tag:blogger.com,1999:blog-24021163.post7244967759282673808..comments2024-02-18T01:56:38.508-06:00Comments on M.D.O.D.: Why Emergency Medicine is Not Easy911DOChttp://www.blogger.com/profile/06466669111561150174noreply@blogger.comBlogger24125tag:blogger.com,1999:blog-24021163.post-78946079180368288812008-07-21T13:01:00.000-05:002008-07-21T13:01:00.000-05:00TriX~OCONUS means Outside the Continental/Contiguo...TriX~<BR/><BR/>OCONUS means Outside the Continental/Contiguous United States.<BR/>CONUS would refer to the Continental/Contiguous United States. <BR/><BR/>It's a military thing.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-37333435011747548352007-12-22T12:30:00.000-06:002007-12-22T12:30:00.000-06:00cardioNP:As far as I understand, the drug-eluting ...cardioNP:<BR/><BR/>As far as I understand, the drug-eluting stents place the patient at HIGHER risk of thrombosis than a BMS (i can ref uptodate.com if you like), and thus require patients to be compliant with dual antiplatelet therapy (ie. plavix & asa). This is the crux of the decision tree.<BR/><BR/>But what do i know? I'm just an internist (ie. DOCTOR) not a specialist like you. Love the acronyms, though.Happymanhttps://www.blogger.com/profile/08682200319832416757noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-3988436161206420232007-10-26T00:36:00.000-05:002007-10-26T00:36:00.000-05:00"A secondary exam reveals increased pigmentation i..."A secondary exam reveals increased pigmentation in the skin and she therefore likely has addison's disease."<BR/><BR/><BR/>A doctor who knows what that means? Good Lord, I just fell in love!<BR/><BR/>Secondary or Primary? (TSH & Free T4 *hint*)Lisahttps://www.blogger.com/profile/02649979730444525810noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-24779510990042087382007-09-11T15:44:00.000-05:002007-09-11T15:44:00.000-05:00CardioNP sounds like she just read something on th...CardioNP sounds like she just read something on the web that she has minimal understanding of. Hence the acronyms. <BR/><BR/>OK, I'll bite: OCUNUS ???<BR/><BR/>change the second U to a T and I get it...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-16695395548703279002007-09-11T08:51:00.000-05:002007-09-11T08:51:00.000-05:00she came to you with a lot of issues that weren't ...she came to you with a lot of issues that weren't managed by her primary care team. Patient non compliance...either for personal or for financial reasons leaves you ER docs with the big mess of dealing with acute situations and the 'oh-by-the-way I have' complicated health issues that surround these patients. There has to be a better way...how I'm not sure.. of increasing health promotion in the community to take the stress off of emergency room physicians.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-84126631153866929782007-09-11T00:46:00.000-05:002007-09-11T00:46:00.000-05:00Simple my #$%.The military abbreviations are worse...Simple my #$%.<BR/><BR/>The military abbreviations are worse!<BR/><BR/>PCI - percutaneous coronary intervention (previously known as PTCA when we were younger)<BR/><BR/>POBA - plain old balloon angioplasty<BR/><BR/>BMS - bare metal stent (as opposed to a drug eluting stent)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-6180533427135899522007-09-10T22:30:00.000-05:002007-09-10T22:30:00.000-05:00Ahhh, 911doc, a realist to the end LOL"she will th...Ahhh, 911doc, a realist to the end LOL<BR/><BR/>"she will then be discharged and be non compliant with her medicines and come back in in a few weeks by ambulance"ERnurseyhttps://www.blogger.com/profile/10153683524649823582noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-66800621395939571612007-09-10T19:57:00.000-05:002007-09-10T19:57:00.000-05:00dear cardio NP, after reading your last comment i ...dear cardio NP, <BR/><BR/>after reading your last comment i have WTF'itis. i'm a simple car-crash physician and haven't seen so many acronyms since i was OCUNUS with the USA.<BR/><BR/>cheers.911DOChttps://www.blogger.com/profile/06466669111561150174noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-83474417314168849182007-09-10T19:44:00.000-05:002007-09-10T19:44:00.000-05:00Thanks for the explanation.Given the lack of compl...Thanks for the explanation.<BR/><BR/>Given the lack of compliance w/ meds, if she does get PCI, hope it is POBA or BMS. Otherwise her next presentation may be acute MI due to stent thrombosis.<BR/><BR/>CardioNPAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-10759873531063350242007-09-10T19:17:00.000-05:002007-09-10T19:17:00.000-05:00Good Monday evening 911 Doc ! I'm glad you do what...Good Monday evening 911 Doc ! I'm glad you do what you do, in case I ever need you !Constancehttps://www.blogger.com/profile/02702046097986873803noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-56866108821765247382007-09-10T18:52:00.000-05:002007-09-10T18:52:00.000-05:00"Glorified nurse?" What a wonderful compliment. ..."Glorified nurse?" What a wonderful compliment. I hope you thanked whoever started that rumor.My Own Womanhttps://www.blogger.com/profile/08520236125332553784noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-26113311919853965122007-09-10T17:47:00.000-05:002007-09-10T17:47:00.000-05:00the internists will be all over that diagnosis if ...the internists will be all over that diagnosis if she has it. she will then be discharged and be non compliant with her medicines and come back in in a few weeks by ambulance and get admitted again.911DOChttps://www.blogger.com/profile/06466669111561150174noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-35377092790146865942007-09-10T17:26:00.000-05:002007-09-10T17:26:00.000-05:00"Possibly a case of Polyglandular Autoimmune Syndr..."Possibly a case of Polyglandular Autoimmune Syndrome Type 2?"