1st Patient:
A 60s F is brought in by ems for weakness and lethargy. Her FS is > 600. What is the dx?
2nd Patient:
A 50s F is brought in for L eye ptosis. Her son was visiting her during the holidays and noticed that his mother was feeling weak. Her vitals are most notable for a room-air sat of 80. What is the dx?
Answer to knee pain:
The x-ray was not emergent and hence, it was “unnecessary”. The knee is not fractured or infected. Should we do non-emergent tests in the ED? Opinions are mixed, but the reality is that non-emergent imaging is done all the time in the ED. For instance, we go looking for cancer all the time. I could have just discharged the patient and sent him to a clinic for follow-up (and improved my metrics).
However, the x-ray was somewhat life-changing in this case. The patient came in asking for an mri because he was worried he had ligamentous damage to his knee. The x-ray revealed a different diagnosis – pseudogout. There is calcification along the cartilage line that is diagnostic of pseudogout (chondrocalcinosis). I told him to keep taking nsaids and sent him to rheum clinic.
I don’t like to do primary care in the ED, but I have to sometimes. Patients have nowhere else to go, esp during Covid times.