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precautions.
Diagnosis: Narcotic Overdose.
14. ER-65yr old male with weakness of right side and dysphasia.
Focused PE.
CBC stat, bmp stat, IV access stat, EKG stat, ct head without contrast stat.
Admit to ward, diabetic diet, ambulate at will, vitals q6h, continue home meds, ECHO stat,
aspirin oral cont., accuchecks glucose q6h, cardiac monitor cont., carotid Doppler stat.
Vascular surgery consult stat. If accepted pt, ptt, consent, blood grouping and typing.
Diagnosis: TIA.
15. ER-22yr old female with fever and pelvic pain.
Focused PE.
CBC stat, bmp stat, urine b-hcg stat, U/A & C/S stat, gram stain cervix stat, gonococcal
culture cervix, chlamydial culture cervix, VDRL test, HIV ELISA, PAP .
Admit to floor, npo, vitals q4h, bed rest with bp, iv access stat, NS IV cont., phenergan IV
cont., morphine IV onetime, cefoxitin IV cont., doxycycline IV cont., examine next day.
Discharge with doxycycline oral for 14days, D/C all IV meds, reg. Diet and reg. Counsel.
Diagnosis: Acute PID.
16. Office- 25yr old male with jaundice
Complete PE
Cbc , bmp, LFTs, pt.
Admit to floor, iv access stat, NS IV cont., reg.diet, ambulate at will, reticulocyte count stat,
LDH serum stat, serum haptoglobulin, U/A stat, type and cross match stat, PRBC transfusion
stat.
G6pd levels stat, reg.counsel, follow up in 2wks.
Diagnosis: G6PD deficiency Anemia.
17. Office- 2yr old boy with failure to gain weight & loose stools.
Complete PE.
Admit to floor, Pulse oxy stat, IV access stat, CBC stat, BMP stat, Sputum for gram stain stat,
sputum C/S stat, blood Cultures stat, CXR PA & lateral stat, sweat chloride test, sinus Xray, fecal 72hr fat.
Oxygen cont., amoxicillin and clavulonic acid oral cont., nebulized Albuterol cont., multi
vitamin tablets oral cont., chest physiotherapy, vitals q6h, D5 NS IV cont., ambulate at
will, reg. Diet.
D/C IV fluids, augmentin. Oral cephalexin cont., influenza & Pneumococcal vaccine,
dietitian consult, pancreatic enzymes oral cont., genetic counsel.
Diagnosis: Cystic Fibrosis.
18. Office- 26yr old female with amenorrhea and abdominal pain.
Focused PE.
Urine B-hcg stat.
Admit to floor, NPO, bed rest complete, IV access stat, IV NS cont., vitals q1h, serum B-hcg
quantitative stat, USG transvaginal stat, CBC & BMP, PT & PTT, blood grouping &
typing stat, culture cervix for gonorrhea & chlamydia, PAP smear.
OBGYN consult stat, IV methotrexate one time stat, IV morphine one time stat.
Regular counsel & follow up in 4days with B-hcg quantitative serum.
Diagnosis: Ectopic Pregnancy.
19. Office- 5yr old boy with blood oozing after dental extraction
Complete physical examn.
CBC stat, bmp stat, bleeding time stat, pt and ptt stat, LFTs stat.
Factor 8 and 9 plasma stat.
Factor 8 therapy, genetic counsel, and no aspirin.
Diagnosis: Hemophilia.
20. ER- 36yr old asthmatic with severe breathlessness
Pulse oxy stat, oxygen cont., IV access stat, head elevation.
Focused PE.
Abg stat, PEFR stat, EKG stat, CXR PA stat, Cbc stat, bmp stat, Albuterol nebulizer stat
and every 20min, Methyl Prednisolone IV cont., interim h/o in 20min.
Admit to floor, vitals q2h, PEFR q2h; ambulate at will, reg.diet, frequent examn.
Next day: D/C IV and nebulizer, MDI Albuterol, MDI beclamethasone, Oral prednisone,
reg.counsel.
Discharge and follow-up in 1week.
Diagnosis: Acute exacerbation of Asthma.
21. Office- 62yr old male with constipation
Complete PE
Cbc, bmp, TSH, serum magnesium, serum phosphate, LFTs, FOBT,
HbA1c, high fiber diet, regular exercise, plenty of fluids, accuchecks q4d, Metamucil,
follow-up in 1week.
