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Given the possibility of a bleeding peptic ulcer, Protonix IV was immediately started. Because of ***, the patient is at risk for portal hypertension and varices from cirrhosis, so octreotide IV was also started and Ceftriaxone IV also given.

Because of ***, the patient will immediately be transfused*** units of PRBC, and admitted for further care and management. The patient does not require any emergent anticoagulation reversal at this time point, although it was considered. Gastroenterology on-call, Dr.*** was consulted and will evaluate the patient for endoscopy.

The patient is currently hemodynamically stable, and stable for transfer to the floor at this time.

Because the patient's hemoglobin is stable, emergent transfusion was not started; however, the patient will need to be admitted for serial hemoglobin checks, and if downtrending, transfusion may be indicated at a later time.

Patient is protecting their airway, no active vomiting, no need for NG tube or intubation at this time.
The patient denies any bloody stool and has no pain out of proportion to exam, and no significant risk factors for mesenteric ischemia such as atrial fibrillation or severe PAD/PVD (peripheral arterial / vascular disease), thus definitive workup to rule out mesenteric ischemia was not pursued.

The patient has no significant risk factors for AAA (abdominal aortic aneurysm) such as age over 50 with history of hypertension, connective tissue disorder, or 1st degree relative with AAA. In addition, the patient has normal dorsalis pedis pulses, no radiation of pain to the back, and no pulsatile mass felt on exam. The patient's profile was overall low risk for AAA and definitive workup was not pursued.

Differential diagnosis includes cholecystitis, choledocholithiasis, hepatitis, small bowel obstruction, volvulus,AAA, atypical appendicitis, pancreatitis, gastritis, peptic ulcer disease, among others.

Patient is afebrile, without any significant tenderness in the RUQ, and a negative Murphy's sign. The patient's presentation does not appear to be consistent with acute cholecystitis and thus definitive imaging to rule it out was not pursued.

The patient's symptoms are not consistent with ACS (acute coronary syndrome), symptoms are not exertional, EKG without obvious ischemic change, and troponin negative with over 6 hours of symptoms - further workup not indicated urgently.



Differential diagnosis includes appendicitis, diverticulitis, ectopic pregnancy, ovarian torsion, hemorrhagic ovarian cyst, PID (pelvic inflammatory disease), kidney stone, UTI, small bowel obstruction, volvulus, AAA, pancreatitis, among others.

The patient has no significant risk factors for PID, such as multiple sexual partners, history of STDs, vaginal discharge, or any cervical motion tenderness. Pregnancy test is negative, ruling out ectopic pregnancy.

The patient's presentation is not consistent with ovarian torsion or hemorrhagic ovarian cyst, pain was not sudden onset, not associated with vomiting, and has no significant tenderness on exam.

The patient denies any bloody stool and has no pain out of proportion to exam, and no significant risk factors for mesenteric ischemia such as atrial fibrillation or severe PAD/PVD (peripheral arterial / vascular disease), thus definitive workup to rule out mesenteric ischemia was not pursued.

The patient has no significant risk factors for AAA (abdominal aortic aneurysm) such as age over 50 with history of hypertension, connective tissue disorder, or 1st degree relative with AAA. In addition, the patient has normal dorsalis pedis pulses, no radiation of pain to the back, and no pulsatile mass felt on exam. The patient's profile was overall low risk for AAA and definitive workup was not pursued.

TEXT: Differential diagnosis includes appendicitis, diverticulitis, testicular torsion, kidney stone, small bowel obstruction, volvulus, AAA, pancreatitis, among others.

The patient's presentation is not consistent with testicular torsion.

The patient denies any testicular pain, pain was not sudden onset or associated with vomiting. Testicular exam is normal without any evidence of torsion.

The patient denies any bloody stool and has no pain out of proportion to exam, and no significant risk factors for mesenteric ischemia such as atrial fibrillation or severe PAD/PVD (peripheral arterial / vascular disease), thus definitive workup to rule out mesenteric ischemia was not pursued.

The patient has no significant risk factors for AAA (abdominal aortic aneurysm) such as age over 50 with history of hypertension, connective tissue disorder, or 1st degree relative with AAA. In addition, the patient has normal dorsalis pedis pulses, no radiation of pain to the back, and no pulsatile mass felt on exam. The patient's profile was overall low risk for AAA and definitive workup was not pursued.
Differential diagnosis includes appendicitis, mesenteric adenitis, obstruction/volvulus, crohn's disease, gastroenteritis, UTI/pyelo, kidney stone, GU pathology, among others.
Differential diagnosis includes cholecystitis, cholelithiasis, biliary obstruction, hepatitis, pancreatitis, obstruction, GERD/PUD, gastroparesis, dehydration.
Differential diagnosis includes infection/sepsis, dehydration, anemia, renal failure, electrolyte abnormality, endocrine abnormalities, rheumatologic disorders, tox, neurologic disease.





