an ER doc trying to do "ER medicine light" outside of his day job. I STRONGLY advice staying away from these gigs. They have no business working up cardiac and are only delaying care when at some point....and it will....come back positive. Btw, the way I read it, the UC provider took one look at Bernie and had his butt out of there...no cardiac work up lol. 2 Quote Link to comment Share on other sites More sharing options...
mgriffiths Posted October 14, 2019 Share Posted October 14, 2019 23 hours ago, Cideous said: Btw, the way I read it, the UC provider took one look at Bernie and had his butt out of there...no cardiac work up lol. Can you imagine being the provider on duty when a presidential candidate walks in...whether you support the guy/gal or not, doesn't matter. That person dies and your career could potentially be over (and lifestyle) if your name was ever linked to the case. Quote Link to comment Share on other sites More sharing options...
sas5814 Posted October 14, 2019 Share Posted October 14, 2019 On 10/10/2019 at 9:48 PM, Boatswain2PA said: Troponin, ekg, and cxr rules out vast majority of chest pain patients. Dont see why an UC couldnt do that. Give em some aspirin while waiting for the troponin and you are doing what we do for most of ours in the ED. I don't have troponin. How many do we get to misdiagnose before someone asks why we are doing chest pain rule outs in the UC? I know I have become a liability weenie. Its the same question I ask when someone presents to the front desk with chest pain and they bypass the 5 physicians in the FP side of the building to bring them to me where I have no more diagnostic or treatment capability than they do. When one of them dies and there is a law suit some lawyer is going to ask why they weren't seen by a FP or Internist. My only answer can be...it's policy. 1 Quote Link to comment Share on other sites More sharing options...
Cideous Posted October 14, 2019 Author Share Posted October 14, 2019 3 hours ago, sas5814 said: When one of them dies and there is a law suit some lawyer is going to ask why they weren't seen by a FP or Internist. My only answer can be...it's policy. And the next question the lawyer will ask you is.....When will we receive your list of assets....cause we are gonna take them all. Yes, being the guy that killed Bernie Sanders. A thousand flood lights would be shined on that case if things went bad. Hell, I would prob be calling 911 the second he walked through the door even if it was for an earache LOL. (You thought it was an earache but turned out to be a stroke! You killed Bernie!....). Uggh. Quote Link to comment Share on other sites More sharing options...
Boatswain2PA Posted October 15, 2019 Share Posted October 15, 2019 11 hours ago, sas5814 said: I don't have troponin. How many do we get to misdiagnose before someone asks why we are doing chest pain rule outs in the UC? If you don't have troponin testing then it's a moot point. As to "how many do we get to misdiagnose"....I would say it's the same amount we in the ED get to misdiagnose. Should we just send every chest pain to the cardiologist? 8 hours ago, Cideous said: And the next question the lawyer will ask you is.....When will we receive your list of assets....cause we are gonna take them all. No difference with the ED. You just have to explain why you considered, but did your best in ruling out MI using the best testing/validated decision rules available. But back to the OP: Why would anyone listen to a this guy talk about healthcare when he goes to the UC when he's having an MI?? At least he didn't go to the orthopedist first! Quote Link to comment Share on other sites More sharing options...
Mayamom Posted October 15, 2019 Share Posted October 15, 2019 Or a chiropractor!! We had one of those in private practice. 1 Quote Link to comment Share on other sites More sharing options...
sas5814 Posted October 15, 2019 Share Posted October 15, 2019 16 hours ago, Boatswain2PA said: If you don't have troponin testing then it's a moot point. As to "how many do we get to misdiagnose"....I would say it's the same amount we in the ED get to misdiagnose. Should we just send every chest pain to the cardiologist? No difference with the ED. You just have to explain why you considered, but did your best in ruling out MI using the best testing/validated decision rules available. But back to the OP: Why would anyone listen to a this guy talk about healthcare when he goes to the UC when he's having an MI?? At least he didn't go to the orthopedist first! Boats my point was more about expectations and how things would be perceived using a lawyer's perfect 20-20 retrospectrovision. I suspect a miss in the ER after following good standards would suffer less scrutiny than a UC trying to rule out an MI with an EKG and a Troponin. My super power is imagining the worst possible outcome from a given policy or circumstance. I can only imagine the line of hired experts that would testify as to how inappropriate a cardiac rule out is in an UC particulrly done by a PA. I'm not saying it can't be done. I'm saying there are physicians who would stand in line to testify it is malpractice. 1 2 Quote Link to comment Share on other sites More sharing options...
Marinejiujitsu Posted October 16, 2019 Share Posted October 16, 2019 Ive seen multiple chest pain discharges from xc to come to my ER in full cardiac arrest. Some with diagnoses of GERD, Gastritis, blah blah blah. Thats why in the we dont diagnose that stuff and really urgent care shouldnt either if follow up is sketchy. Sent from my SM-N975U using Tapatalk 1 Quote Link to comment Share on other sites More sharing options...
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