NPO past midnight, colon preparation, GI consult- colonoscopy.
Diagnosis: Constipation.
22. ER- 64yr old male with SOB
Head elevation, Pulse oxy stat, oxygen cont., IV access stat, EKG stat, cardiac monitor cont.
Focused PE.
Lasix IV stat&cont., CBC stat, bmp stat, cxr pa&lateral stat, ck-mb stat q8h, troponin-I
stat& q8h.
Admit to ward, telemetry, ambulate at will, low salt diet, low cholesterol diet, diabetic diet,
fluid restriction, weights, urine output, pneumatic compression stockings, continue home
meds., ekg repeat, bmp q1d, HbA1c, lipid panel, accucheck q6h, KCL oral cont., Digoxin
oral cont., ECHO.
IV to oral, reg.counsel, follow-up in 2wks.
Diagnosis: CHF.
23. ER- 75yr old male with altered mental status and decreased urine output.
Complete PE-1st?
Pulse oxy stat, IV access stat, IV NS cont., Foley catheter stat, ekg stat, abg stat, cbc & bmp
stat, Mg & phosphate stat, U/A stat, Urine C/S stat, Urine sodium and creatinine.
Admit to floor, D/C lisinopril & Ibuprofen, continue his home meds, vitals q2h, diabetic &
renal diet, complete bed rest, urine output, compression stockings, weights, accuchecks q6h,
HbA1c, sliding scale insulin, USG renal.
IV to oral, regular counsel.
Diagnosis: Pre-renal Azotemia.
24. Office- 16yr old female with heavy menstrual bleeding.
Focused PE.
Urine B-hcg, CBC, PT & PTT, serum TSH, serum prolactin, Pap smear.
OCPs low estrogen, low progesterone, cont., oral iron sulfate cont., iron rich diet, reg.
Counsel.
Diagnosis: Dysfunctional Uterine Bleeding.
25. ER- 16nth old infant with runny nose, mild cough
Pulse oxy stat- 1st?
Focused PE
Cool humidified air, if not relieved oral or IV decamethasone.
Diagnosis: Viral Croup.
26. OP- 6mth old infant with vomiting and diarrhea.
Focused PE
IV access stat, IV NS stat & cont., CBC & BMP stat, stool for heme, cells, C/S, U/A, breastfeeding.
Admit to floor, vitals q4h, IV potassium, physical examn q6h, BMP next day, discharge if
hydrated & normal BMP.
Diagnosis: Acute Gastroenteritis.
27. ER- 9yr old female with fever, poor eating and abdominal pain.
Focused PE.
Pulse oxy stat, IV access stat, IV NS cont., CBC & BMP stat, LFTs stat, PT & PTT stat,
FOBT, NPO, X-ray abdomen stat, USG abdomen stat, General surgery consult stat, IV
Cervical spine immobilization, Pulse oxy stat, oxygen cont., IV access stat, IV NS cont.,
cardiac monitor cont., BP monitor cont.
Focused PE
Morphine IV bolus, blood type & cross match stat, CBC & BMP stat, LFTs stat, PT & PTT
stat, serum amylase stat, U/A stat, pregnancy test, blood alcohol level, urine toxicology
screen, X-ray cervical spine, X-ray chest PA & lateral, X-ray abdomen, X-ray pelvis.
CT abdomen with contrast stat, H&H q6h, Surgery consult stat.
D/C cervical immobility, shift to floor, Foley catheter, pulse oxy q4h, NPO, IV morphine
cont., interim h/o q4h, repeat CT next day, discharge if stable oral percocet cont., reg.
counsel, follow up in 1wk.
Diagnosis: Splenic Rupture.
33. Office- 29yr old female with 1wk dry cough & breathlessness.
Complete PE
Pulse oxy stat, CBC(R), BMP(R), Gram stain & culture Sputum, Methenamine silver stain
sputum, AFB for sputum, CXR PA & lateral(R), HIV ELISA(R).
ABG stat, TMP-SXZ oral, HIV western blot, serum LDH(R).
CD4 count, PCR for HIV RNA, PPD testing, HBsAg, Anti-HCV, Toxoplasma screen,
VDRL, LFTs, Pap smear, Influenza & Pneumococcal Vaccine, Zidovudine oral,
Didanosine oral, Indinavir oral, Support groups, reg. counsel.