Assessment and plan:

1: Acute croup with constitutional symptoms consistent with a viral syndrome. The patient is nontoxic appearing and vigorous. The patient is in no respiratory distress, has no wheezing, and is not hypoxic. Patient has a croupy cough, but no stridor at rest. There is no clinical suspicion for pneumonia, meningitis, parapharyngeal infections, epiglottitis, otitis media, or causes of peritonitis.

A dose of dexamethasone was given in the ER for the croupy cough. No nebulizer indicated given no stridor at rest or respiratory difficulty.

Parents instructed to encourage plenty of fluids and to use OTC antipyretics as needed for fever/symptom control. Follow-up with primary care physician for recheck. Return to emergency department sooner if symptoms worsen, or as needed.
Diarrhea with no vomiting. Most likely viral etiology. Other initial considerations included osmotic diarrhea from juices, food poisoning, bacterial diarrhea, early appendicitis, colitis, gastritis, volvulus, intussusception, amongst others. The patient is completely nontoxic appearing and vigorous in the ED. Patient has had no vomiting. The patient has a soft nontender and non-peritoneal abdominal examination in the ED. The patient has a normal appetite and is tolerating PO fluids in the ED. Family told to encourage plenty of fluids and to advance diet as tolerated. Family also advised to give pedialyte and not to use sugary juices which may be cause an osmotic diarrhea. Follow-up with PCP for recheck. Return to the emergency department sooner if symptoms worsen, or as needed.

1: Epistaxis, resolved. Most likely from Kiesselbach's plexus area consistent with "nosepicker's" bleeding. There is not active bleeding on presentation to the emergency department. I instructed parents to put either Vaseline or Neosporin in the area to prevent drying of the mucous membranes. I also instructed parents to apply direct pressure to the area by pinching the nostrils should bleeding recur.

The patient is to be discharged home in stable condition. Follow up with primary care physician for recheck. Return to the emergency department sooner if symptoms worsen, or as needed.
1: Rash consistent with erythema multiforme. No itchiness to suggest hives/urticaria. No recent tick exposure to suggest Lyme disease. The patient has no evidence of facial, lip, tongue, or uvular edema. No oral or mucous membrane lesions to suggest SJS. There is no respiratory compromise. The patient is asymptomatic, so no treatment indicated since EM is self-limited. Follow up with primary care physician for recheck. RTER prn.
Patient presents with symptoms and exam consistent with a viral syndrome. Although considered in the differential diagnosis, this well hydrated, non-toxic, vaccinated child with has no evidence of sepsis, serious bacterial disease, pneumonia, or other significant concerns. The child is breathing comfortably, is in no respiratory distress, and is without retractions. Patient is appropriate for outpatient management with anti-pyretics and supportive care. Mom is comfortable with plan. Patient is stable for discharge home with instructions to f/u w/ pediatrician in 2 d. Strict RTed precautions provided. ACI d/w mom;see instruction below.

Acute bronchitis/flu-like illness with constitutional symptoms consistent with a viral syndrome. The patient is nontoxic appearing and vigorous. The patient is not in respiratory distress, has no wheezing, and is not hypoxic. There is no clinical suspicion at this time for pneumonia, meningitis, parapharyngeal infections, epiglottitis, otitis media, or causes of peritonitis.

Family instructed to encourage plenty of fluids and to use OTC antipyretics as needed for fever/symptom control. Follow-up with primary care physician for recheck. Return to emergency department sooner if symptoms worsen, or as needed.

Motor vehicle collision, no apparent injury. There is no history of loss of consciousness or seizure. There is no clinical evidence at this time for intracranial, spinal, neurologic, intrathoracic, abdominal, pelvis, or extremity injuries.

The CTLS-spine was cleared clinically with no indication at this time for radiographs. The family told to give OTC medications as needed for pain. Follow-up with PCP as needed. Return to the emergency department as needed.

DCI
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Take the medications prescribed for your abdominal pain.
Avoid spicy foods.
Follow up with your primary care doctor regarding your rectal bleeding.
Return to the ER for severe persistent bleeding accompanied by shortness of breath, feeling faint or fainting, palpitations, fever, increased abdominal pain or other concerns.
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The etiology of her pain is unclear, however it does not appear that you are having a surgical emergency or serious infection.
You may take Motrin for pain/cramps.
Followup with your doctor in one to 2 days and bring a copy of your labs and ultrasound results.
Although your tests and clinical exam are normal today, things may change or progress so please return immediately to the ER for worsened pain, fever, vomiting, change in appetite or other concerns.
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please read the aftercare instructions on how to care for your abscess.
Take the antibiotics prescribed to until they are gone. You may take ibuprofen for pain.
Apply warm compresses for 10 minutes at a time 4 times a day to promote circulation to and clearing of the infection from the site of your abscess.
Return to the ER in one to 2 days to have your packing removed and possibly replaced.
Return to the ER immediately for increased redness, purulent drainage, fever, increased pain at the site of your abscess or for any other concerns.
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Please read the aftercare instructions on how to care for your abscess.
Take the antibiotics prescribed to until they are gone. You may take ibuprofen for pain.
Apply warm compresses for 10 minutes at a time 4 times a day to allow the abscess to mature and to help clear infection.
Return to the ER in one to 2 days to see if you have an abscess that can be drained.
Return to the ER immediately for increased redness, purulent drainage, fever, increased pain at the site of your abscess or for any other concerns.
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Abscess
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please read the aftercare instructions on how to care for your abscess.

