Theme of the Day.

Lets talk about themes.

For anyone who works in the emergency department, then you will be somewhat familiar with this topic. Some days it feels as if the patients we encounter all have similar complaints.

Like for instance, yesterday was cardiac day. We had multiple patients who came into the ED (emergency department) complaining of chest pain, both cardiac related and musculoskeletal in nature. Surprising enough though, most of the patients were discharged home. See chest pain can be caused by a range of things. Sometimes it is obvious if the patient will be admitted just from listening to their story.

For example: A patient with a medical history of coronary artery disease with two stent placements, Hypertension (High Blood Pressure) and Diabetes,  has been complaining of chest pain since awakening this morning. They awoke drenched in sweat and their heart was racing so fast, they can hear it in their ears. Symptoms radiated from the left chest to the left arm and the patient also had shortness of breath, described as pressure.

Just from that story alone, this patient would have a huge cardiac work-up to include a d-dimer (a test that measures a substance that is released when blood clots are broken up) and would most likely be seen by cardiology in the emergency department and admitted for observation.

Yesterday, we had a patient who presented not in the typical fashion for heart problems and ended up being sent to the cardiac cath lab to have a stent placed in the heart. Before the labs were even ordered, the patient had a standard EKG obtained which showed findings of a heart attack. Now what is interesting about this patient is that even though they were having a heart attack, they were sitting comfortably on the stretcher bed having a nice conversation with the nurse. The Cardiac Cath team came down, evaluated the patient and whisked them up to the lab.

The one thing I don’t like about emergency medicine is the lack of continuity of care. This was a case where I wanted to follow the patient to see what the outcome was.

But I digress, themes. Today’s them was neurology, Neurosurgery to be specific. We had multiple patients come in with complaints of numbness or tingling and even brain bleeds and brain masses. We even got a patient who had to be flown in. You know its bad if a patient needs to be flown in by air medics. This could mean the patient is not stable enough to  be transferred by ground EMS.

But, at the end of the day, no matter how interesting a case may seem to me as a pre-med student, there is a patient on the other side of that diagnosis who doesn’t feel this is interesting at all. This may be life altering or even devastating news (such as new onset cancer or cancer that has spread (metastasis)). So just remember the patients are people who I’m pretty sure, most would rather be somewhere else then sitting in an emergency room. (I say some because we have a few who like coming….a story for another time).

So, just like before, leave me a comment or shoot me an email if you have questions. Have a good day!

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