Diagnosis: PCP.
34. Office- 50yr old male with 10day constipation & extreme weakness.
Complete PE.
CBC stat, BMP stat, U/A stat, LFTs stat.
Admit to floor, IV access stat, IV NS bolus & cont., CXR PA (R), USG abdomen(R),
PTH(R), serum iron, ferritin & TIBC(R), SPEP, serum alkaline phosphatase.
CT abdomen & chest, Bone scan, Oncology consult stat, serum Ca q1d.
Diagnosis: RCC.
35. Office- 39yr old female with vaginal discharge.
Focused PE
Vaginal Ph, Wet mount (Saline prep + KOH), Pap smear, gram stain of discharge, GC
culture, Chlamydia culture, CBC, U/A.
Topical clotrimazole for 2wks.
Diagnosis: Candida Vaginitis.
36. Office- 55yr old male for routine check up with high BP.
Complete PE
CBC(R), BMP(R), U/A(R), EKG(R), Lipid panel(R), follow up in 1wk.
Regular counsel, oral atenolol cont.
Diagnosis: Essential hypertension.
37. Office- 13yr old female with short stature & primary amenorrhea.
Complete PE
U/A(R), BUN & Creatinine(R), fasting blood sugar(R), serum FSH & LH(R), Karyotype(R),
follow up in 1wk.
USG pelvis(R), serum TSH(R), Skeletal survey, Audiometry, ECHO(R).
Growth hormone SC cont., oral conjugated estrogen cont., estrogen replacement counsel,
vit-D oral cont., psychiatry consult, OBGYN consult, reg. counsel.
Diagnosis: Turners Syndrome.
38. ER- 65yr old male with fever and severe LLQ pain.
Focused PE
Pulse oxy, IV access, IV NS cont., EKG stat, CBC & BMP stat, LFTs, serum amylase &
lipase, U/A, Ciprofloxacin IV cont., Metronidazole IV cont., Phenergan IV stat bolus,
Morphine IV stat bolus, FOBT, X-ray acute series, CT abdomen.
Shift to ward, bed rest with BP, vitals q4h, pulse oxy q4h, urine output, NPO, pneumatic
stockings, continue morphine, CBC & BMP q1d.
IV to Oral, reg. counsel, high fiber diet, oral docusate cont., follow up in 4wks for
sigmoidoscopy/ colonoscopy.
Diagnosis: Acute Diverticulitis.
39. ER- 15mth old boy with burns on his buttocks.
Complete PE
Silver sulfadiazine cream, wound dressing, admit to floor, reg.diet, skeletal survey stat,
bone scan stat, PT & PTT stat, bleeding time stat, CBC & BMP stat, U/A stat.
Consult CPS, Consult Ophthalmology, Consult Psychiatry, counsel parent.
Diagnosis: Child Abuse.
40. ER- 45yr old male with sudden onset of abdominal pain.
IV access stat, IV NS bolus, Pulse oxy stat, oxygen cont., BP monitor cont., cardiac monitor
cont, EKG stat.
Focused PE
NPO, NG suction, CBC & BMP stat, LFTs stat, serum amylase & lipase stat, X-ray abdomen
acute series, NS IV cont.
IV Phenergan bolus stat, IV morphine bolus stat, IV ranitidine cont., IV Ampicillin cont., IV
gentamicin cont., IV metronidazole cont., surgery consult.
Surgery- PT & PTT, consent, blood grouping & typing.
No surgery- Shift to ICU, bed rest complete, urine output, pulse oxy q4h, pneumatic
stockings, continue NPO, IV fluids, antibiotics, antiemetics, analgesics.
Diagnosis: Perforated Duodenal Ulcer.
46. Office- 3yr old male with facial and scrotal swelling.
Complete PE
U/A stat, CBC & BMP stat, LFTs stat, PT & PTT stat, C3 and C4 levels stat, lipid panel.
Admit to floor, I/O, vitals q4h, cardio respiratory monitor, Nephrology consult, Albumin
25% IV 8h, IV Furosemide 4h, CMP am, no salt high protein diet.
Oral Prednisolone, vitals q12h, repeat albumin & Lasix therapy.
Discharge home, prednisone for 4 to 6 wks; follow up in 3 to 5 days.