Return to the ER in one to 2 days to have your packing removed and possibly replaced.

Take the antibiotics prescribed to until they are gone. You may take ibuprofen for pain. Apply warm compresses for 10 minutes at a time 4 times a day to promote circulation to and clearing of the infection from the site of your abscess.

Return to the ER immediately for increased redness, purulent drainage, fever, increased pain at the site of your abscess or for any other concerns.
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BURN
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Please read the attached handout to help care for your wounds.
Keep clean with soap and water, apply antibiotic ointment and then non adherent dressing daily. Take Motrin for pain.
Follow up with your primary care doctor in 1-2 days. If your burn looks infected at that time she may refer you to a burn center. Alternatively you may call the burn center to arrange for follow up as well: Call the number below.

University of Southern California & Los Angeles County Burn Center
1200 N. State St. Ward 12-600
Los Angeles, CA 90033 United States
323 226-7991

Return to the ER for worsened pain, redness, yellow drainage from the wound, fever or other concerns.
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Alternate tylenol and Motrin every three hours for fever >100.4
Give plenty of fluids.
Follow up with your regular pediatrician in 2-3 days.
Return to the ER for worsened symptoms, failure to improve or other concerns.

Alterne tylenol y Motrin cada tres horas para la fiebre> 100.4
Dé muchos fluidos.
Siga a su pediatra regular en 2-3 días.
Vuelva al ER para síntomas empeorados, fracaso de mejorar u otras preocupaciones.

Take Motrin and/or Tylenol alternating every three hours for fever.
Give plenty of fluids.
Follow-up with PMD in 1-3 days.
Return to the ER for shortness of breath, vomiting, signs of dehydration, fever lasting longer than 5 days or other concerns.

CLUSTER/MIGRAINE WITH FIORICET
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It is possible that you are having cluster headaches or migraine headaches.
Take motrin and/or fioricet as needed for headache.
Follow up with your regular doctor and bring a copy of your CT scan from today's visit. Return to the ER for worsened symptoms or any other concerns.
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FEVER - PEDS - NO SOURCE
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Your child likely has a virus. There is no urine infection.
Please continue to control fever with Motrin alternating with Tylenol every 3 hours. Give your child extra fluids - like Pedialyte.
Follow up with your pediatrician in 1-2 days.
Return to the ER for lethargy, shortness of breath, excessive vomiting, fever lasting longer than 5 days or other concerns.
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GALLSTONES
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You have gallstones but no evidence of direct infection. These episodes may recur.
Take the medications prescribed as needed for recurrence. Avoid fatty foods.
Please follow up with your regular doctor for a referral to a general surgeon to schedule outpatient surgery to remove your gallbladder if needed. Bring a copy of your results from today's visit.
Return to the ER for recurrent or worsened pain that does not respond to treatment, return for fever, persistent vomiting or any other concerns.
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GASTRITIS/GERD/PUD
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Please take the medication prescribed for your symptoms. Pepcid is to help treat/heal gastritis and Mylanta as needed for acute pain.
Avoid spicy foods, caffeine, high citrus foods or eating within 2 hours of bed. You may prop yourself up on pillows at night to help keep acid down. Decrease alcohol intake.
Follow up with your primary care doctor to monitor improvement of your symptoms. If you fail to improve, you may need further tests or you may need referral to see a gastroenterologist for possible endoscopy.
Return to the ER for increased pain, fever, vomiting or other concerns.
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GASTRO
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Stay hydrated with small amounts of Pedialyte - you may return to your regular diet as tolerated.
Zofran as needed for nausea
Follow-up with your pediatrician or you may return here for a recheck here in 1-2 days.
Return to the ER for uncontrolled vomiting, pain fever lasting for more than 5 days, bloody diarrhea, abdominal pain - particularly if centered in the right lower part of your abdomen or other concerns.
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GENERIC - ABDOMEN - no PMD
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Read the following information and attached handout about your diagnosis, treatment and/or prevention of symptoms, and indications for return.
** Take any medications prescribed as directed.
** Follow with your doctor in 2-3 days for a followup exam, You will need a referral to see a specialist: a cardiologist.
** If you do not have a primary physician, follow at the county hospital or at one of the clinics listed. (Phone and/or address for referrals can be found above)
** Bring your exam results to your follow up appointments. Retain a copy for your records as well.
** ALWAYS have a list of your current medications with you.
** Return to the ER for worsened or uncontrolled pain, particularly if the pain localizes to the right lower part of your abdomen, for fever, vomiting, or for any other concerns.
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GENERIC TEMPLATE
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Read the following information about your diagnosis, treatment and prevention of symptoms, and indications for return.

