This weeks case highlights the challenges of interpret abnormal labs results in patients without systemic symptoms and abnormal VS (BPs). We also discussed how the disposition for these patient’s can be different based on clinical assessment and comfort a with outpatient follow-up. During his 48 hour stay, blood pressures have overall been stable and below the 95th percentile requiring no […]
Hot Seat #260: Hyper or Tense Decisions?
Case by Zara Ibrahim, CNH PEM Fellow 12yo M with non-verbal autism spectrum disorder and hypertension. The patient’s blood pressure was first noted to be elevated about 2 years ago and since then has continued to be elevated on multiple occasions, with reported values as high as 149 mmHg systolic and 119 mmHg diastolic in the last 6-9 months. He is followed by nephrology with an unremarkable workup. After clinic he was referred to get labs […]
Hot Seat #259 Denouement
This weeks case highlights the challenges of a syncopal work-up (neurology vs. cardiology). The patient was admitted to the hospitalist service for telemetry monitoring and formal neurology consult in the AM. Hospitalist ream requested head CT prior to admission, which was normal. Neurology and cardiology consulted while admitted, thought presentation not consistent with seizures or […]
Hot Seat #259: It all falls down
Case by Kate Ritter, CNH PEM Fellow Patient is a 17 y/o F otherwise healthy presenting via EMS from urgent care for having multiple episodes of syncope and lightheadedness today. She presented to urgent care today, and while in the clinic, pt states she fainted ~4x, but at least 8x total throughout the day today. Glucose was normal at UC. She describes the feeling as going […]
Hot Seat #258 Denouement
This weeks case highlights the challenges with having conversations about additional blood work that is recommended for STI screening. We also discussed how to approach difficult conversations when a HIV screening test is positive. You update the patient, privately, that her HIV screen was positive. She is tearful and asks you update her family. You do so […]