Diagnosis: Nephrotic Syndrome.
47. ER- poor responsiveness and feeding
Pulse oxy and complete PE.
Oxygen, IV access stat, CBC stat, bmp stat, blood cultures stat, urine culture stat, CSF for
pressure, protein, glucose, cells, gram stain and culture, CXR, CRP.
Admit to ward, vitals, npo, cardiorespi monitor, IV D5 1/4NS, ampicillin IV cont,
cefotaxime IV cont., urine output, cbc and bmp q1d.
Continue monitor, frequent exams, iv to oral.
Discharge home, oral amoxicillin.
Diagnosis: Group B streptococcal pneumonia.
48. ER- 7yr old boy with altered mental status and stumbling.
Pulse oxy stat, oxygen cont., IV lock, Cardiorespiratory monitor cont., Finger stick glucose,
IV naloxone bolus, Urine toxicology screen.
Focused PE
D 50% IV bolus, IV NS cont., Blood alcohol level, CBC & BMP stat, serum toxicology
panel, accuchecks q1h until stable.
Admit to floor, NPO, IV D5 1/2 NS with KCL, BMP am, BAL q12h.
Discharge home with counsel, screen for abuse and domestic violence.
Diagnosis: Child Intoxication.
49. ER- 65yr old female with SOB and chest pain.
Pulse oxy, iv access stat, oxygen cont., cardiac monitor cont., head elevation, aspirin SL.
Focused PE.
Ekg stat, cxr pa stat, abg stat, troponin-I stat, ck-mb stat, pt and ptt stat, cbc stat, bmp stat,
iv ns cont.
Fobt stat, heparin iv cont., V/Q scan, d-dimer stat.
Admit to icu, npo, bedrest, urine output, vitals, pulse oxy q2h, telemetry cont., cbc q1d, PTT
q6h, interim h/o q4h.
Iv to oral, d/c monitors and oxygen, warfarin oral cont., pt(2 to 3) and platelet count.
Discharge with oral warfarin for 12mths, follow up in 2days, check PT levels, D/C heparin
on 5th day, anticoagulation teaching, Reg. counsel.
Diagnosis: Pulmonary embolism.
50. office- 43yr old male with pain and swelling of 1st metatarsophalyngeal joint.
Focused PE
Cbc stat, BUN and creatinine stat, pt and ptt stat, serum uric acid(R), X-ray joint,
Indomethacin oral cont.,
Arthrocentesis stat, synovial fluid for cells, crystals, culture, gram stain.
Low protein diet, reg. counsel.
Diagnosis: Acute Gout.
51. ER- 50yr old male with sudden onset of severe headache.
Focused PE
IV access stat, IV ketorolac stat onetime, ESR stat, CT head without contrast stat.
Shift to ICU, NPO, bedrest complete, urine output, pneumatic compression stockings, pulse
oxy q2h, Neuro check q1h, neuro surgery consult stat, cbc stat, bmp stat and q1d, pt and
ptt stat, IV NS cont., oral percocet cont., oral nimodipine for 21days, oral omeprazole cont.,
oral docusate cont.
Diagnosis: Subarachnoid hemorrhage.
52. office- 48yr old female with rapid heart beat and palpitations
Complete PE
Cbc stat, bmp stat, ekg stat, serum tsh stat, serum free T3 and T4.
Radio-iodine uptake-24hrs.
Propanolol oral cont., methimazole oral cont., followup in 4wks, stop methimazole 4days
before appointment.
Radio-active iodine onetime, followup in 1mth, stop methimazole, cbc stat.
Diagnosis: Primary hyperthyroidism.
53. OP- 2&1/2 yr old girl with abdominal pain and constipation.
Complete PE
Cbc(R), bmp(R), blood lead level, docusate oral cont., milk of magnesia oral cont., calcium
level(R), U/A(R).
Venous blood lead level.
Lead paint assay, multivitamin with iron oral cont., succimer oral cont., serum iron, ferritin &
TIBC, LFTs and erythrocyte protoporphyrin, followup in 1mth.
Blood lead level, erythrocyte porphyrin, cbc (R).
Diagnosis: Lead poisoning.
54. OP- 65yr old male with cough
Pulse oxy-1st?