Take any medications prescribed as directed
Continue all current home medications unless specified below

See your doctor for follow-up in
See the specialist for follow-up in

If you do not have a primary physician, you may follow up at one of the clinics listed above.

Bring your exam results to your follow up appointments. Keep a copy for your records as well
ALWAYS have a list of your current medications with you.

Come back to the ER for ** or for any other concerns
** worsened or uncontrolled pain, particularly if the pain localizes to the right lower part of your abdomen
** worsened or uncontrolled pain, fever, excessive vomiting, bloody diarrhea
** signs of dehydration - decreased tears, decreased urination, lethargy
** fever lasting longer than 5 days
** vaginal bleeding (more than 1 pad an hour for 2-3 consecutive hours), light headedness, fainting
** Worsened chest pain, shortness of breath, dizziness, fainting, swelling
** bleeding that does not stop with simple pressure within 10 minutes
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HERNIA
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Take the medications prescribed as needed for pain and/or constipation.
Wear the abdominal binder or hernia truss to reinforce your abdominal wall.
Try to avoid heavy lifting and excessive or prolonged straining. Drink plenty of water.
Follow up with your primary doctor for referral to a general surgeon.
Return to the ER for abdominal distention, uncontrolled abdominal pain, irreducible hernia, vomiting, inability to pass gas, extreme constipation or other concerns.
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METH ABUSE
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Please avoid methamphetamine in the future.
Further use, may end in death or permanent, or prolonged psychosis.
Drink plenty of fluids, rest.
Followup with the mental health referrals given to you and with your primary care doctor in 2-3 days.
Return to the ER for ongoing hallucinations, paranoia, psychosis, palpitations, fainting, or other concerns.
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MVC - NO INJURY
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You were seen today after a motor vehicle collision. Your evaluation, including imaging if done, was not concerning for an emergency or fracture at this time.
You may experience some worsening soreness over the next two days, which is normal after a collision.
Continue to take pain medication as directed, ice, and rest.
Follow up with your primary care doctor within the next week. Call for an appointment today.
Return to the ER if you experience confusion, worsening headache, weakness or numbness, any changes in vision such as blurring or loss of vision, pain with neck movement, or other concerning symptoms.
Return to the ER if you develop severe neck, chest, or abdominal pain, repeated vomiting, severe lightheadedness or weakness, trouble breathing, numbness or weakness in any extremity, problems with your bladder or bowel, or pain radiating down an arm or leg.
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PANIC WITH ATIVAN
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You may take Ativan for short term relief of your anxiety/insomnia.
This is only temporary and these pills may be habit forming - therefore it is important that you follow up with your primary care doctor to be started on a medicine to control your anxiety long term.
Return to the ER for worsened symptoms or concerns, chest pain, persistent shortness of breath. Return also for fever, increased abdominal pain, persistent vomiting.
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Peds UTI
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Please continue oral rehydration with pedialyte.
You may treat ongoing nausea with Zofran.
Take the antibiotic prescribed for your urine infection.
Follow up with your pediatrician to have your urine rechecked. If infections recur your child may need a follow up ultrasound.
Return to the ER for persistent vomiting, increased abdominal pain, fever lethargy or other concerns.
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Plantar Fasciitis
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Read the aftercare instructions to learn how to treat your condition.
Take Ibuprofen and/or Norco for pain as needed.
Follow up with you PMD in 1-2 days.
Return for increased swelling, pain, fever or redness going up the leg.
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STREP - PEDS - TREATED
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Take Motrin and/or Tylenol for fever.
Stay well hydrated.
You have been treated for strep throat. your rapid strep screen was positive.
Follow up with your pediatrician in 2-3 days.
Return to the ER for worsened symptoms, excessive vomiting, fever lasting more than 5 days or other concerns.*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-
THREATENED MISCARRIAGE*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-
Bedrest
Pelvic Rest
Drink plenty of fluids
Follow up with your OB/GYN in 2 days for a repeat blood test and bring a copy of your ultrasound and labs
Return to the ER for worsened bleeding (more than 1 pad an hour for 2-3 hours) accompanied by increased pain or other concerns.
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URI-peds - SALINE SXN
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Alternate between Motrin and Tylenol every 3 hours for fever.
Zofran as needed for nausea/vomiting
If appetite poor, encourage your child to drink fluids.
If runny nose, use saline solution with aspirator, especially prior to feeding and prior to laying down
Follow-up with your doctor in 1-2 days for a recheck.
Return to the ER for worsened symptoms - increased shortness of breath, vomiting, fever lasting longer than 5 days or any other concerns.
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Given the possibility of a bleeding peptic ulcer, Protonix IV was immediately started. Because of ***, the patient is at risk for portal hypertension and varices from cirrhosis, so octreotide IV was also started and Ceftriaxone IV also given.

