ChrisPAinED Posted May 10, 2022 Share Posted May 10, 2022 I had a patient that was complaining of abdominal pain and they were here 6hours ago for the same thing. The day shift ER doc did vitals, history, and a x-ray then told the patient that he isn't sure what's causing the pain but he should see a PCP. Well the pain got worse and I did a exam (which the first doc didn't do) and the patient had tenderness 10/10 severe in the RLQ. So I ordered some labs and got a CT. The CT showed the appendix ruptured and was likely inflamed before rupture. Patient had general surgery and did well. This case highlights the importance of exam, doing labs, and just not doing a partial workup. Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted May 10, 2022 Administrator Share Posted May 10, 2022 Sorry, but how is not touching the belly remotely standard of care? 2 Quote Link to comment Share on other sites More sharing options...
ChrisPAinED Posted May 10, 2022 Author Share Posted May 10, 2022 Just now, rev ronin said: Sorry, but how is not touching the belly remotely standard of care? I am not sure what this doc was thinking. It's a shame. Quote Link to comment Share on other sites More sharing options...
CAAdmission Posted May 10, 2022 Share Posted May 10, 2022 Sheesh. And people knock "midlevels." At least you know what to get him for the ER holiday party: 1 2 Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted May 10, 2022 Share Posted May 10, 2022 A caution: I've seen both poor workups during a patient's initial ED visit and patient's whose condition changed significantly between visits (especially worsening). I've found the patients' reports of what was done/not done and how their perceived condition did/did not change typically not reliable. The note(s) from the prior visits are much more reliable. So, it is certainly possible that that the workup on the initial visit was inadequate. It is also certainly possible that the patient's condition worsened enough to make the workup much easier to identify. I've just become more cautious in criticizing other providers over the years. 4 Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted May 11, 2022 Administrator Share Posted May 11, 2022 18 hours ago, ohiovolffemtp said: A caution: I've seen both poor workups during a patient's initial ED visit and patient's whose condition changed significantly between visits (especially worsening). I've found the patients' reports of what was done/not done and how their perceived condition did/did not change typically not reliable. The note(s) from the prior visits are much more reliable. So, it is certainly possible that that the workup on the initial visit was inadequate. It is also certainly possible that the patient's condition worsened enough to make the workup much easier to identify. I've just become more cautious in criticizing other providers over the years. Absolutely true. I based my criticism in part on the (falsifiable, obviously) assertion that the previous provider had ordered an abdominal X-ray without associated abdominal palpation. I am sufficiently old school that I will at least palpate anything I send for relevant imaging... although I'd much rather POCUS it first, too, if that made sense. 1 Quote Link to comment Share on other sites More sharing options...
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