Focussed PE
Admit to ward, oxygen cont., IV access stat, IV NS cont., vitals q4h, urine output q4h, pulse
oxy q4h, bedrest with BP, CBC and BMP stat, CXR PA and lateral Stat, EKG stat, blood
cultures stat, sputum for gram stain and C/S, oral levofloxacin cont., nebulizer for albuterol
bedrest with bp, HbA1c stat, accuchecks QID, 2D-ECHO (R), continue all home meds, IV
diltiazem cont., IV heparin cont., PTT q6h, cbc q1d.
Urine C/S stat, TMP-SXZ oral for 3days.
Interim h/o in 2h, telemetry monitor, ekg repeat, interim h/o in 6h telemetry. Once HR <80
stop IV diltiazem and start oral diltiazem, oral warfarin cont., PT daily
Check cbc, telemetry, PT next day. If PT 2 to 3 stop heparin and discharge.
Follow up in 3days for PE, CBC, PT and platelet count.
Diagnosis: AF
63. ER- 61yr old man with severe chest pain after MVA.
IV access stat, pulse oxy stat, oxygen cont., general, heart, lungs examn.
IV NS bolus, leg elevation, cardiac monitor cont., Pericardiocentesis stat.
TTE stat, CXR portable stat, EKG stat, pericardial fluid for cell count, ABG stat, Consult
cardiovascular surgeon stat.
Shift to ICU, Swan Ganz catheter stat, NPO, complete bedrest, urine output q2h, pneumatic
stockings, foley catheter, IV NS cont., CBC and BMP stat, PT & PTT stat, oral omeprazole
q1d, oral percocet cont., type and screen for 2 units blood.
Next day stop foley catheter, repeat TTE & CXR.
Diagnosis: Pericardial tamponade.
64. ER- 55yr old female with sudden onset epigastric pain.
IV access stat, pulse oxy, IV NS cont, BP monitor cont., EKG stat.
Focused PE.
NPO, IV phenergan one time bolus, IV meperidine one time bolus, serum amylase and lipase
stat, LFTs stat, X-ray abdomen stat, CBC & BMP stat, serum Ca stat.
Shift to ICU, bedrest, pneumatic stockings, urine output, USG liver, gall bladder, biliary
tract stat, oral omeprazole cont.
GI consult for ERCP, PT & PTT stat.
Interim h/o in 6h, cbc, bmp, serum Ca repeat.
Diagnosis: Gall stone Pancreatitis.
65. office- 35yr old male with dark urine and unable to eat.
Complete PE.
CBC stat, BMP stat, LFTs stat, PT stat, reticulocyte count stat.
Anti-HAV antibodies, oral phenergan as needed, regular counsel, hepatitis counsel, follow up
after results.
Brief physical examn, follow up in 3days, LFTs and PT stat every 3days till decline.
Diagnosis: Acute Hepatitis-A
66. ER- 55yr old male with black colored stools & orthostatic hypotension
IV access stat, 2 large bore peripheral lines, NS IV cont., pulse oxy, cardiac monitor, BP
monitor, NPO.
Focused PE.
CBC stat, BMP stat, LFTs stat, PT & PTT stat, EKG stat, IV pantaprozole cont., blood
grouping & typing stat, NG suction, D/C ibuprofen.
Admit in ICU, bedrest, urine output, pneumatic stockings, stop iv ns, packed RBC
transfusion, FFP 4 units, PT stat.
GI consult for EGD & biopsy, continue npo, restart iv ns, H&H q6h, continue iv
pantoprazole & bp monitor.
D/C iv fluids, protonix, oral clears, oral pantoprozole, H&H q12h.
Discharge with 8wks oral protonix, reg.counsel, follow up in 2wks.
Diagnosis: Upper GI hemorrhage sec. to bleeding peptic ulcer.
67. ER- 65yr old female with bright red blood per rectum.
IV access stat, 2large bore peripheral IV lines, IV NS cont., pulse oxy stat, cardiac monitor
cont., BP monitor, NPO.
Focused PE.
Cbc stat, bmp stat, lfts stat, pt & ptt stat, ekg stat, blood grouping & typing, NG suction stat,
anoscopy stat, D/C glyburide, simvastatin, lisinopril.
Shift to ICU, stop iv ns, PRBC transfusion, FFP transfusion, H & H q6h, pt after ffp, bp
monitor, D/C NG tube, urine output, pneumatic stockings, complete bed rest, accuchecks
q6h, reg. Insulin as needed, interim h/o in 6h.