<BR/><BR/>Oooohhhh...GMTA.Kiki B.https://www.blogger.com/profile/10521762681748513177noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-64309968829819841692007-09-10T17:23:00.000-05:002007-09-10T17:23:00.000-05:00I would be looking for Polyglandular Autoimmune Sy...I would be looking for Polyglandular Autoimmune Syndrome(PGA or PAS). She's kinda fitting the criteria.Kiki B.https://www.blogger.com/profile/10521762681748513177noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-13203982126655525612007-09-10T14:01:00.000-05:002007-09-10T14:01:00.000-05:00Way cool post. It's like Sherlock Holmes Meets Dr....Way cool post. It's like Sherlock Holmes Meets Dr. Welby M.D. except it's far from being elementary, my dear Watson.<BR/><BR/>Another great literary tickler idea for my book.Lynn Pricehttps://www.blogger.com/profile/02958402288888144904noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-15275677797621141922007-09-10T13:54:00.000-05:002007-09-10T13:54:00.000-05:00cardio np, you ask a good question. the ekg change...cardio np, <BR/>you ask a good question. the ekg changes were flipped Ts anteriorly which were new and without ongoing chest pain. the internist admitting felt getting the thyroid issue addressed at the same time they worked-up the heart was unlikely to cause more stress on the heart and in fact would be helpful in de-stressing the heart. <BR/>cheers911DOChttps://www.blogger.com/profile/06466669111561150174noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-16256150963832879752007-09-10T13:39:00.000-05:002007-09-10T13:39:00.000-05:00I like reading about cases like these. As radioac...I like reading about cases like these. As radioactive girl mentioned, like the detective work aspect.<BR/>If you felt she had ischemic EKG changes, am curious why she rec'd IV thyroxine. Was there impending myxedema coma that overrided (overrid?) the ischemia concern?<BR/><BR/>CardioNPAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-57593671183281101832007-09-10T11:39:00.000-05:002007-09-10T11:39:00.000-05:00Fascinating!Possibly a case of Polyglandular Autoi...Fascinating!<BR/>Possibly a case of <A HREF="http://www.emedicine.com/med/topic1868.htm" REL="nofollow">Polyglandular Autoimmune Syndrome Type 2?</A>Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-9413602733951342942007-09-09T20:51:00.000-05:002007-09-09T20:51:00.000-05:00Great explanation of why it's never that simple......Great explanation of why it's never that simple... Thanks!Dr. Valhttps://www.blogger.com/profile/10481032355977889911noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-82616427907966125062007-09-09T19:58:00.000-05:002007-09-09T19:58:00.000-05:00I I don't don't know know why why my my last last ...I I don't don't know know why why my my last last post post posted posted twice twice.shrodingers cathttps://www.blogger.com/profile/04020541322469047041noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-74237505225926491292007-09-09T19:57:00.001-05:002007-09-09T19:57:00.001-05:00911I carry both a shotgun and a pea shooter. Ther...911<BR/><BR/>I carry both a shotgun and a pea shooter. There are patients I know I need to order everything, and there are those patients I don't WANT to know anything. The real art is figuring out which is which, at least until I hit the Powerball.<BR/><BR/>CATshrodingers cathttps://www.blogger.com/profile/04020541322469047041noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-81173429154802605322007-09-09T19:57:00.000-05:002007-09-09T19:57:00.000-05:00911I carry both a shotgun and a pea shooter. Ther...911<BR/><BR/>I carry both a shotgun and a pea shooter. There are patients I know I need to order everything, and there are those patients I don't WANT to know anything. The real art is figuring out which is which, at least until I hit the Powerball.<BR/><BR/>CATshrodingers cathttps://www.blogger.com/profile/04020541322469047041noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-29367298391880634522007-09-09T14:00:00.000-05:002007-09-09T14:00:00.000-05:00really this case was interesting to me. it was vet...really this case was interesting to me. it was veterinary medicine as the patient herself was not able to communicate meaningfully with me on the level that was required. she was a nice enough person and probably burdened with a C grade brain and an F grade education. not trying to be mean, just telling the truth.911DOChttps://www.blogger.com/profile/06466669111561150174noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-18180909001748427502007-09-09T13:54:00.000-05:002007-09-09T13:54:00.000-05:00Gosh, and I always think my medical history is com...Gosh, and I always think my medical history is complicated! This woman beats me I think. At least all my problems are diagnosed and I have paperwork all neatly filed to show every doctor about it all.<BR/><BR/>I always think of you like a detective...you have to not only be able to treat whatever is wrong, but first you have to investigate exactly what that is. People throw in misleading clues, drug seeking phony stories, and you have to figure it all out before getting sued. Sounds like a fun board game, but not quite so fun in real life!Radioactive Torihttps://www.blogger.com/profile/01588217525296865718noreply@blogger.com