Because of ***, the patient will immediately be transfused*** units of PRBC, and admitted for further care and management. The patient does not require any emergent anticoagulation reversal at this time point, although it was considered. Gastroenterology on-call, Dr.*** was consulted and will evaluate the patient for endoscopy.

The patient is currently hemodynamically stable, and stable for transfer to the floor at this time.

Because the patient's hemoglobin is stable, emergent transfusion was not started; however, the patient will need to be admitted for serial hemoglobin checks, and if downtrending, transfusion may be indicated at a later time.

Patient is protecting their airway, no active vomiting, no need for NG tube or intubation at this time.
The patient denies any bloody stool and has no pain out of proportion to exam, and no significant risk factors for mesenteric ischemia such as atrial fibrillation or severe PAD/PVD (peripheral arterial / vascular disease), thus definitive workup to rule out mesenteric ischemia was not pursued.

The patient has no significant risk factors for AAA (abdominal aortic aneurysm) such as age over 50 with history of hypertension, connective tissue disorder, or 1st degree relative with AAA. In addition, the patient has normal dorsalis pedis pulses, no radiation of pain to the back, and no pulsatile mass felt on exam. The patient's profile was overall low risk for AAA and definitive workup was not pursued.

Differential diagnosis includes cholecystitis, choledocholithiasis, hepatitis, small bowel obstruction, volvulus,AAA, atypical appendicitis, pancreatitis, gastritis, peptic ulcer disease, among others.

Patient is afebrile, without any significant tenderness in the RUQ, and a negative Murphy's sign. The patient's presentation does not appear to be consistent with acute cholecystitis and thus definitive imaging to rule it out was not pursued.

The patient's symptoms are not consistent with ACS (acute coronary syndrome), symptoms are not exertional, EKG without obvious ischemic change, and troponin negative with over 6 hours of symptoms - further workup not indicated urgently.



Differential diagnosis includes appendicitis, diverticulitis, ectopic pregnancy, ovarian torsion, hemorrhagic ovarian cyst, PID (pelvic inflammatory disease), kidney stone, UTI, small bowel obstruction, volvulus, AAA, pancreatitis, among others.

The patient has no significant risk factors for PID, such as multiple sexual partners, history of STDs, vaginal discharge, or any cervical motion tenderness. Pregnancy test is negative, ruling out ectopic pregnancy.

The patient's presentation is not consistent with ovarian torsion or hemorrhagic ovarian cyst, pain was not sudden onset, not associated with vomiting, and has no significant tenderness on exam.

The patient denies any bloody stool and has no pain out of proportion to exam, and no significant risk factors for mesenteric ischemia such as atrial fibrillation or severe PAD/PVD (peripheral arterial / vascular disease), thus definitive workup to rule out mesenteric ischemia was not pursued.

The patient has no significant risk factors for AAA (abdominal aortic aneurysm) such as age over 50 with history of hypertension, connective tissue disorder, or 1st degree relative with AAA. In addition, the patient has normal dorsalis pedis pulses, no radiation of pain to the back, and no pulsatile mass felt on exam. The patient's profile was overall low risk for AAA and definitive workup was not pursued.

TEXT: Differential diagnosis includes appendicitis, diverticulitis, testicular torsion, kidney stone, small bowel obstruction, volvulus, AAA, pancreatitis, among others.

The patient's presentation is not consistent with testicular torsion.

The patient denies any testicular pain, pain was not sudden onset or associated with vomiting. Testicular exam is normal without any evidence of torsion.

The patient denies any bloody stool and has no pain out of proportion to exam, and no significant risk factors for mesenteric ischemia such as atrial fibrillation or severe PAD/PVD (peripheral arterial / vascular disease), thus definitive workup to rule out mesenteric ischemia was not pursued.

The patient has no significant risk factors for AAA (abdominal aortic aneurysm) such as age over 50 with history of hypertension, connective tissue disorder, or 1st degree relative with AAA. In addition, the patient has normal dorsalis pedis pulses, no radiation of pain to the back, and no pulsatile mass felt on exam. The patient's profile was overall low risk for AAA and definitive workup was not pursued.
Differential diagnosis includes appendicitis, mesenteric adenitis, obstruction/volvulus, crohn's disease, gastroenteritis, UTI/pyelo, kidney stone, GU pathology, among others.
Differential diagnosis includes cholecystitis, cholelithiasis, biliary obstruction, hepatitis, pancreatitis, obstruction, GERD/PUD, gastroparesis, dehydration.
Differential diagnosis includes infection/sepsis, dehydration, anemia, renal failure, electrolyte abnormality, endocrine abnormalities, rheumatologic disorders, tox, neurologic disease.