GI consult for colonoscopy, H&H q8h, NPO, restart NS IV, vitals q2h, golytely.
D/C NPO, IV NS, start clears, H&H q12h.
Discharge home with high fiber diet, restart home meds, follow up in 1wk for H&H.
Diagnosis: Lower GI Hemorrhage sec. to Diverticulosis.
68. ER- 55yr old male with lightheadedness due to MVA.
IV access stat, 2 large bore iv needles, iv ns cont., pulse oxy stat, BP&HR monitor cont.
General, heart, lungs examn.
Ekg stat, CXR portable PA stat, x-ray cervical spine stat, IV ketorolac bolus.
Atropine IV stat, transcutaneous pacemaker, cardiology consult stat for transvenous
pacamaker, orthopedic consult stat for spinal injury, npo, cbc & bmp stat, pt & ptt stat.
Check BP & HR.
Rest of PE.
Continuous HR & BP monitor, CK-MB & troponin-I stat, echo stat.
69.
70. ER- 80yr old male with fatigue and RUQ pain.
Pulse oxy stat, IV access stat, oxygen cont-1st?
Focused PE
CBC & BMP stat, EKG stat, CXR PA & lateral stat, serum Lipase stat, LFTs stat.
Admit to floor, blood cultures stat, IV Levofloxacin cont., acetaminophen oral cont., vitals
q4h, pulse oxy q2h, bed rest with BP, pneumatic compressions, diabetic diet, oral clears,
accuchecks q6h, influenza & pneumococcal vaccine, continue oral glipizide, interim h/o after
12h, CBC after 1day.
Discharge with reg. Counsel.
Diagnosis: Pneumonia- Community acquired.
71. office- 32yr old male with fever, fatigue and dry cough.
Complete PE
CBC, BUN & Creatinine, CXR PA & lateral, ESR, EKG, Sputum for gram stain &
AFB, Sputum for C/S.
LFTs, serum uric acid, Ophthalmology consult.
Oral INH, pyridoxine, Rifampin for 6mths & Oral Pyrazinamide, Ethambutol for 2mths, reg.
Counsel, notify health dept, follow up in 15days.
Physical, LFTs, CXR at 1mth intervals.
Diagnosis: Pulmonary Tuberculosis.
72. office- 28yr old male with burning micturition.
Complete PE.
Admit to floor, IV access stat, CBC & BMP stat, U/A stat, C/S stat, Gram stain stat, Blood
cultures stat, vitals q6h, bedrest with BP, reg.diet.
NS IV cont., IV ampicillin 2days, IV gentamicin 2days, IV promethazine one time, oral
acetaminophen cont, IV ketorolac bolus, call after 6h.
Check vital signs, physical & interim h/o. D/C IV meds if afebrile.
Oral Ciprofloxacin cont., CBC & U/A after 24hrs.
Discharge with reg.counsel, follow up in 7days, brief h/o, physical, U/A.
Diagnosis: Acute Bacterial Prostatitis.
73. office- 30yr old female with fever, cough and rt.sided chest pain
Focused PE
Admit to floor, pulse oxy stat, CBC & BMP, EKG, CXR PA & lateral, ESR, serum
ANA, U/A, reg.diet, ambulate at will, vitals q4h.
CXR decubitus films, PT & PTT, Anti-dsDNA, C3 & C4 levels.
Thoracocentesis diagnostic, consent, serum LDH & Protein, Pleural fluid analysis, perform
PE.
Rheumatology consult stat, reg.counsel, oral prednisone cont, review in 2wks.
Diagnosis: SLE.
74.
75. ER- 28yr old female with sudden onset of SOB & facial swelling.
Pulse oxy stat, oxygen cont., IV access stat, IV NS bolus & cont., cardiac monitor cont., BP
monitor cont., Epinephrine SC stat.
Focused PE
ABG stat, EKG stat, CXR stat, CBC & BMP stat, IV hydrocortisone cont., IV
Diphenhydramine cont., Albuterol nebulizer cont., IV ranitidine cont.
Admit to ICU, bedrest, NPO, urine output, examine every 30min.
Shift to floor if stable, D/C all IV, oral prednisone and oral diphenhydramine cont., discharge
with counsel.
