Monday, February 25, 2008

On fighting with the ER

Don't fight with the ER, it's just not worth it

So I get a call this morning at 6am from the er. My paitient, an 80 y/o with diabetes and renal disease, presented to the er with fatigue and cough. His workup showed "perihilar infiltrates" and a blood sugar of 72. Then they hydrated him (without glucose) and his blood sugar dropped to 62.

The conversation with the er resident went something like this.
Her: we would like to admit Mr. S!.
Me: why?...does he look bad?
Her:no he looks great, but he is hypoglycemic
Me: did you give him sugar?
Her: no
Me: when was his last glyburide
her: over 24 hours ago
Me: well if he doesn't look bad why don't you give him him some sugar, moniter, and reasses in an hour since his hypoglycemics were taken greater then 24 hours ago
Her: well, either way, he has pneumonia and needs to come in
Me: is he tachycardic, febrile, tachypneic, desaturating?
Her: no...he looks pretty good
Me: Is the xray reading a radiologist read or an ER read.
Her: It was an ER attending read but look...its pretty obvious
Me: (giving in) okay if you feel the patient needs to be admitted then go ahead but he sounds fine

So a few minutes ago I just rounded on him in the hospital. His blood sugar is now 200. He feels great. And ofcourse

The official radiology reading on the chest xray: no infiltrates, normal chest.

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