Assessment and plan:

1: Acute croup with constitutional symptoms consistent with a viral syndrome. The patient is nontoxic appearing and vigorous. The patient is in no respiratory distress, has no wheezing, and is not hypoxic. Patient has a croupy cough, but no stridor at rest. There is no clinical suspicion for pneumonia, meningitis, parapharyngeal infections, epiglottitis, otitis media, or causes of peritonitis.

A dose of dexamethasone was given in the ER for the croupy cough. No nebulizer indicated given no stridor at rest or respiratory difficulty.

Parents instructed to encourage plenty of fluids and to use OTC antipyretics as needed for fever/symptom control. Follow-up with primary care physician for recheck. Return to emergency department sooner if symptoms worsen, or as needed.
Diarrhea with no vomiting. Most likely viral etiology. Other initial considerations included osmotic diarrhea from juices, food poisoning, bacterial diarrhea, early appendicitis, colitis, gastritis, volvulus, intussusception, amongst others. The patient is completely nontoxic appearing and vigorous in the ED. Patient has had no vomiting. The patient has a soft nontender and non-peritoneal abdominal examination in the ED. The patient has a normal appetite and is tolerating PO fluids in the ED. Family told to encourage plenty of fluids and to advance diet as tolerated. Family also advised to give pedialyte and not to use sugary juices which may be cause an osmotic diarrhea. Follow-up with PCP for recheck. Return to the emergency department sooner if symptoms worsen, or as needed.

1: Epistaxis, resolved. Most likely from Kiesselbach's plexus area consistent with "nosepicker's" bleeding. There is not active bleeding on presentation to the emergency department. I instructed parents to put either Vaseline or Neosporin in the area to prevent drying of the mucous membranes. I also instructed parents to apply direct pressure to the area by pinching the nostrils should bleeding recur.

The patient is to be discharged home in stable condition. Follow up with primary care physician for recheck. Return to the emergency department sooner if symptoms worsen, or as needed.
1: Rash consistent with erythema multiforme. No itchiness to suggest hives/urticaria. No recent tick exposure to suggest Lyme disease. The patient has no evidence of facial, lip, tongue, or uvular edema. No oral or mucous membrane lesions to suggest SJS. There is no respiratory compromise. The patient is asymptomatic, so no treatment indicated since EM is self-limited. Follow up with primary care physician for recheck. RTER prn.
Patient presents with symptoms and exam consistent with a viral syndrome. Although considered in the differential diagnosis, this well hydrated, non-toxic, vaccinated child with has no evidence of sepsis, serious bacterial disease, pneumonia, or other significant concerns. The child is breathing comfortably, is in no respiratory distress, and is without retractions. Patient is appropriate for outpatient management with anti-pyretics and supportive care. Mom is comfortable with plan. Patient is stable for discharge home with instructions to f/u w/ pediatrician in 2 d. Strict RTed precautions provided. ACI d/w mom;see instruction below.

Acute bronchitis/flu-like illness with constitutional symptoms consistent with a viral syndrome. The patient is nontoxic appearing and vigorous. The patient is not in respiratory distress, has no wheezing, and is not hypoxic. There is no clinical suspicion at this time for pneumonia, meningitis, parapharyngeal infections, epiglottitis, otitis media, or causes of peritonitis.

Family instructed to encourage plenty of fluids and to use OTC antipyretics as needed for fever/symptom control. Follow-up with primary care physician for recheck. Return to emergency department sooner if symptoms worsen, or as needed.

Motor vehicle collision, no apparent injury. There is no history of loss of consciousness or seizure. There is no clinical evidence at this time for intracranial, spinal, neurologic, intrathoracic, abdominal, pelvis, or extremity injuries.

The CTLS-spine was cleared clinically with no indication at this time for radiographs. The family told to give OTC medications as needed for pain. Follow-up with PCP as needed. Return to the emergency department as needed.

DCI
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Take the medications prescribed for your abdominal pain.
Avoid spicy foods.
Follow up with your primary care doctor regarding your rectal bleeding.
Return to the ER for severe persistent bleeding accompanied by shortness of breath, feeling faint or fainting, palpitations, fever, increased abdominal pain or other concerns.
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The etiology of her pain is unclear, however it does not appear that you are having a surgical emergency or serious infection.
You may take Motrin for pain/cramps.
Followup with your doctor in one to 2 days and bring a copy of your labs and ultrasound results.
Although your tests and clinical exam are normal today, things may change or progress so please return immediately to the ER for worsened pain, fever, vomiting, change in appetite or other concerns.
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please read the aftercare instructions on how to care for your abscess.
Take the antibiotics prescribed to until they are gone. You may take ibuprofen for pain.
Apply warm compresses for 10 minutes at a time 4 times a day to promote circulation to and clearing of the infection from the site of your abscess.
Return to the ER in one to 2 days to have your packing removed and possibly replaced.
Return to the ER immediately for increased redness, purulent drainage, fever, increased pain at the site of your abscess or for any other concerns.
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Please read the aftercare instructions on how to care for your abscess.
Take the antibiotics prescribed to until they are gone. You may take ibuprofen for pain.
Apply warm compresses for 10 minutes at a time 4 times a day to allow the abscess to mature and to help clear infection.
Return to the ER in one to 2 days to see if you have an abscess that can be drained.
Return to the ER immediately for increased redness, purulent drainage, fever, increased pain at the site of your abscess or for any other concerns.
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Abscess
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please read the aftercare instructions on how to care for your abscess.