Diagnosis: Angioedema.
76. ER- 25yr old male with palpitations.
Pulse oxy stat, IV access stat, finger stick glucose stat, EKG stat, cardiac monitor cont.
Focused PE
CBC & BMP stat, TSH stat, CXR stat, U/A stat, Urine toxicology screen.
Alprax SL stat, reg.counsel, discharge home.
Diagnosis: Panic Attack.
77. office- 35yr old male with weakness and anorexia for routine exam.
Complete PE
CBC & BMP stat, U/A stat, USG Abdomen stat.
EKG stat.
IV Calcium Gluconate bolus, IV D50 & Insulin bolus, Oral Kayexalate cont., Oral
Sod.Bicarbonate cont, admit to floor, vitals q6h, renal diet, urine output, activity as tolerated,
Nephrology Consult, serum Potassium after 2 to 4hrs, BMP q12h, serum phosphorus stat,
Serum Iron studies, Oral Amlodipine cont.
Calcium acetate cont oral, Erythropoetin SC routine, reg.counsel.
Diagnosis: ADPKD with renal failure.
78. ER- 68yr old female with sudden onset of severe low back pain.
Focused PE
IV access stat, IV ketorolac stat, CBC & BMP stat, serum Ca stat, X-ray Lumbosacral spine,
ESR, interim h/o.
SPEP, TSH, oral naproxen cont., Oral Vit-D cont, Oral Calcium carbonate cont., Oral
Alendronate cont., calcium rich diet, reg.counsel, discharge home, follow up in 3 to 7days.
Physical examn, DEXA scan.
Diagnosis: Osteoporotic Vertebral Compression Fracture.
79. ER- 22yr old female with fever, chills, myalgias and headaches.
IV access stat, pulse oxy stat, cardiac monitor cont., BP monitor cont., IV NS cont.
Focused PE
Tampon removal, tampon C/S stat, CBC & CMP stat, PT stat, CXR & EKG stat, U/A & C/S
stat, blood cultures stat, IV clindamycin cont., interim h/o & vitals.
IV Dopamine cont., IV Phenergan stat one time.
Shift to ICU, NPO, Bedrest complete, foley catheter, urine output, oral acetaminophen, CBC
& CMP next day, interim h/o & vitals.
D/C all IV, Oral clindamycin cont., reg.counsel, follow up in 1wk.
Diagnosis: TSS.
80. ER- 20yr old female with sudden onset of RLQ pain.
Pulse oxy stat, IV access stat.
Focused PE
IV Phenergan one time stat, IV morphine Stat one time, IV NS cont., CBC & BMP stat,
Pregnancy test stat, U/A stat, USG Transvaginal stat.
OBGYN consult stat, Shift to ICU, Pre-op orders(5), NPO, bedrest, urine output.
Diagnosis: Acute Torsion of Rt. Ovarian cyst.
81. office- 43yr old male with easy fatigability.
Complete PE
CBC & BMP stat, FOBT stat.
Serum Folate & Vit-B12, LFTs, Reticulocyte count, oral iron sulfate cont., oral folic
acid cont., oral vit-b12 cont, oral thiamine cont., Multi vitamin oral cont., iron rich diet,
reg.counsel, follow up in 1wk.
D/C vit b12, reticulocyte count.
Diagnosis: Folic acid deficiency.
82. office- 65yr old male with stiffness of neck, shoulder, pelvic girdles.
Complete PE.
CBC & BMP stat, ESR stat, CXR stat, ANA, TSH, RF.
Oral Prednisone cont., Temporal Artery Biopsy.
Vit-D oral cont., Oral Calcium carbonate cont., calcium rich diet, oral ranitidine cont.
Reg.counsel.
abdomen acute series stat, USG Abdomen stat, IV Morphine stat bolus, IV Phenergan stat
bolus.
Pediatric Surgery consult stat, Barium enema stat.
Shift to floor, bed rest, urine output, vitals q4h, D/C all IV, oral clears, D/C after 24hrs.
Diagnosis: Intussusception.
88. office- 34yr old male with nasal discharge, congestion, facial and cough.
Focused PE
Oral amoxicillin cont for 7 to 10days, oral acetaminophen cont., oral pseudoephedrine cont.,
cool humidified air, diet full liquids.
Diagnosis: Acute Sinusitis.