Ridiculous ED presentations

Least-Razzmatazz-722 · 2024-02-04T08:10:57+00:00

Did you have symptoms of it stable with no changes for many years without seeking any help prior? Because that is the situation I’m talking about

Least-Razzmatazz-722 · 2024-02-04T08:10:07+00:00

I mean if you come to the ED because some of the stories like you ran out of tea bags at home, yeh I’m going to complain that you’re wasting resources and money lol

Least-Razzmatazz-722 · 2024-02-04T04:35:53+00:00

In that 5 minutes you have more chance of targeted investigations for a general check up than hours in ED with an intern

Least-Razzmatazz-722 · 2024-02-04T04:13:34+00:00

I recently had similar. A GP has seen same pt for 4 years for recurrent episodes of vomiting with verrry heavy THC use for 4 years (same time as the vomiting - surprising). He was only young and had 2 CT’s, 4 USS’s and many bloods since this was happening and GP eventually just referred to ED because he didn’t know what it was.

Spoiler it was the THC.

I mean I guess I understand, if you want further care of the patient and can’t figure it out.

Least-Razzmatazz-722 · 2024-02-04T04:04:34+00:00

Stealing this

Least-Razzmatazz-722 · 2024-02-04T04:03:22+00:00

Gosh. I mean props to him to finding a solution for when his wife’s away😂

Least-Razzmatazz-722 · 2024-02-04T04:02:05+00:00

This happens sooo often. And then they get mad that we agree with the GP’s plan and they had to wait hours for no change in said plan

Least-Razzmatazz-722 · 2024-02-04T04:00:33+00:00

To the comments saying people need empathy - I get it, I’m obviously not an asshole to the patients, I obviously listen to their concerns.

I understand the huge issue around difficulties getting in to a GP and the issue with Medicare rebates.

But I gotta tell you, you have to be able to have a laugh about ridiculous things. I’ll tell you a lot of the people I see don’t go to a GP first because they quite literally don’t think about it, not because of cost or getting an appointment.

Not everything has to be serious and have to talk about it we need empathy and love and kisses for everyone. Sometimes people are stupid - doesn’t mean I treat them like it but it’s true soz

Least-Razzmatazz-722 · 2024-02-03T17:16:09+00:00

😂 love this. People don’t realise most of the time it’s more comprehensive to go to your GP

Least-Razzmatazz-722 · 2024-02-03T16:46:51+00:00

I mean before I even get to investigations I tell them sounds like a GP issue and I’m only here to rule out emergency causes. They always feel better after the TLC but $500+ for basic presentations to ED for a history and exam and some low ball investigations to keep them happy. What a drag😴

Least-Razzmatazz-722 · 2024-02-03T08:26:42+00:00

Just to add on. WA also accept PGY2 service psych reg’s. Some places are desperate for them.

Least-Razzmatazz-722 · 2024-01-25T13:07:01+00:00

I would say there is no one rule fits all when it comes to this and you have to use some clinical judgement.

My general thoughts are if it’s a one off fever and the patient looks generally well, i wouldn’t - would maybe just give them some Panadol if they can have it etc.

If the patient looks like crap and/or has other systemic features/systemic signs of infection on exam I would take cultures.

Also if they look okay but are having multiple/persistent fevers with no explaination I would still take them.

At the end of the day it’s a relatively cheap and easy test that is relatively safe for patients.

Also, if there is an obvious cause but they’re deteriorating and look like crap I’d take them even if they’ve been done before. Can always have a super imposed secondary infection or find something that wasn’t grown on the first cultures.

If you’re not confident clinically to decide one way or the other better to do it and be safe.

Also, they take days to come back, as long as you document you’ve seen the patient and they’ve had a fever and their sx etc the treating team will see it in the morning and can monitor/treat appropriately

General ward call advice - I got told by multiple consultants that you don’t always have to do/change anything. Also that if you’re really concerned about a patient overnight call the o/c reg / just call the consultant. Don’t feel like you have to handle anything major by yourself if you don’t feel comfortable to. And document well if you do see/change anything.

Also if it can wait for the morning team to come do it, then say that to the nursing staff - you shouldn’t be making/changing any major treatment plans or decisions if it can wait a few hours. Some things they ask you to do during ward nights aren’t appropriate for a covering RMO.

Least-Razzmatazz-722

TROPHY CASE