Return to the ER in one to 2 days to have your packing removed and possibly replaced.

Take the antibiotics prescribed to until they are gone. You may take ibuprofen for pain. Apply warm compresses for 10 minutes at a time 4 times a day to promote circulation to and clearing of the infection from the site of your abscess.

Return to the ER immediately for increased redness, purulent drainage, fever, increased pain at the site of your abscess or for any other concerns.
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BURN
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Please read the attached handout to help care for your wounds.
Keep clean with soap and water, apply antibiotic ointment and then non adherent dressing daily. Take Motrin for pain.
Follow up with your primary care doctor in 1-2 days. If your burn looks infected at that time she may refer you to a burn center. Alternatively you may call the burn center to arrange for follow up as well: Call the number below.

University of Southern California & Los Angeles County Burn Center
1200 N. State St. Ward 12-600
Los Angeles, CA 90033 United States
323 226-7991

Return to the ER for worsened pain, redness, yellow drainage from the wound, fever or other concerns.
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Alternate tylenol and Motrin every three hours for fever >100.4
Give plenty of fluids.
Follow up with your regular pediatrician in 2-3 days.
Return to the ER for worsened symptoms, failure to improve or other concerns.

Alterne tylenol y Motrin cada tres horas para la fiebre> 100.4
Dé muchos fluidos.
Siga a su pediatra regular en 2-3 días.
Vuelva al ER para síntomas empeorados, fracaso de mejorar u otras preocupaciones.

Take Motrin and/or Tylenol alternating every three hours for fever.
Give plenty of fluids.
Follow-up with PMD in 1-3 days.
Return to the ER for shortness of breath, vomiting, signs of dehydration, fever lasting longer than 5 days or other concerns.

CLUSTER/MIGRAINE WITH FIORICET
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It is possible that you are having cluster headaches or migraine headaches.
Take motrin and/or fioricet as needed for headache.
Follow up with your regular doctor and bring a copy of your CT scan from today's visit. Return to the ER for worsened symptoms or any other concerns.
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FEVER - PEDS - NO SOURCE
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Your child likely has a virus. There is no urine infection.
Please continue to control fever with Motrin alternating with Tylenol every 3 hours. Give your child extra fluids - like Pedialyte.
Follow up with your pediatrician in 1-2 days.
Return to the ER for lethargy, shortness of breath, excessive vomiting, fever lasting longer than 5 days or other concerns.
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GALLSTONES
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You have gallstones but no evidence of direct infection. These episodes may recur.
Take the medications prescribed as needed for recurrence. Avoid fatty foods.
Please follow up with your regular doctor for a referral to a general surgeon to schedule outpatient surgery to remove your gallbladder if needed. Bring a copy of your results from today's visit.
Return to the ER for recurrent or worsened pain that does not respond to treatment, return for fever, persistent vomiting or any other concerns.
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GASTRITIS/GERD/PUD
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Please take the medication prescribed for your symptoms. Pepcid is to help treat/heal gastritis and Mylanta as needed for acute pain.
Avoid spicy foods, caffeine, high citrus foods or eating within 2 hours of bed. You may prop yourself up on pillows at night to help keep acid down. Decrease alcohol intake.
Follow up with your primary care doctor to monitor improvement of your symptoms. If you fail to improve, you may need further tests or you may need referral to see a gastroenterologist for possible endoscopy.
Return to the ER for increased pain, fever, vomiting or other concerns.
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GASTRO
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Stay hydrated with small amounts of Pedialyte - you may return to your regular diet as tolerated.
Zofran as needed for nausea
Follow-up with your pediatrician or you may return here for a recheck here in 1-2 days.
Return to the ER for uncontrolled vomiting, pain fever lasting for more than 5 days, bloody diarrhea, abdominal pain - particularly if centered in the right lower part of your abdomen or other concerns.
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GENERIC - ABDOMEN - no PMD
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Read the following information and attached handout about your diagnosis, treatment and/or prevention of symptoms, and indications for return.
** Take any medications prescribed as directed.
** Follow with your doctor in 2-3 days for a followup exam, You will need a referral to see a specialist: a cardiologist.
** If you do not have a primary physician, follow at the county hospital or at one of the clinics listed. (Phone and/or address for referrals can be found above)
** Bring your exam results to your follow up appointments. Retain a copy for your records as well.
** ALWAYS have a list of your current medications with you.
** Return to the ER for worsened or uncontrolled pain, particularly if the pain localizes to the right lower part of your abdomen, for fever, vomiting, or for any other concerns.
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GENERIC TEMPLATE
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Read the following information about your diagnosis, treatment and prevention of symptoms, and indications for return.

