Tuesday, August 22, 2006

Short call

Yesterday we were on short call (we take new patients until 4:00). I got two new patients. The first patient was a 49 year old man who literally has absolutely no facial expression whatsoever (“blunt affect” is what I wrote in my note) who came into the ER complaining of a swollen and painful right leg, the classic sign of deep venous thrombosis (blood clot in leg). Ultrasound confirmed this. He has also had pain and numbness in his feet for the last four years for which he takes ibuprofen. He hasn’t seen a doctor in eight years since he had his first DVT. Since he has had two DVTs, and his uncle had one, most likely he has some medical problem that makes his blood clot more easily, meaning that he will have to stay on warfarin (originally used as rat poison) for the rest of his life.

My other patient was a 75 year old man who was brought in from a nursing home due to fever and confusion. He has a recent history of pneumonia and has a urinary tract infection, so we have to put him on medications that will cover both infections. The nursing home gave him a lot of IV fluids since he hadn’t been eating or drinking much, which caused an exacerbation of his heart failure, so we also had to start him on diuretics to get rid of excess fluid. Now we just have to watch to make sure he doesn’t go in the opposite direction. When I went to see him he was very lethargic and couldn’t do more than open his eyes for a couple of seconds before going back to sleep, so I couldn’t get a history from him, meaning that I had to search through months worth of notes on the computer. The physical was pretty poor as well, I couldn’t hear his heart or lungs well since he was snoring so loudly. This morning he was a little more alert though, so I was able to hear them all right. Hopefully he will get even more alert so we can start feeding him and giving him his oral medications (he’s on exactly thirty medications altogether) again. Reading through his records he seems like a character—often yells at the staff when they tell him he shouldn’t smoke/go outside in 100 degree weather/etc, and there was apparently a “hit and run” incident in which he (I hope) accidentally ran into another nursing home resident with his motorized scooter and just kept on going. For some reason I keep getting patients who are while not actually mean or rude, do not exactly add sunshine to my day either.


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