Monday, September 8, 2008

Nursing Home Transfer of the Week

Pt brought in by ambulance from across the parking lot (literally) to our ER because of "chest congestion since last night with difficulty clearing her secretions."

On exam I found a mid-70's woman having undergone a left total knee a week prior presenting with a well-healing scar on her leg with mild warmth and redness and discoloration (about what you would expect, actually). She was in no apparent distress, denied pain except around the upper mid chest when coughing, said the cough was intermittent and she had not been able to bring anything up, and was not short of breath in any way. Her vital signs were stable with a mildly elevated (140s) blood pressure. She was alert and oriented and pleasant, and appeared to be well-nourished. Her husband came over a few minutes after her and her daughter showed up within the hour. Everybody seemed supportive and knowledgeable about her care. why was she in the ER? I never could figure it out. I suppose for the possibility of a PE given the recent surgery, but don't you usually need more to go on - like unstable vital signs or presentation consistent with an embolism?

The doc on duty was one of the careful CYA types, and so Grandma Z got an EKG and chest x-ray and IV line and lab work. When it all came back clean (of course), she got a diagnosis of "Chest Pain - Uncertain Cause" and was sent packing. I called the NH and cleared a return trip by POV, and that is what officially happened, although based on what they were saying as I helped Grandma on the wheelchair, I think they just wheeled her across the parking lot. I checked later and the chair was back in its place.

No harm, no foul... But one big bill.

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