Take any medications prescribed as directed
Continue all current home medications unless specified below

See your doctor for follow-up in
See the specialist for follow-up in

If you do not have a primary physician, you may follow up at one of the clinics listed above.

Bring your exam results to your follow up appointments. Keep a copy for your records as well
ALWAYS have a list of your current medications with you.

Come back to the ER for ** or for any other concerns
** worsened or uncontrolled pain, particularly if the pain localizes to the right lower part of your abdomen
** worsened or uncontrolled pain, fever, excessive vomiting, bloody diarrhea
** signs of dehydration - decreased tears, decreased urination, lethargy
** fever lasting longer than 5 days
** vaginal bleeding (more than 1 pad an hour for 2-3 consecutive hours), light headedness, fainting
** Worsened chest pain, shortness of breath, dizziness, fainting, swelling
** bleeding that does not stop with simple pressure within 10 minutes
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HERNIA
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Take the medications prescribed as needed for pain and/or constipation.
Wear the abdominal binder or hernia truss to reinforce your abdominal wall.
Try to avoid heavy lifting and excessive or prolonged straining. Drink plenty of water.
Follow up with your primary doctor for referral to a general surgeon.
Return to the ER for abdominal distention, uncontrolled abdominal pain, irreducible hernia, vomiting, inability to pass gas, extreme constipation or other concerns.
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METH ABUSE
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Please avoid methamphetamine in the future.
Further use, may end in death or permanent, or prolonged psychosis.
Drink plenty of fluids, rest.
Followup with the mental health referrals given to you and with your primary care doctor in 2-3 days.
Return to the ER for ongoing hallucinations, paranoia, psychosis, palpitations, fainting, or other concerns.
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MVC - NO INJURY
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You were seen today after a motor vehicle collision. Your evaluation, including imaging if done, was not concerning for an emergency or fracture at this time.
You may experience some worsening soreness over the next two days, which is normal after a collision.
Continue to take pain medication as directed, ice, and rest.
Follow up with your primary care doctor within the next week. Call for an appointment today.
Return to the ER if you experience confusion, worsening headache, weakness or numbness, any changes in vision such as blurring or loss of vision, pain with neck movement, or other concerning symptoms.
Return to the ER if you develop severe neck, chest, or abdominal pain, repeated vomiting, severe lightheadedness or weakness, trouble breathing, numbness or weakness in any extremity, problems with your bladder or bowel, or pain radiating down an arm or leg.
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PANIC WITH ATIVAN
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You may take Ativan for short term relief of your anxiety/insomnia.
This is only temporary and these pills may be habit forming - therefore it is important that you follow up with your primary care doctor to be started on a medicine to control your anxiety long term.
Return to the ER for worsened symptoms or concerns, chest pain, persistent shortness of breath. Return also for fever, increased abdominal pain, persistent vomiting.
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Peds UTI
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Please continue oral rehydration with pedialyte.
You may treat ongoing nausea with Zofran.
Take the antibiotic prescribed for your urine infection.
Follow up with your pediatrician to have your urine rechecked. If infections recur your child may need a follow up ultrasound.
Return to the ER for persistent vomiting, increased abdominal pain, fever lethargy or other concerns.
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Plantar Fasciitis
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Read the aftercare instructions to learn how to treat your condition.
Take Ibuprofen and/or Norco for pain as needed.
Follow up with you PMD in 1-2 days.
Return for increased swelling, pain, fever or redness going up the leg.
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STREP - PEDS - TREATED
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Take Motrin and/or Tylenol for fever.
Stay well hydrated.
You have been treated for strep throat. your rapid strep screen was positive.
Follow up with your pediatrician in 2-3 days.
Return to the ER for worsened symptoms, excessive vomiting, fever lasting more than 5 days or other concerns.*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-
THREATENED MISCARRIAGE*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-
Bedrest
Pelvic Rest
Drink plenty of fluids
Follow up with your OB/GYN in 2 days for a repeat blood test and bring a copy of your ultrasound and labs
Return to the ER for worsened bleeding (more than 1 pad an hour for 2-3 hours) accompanied by increased pain or other concerns.
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URI-peds - SALINE SXN
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Alternate between Motrin and Tylenol every 3 hours for fever.
Zofran as needed for nausea/vomiting
If appetite poor, encourage your child to drink fluids.
If runny nose, use saline solution with aspirator, especially prior to feeding and prior to laying down
Follow-up with your doctor in 1-2 days for a recheck.
Return to the ER for worsened symptoms - increased shortness of breath, vomiting, fever lasting longer than 5 days or any other concerns.
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Result - Copy and paste this output: