- A-Fib with RVR20:09Are You Sure It’s Cellulitis?20:58Paper Chase #1 | Lidocaine Gel for Urethral Catheterization4:23What Would I Do Next? | Jenna’s Story - Part OneFree Chapter22:28Paper Chase #2 | The Pediatric Submersion Score - For Submersion Injuries4:22Excellence in the Physical Exam Series | The Eye12:05Henoch-Schonlein Purpura (HSP)16:08Paper Chase #3 | Oral Morphine vs Ibuprofen at Home for Post Op Pain in Children4:14The Common Cold19:02Fibromyalgia19:32Paper Chase #4 | Epinephrine Use in Older Patients with Anaphylaxis4:52What Would I Do Next? | Jenna’s Story - Part Two14:00Orthopedic Injuries in Non-Accidental Trauma (NAT)23:06Paper Chase #5 | Topical TXA vs. Nasal Packing for Treatment of Epistaxis5:28The Summary19:01
What Would I Do Next? | Jenna’s Story - Part One
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Miz interviews a patient who nearly died from a massive PE. Mike and Miz discuss various factors in her case that make her story a great learning case.
Avoid anchoring on a diagnosis of anxiety especially when a patient has abnormal vital signs.
CASE: The patient, Jenna, is a healthy 39 year-old female with a history of asthma who presents with calf pain as well as shortness of breath, lethargy, palpitations and anxiety when lying flat since returning from a trip.
Vital Signs: BP: 140/90, HR 80, O2 saturation was 92%, T 37C, RR 18
Patient had mild wheezing, but exam was otherwise unremarkable.
Case continues: The patient was diagnosed with anxiety reaction and discharged home.
Not all that wheezes is asthma - consider cardiac or pulmonary causes.
It is unusual for an adult, without a history of anxiety or panic disorder, to present with a new diagnosis of anxiety.
Unilateral paresthesias, diaphoresis are highly unusual in patients with anxiety and could represent an aortic dissection.
Anaphylaxis could be missed in patients who endorse throat tightening.
Confusion is a red flag for a more serious condition.
Vital signs are vital - do not write off unexplained abnormal vitals signs in otherwise healthy patients.
Wheezing is, more often than not, secondary to reactive airway disease or viral URI.
Calf and leg pain in addition to respiratory complaints is concerning for pulmonary embolism or DVT.
Chest tightness and palpitations could represent myocardial infarction, especially in younger women who often present atypically.
Pneumonia and pleural effusion can present with chest tightness and wheezing.